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Sravani AB, Ghate V, Lewis S. Human papillomavirus infection, cervical cancer and the less explored role of trace elements. Biol Trace Elem Res 2023; 201:1026-1050. [PMID: 35467267 PMCID: PMC9898429 DOI: 10.1007/s12011-022-03226-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/29/2022] [Indexed: 02/06/2023]
Abstract
Cervical cancer is an aggressive type of cancer affecting women worldwide. Many affected individuals rely on smear tests for the diagnosis, surgery, chemotherapy, or radiation for their treatment. However, due to a broad set of undesired results and side-effects associated with the existing protocols, the search for better diagnostic and therapeutic interventions is a never-ending pursuit. In the purview, the bio-concentration of trace elements (copper, selenium, zinc, iron, arsenic, manganese, and cadmium) is seen to fluctuate during the occurrence of cervical cancer and its progression from pre-cancerous to metastatic nature. Thus, during the occurrence of cervical cancer, the detection of trace elements and their supplementation will prove to be highly advantageous in developing diagnostic tools and therapeutics, respectively. This review provides a detailed overview of cervical cancer, its encouragement by human papillomavirus infections, the mechanism of pathology, and resistance. Majorly, the review emphasizes the less explored role of trace elements, their contribution to the growth and inhibition of cervical cancer. Numerous clinical trials have been listed, thereby providing a comprehensive reference to the exploration of trace elements in the management of cervical cancer.
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Affiliation(s)
- Anne Boyina Sravani
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Vivek Ghate
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Shaila Lewis
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India.
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Hossain A, Miah S, Ray PK, Ghosh AK, Khatun RA, Khatun J, Habib S, Sarker S. Relationship Between Total Reference Air Kerma and Outcomes of Single-Channel and Tri-Channel Applicators used in High-Dose-Rate Brachytherapy for Cervical Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Nakalembe M, Makanga P, Kambugu A, Laker-Oketta M, Huchko MJ, Martin J. A public health approach to cervical cancer screening in Africa through community-based self-administered HPV testing and mobile treatment provision. Cancer Med 2020; 9:8701-8712. [PMID: 32966684 PMCID: PMC7666725 DOI: 10.1002/cam4.3468] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 01/01/2023] Open
Abstract
The World Health Organization (WHO) refers to cervical cancer as a public health problem, and sub‐Saharan Africa bears the world's highest incidence. In the realm of screening, simplified WHO recommendations for low‐resource countries now present an opportunity for a public health approach to this public health problem. We evaluated the feasibility of such a public health approach to cervical cancer screening that features community‐based self‐administered HPV testing and mobile treatment provision. In two rural districts of western‐central Uganda, Village Health Team members led community mobilization for cervical cancer screening fairs in their communities, which offered self‐collection of vaginal samples for high‐risk human papillomavirus (hrHPV) testing. High‐risk human papillomavirus‐positive women were re‐contacted and referred for treatment with cryotherapy by a mobile treatment unit in their community. We also determined penetrance of the mobilization campaign message by interviewing a probability sample of adult women in study communities about the fair and their attendance. In 16 communities, 2142 women attended the health fairs; 1902 were eligible for cervical cancer screening of which 1892 (99.5%) provided a self‐collected vaginal sample. Among the 393 (21%) women with detectable hrHPV, 89% were successfully contacted about their results, of which 86% returned for treatment by a mobile treatment team. Most of the women in the community (93%) reported hearing about the fair, and among those who had heard of the fair, 68% attended. This public health approach to cervical cancer screening was feasible, effectively penetrated the communities, and was readily accepted by community women. The findings support further optimization and evaluation of this approach as a means of scaling up cervical cancer control in low‐resource settings.
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Affiliation(s)
- Miriam Nakalembe
- Infectious Diseases Institute-Makerere University, Kampala, Uganda
| | - Philippa Makanga
- Infectious Diseases Institute-Makerere University, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Diseases Institute-Makerere University, Kampala, Uganda
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Okunade KS, Salako O, Adejimi AA, Akinsola OJ, Fatiregun O, Adenekan MA, Moses OE, Ebenso B, Allsop MJ, Anorlu RI, Berek JS. Impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria (mHealth-Cervix): Protocol for a randomised controlled trial. F1000Res 2020; 9:322. [PMID: 32528665 PMCID: PMC7265590 DOI: 10.12688/f1000research.22991.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Incidence and mortality from cervical cancer have remained high due to many obstacles facing the implementation of organized screening programs in resource-constrained countries such as Nigeria. The application of mobile technologies (mHealth) to health services delivery has the potential to reduce inequalities, empower patients to control their health, and improve the cost-effectiveness of health care delivery. Aim: To assess the efficacy of mobile technology intervention on Pap test screening adherence compared to a control condition and also determine the factors affecting the uptake of Pap smear screening practices among women in Lagos. Methods: This is a multi-center randomized controlled trial that will involve women aged 25 to 65 years attending the General Outpatient clinics of the two tertiary health institutions in Lagos, Nigeria between April and December 2020. At baseline, a total of 200 National Health Insurance Scheme (NHIS) enrollees will be randomized to either a text message arm or usual care (control) arm. The primary outcome is the completion of a Pap smear within 6 months of enrolment in the study. The associations between any two groups of continuous variables will be tested using the independent sample t-test (normal distribution) or the Mann-Whitney U test (skewed data) and that of two groups of categorical variables with Chi-square
X
2or Fisher's exact test where appropriate. Using binary logistic regression model, we will adjust for age and other relevant sociodemographic and clinical variables and adherence to Pap test screening. Statistical significance will be defined as
P-value less than 0.05. Discussion: The mHealth-Cervix study will evaluate the impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria as a way of contributing to the reduction in the wide disparities in cervical cancer incidence through early detection facilitated using health promotion to improve Pap smear screening adherence. Registration:
PACTR202002753354517 13/02/2020
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Affiliation(s)
- Kehinde S Okunade
- Department of Obstetrics and Gynaecology, University of Lagos, Lagos, Lagos, 2345, Nigeria
| | - Omolola Salako
- Department of Radiation Biology, Radiotherapy and Radiodiagnosis, University of Lagos, Lagos, 2345, Nigeria
| | - Adebola A Adejimi
- Department of Community Health and Primary Care, University of Lagos, Lagos, Lagos, 2345, Nigeria
| | - Oluwatosin J Akinsola
- Department of Community Health and Primary Care, University of Lagos, Lagos, Lagos, 2345, Nigeria
| | - Omolara Fatiregun
- Department of Clinical and Radiation Oncology, Lagos State University Teaching Hospital,, Ikeja, Lagos, 2345, Nigeria
| | - Muisi A Adenekan
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital,, Lagos, Lagos, 2345, Nigeria
| | - Olusanjo E Moses
- Department of Obstetrics and Gynaecology, State University Teaching Hospital, Ikeja, Lagos, 2345, Nigeria
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, LS2 9JT, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, University of Leeds, Leeds, LS2 9JT, UK
| | - Rose I Anorlu
- Department of Obstetrics and Gynaecology, University of Lagos, Lagos, Lagos, 2345, Nigeria
| | - Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Palo Alto, California, 94304, USA
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Wassie M, Argaw Z, Tsige Y, Abebe M, Kisa S. Survival status and associated factors of death among cervical cancer patients attending at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia: a retrospective cohort study. BMC Cancer 2019; 19:1221. [PMID: 31842805 PMCID: PMC6916089 DOI: 10.1186/s12885-019-6447-x] [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: 08/27/2019] [Accepted: 12/09/2019] [Indexed: 12/24/2022] Open
Abstract
Background Cervical cancer is a cancer of uterine cervix caused mostly by sexually-acquired infection called Human papillomavirus (HPV. In developing region of the globe, fewer than 50% of women with cervical malignancy survive more than 5 years. Therefore, the objective of this study was to assess survival status and associated factors of death among cervical cancer patients attending at Tikur Anbesa Specialized Hospital (TASH), Ethiopia. Methods Facility based retrospective cohort study was conducted from March to April 2019 at Tikur Anbesa Specialized Hospital oncology center. Data was collected from patient’s chart using pre-tested and structured checklist prepared in English and analyzed using STATA14.2. Cox regression model was used to identify Variables that affected survival. Result The overall survival rate was 38.62% at 5 years. There were a significance differences in survival experience between categories of stage of cervical cancer, age of patients, comorbidity, substance use, base line anemia and treatment modalities. Being stage IV [AHR = 11.76; 95% CI (4.02–34.4)],being advanced age [AHR = 5.99; 95% CI (2.1–17.08)], being comorbid [AHR = 1.58; 95%CI(1.14–2.19)], using substance [AHR = 1.56;95% CI(1.09–2.22)] and being anemic [AHR = 1.6;95% CI(1.11–2.36)] increased the risk of death. Conclusion The overall survival rate was lower than high- and middle-income countries and Significant factors of death after diagnosis of cervical cancer were; advanced FIGO stage, base line anemia, comorbidity, substance use, advanced age and treatment modality. Authors recommend that it is better to expand cervical cancer early screening programs and treatment facilities, strengthen awareness in collaboration with public medias about cervical cancer prevention, screening and treatment options.
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Affiliation(s)
- Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Zeleke Argaw
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yosief Tsige
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mesfin Abebe
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sezer Kisa
- Oslo University Collaboration Unit, Oslo, Norway
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Gizaw M, Teka B, Ruddies F, Abebe T, Kaufmann AM, Worku A, Wienke A, Jemal A, Addissie A, Kantelhardt EJ. Uptake of Cervical Cancer Screening in Ethiopia by Self-Sampling HPV DNA Compared to Visual Inspection with Acetic Acid: A Cluster Randomized Trial. Cancer Prev Res (Phila) 2019; 12:609-616. [PMID: 31337647 DOI: 10.1158/1940-6207.capr-19-0156] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/23/2019] [Accepted: 07/16/2019] [Indexed: 12/24/2022]
Abstract
In Ethiopia, the standard method of cervical cancer screening is using Visual Inspection with Acetic Acid (VIA). Self-collection-based human papillomavirus (HPV) testing is assumed to improve the uptake of screening, especially for hard to reach populations. We investigated whether HPV DNA testing with the self-collection of cervical samples would be associated with increased uptake and adherence to procedures at the population level compared with VIA within defined rural population in Ethiopia. A total of 22 clusters (comprising 2,356 women ages 30-49 years) were randomized in two arms. Following the community mobilization, women of the clusters were invited to go either to the local health post for a self-collection-based HPV DNA testing (arm A) or Butajira Hospital for VIA screening (arm B). In the HPV arm, of the 1,213 sensitized women, 1,020 (84.1%) accessed the health post for self-sampling compared with the VIA arm, where 575 of 1,143 (50.5%) visited the hospital for VIA (P < 0.0001). Of those women who attended the VIA and HPV arms, 40% and 65.4% adhered to all procedures expected after screening, respectively. Out of women positive for high risk HPV, 122 (85%) attended VIA as a follow-up test. The trial demonstrated significantly higher levels of population-based uptake and adherence for self-collection HPV testing. Women were more receptive for VIA after their HPV testing result was positive. Self-collection HPV testing can be done at the local health facility and may significantly improve the uptake of cervical cancer screening in Ethiopia.
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Affiliation(s)
- Muluken Gizaw
- Addis Ababa University, School of Public Health, Department of Preventive Medicine, Ethiopia.,Institute of Medical Epidemiology, Biometrics and Informatics Martin-Luther-University, Halle-Wittenberg, Germany
| | - Brhanu Teka
- Addis Ababa University, School of Medicine, Department of Microbiology, Immunology and Parasitology, Ethiopia
| | - Friederike Ruddies
- Institute of Medical Epidemiology, Biometrics and Informatics Martin-Luther-University, Halle-Wittenberg, Germany
| | - Tamrat Abebe
- Addis Ababa University, School of Medicine, Department of Microbiology, Immunology and Parasitology, Ethiopia
| | - Andreas M Kaufmann
- Department of Gynecology, Charité-Universitätmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alemayehu Worku
- Addis Ababa University, School of Public Health, Department of Preventive Medicine, Ethiopia
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics Martin-Luther-University, Halle-Wittenberg, Germany
| | - Ahmedin Jemal
- Department of Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Adamu Addissie
- Addis Ababa University, School of Public Health, Department of Preventive Medicine, Ethiopia
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics and Informatics Martin-Luther-University, Halle-Wittenberg, Germany. .,Department of Gynecology Martin-Luther-University, Halle-Wittenberg, Germany
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Šarenac T, Mikov M. Cervical Cancer, Different Treatments and Importance of Bile Acids as Therapeutic Agents in This Disease. Front Pharmacol 2019; 10:484. [PMID: 31214018 PMCID: PMC6558109 DOI: 10.3389/fphar.2019.00484] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/16/2019] [Indexed: 01/15/2023] Open
Abstract
Cervical cancer can be cured, because it has a long preinvasive period. Early diagnosis and treatment of cervical cancer at women are crucial for reducing of rate mortality. Today, there are many methods for detecting premalignant lesions and one of them is a conventional Papanicolaou test. Cervical cancer develops through a series of changes in the epithelium called cervical intraepithelial neoplasia (CIN). The biological and genetic characteristics of the cells at cancer in situ are irreversibly altered and abnormal cells have the potential to metastasize to others anatomical regions. Infection with human Papillomavirus, which is transmitted sexually, is considered the main cause and represent the necessary, but not the only factor for the development of cervical cancer. Types of high risk human Papillomavirus are often associated with invasive cervical cancer. The carcinogenic types of HPV 16 and 18 are responsible for 70% of cervical cancer and about 50% of CIN 3. Primary prevention of cervical cancer is aimed at reducing incidence, control of causes and risk factors. In this scientific work, in addition to explaining the various treatments necessary for the treatment of cervical carcinoma, we were discussed about the anticancer effects of the synthetic derivative of ursodeoxycholic acid, such as HS-1183, and synthetic derivatives of chenodeoxycholic acid such as HS-1199 and HS-1200. Also, the effects of bile acid complexes with metals such as platinum, zinc, nickel, and copper were considered in the effective treatment of cervical cancer. KEY POINTS • Lymphogenic spreading of cervical cancer occurs relatively early in the regional lymph nodes, while this sort of progression of cervical cancer is rarer in the juxtaregional (paraaortic), mediastinal and supraclavicular nodes. Clinically proven supraclavicular metastases are not a rarity. In stages IIb and IIIa with metastases in paraaortal nodes occur a 20% metastases at the neck lymph nodes. Hematogenic metastases are relatively rare and occur in the posterior phase. Distant metastases are detected in the lungs and liver. Preinvasive and microinvasive stages of cervical cancer are without symptoms. With deeper invasion of the strome, certain clinical symptoms such as prolonged menstruation, increased vaginal secretions, vaginal bleeding between the two periods, contact bleeding (after coitus), unilateral pelvic pain with spreading in hip joint (infiltration of the pelvic nerve plexus), dysuric disturbance, anemia, islet of the lower extremities. In order to diagnose the level spreading of primary lesion of cervical cancer most commonly are used the supplemental searches such as cytoscopy, rectoscopy, urography, irigography, lung and bone radiography, scintigraphy of the liver, kidney and bone, lymphography, CT (MR) of abdomen and pelvis, as well as laboratory analysis. Surgical treatment consists of transvaginal hysterectomy, transabdominal removal of the uterus (via laparotomy), bilateral adenectomy (removal of the ovaries and the fallopian tubes), upper and middle third of the vagina and lymphonodectomy of the regional lymph nodes. The most commonly used radiotherapy, intracavitary brachytherapy, manual afterloading technique and remote afterloading techniques. The synthetic derivatives of ursodeoxycholic acid and chenodeoxycholic acid such as HS-1183, HS-1199, and HS-1200 are used to treat cervical cancer. These derivatives of chenodeoxycholic acid and ursodeoxycholic acid are capable of inhibiting cell proliferation and inducing apoptosis in SiHa human cells of cervix. Platinum compounds are used as catalysts in cervical cancer therapy. Clinical use of platinum complexes for which the bile acids bind is based on the desire to achieve the death of tumor cells and the spectrum of drug activity in the treatment of cervical cancer. Bisursodeoxycholate (ethylenediamine) platinum (II) [Pt(UDC)2(en)] is characterized by important cytotoxicity against HeLa cervical carcinoma cells and this effect already being clearly detectable after 24 h.
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Affiliation(s)
- Tanja Šarenac
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Li D, Wen E, Zhang Y, Wu Z, Pang H, Ren P, Shang C, He L, Zhang J, Xiang L, Yang H, Liu Q, Wen Q, Fan J, Lin S, Wu J. Preliminary report of a single-channel applicator in high dose rate afterloading brachytherapy for cervical cancer. Cancer Sci 2018; 109:3953-3961. [PMID: 30353607 PMCID: PMC6272109 DOI: 10.1111/cas.13845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to evaluate whether a patented single‐channel applicator, which was modified from the traditional tandem applicator and wrapped with an oval‐shield alloy around the source channel, has the same clinical efficacy and safety as the standard Fletcher‐type applicator in high dose rate (HDR) brachytherapy for carcinoma of the cervix. Between December 2011 and February 2017, 299 patients with pathologically confirmed International Federation of Gynecology and Obstetrics (2009) stage Ib2‐IVa cervical cancer were recruited to the trial and finished the allocated intervention. Of the first 151 patients, 71 were allocated to the Fletcher group and 80 to the single‐channel group, satisfying the criteria for a preliminary analysis. All but 3 patients were treated with concurrent cisplatin chemotherapy and external beam radiotherapy followed by HDR brachytherapy. The 2‐year overall survival, progression‐free survival, and locoregional failure‐free survival was 80.3%, 77.5%, and 78.9%, respectively, for the Fletcher group, and 86.3%, 82.5%, and 83.8%, respectively, for the single‐channel group. The seriousness of acute treatment‐related toxicities was similar in the 2 groups. The cumulative rate of late rectal complications of grade 3‐4 in the Fletcher group and the single‐channel group was 2.8% and 2.5%, respectively. The cumulative rate of grade 3 bladder complications was 2.8% for the Fletcher group and 1.3% for the single‐channel group. The preliminary results of our study show that the patented single‐channel intracavitary applicator might be able to provide protection for the rectum and bladder and seems to have the same clinical efficacy as the standard Fletcher‐type 3‐channel applicator in HDR brachytherapy for carcinoma of the cervix. This trial was registered with the Chinese Clinical Trial Registry (registration no. ChiCTR‐TRC‐12002321).
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Affiliation(s)
- Dan Li
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - En Wen
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Oncology, The First People's Hospital of Neijiang, Neijiang, China
| | - Yingjie Zhang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhouxue Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haowen Pang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Peirong Ren
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Changling Shang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lijia He
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianwen Zhang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Li Xiang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongru Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qiaoli Liu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qinglian Wen
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Juan Fan
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Sheng Lin
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jingbo Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Abstract
Since the publication of the last FIGO Cancer Report there have been giant strides in the global effort to reduce the burden of cervical cancer, with WHO announcing a call for elimination. In over 80 countries, including LMICs, HPV vaccination is now included in the national program. Screening has also seen major advances with implementation of HPV testing on a larger scale. However, these interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for management of these cases. The FIGO Gynecologic Oncology Committee has revised the staging system based on these advances. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Khan M, Zafar A, Muneer R, Siddiqui AA. Awareness Regarding Pap Smear Among Female University Students of Karachi: A Cross-sectional Survey. Cureus 2018; 10:e2784. [PMID: 30112260 PMCID: PMC6089492 DOI: 10.7759/cureus.2784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the knowledge and practices regarding Papanicolaou (Pap) smear test among female university students of Karachi. METHOD This cross-sectional study was carried out among 491 female university students of Karachi. Participants were selected by random sampling between the ages of 18 to 30 years; from different universities namely Dow University of Health Sciences (DUHS), Jinnah Sindh Medical University (JSMU), and Institute of Business administration (IBA). Pearson chi-square test and Mann-Whitney U tests were applied as the primary statistical methods. RESULTS Out of 491 participants, three-quarters of the participants knew about the Pap smear test. However, only 1.6% had undergone the procedure. Age, socioeconomic status (SES), and medical background all had a significant relationship with the awareness of Pap smear test. One-third of the females in the study blamed lack of knowledge as the major reason for not getting a Pap smear while another third blamed the lack of recommendation by health care professionals. CONCLUSION According to our study, female undergraduate students of Karachi have insufficient knowledge and exposure to Pap smear, a screening test that could decrease the burden of cervical cancer among the female population of our country. Further research is required to assess the severity of the problem and consequently strategize to control it.
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Affiliation(s)
- Meeshal Khan
- Dow Medical College, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Amara Zafar
- Dow Medical College, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
| | - Ramsha Muneer
- Dow Medical College, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Amna A Siddiqui
- Dow Medical College, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
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Idehen EE, Koponen P, Härkänen T, Kangasniemi M, Pietilä AM, Korhonen T. Disparities in cervical screening participation: a comparison of Russian, Somali and Kurdish immigrants with the general Finnish population. Int J Equity Health 2018; 17:56. [PMID: 29728104 PMCID: PMC5935973 DOI: 10.1186/s12939-018-0768-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is currently ranked as the fourth commonly diagnosed cancer in women globally. A higher incidence has been reported in low- and-middle-income countries, and the disease poses significant public health challenges. Evidence suggests that this disease is preventable by means of regular screening using the Papanicolaou (Pap) test. However, limited knowledge exists about disparities in cervical screening participation among immigrants compared with non-immigrants, in countries with universal cervical screening programmes. We aimed to examine disparities in cervical screening participation among women of Russian, Somali, and Kurdish, origin in Finland, comparing them with the general Finnish population (Finns). We controlled for differences in several socio-demographic and health-related variables as potential confounders. Methods We employed data from the Finnish Migrant Health and Well-being Study 2010–2012 and the National Health 2011 Survey. Data collection involved face-to-face interviews. Data on screening participation in the previous five years from women aged 29–60 were available from 537 immigrants (257 Russians, 113 Somalis, 167 Kurds) and from 436 Finns. For statistical analyses, we used multiple logistic regression. Results Age-adjusted screening participation rates were as follows: Russians 79% (95% CI 72.9–84.4), Somalis 41% (95% CI 31.4–50.1), and Kurds 64% (95% CI 57.2–70.8), compared with 94% (95% CI 91.4–95.9) among Finns. After additionally adjusting for socio-demographic and health-related confounders, all the immigrant groups showed a significantly lower likelihood of screening participation when compared with Finns. The Odds Ratios were as follows: Russians 0.32 (95% CI 0.18–0.58), Somalis 0.10 (95% CI 0.04–0.23), and Kurds 0.17 (95% CI 0.09–0.35). However, when additionally accounting for country of origin-confounder interactions, such differences were attenuated. Conclusions Our results indicate disparities in screening participation among these immigrants and a lower likelihood of screening participation compared with the general Finnish population. To improve equity in cervical cancer screening participation, appropriate culturally tailored intervention programmes for each immigrant group might be beneficial.
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Affiliation(s)
- Esther E Idehen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 70211, Kuopio, Finland.
| | - Päivikki Koponen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tellervo Korhonen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 70211, Kuopio, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Radiation Therapy for Very Elderly Patients Aged 80 Years and Older With Squamous Cell Carcinoma of the Uterine Cervix. Am J Clin Oncol 2017; 40:178-182. [PMID: 25222073 DOI: 10.1097/coc.0000000000000125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We carried out a retrospective review to determine the role played by radiation therapy in the treatment of very elderly patients with uterine cervical cancer. MATERIALS AND METHODS Thirty elderly patients aged 80 years and older with squamous cell carcinoma of the uterine cervix, at clinical stages IB-IVA, underwent radiation therapy. Of these 30 patients, 6 received external irradiation alone and 24 received external irradiation and intracavitary brachytherapy. A total median dose of 69.0 Gy (range, 45.6 to 75.4 Gy) was delivered to the cervical tumors. No patients underwent chemotherapy. RESULTS At a median follow-up time of 24 months, 7 patients had developed recurrences, including local recurrences in 3 and distant metastases in 5. The local control and distant metastasis-free rates were 88% and 79%, respectively, at 2 years. The disease-free, cause-specific, and overall survival rates were 69%, 77%, and 75%, respectively, at 2 years. Primary tumor size, T category, and clinical stage were found to be significant prognostic factors for distant metastasis. Age and primary tumor size were considered as being significant variables that affected survival. With the exception of a transient hematologic reaction, there were no therapy-related toxicities of grade ≥3. CONCLUSIONS Radiation therapy was safe and effective regarding local control of uterine cervical cancer in elderly patients aged 80 years and older, and appeared to contribute to their prolonged survival. Curative radiation therapy should be considered as a viable treatment option, even in very elderly patients.
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Suneja G, Brown D, Chang A, Erickson B, Fidarova E, Grover S, Mahantshetty U, Nag S, Narayan K, Bvochora-Nsingo M, Viegas C, Viswanathan AN, Lin MY, Gaffney D. American Brachytherapy Society: Brachytherapy treatment recommendations for locally advanced cervix cancer for low-income and middle-income countries. Brachytherapy 2016; 16:85-94. [PMID: 27919654 DOI: 10.1016/j.brachy.2016.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Most cervix cancer cases occur in low-income and middle-income countries (LMIC), and outcomes are suboptimal, even for early stage disease. Brachytherapy plays a central role in the treatment paradigm, improving both local control and overall survival. The American Brachytherapy Society (ABS) aims to provide guidelines for brachytherapy delivery in resource-limited settings. METHODS AND MATERIALS A panel of clinicians and physicists with expertise in brachytherapy administration in LMIC was convened. A survey was developed to identify practice patterns at the authors' institutions and was also extended to participants of the Cervix Cancer Research Network. The scientific literature was reviewed to identify consensus papers or review articles with a focus on treatment of locally advanced, unresected cervical cancer in LMIC. RESULTS Of the 40 participants invited to respond to the survey, 32 responded (response rate 80%). Participants were practicing in 14 different countries including both high-income (China, Singapore, Taiwan, United Kingdom, and United States) and low-income or middle-income countries (Bangladesh, Botswana, Brazil, India, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). Recommendations for modifications to existing ABS guidelines were reviewed by the panel members and are highlighted in this article. CONCLUSIONS Recommendations for treatment of locally advanced, unresectable cervical cancer in LMIC are presented. The guidelines comment on staging, external beam radiotherapy, use of concurrent chemotherapy, overall treatment duration, use of anesthesia, applicator choice and placement verification, brachytherapy treatment planning including dose and prescription point, recommended reporting and documentation, physics support, and follow-up.
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Affiliation(s)
| | - Derek Brown
- University of California San Diego, San Diego, CA
| | - Amy Chang
- Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | | | - Surbhi Grover
- University of Pennsylvania, Philadelphia, PA; Princess Marina Hospital, Gaborone, Botswana
| | | | | | | | | | - Celia Viegas
- Instituto Nacional de Cancer- INCA, Rio de Janeiro, Brazil
| | | | - Ming Yin Lin
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Mou Z, Xu X, Dong M, Xu J. MicroRNA-148b Acts as a Tumor Suppressor in Cervical Cancer by Inducing G1/S-Phase Cell Cycle Arrest and Apoptosis in a Caspase-3-Dependent Manner. Med Sci Monit 2016; 22:2809-15. [PMID: 27505047 PMCID: PMC4982527 DOI: 10.12659/msm.896862] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The purpose of our study was to investigate the role of microRNA (miR)-148b in cervical cancer. MATERIAL AND METHODS The expression of miR-148b was determined in HPV-16-immortalized cervical epithelial cell line CRL-2614 cells and in cervical cancer cell line HeLa cells. The miR-148b mimics or scrambled RNA were then transfected into Hela cells. Forty-eight hours after transfection, the mRNA expression of miR-148b and DNA methyltransferase 1 (DNMT1) were confirmed. Cell proliferation ability (cell viability and colony formation ability), invasion ability, and apoptosis were assessed after transfection with miR-148b mimics or scrambled RNA, as well as the protein expression of cyclin D1 and caspase-3. RESULTS The expression of miR-148b was significantly downregulated in HeLa cells compared with CRL2614 cells (P<0.05), but was statistically upregulated by transfection with miR-148b mimics compared with the cells transfected with scrambled RNA (P<0.05). Also, we found that the expression of DNMT1 was significantly decreased by transfection with miR-148b mimics (P<0.05). Additionally, miR-148b mimics significantly decreased the cell proliferation ability and invasion ability, and statistically induced apoptosis. Furthermore, the expression of cyclin D1 protein was significantly decreased and the expression of caspase-3 protein was significantly increased by miR-148b mimics compared with that in the cells transfected with scrambled RNA (P<0.05). CONCLUSIONS Our results suggest that overexpression of miR-148b protects against cervical cancer by inducing G1/S-phase cell cycle arrest and apoptosis through caspase-3-dependent manner, and overexpression of miR-148b might develop a therapeutic intervention for cervical cancer.
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Affiliation(s)
- Zongmei Mou
- Department of Gynaecology, People's Hospital of Rizhao, Rizhao, Shandong, China (mainland)
| | - Xiangting Xu
- Department of Gynaecology and Obstetrics, Binzhou City Central Hospital, Binzhou, Shandong, China (mainland)
| | - Mei Dong
- Department of Gynaecology, People's Hospital of Zoucheng, Zoucheng, Shandong, China (mainland)
| | - Jin Xu
- Department of Reproduction and Genetics, Taian City Central Hospital, Taian, Shandong, China (mainland)
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Cervical cancer 2015 and beyond: a focus on innovative treatments and attention to survivorship. Clin Ther 2015; 37:6-8. [PMID: 25592087 DOI: 10.1016/j.clinthera.2014.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/04/2014] [Indexed: 11/20/2022]
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Demment MM, Peters K, Dykens JA, Dozier A, Nawaz H, McIntosh S, Smith JS, Sy A, Irwin T, Fogg TT, Khaliq M, Blumenfeld R, Massoudi M, De Ver Dye T. Developing the Evidence Base to Inform Best Practice: A Scoping Study of Breast and Cervical Cancer Reviews in Low- and Middle-Income Countries. PLoS One 2015; 10:e0134618. [PMID: 26325181 PMCID: PMC4556679 DOI: 10.1371/journal.pone.0134618] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/12/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast and cervical cancers have emerged as major global health challenges and disproportionately lead to excess morbidity and mortality in low- and middle-income countries (LMICs) when compared to high-income countries. The objective of this paper was to highlight key findings, recommendations, and gaps in research and practice identified through a scoping study of recent reviews in breast and cervical cancer in LMICs. METHODS We conducted a scoping study based on the six-stage framework of Arskey and O'Malley. We searched PubMed, Cochrane Reviews, and CINAHL with the following inclusion criteria: 1) published between 2005-February 2015, 2) focused on breast or cervical cancer 3) focused on LMIC, 4) review article, and 5) published in English. RESULTS Through our systematic search, 63 out of the 94 identified cervical cancer reviews met our selection criteria and 36 of the 54 in breast cancer. Cervical cancer reviews were more likely to focus upon prevention and screening, while breast cancer reviews were more likely to focus upon treatment and survivorship. Few of the breast cancer reviews referenced research and data from LMICs themselves; cervical cancer reviews were more likely to do so. Most reviews did not include elements of the PRISMA checklist. CONCLUSION Overall, a limited evidence base supports breast and cervical cancer control in LMICs. Further breast and cervical cancer prevention and control studies are necessary in LMICs.
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Affiliation(s)
- Margaret M. Demment
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
| | - Karen Peters
- Division of Community Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - J. Andrew Dykens
- Department of Family Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Ann Dozier
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America
| | - Haq Nawaz
- Department of Medicine, Griffin Hospital & Yale University-Griffin Prevention Research Center, New Haven, Connecticut, United States of America
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America
| | - Jennifer S. Smith
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Angela Sy
- School of Nursing and Dental Hygiene, University of Hawai’i at Mānoa, Honolulu, Hawaii, United States of America
| | - Tracy Irwin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Thomas T. Fogg
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
| | - Mahmooda Khaliq
- Department of Community and Family Health, University of South Florida, Tampa, Florida, United States of America
| | - Rachel Blumenfeld
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mehran Massoudi
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Timothy De Ver Dye
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- * E-mail:
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Mobit PN, Packianathan S, He R, Yang CC. Comparison of Axxent-Xoft, (192)Ir and (60)Co high-dose-rate brachytherapy sources for image-guided brachytherapy treatment planning for cervical cancer. Br J Radiol 2015; 88:20150010. [PMID: 25996576 DOI: 10.1259/bjr.20150010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To evaluate the dosimetric differences and similarities between treatment plans generated with Axxent-Xoft electronic brachytherapy source (Xoft-EBS), (192)Ir and (60)Co for tandem and ovoids (T&O) applicators. METHODS In this retrospective study, we replanned 10 patients previously treated with (192)Ir high-dose-rate brachytherapy. Prescription was 7 Gy × 4 fractions to Point A. For each original plan, we created two additional plans with Xoft-EBS and (60)Co. The dose to each organ at risk (OAR) was evaluated in terms of V(35%) and V(50%), the percentage volume receiving 35% and 50% of the prescription dose, respectively, and D(2cc), highest dose to a 2 cm(3) volume of an OAR. RESULTS There was no difference between plans generated by (192)Ir and (60)Co, but the plans generated using Xoft-EBS showed a reduction of up to 50% in V(35%), V(50%) and D(2cc). The volumes of the 200% and 150% isodose lines, however, were 74% and 34% greater than the comparable volumes generated with the (192)Ir source. Point B dose was on average only 16% of the Point A dose for plans generated with Xoft-EBS compared with 30% for plans generated with (192)Ir or (60)Co. CONCLUSION The Xoft-EBS can potentially replace either (192)Ir or (60)Co in T&O treatments. Xoft-EBS offers either better sparing of the OARs compared with (192)Ir or (60)Co or at least similar sparing. Xoft-EBS-generated plans had higher doses within the target volume than (192)Ir- or (60)Co-generated ones. ADVANCES IN KNOWLEDGE This work presents newer knowledge in dosimetric comparison between Xoft-EBS, (192)Ir or (60)Co sources for T&O implants.
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Affiliation(s)
- P N Mobit
- 1 Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA.,2 Cameroon Oncology Center, PO Box 1870, Douala, Cameroon
| | - S Packianathan
- 1 Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - R He
- 1 Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - C C Yang
- 1 Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
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Petereit DG, Coleman CN. Editorial: "global challenges in radiation oncology". Front Oncol 2015; 5:103. [PMID: 26029661 PMCID: PMC4432796 DOI: 10.3389/fonc.2015.00103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 12/27/2022] Open
Affiliation(s)
- Daniel Grant Petereit
- Walking Forward Program, Rapid City Regional Cancer Center, Rapid City, SD, USA
- International Cancer Expert Corps, New York, NY, USA
| | - C. Norman Coleman
- International Cancer Expert Corps, New York, NY, USA
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, USA
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Wang HY, Park S, Kim S, Lee D, Kim G, Kim Y, Park KH, Lee H. Use of hTERT and HPV E6/E7 mRNA RT-qPCR TaqMan assays in combination for diagnosing high-grade cervical lesions and malignant tumors. Am J Clin Pathol 2015; 143:344-51. [PMID: 25696792 DOI: 10.1309/ajcpf2xgz2xiqyqx] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Human papillomavirus (HPV) is a major cause of cervical cancer, which is the second most common cancer in women. HPV E6 initiates degradation of cellular tumor suppressor protein p53, induces human telomerase reverse transcriptase (hTERT) activity, and then leads to progressive cervical carcinogenesis. METHODS In this study, the CervicGen HPV RT-qDX assay (Optipharm, Osong, Republic of Korea), which detects 16 HPV high-risk subtypes (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, and 69), and the CervicGen hTERT RT-qDX assay (Optipharm) were evaluated using 545 ThinPrep (Hologic, Bedford, MA) Papanicolaou samples. RESULTS The positivity for the HPV E6/E7 messenger RNA (mRNA) assay was 94.4%, 95.2%, 82.4%, 46.5%, 25.0%, and 1.1% in squamous cell carcinomas, high-grade squamous intraepithelial lesions (HSILs), atypical squamous cells--cannot exclude HSIL, low-grade squamous intraepithelial lesions, atypical squamous cells of undetermined significance, and normal cytology samples, respectively. Five cervical intraepithelial neoplasia grade 2+ samples were not detected by the HPV E6/E7 mRNA assay, but they exhibited positive signals in the hTERT mRNA assay. Notably, the hTERT mRNA expression level was increased in high-grade cervical lesions but was very low in all 288 normal samples. CONCLUSIONS These data suggest that the combination of HPV E6/E7 and hTERT mRNA expression levels could be used in a complementary manner in diagnosing high-grade cervical lesions and malignant tumors and might be useful as a predictive marker in monitoring low-grade cervical lesions.
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Affiliation(s)
- Hye-Young Wang
- M&D, Wonju Eco Environmental Technology Center, Wonju, Gangwon, Republic of Korea
| | - Sunyoung Park
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, Republic of Korea
| | - Sunghyun Kim
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, Republic of Korea
- Institute for Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Dongsup Lee
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, Republic of Korea
- Department of Clinical Laboratory Science, Hyejeon College, Hongseong, Chungnam, Republic of Korea
| | - Geehyuk Kim
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, Republic of Korea
| | - Yeun Kim
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, Republic of Korea
| | - Kwang Hwa Park
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Gangwon, Republic of Korea
| | - Hyeyoung Lee
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, Republic of Korea
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Suneja G, Bacon M, Small W, Ryu SY, Kitchener HC, Gaffney DK. The cervix cancer research network: increasing access to cancer clinical trials in low- and middle-income countries. Front Oncol 2015; 5:14. [PMID: 25745604 PMCID: PMC4333873 DOI: 10.3389/fonc.2015.00014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/12/2015] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The burden of cervical cancer is large and growing in developing countries, due in large part to limited access to screening services and lack of human papillomavirus (HPV) vaccination. In spite of modern advances in diagnostic and therapeutic modalities, outcomes from cervical cancer have not markedly improved in recent years. Novel clinical trials are urgently needed to improve outcomes from cervical cancer worldwide. METHODS The Cervix Cancer Research Network (CCRN), a subsidiary of the Gynecologic Cancer InterGroup, is a multi-national, multi-institutional consortium of physicians and scientists focused on improving cervical cancer outcomes worldwide by making cancer clinical trials available in low-, middle-, and high-income countries. Standard operating procedures for participation in CCRN include a pre-qualifying questionnaire to evaluate clinical activities and research infrastructure, followed by a site visit. Once a site is approved, they may choose to participate in one of four currently accruing clinical trials. RESULTS To date, 13 different CCRN site visits have been performed. Of these 13 sites visited, 10 have been approved as CCRN sites including Tata Memorial Hospital, India; Bangalore, India; Trivandrum, India; Ramathibodi, Thailand; Siriaj, Thailand; Pramongkutklao, Thailand; Ho Chi Minh, Vietnam; Blokhin Russian Cancer Research Center; the Hertzen Moscow Cancer Research Institute; and the Russian Scientific Center of Roentgenoradiology. The four currently accruing clinical trials are TACO, OUTBACK, INTERLACE, and SHAPE. DISCUSSION The CCRN has successfully enrolled eight sites in developing countries to participate in four randomized clinical trials. The primary objectives are to provide novel therapeutics to regions with the greatest need and to improve the validity and generalizability of clinical trial results by enrolling a diverse sample of patients.
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Affiliation(s)
- Gita Suneja
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Monica Bacon
- GCIG: Gynecologic Cancer Intergroup, Kingston, ON, Canada
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine Loyola University, Chicago, IL, USA
| | - Sang Y. Ryu
- Department of Surgery, Division of Gastroenterologic Surgery, Chonnam National University Medical School, Gwangju, South Korea
| | - Henry C. Kitchener
- Institute of Cancer Sciences, St Mary’s Hospital, University of Manchester, Manchester, UK
| | - David K. Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Bigoni J, Gundar M, Tebeu PM, Bongoe A, Schäfer S, Fokom-Domgue J, Catarino R, Tincho EF, Bougel S, Vassilakos P, Petignat P. Cervical cancer screening in sub-Saharan Africa: a randomized trial of VIA versus cytology for triage of HPV-positive women. Int J Cancer 2014; 137:127-34. [PMID: 25420434 DOI: 10.1002/ijc.29353] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/17/2014] [Indexed: 12/16/2022]
Abstract
Developing countries are interested in using human papillomavirus (HPV) testing as a primary screening test for cervical cancer prevention programs. The low specificity of the HPV assay requires triage testing of HPV-positive women. The aim of the study is to compare visual inspection with acetic acid (VIA) and cytology as triage testing methods in HPV-positive women to detect cervical intraepithelial neoplasia or Grade 2 or higher (CIN2+). The study was conducted in two Cameroonian towns (Yaoundé and Edea) and included 846 eligible women aged 25 to 65 years. All participants performed self-HPV testing. HPV-positive women (n = 259) were randomly assigned to be tested either by VIA (VIA group) or cytology (cytology group). HPV-positive women had both cervical biopsy and endocervical curettage to detect biopsy-confirmed CIN2+. All statistical tests were two-sided. The prevalence of HPV was 38.5%, and the mean age of HPV-positive women was 41.5 ± 10.1 years. One hundred ninety-eight women (97 in the VIA group and 99 in the cytology) were randomly assigned to one of the two testing arms. The sensitivity of VIA was 25.0% (95% CI, 7.1-59.1%), and the sensitivity of cytology was 90.0% (59.6-98.2%). The specificity was 74.2% (95% CI, 64.2-82.1%) for VIA and 85.2% (76.3-91.2%) for cytology. ROC area for cytology was 0.910 against the 0.496 area for VIA. In this trial, VIA was inferior to cytology as a triage test among HPV-positive women. Further investigations are needed to determine the optimal triage method for HPV-positive women.
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Affiliation(s)
- Jérôme Bigoni
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Bircan H, Koc B, Ozcelik U, Demirag A. Jejunal torsion around the right ureter presenting as postoperative bowel obstruction: a case report. J Med Case Rep 2014; 8:209. [PMID: 24946938 PMCID: PMC4086696 DOI: 10.1186/1752-1947-8-209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/10/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction Since abdominal radical hysterectomy was first described by Clark and Reis in 1895, it has been commonly used in the primary surgical treatment of carcinoma of the cervix. We report the case of a 45-year-old woman who was diagnosed with a small bowel obstruction due to jejunal torsion to her right ureter mimicking postoperative adhesion ileus. Case presentation A 45-year-old Turkish woman was admitted to our emergency department with complaints of abdominal pain, constipation, nausea and vomiting. She had undergone an abdominal radical hysterectomy for cervical carcinoma three years earlier. Computed tomography scans revealed intestinal dilatation, a large amount of free fluid in the abdominal cavity and an area suspicious for jejunal perforation. Because of these radiological findings suggestive of obstruction and bowel ischemia, our patient underwent emergency surgery. Operative findings that showed a jejunal segment was turned around her right ureter so that it was mimicking a fibrous band. Conclusions In this current case, we present the first determined complication of radical hysterectomy. According to our case report, surgical oncologists should be aware of this complication and review the surgical technique. It is considered that readaptation of the dorsolateral peritoneal layer after extended pelvic lymph node dissection resulted in fewer complications.
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Affiliation(s)
| | - Bora Koc
- Department of Surgery, Baskent University, Faculty of Medicine, Istanbul Research Hospital, Oymacı sokak No:7 Altunizade, Istanbul, Turkey.
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Law I, Fong JJ, Buadromo EM, Samuela J, Patel MS, Garland SM, Mulholland EK, Russell FM. The high burden of cervical cancer in Fiji, 2004-07. Sex Health 2014; 10:171-8. [PMID: 23557630 DOI: 10.1071/sh12135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 12/02/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND There are few population-based data on the disease burden of cervical cancer from developing countries, especially South Pacific islands. This study aimed to determine the incidence and mortality associated with cervical cancer and the coverage of Papanicolaou (Pap) cervical cytology in 20- to 69-year-old women in Fiji from 2004 to 2007. METHODS National data on the incident cases of histologically confirmed cervical cancer and the associated deaths, and on Pap smear results were collected from all pathology laboratories, and cancer and death registries in Fiji from 2004 to 2007. RESULTS There were 413 incident cases of cervical cancer and 215 related deaths during the study timeframe. The annualised incidence and mortality rates in 20- to 69-year-old Melanesian Fijian women, at 49.7 per 100?000 (95% confidence interval (CI): 43.7-56.4) and 32.3 per 100?000 (95% CI: 26.9-38.4) respectively, were significantly higher than among 20- to 69-year-old Indo-Fijian women at 35.2 per 100?000 (P<0.001, 95% CI: 29.5-41.7) and 19.8 per 100?000 (P=0.002, 95% CI: 15.1-25.5) respectively. Of 330 cases diagnosed between 2004 and 2006, 186 (56%) had died by 31 December 2006. Pap smear coverage for this period was 8.0% (95% CI: 7.9-8.1) of the target population. CONCLUSIONS The incidence and mortality related to cervical cancer in Fiji is high, whereas Pap smear coverage is very low. Greater investment in alternative screening strategies and preventive measures should be integrated into a comprehensive, strategic cervical cancer control program in Fiji.
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Affiliation(s)
- Irwin Law
- National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT 0200, Australia
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Bharti AC, Shukla S, Mahata S, Hedau S, Das BC. Human papillomavirus and control of cervical cancer in India. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Sanad AS, Kamel HH, Hasan MM. Prevalence of cervical intraepithelial neoplasia (CIN) in patients attending Minia Maternity University Hospital. Arch Gynecol Obstet 2013; 289:1211-7. [PMID: 24305750 DOI: 10.1007/s00404-013-3109-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 11/21/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cervical cancer is the second most common cancer of the genital tract. Wide use of screening programs can help in prevention of cervical cancer. OBJECTIVE To screen and evaluate the prevalence of cervical intraepithelial neoplasia (CIN) by visualization of the cervix after application of 5 % acetic acid (VIA) in Minia Maternity University Hospital. PATIENTS AND METHODS The study included 3,600 women from outpatient clinics of Minia Maternity University Hospital. They were screened for cervical cancer with the use of visual inspection of the cervix after application of 5 % acetic acid (VIA). Positive cases were subjected to colposcopy after referral to the colposcopy unit in the same hospital. Colposcopy-guided biopsies were done for colposcopic positive patients. One hundred and twenty women with negative VIA as control were randomly examined with colposcopy to evaluate the effectiveness of the test used, and no cases experienced cervical lesion. RESULTS The prevalence was 5.8 % for cervical lesions, 1.4 % for HPV infection alone, 3.3, 0.84 and 0.27 % for CIN I, CIN II and CIN III, respectively. The prevalence of CIN II or higher was 1.11 % (40/3,600). CONCLUSIONS Prevalence of CIN in the study population was 138 out of 1,800 cases (7.7 %). Pre-invasive high-grade lesions represent 1.3 % in participant women. VIA can be used in national programs for cervical cancer screening.
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Affiliation(s)
- Ahmad Sameer Sanad
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Minia University, El-Minia, Egypt,
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Martínez-Mesa J, Werutsky G, Campani RB, Wehrmeister FC, Barrios CH. Inequalities in Pap smear screening for cervical cancer in Brazil. Prev Med 2013; 57:366-71. [PMID: 23827721 DOI: 10.1016/j.ypmed.2013.06.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/29/2013] [Accepted: 06/17/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the risk factors associated with never being screened for cervical cancer (CC) in Brazil. METHODS Using the National Household Sample Survey 2008 (PNAD), we analyzed data from 102,108 Brazilian women ages 25-64years. The patients were analyzed as having been or never having been screened with a Pap smear (Yes/No). Age-adjusted prevalence of never-screening was analyzed using a Chi-squared test. Crude and adjusted models using Poisson regression were performed. RESULTS The prevalence of never-screened women for CC was 12.9%, 11.5% and 22.2% in Brazil in general, urban and rural areas, respectively. The Brazilian region with the highest prevalence of never-screening was the North (17.4%, 14.7% and 27.3% in general, urban and rural areas, respectively). The factors associated with a higher risk for never being screened were the following: poverty, younger age, lower educational level, non-white skin color, a greater number of children, no supplemental health insurance and not having visited a doctor in the past 12months. CONCLUSION Socioeconomic and demographic conditions lead to inequalities in access to Pap smear screening in Brazil. Public health policy addressing these risk groups is necessary.
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Kim MS, Bak Y, Park YS, Lee DH, Kim JH, Kang JW, Song HH, Oh SR, Yoon DY. Wogonin induces apoptosis by suppressing E6 and E7 expressions and activating intrinsic signaling pathways in HPV-16 cervical cancer cells. Cell Biol Toxicol 2013; 29:259-72. [PMID: 23955116 DOI: 10.1007/s10565-013-9251-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 07/22/2013] [Indexed: 01/14/2023]
Abstract
Wogonin is a flavonoid compound extracted from Scutellaria baicalensis and is well known as a benzodiazepine receptor ligand with anxiolytic effects. Many recent studies have demonstrated that wogonin modulates angiogenesis, proliferation, invasion, and tumor progress in various cancer tissues. We further explored the mechanism of action of wogonin on cervical cancer cells that contain or lack human papillomavirus (HPV) DNA. Wogonin was cytotoxic to HPV 16 (+) cervical cancer cells, SiHa and CaSki, but not to HPV-negative cells. We demonstrated that wogonin induced apoptosis by suppressing the expressions of the E6 and E7 viral oncogenes in HPV-infected cervical cancer CaSki and SiHa cells. The modulation of p53 and protein retinoblastoma (pRb) were also triggered by the suppression of E6 and E7 expressions. However, p53 was not altered in HPV-negative cervical cancer C33A cells. Moreover, wogonin modulated the mitochondrial membrane potential and the expression of pro- and anti-apoptotic factors such as Bax and Bcl-2. Wogonin also provoked the cleavage of caspase-3, caspase-9, and poly ADP ribose polymerase. After transfection of siRNAs to target E6 and E7, additional restoration of p53 and pRb was not induced, but processing of caspases and PARP was increased compared with wogonin treatment alone. Together, our findings demonstrated that wogonin effectively promotes apoptosis by downregulating E6 and E7 expressions and promoting intrinsic apoptosis in human cervical cancer cells.
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Affiliation(s)
- Man Sub Kim
- Department of Bioscience and Biotechnology, Bio/Molecular Informatics Center, Konkuk University, 1 Hwayang-dong, Gwangjin-gu, Seoul, 143-701, Republic of Korea
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Pruitt CN, Reese CS, Grossardt BR, Shire AM, Creedon DJ. Completion of the human papillomavirus vaccination series lags in Somali adolescents. J Low Genit Tract Dis 2013; 17:280-8. [PMID: 23486073 PMCID: PMC3688667 DOI: 10.1097/lgt.0b013e3182759a64] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE It is unknown whether the Somali population in the United States is likely to participate in human papillomavirus (HPV) vaccination. We aimed to determine whether Somali girls living in a US community are following the recommendations for HPV vaccination. MATERIALS AND METHODS We conducted a study of HPV vaccination among Somali girls seen at Mayo Clinic, Rochester, MN. Each Somali subject was matched by year of birth to white/non-Hispanic subjects in a 1:3 ratio. We abstracted information between August 1, 2006, and December 31, 2009, related to HPV vaccine series initiation and completion. Initiation and completion frequencies were compared between study groups using the χ(2) test. RESULTS A total of 251 Somali and 727 white/non-Hispanic girls were identified, using the Rochester Epidemiology Project, who met all inclusion criteria for final analysis. A total of 114 Somali girls (45%) and 334 white/non-Hispanic girls (46%) initiated the series (odds ratio = 0.98; 95% confidence interval = 0.73-1.31), but only 59 Somali girls (52%) completed the vaccination series, compared with 240 (72%) of the white/non-Hispanic girls (odds ratio = 0.42; 95% confidence interval = 0.27-0.65). CONCLUSIONS We found Somali girls to be generally accepting of initiating the HPV vaccine series but less likely to complete the series as compared with white non-Hispanic girls of the same age.
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Affiliation(s)
- Crystal N Pruitt
- Mayo Medical School, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Zhang Y, Li Q, Huang W, Zhang J, Han Z, Wei H, Cui J, Wang Y, Yan W. Increased expression of apoptosis-related protein 3 is highly associated with tumorigenesis and progression of cervical squamous cell carcinoma. Hum Pathol 2013; 44:388-93. [DOI: 10.1016/j.humpath.2012.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/23/2012] [Accepted: 05/25/2012] [Indexed: 02/03/2023]
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Hata M, Omura M, Miyagi E, Koike I, Numazaki R, Asai-Sato M, Tayama Y, Ogino I, Hirahara F, Inoue T. The role of radiation therapy for uterine cervical cancer with distant metastasis. Oncology 2012; 83:67-74. [PMID: 22760158 DOI: 10.1159/000337985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 02/26/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We carried out a review to determine the role of radiation therapy in uterine cervical cancer with distant metastasis. METHODS Forty-four patients with uterine cervical cancer with distant metastasis underwent radiation therapy; 29 of these also underwent chemotherapy. A total dose of 19.8-90.4 Gy (median 62.9 Gy) was delivered to the cervical tumors. RESULTS Thirty-three patients died during the follow-up period of 1-94 months (median 10 months) after irradiation. The overall survival rate at 3 years was 20%, and the estimated median survival time was 15 months. Ten patients developed primary tumor progression, and the primary tumor control rate at 3 years was 49%. A distant metastatic site and primary tumor size were significant prognostic factors for their survival. Total radiation dose was considered a significant and useful variable for primary tumor control. With the exception of transient hematologic reactions and hemorrhagic cystitis, there were no therapy-related toxicities of grade 3 or greater. CONCLUSIONS Radiation therapy was safe and effective for local control in patients with uterine cervical cancer with distant metastasis. More aggressive treatment, including radiation therapy with a curative radiation dose, should be considered for patients with favorable prognostic factors for survival.
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Affiliation(s)
- Masaharu Hata
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
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IMP3, a new biomarker to predict progression of cervical intraepithelial neoplasia into invasive cancer. Am J Surg Pathol 2011; 35:1638-45. [PMID: 21997684 DOI: 10.1097/pas.0b013e31823272d4] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The expression of IMP3, an oncofetal protein, has been strongly associated with aggressive cancers. In this study, we investigated whether IMP3 can serve as a biomarker to predict invasive squamous cell carcinoma (SCC) in patients with cervical intraepithelial neoplasia (CIN) II and III. A total of 1249 patients with no dysplasia, CINs, or invasive SCC were studied for IMP3 expression. The 710 patients with CIN II and III in their cervical biopsies were further evaluated for invasive cancer-free survival analysis. The role of IMP3 in the regulation of cell proliferation and migration of HeLa cervical cancer cells was examined by modification of IMP3 expression with small interference RNA. Compared with CIN I or cervical tissues without dysplasia, IMP3 expression was significantly increased not only in invasive SCC but also most importantly in a subset of CIN III cases with concurrent invasive SCC. Importantly, invasive cancer was found only in patients with IMP3-positive CIN II and III, whereas no invasive cancer was detected in patients with IMP3-negative CIN II and III in their follow-up resections (P<0.0001). Reduction of IMP3 expression in cervical cancer cells significantly reduced cell migration without altering cell proliferation. IMP3 plays a critical role in the development of invasive SCC from cervical dysplasia. IMP3 can be used at the time of initial diagnosis of CIN to identify a group of patients with an increased chance of developing invasive cancer.
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Rao NH, Babu PB, Rajendra L, Sriraman R, Pang YYS, Schiller JT, Srinivasan V. Expression of codon optimized major capsid protein (L1) of human papillomavirus type 16 and 18 in Pichia pastoris; purification and characterization of the virus-like particles. Vaccine 2011; 29:7326-34. [PMID: 21803095 PMCID: PMC3507537 DOI: 10.1016/j.vaccine.2011.07.071] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/04/2011] [Accepted: 07/18/2011] [Indexed: 11/30/2022]
Abstract
The major capsid protein (L1) of human papillomaviruses (HPV) expressed in heterologous systems assembles into virus-like particles (VLPs). We report cloning and expression of codon optimized HPV L1 genes of the two high-risk HPV types 16 and 18 in methylotropic yeast, Pichia pastoris. The VLPs produced in P. pastoris were subjected to three step purification method involving density gradient centrifugations and size exclusion chromatography. The enriched VLPs were characterized using conformation-specific monoclonal antibodies in ELISA and by transmission electron microscopy. Mice immunized with a bivalent HPV16 and HPV18 VLPs developed high serum antibody titers to both HPV types that persisted for 190 days post vaccination. Serum of mice immunized with the HPV-VLP preparations could neutralize homologous pseudoviruses in an in vitro assays. Our results demonstrate that the L1 proteins expressed in P. pastoris fold properly as evidenced by assembly into VLPs and induction of type-specific neutralizing antibody response in mice. This work constitutes a step towards developing an alternate production platform for generating an affordable HPV vaccine to meet the needs of developing countries.
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MESH Headings
- Animals
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Capsid Proteins/chemistry
- Capsid Proteins/genetics
- Capsid Proteins/immunology
- Cloning, Molecular
- HEK293 Cells
- Human papillomavirus 16/genetics
- Human papillomavirus 16/immunology
- Human papillomavirus 18/genetics
- Human papillomavirus 18/immunology
- Humans
- Mice
- Mice, Inbred BALB C
- Oncogene Proteins, Viral/chemistry
- Oncogene Proteins, Viral/genetics
- Oncogene Proteins, Viral/immunology
- Papillomavirus Infections/prevention & control
- Papillomavirus Vaccines/immunology
- Pichia/genetics
- Vaccines, Virus-Like Particle/immunology
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Affiliation(s)
- N. Hanumantha Rao
- Research & Development Centre, Indian Immunologicals Limited, Rakshapuram, Gachibowli, Hyderabad 500032, Andhra Pradesh, India
| | - P. Baji Babu
- Research & Development Centre, Indian Immunologicals Limited, Rakshapuram, Gachibowli, Hyderabad 500032, Andhra Pradesh, India
| | - L. Rajendra
- Research & Development Centre, Indian Immunologicals Limited, Rakshapuram, Gachibowli, Hyderabad 500032, Andhra Pradesh, India
| | - R. Sriraman
- Research & Development Centre, Indian Immunologicals Limited, Rakshapuram, Gachibowli, Hyderabad 500032, Andhra Pradesh, India
| | - Yuk-Ying S. Pang
- Laboratory of Cellular Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - John T. Schiller
- Laboratory of Cellular Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - V.A. Srinivasan
- Research & Development Centre, Indian Immunologicals Limited, Rakshapuram, Gachibowli, Hyderabad 500032, Andhra Pradesh, India
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Kawakami Y, Toda T, Nishimura T, Sakane J, Kuraoka K, Takehara K, Mizunoe T, Taniyama K. Histological correlation of glandular abnormalities in cervical liquid-based cytology. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:743836. [PMID: 21961080 PMCID: PMC3179896 DOI: 10.4061/2011/743836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 06/12/2011] [Indexed: 11/20/2022]
Abstract
Conventional Papanicolaou smear method is still commonly used for cervical cancer screening in Japan, despite the liquid-based cytology (LBC) that has become a global tendency in the world recently. One of the obstacles in the way of popularization of this method seems to be the confusion as to diagnosis upon cervical glandular lesions. We performed comparison study between LBC and conventional Papanicolaou smear about cytological diagnosis using split-sample method in 4522 patients. In 13 cases analyses, which were reported with either AGC or adenocarcinoma by either method, LBC tends to be milder than that by conventional smear, however, the credibility of LBC is considered to be near to that of conventional smear with regard to screening for glandular abnormalities. These results indicate that cervical cancer screening should shift to LBC under the enough experience and appropriate dealing with the cytological diagnosis.
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Affiliation(s)
- Yosuke Kawakami
- Institute for Clinical Research, National Hospital Organization Japan, Kure Medical Center/Chugoku Cancer Center, 3-1 Aoyama-Cho, Kure-City, Hiroshima 737-0023, Japan
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Kwan TTC, Tam KF, Lee PWH, Chan KKL, Ngan HYS. The effect of school-based cervical cancer education on perceptions towards human papillomavirus vaccination among Hong Kong Chinese adolescent girls. PATIENT EDUCATION AND COUNSELING 2011; 84:118-122. [PMID: 20650592 DOI: 10.1016/j.pec.2010.06.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 06/15/2010] [Accepted: 06/16/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate the effects of school-based cervical cancer education on Hong Kong Chinese adolescent girls. METHODS Adolescent girls (n=953) in local secondary schools attended a tailored educational program on cervical cancer prevention. Self-administered questionnaires were used before and after the program to measure its effects on participants' knowledge, attitude and perceived social norms towards human papillomavirus (HPV) vaccination and their intention to be HPV vaccinated. RESULTS Before the program, HPV vaccine acceptance was favorable but relevant knowledge was low. After the program, participants had greater knowledge and a more positive attitude (both p<0.001), with more girls anticipating family (41.6% before vs. 58.9% after) and peer support (32.8% before vs. 56.9% after). There were 11.3% more girls who indicated an intention to accept the vaccine afterward. More knowledge, a more positive attitude and perceived support from significant others predicted a stronger intention to be HPV vaccinated. CONCLUSION The educational program had a positive impact on participants' perceptions towards HPV vaccination and their intention to be vaccinated. PRACTICE IMPLICATIONS School-based cervical cancer education is a viable means to meet the substantial educational needs of adolescents. Promotion of HPV vaccination should also include educating and influencing perceptions of families and peers.
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Affiliation(s)
- Tracy T C Kwan
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong
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Ma DM, Xu YP, Zhu L. Expression of vascular endothelial growth factor C correlates with a poor prognosis based on analysis of prognostic factors in patients with cervical carcinomas. J Obstet Gynaecol Res 2011; 37:1519-24. [DOI: 10.1111/j.1447-0756.2011.01566.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Shukla S, Shishodia G, Mahata S, Hedau S, Pandey A, Bhambhani S, Batra S, Basir SF, Das BC, Bharti AC. Aberrant expression and constitutive activation of STAT3 in cervical carcinogenesis: implications in high-risk human papillomavirus infection. Mol Cancer 2010; 9:282. [PMID: 20977777 PMCID: PMC2984472 DOI: 10.1186/1476-4598-9-282] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 10/27/2010] [Indexed: 12/31/2022] Open
Abstract
Background Recent observations indicate potential role of transcription factor STAT3 in cervical cancer development but its role specifically with respect to HPV infection is not known. Present study has been designed to investigate expression and activation of STAT3 in cervical precancer and cancer in relation to HPV infection during cervical carcinogenesis. Established cervical cancer cell lines and prospectively-collected cervical precancer and cancer tissues were analyzed for the HPV positivity and evaluated for STAT3 expression and its phosphorylation by immunoblotting and immunohistochemistry whereas STAT3-specific DNA binding activity was examined by gel-shift assays. Results Analysis of 120 tissues from cervical precancer and cancer lesions or from normal cervix revealed differentially high levels of constitutively active STAT3 in cervical precancer and cancer lesions, whereas it was absent in normal controls. Similarly, a high level of constitutively active STAT3 expression was observed in HPV-positive cervical cancer cell lines when compared to that of HPV-negative cells. Expression and activity of STAT3 were found to change as a function of severity of cervical lesions from precancer to cancer. Expression of active pSTAT3 was specifically high in cervical precancer and cancer lesions found positive for HPV16. Interestingly, site-specific accumulation of STAT3 was observed in basal and suprabasal layers of HPV16-positive early precancer lesions which is indicative of possible involvement of STAT3 in establishment of HPV infection. In HPV16-positive cases, STAT3 expression and activity were distinctively higher in poorly-differentiated lesions with advanced histopathological grades. Conclusion We demonstrate that in the presence of HPV16, STAT3 is aberrantly-expressed and constitutively-activated in cervical cancer which increases as the lesion progresses thus indicating its potential role in progression of HPV16-mediated cervical carcinogenesis.
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Affiliation(s)
- Shirish Shukla
- Division of Molecular Oncology, Institute of Cytology & Preventive Oncology, I-7, Sector-39, NOIDA, U.P., India
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Ware RA, van Nagell JR. Radical hysterectomy with pelvic lymphadenectomy: indications, technique, and complications. Obstet Gynecol Int 2010; 2010:587610. [PMID: 20871657 PMCID: PMC2939408 DOI: 10.1155/2010/587610] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 06/11/2010] [Indexed: 12/03/2022] Open
Abstract
Radical hysterectomy with pelvic lymphadenectomy remains the treatment of choice for women with Stages IA(2) and IB(1) carcinoma of the cervix, and selected patients with Stage II endometrial cancer. Improvement in surgical techniqe, administration of prophylactic antibiotics, thromboemolic prophylaxis, and advances in critical care medicine have resulted in lower operative morbidity associated with this procedure. Major urinary tract complications such as ureteral injury or vesico-vaginal fistula are now extremely rare (<1%). Five-year survival rates following this procedure vary according to a number of clinical and histologic variables, and may be as high as 90% in women without lymph node metastases.
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Affiliation(s)
- Rachel A. Ware
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA
| | - John R. van Nagell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA
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Dowling EC, Klabunde C, Patnick J, Ballard-Barbash R. Breast and cervical cancer screening programme implementation in 16 countries. J Med Screen 2010; 17:139-46. [PMID: 20956724 DOI: 10.1258/jms.2010.010033] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective There is a continuing need to monitor and evaluate the impact of organized screening programmes on cancer incidence and mortality. We report results from a programme assessment conducted within the International Cancer Screening Network (ICSN) to understand the characteristics of cervical screening programmes within countries that have established population-based breast cancer screening programmes. Methods In 2007-2008, we asked 26 ICSN country representatives to complete a web-based survey that included questions on breast and cervical cancer screening programmes. We summarized information from 16 countries with both types of organized programmes. Results In 63% of these countries, the organization of the cervical cancer screening programme was similar to that of the breast cancer screening programme in the same country. There were differences in programme characteristics, including year established (1962-2003 cervical; 1986-2002 breast) and ages covered (15-70+ cervical; 40-75+ breast). Adoption of new screening technologies was evident (44% liquid-based Pap tests; 13% human papillomavirus (HPV)-triage tests cervical; 56% digital mammography breast). There was wide variation in participation rates for both programme types (<4-80% cervical; 12-88% breast), and participation rates tended to be higher for cervical (70-80%) than for breast (60-70%) cancer screening programmes. Eleven ICSN member countries had approved the HPV vaccine and five more were considering its use in their organized programmes. Conclusion Overall, there were similarities and differences in the organization of breast and cervical cancer screening programmes among ICSN countries. This assessment can assist established and new screening programmes in understanding the organization and structure of cancer screening programmes.
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Affiliation(s)
- Emily C Dowling
- Public Health Adviser, Applied Research Program, Division of
Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Carrie Klabunde
- Epidemiologist, Applied Research Program, Division of Cancer
Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Julietta Patnick
- Director, National Health Service Cancer Screening Programmes,
Fulwood House, Sheffield, UK
| | - Rachel Ballard-Barbash
- Associate Director, Applied Research Program, Division of
Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Li C, Wu M, Wang J, Zhang S, Zhu L, Pan J, Zhang W. A Population-based Study on the Risks of Cervical Lesion and Human Papillomavirus Infection among Women in Beijing, People's Republic of China. Cancer Epidemiol Biomarkers Prev 2010; 19:2655-64. [PMID: 20719907 DOI: 10.1158/1055-9965.epi-10-0212] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Changdong Li
- Beijing Obstetric and Gynecology Hospital, Capital Medical University, Beijing, China
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Menéndez C, Castellsagué X, Renom M, Sacarlal J, Quintó L, Lloveras B, Klaustermeier J, Kornegay JR, Sigauque B, Bosch FX, Alonso PL. Prevalence and risk factors of sexually transmitted infections and cervical neoplasia in women from a rural area of southern Mozambique. Infect Dis Obstet Gynecol 2010; 2010:609315. [PMID: 20706691 PMCID: PMC2913799 DOI: 10.1155/2010/609315] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 05/12/2010] [Indexed: 11/18/2022] Open
Abstract
There is limited information on the prevalence of sexually transmitted infections and the prevalence of cervical neoplasia in rural sub-Saharan Africa. This study describes the prevalence and the etiology of STIs and the prevalence of cervical neoplasia among women in southern Mozambique. An age-stratified cross-sectional study was performed where 262 women aged 14 to 61 years were recruited at the antenatal clinic (59%), the family-planning clinic (7%), and from the community (34%). At least one active STI was diagnosed in 79% of women. Trichomonas vaginalis was present in 31% of all study participants. The prevalence of Neisseria gonorrhea and Chlamydia trachomatis were 14% and 8%, respectively, and Syphilis was diagnosed in 12% of women. HPV DNA was detected in 40% of women and cervical neoplasia was diagnosed in 12% of all women. Risk factors associated with the presence of some of the STIs were being divorced or widowed, having more than one sexual partner and having the partner living in another area. A higher prevalence was observed in the reproductive age group and some of the STIs were more frequently diagnosed in pregnant women. STI control programs are a priority to reduce the STIs burden, including HIV and cervical neoplasia.
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Affiliation(s)
- Clara Menéndez
- Manhiça Health Research Center, Manhiça, Maputo, Mozambique.
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Ali SF, Ayub S, Manzoor NF, Azim S, Afif M, Akhtar N, Jafery WA, Tahir I, Farid-Ul-Hasnian S, Uddin N. Knowledge and awareness about cervical cancer and its prevention amongst interns and nursing staff in Tertiary Care Hospitals in Karachi, Pakistan. PLoS One 2010; 5:e11059. [PMID: 20548787 PMCID: PMC2883573 DOI: 10.1371/journal.pone.0011059] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 05/14/2010] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Cervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. It is imperative for at least health professionals in developing countries like Pakistan to have a sound knowledge about the disease. This study was carried out to assess the knowledge and awareness about cervical cancer and its prevention amongst health professionals in tertiary care hospitals in Karachi, Pakistan. Methods and Design A cross-sectional, interview based survey was conducted in June, 2009. Sample of 400 was divided between the three tertiary care centers. Convenience sampling was applied as no definitive data was available regarding the number of registered interns and nurses at each center. Results Of all the interviews conducted, 1.8% did not know cervical cancer as a disease. Only 23.3% of the respondents were aware that cervical cancer is the most common cause of gynecological cancers and 26% knew it is second in rank in mortality. Seventy-eight percent were aware that infection is the most common cause of cervical cancer, of these 62% said that virus is the cause and 61% of the respondents knew that the virus is Human Papilloma Virus (HPV). Majority recognized that it is sexually transmitted but only a minority (41%) knew that it can be detected by PCR. Only 26% of the study population was aware of one or more risk factors. Thirty seven percent recognized Pap smear as a screening test. In total only 37 out of 400 respondents were aware of the HPV vaccine. Conclusion This study serves to highlight that the majority of working health professionals are not adequately equipped with knowledge concerning cervical cancer. Continuing Medical Education program should be started at the hospital level along with conferences to spread knowledge about this disease.
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He M, Cheng Y, Li W, Liu Q, Liu J, Huang J, Fu X. Vascular endothelial growth factor C promotes cervical cancer metastasis via up-regulation and activation of RhoA/ROCK-2/moesin cascade. BMC Cancer 2010; 10:170. [PMID: 20429915 PMCID: PMC2873393 DOI: 10.1186/1471-2407-10-170] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 04/29/2010] [Indexed: 01/01/2023] Open
Abstract
Background The elevated expression of vascular endothelial growth factor C (VEGF-C) is correlated with clinical cervical cancer metastasis and patient survival, which is interpreted by VEGF-C functions to stimulate angiogenesis and lymphatic genesis. However, the direct impact of VEGF-C on cervical cancer cell motility remains largely unknown. Methods In this study, we investigated the effects of VEGF-C on actin cytoskeleton remodeling and on cervical cancer cell migration and invasion and how the actin-regulatory protein, moesin regulated these effects through RhoA/ROCK-2 signaling pathway. Results On cervical carcinoma cell line SiHa cells, exposure of VEGF-C triggered remodeling of the actin cytoskeleton and the formation of membrane ruffles, which was required for cell movement. VEGF-C significantly enhanced SiHa cells horizontal migration and three-dimensional invasion into matrices. These actions were dependent on increased expression and phosphorylation of the actin-regulatory protein moesin and specific moesin siRNA severely impaired VEGF-C stimulated-cell migration. The extracellular small GTPase RhoA/ROCK-2 cascade mediated the increased moesin expression and phosphorylation, which was discovered by the use of Y-27632, a specific inhibitor of Rho kinase and by transfected constitutively active, dominant-negative RhoA as well as ROCK-2 SiRNA. Furthermore, in the surgical cervical specimen from the patients with FIGO stage at cervical intra-epithelial neoplasia and I-II cervical squamous cell carcinoma, the expression levels of moesin were found to be significantly correlated with tumor malignancy and metastasis. Conclusions These results implied that VEGF-C promoted cervical cancer metastasis by upregulation and activation of moesin protein through RhoA/ROCK-2 pathway. Our findings offer new insight into the role of VEGF-C on cervical cancer progression and may provide potential targets for cervical cancer therapy.
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Affiliation(s)
- Mian He
- Department of Gynecology and obstetrics, the first affiliated hospital of Sun Yat-sen University, Guangdong, Guangzhou, 510089, China.
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Tsai CS, Lai CH, Chang TC, Yen TC, Ng KK, Hsueh S, Lee SP, Hong JH. A Prospective Randomized Trial to Study the Impact of Pretreatment FDG-PET for Cervical Cancer Patients With MRI-Detected Positive Pelvic but Negative Para-Aortic Lymphadenopathy. Int J Radiat Oncol Biol Phys 2010; 76:477-84. [DOI: 10.1016/j.ijrobp.2009.02.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 12/17/2008] [Accepted: 02/09/2009] [Indexed: 10/20/2022]
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Redaniel MT, Laudico A, Mirasol-Lumague MR, Gondos A, Uy GL, Toral JA, Benavides D, Brenner H. Ethnicity and Health Care in Cervical Cancer Survival: Comparisons between a Filipino Resident Population, Filipino-Americans, and Caucasians. Cancer Epidemiol Biomarkers Prev 2009; 18:2228-34. [DOI: 10.1158/1055-9965.epi-09-0317] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kwan TTC, Chan KKL, Yip AMW, Tam KF, Cheung ANY, Lo SST, Lee PWH, Ngan HYS. Acceptability of human papillomavirus vaccination among Chinese women: concerns and implications. BJOG 2009; 116:501-10. [DOI: 10.1111/j.1471-0528.2008.01988.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wong WCW, Fong B, Chan PKS. Acceptance of human papillomavirus vaccination among first year female university students in Hong Kong. Sex Health 2009; 6:264-71. [DOI: 10.1071/sh09017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 09/04/2009] [Indexed: 11/23/2022]
Abstract
The present study assessed sexual behaviour, knowledge and attitudes among first year university students in order to identify factors that may affect their acceptance of human papillomavirus (HPV) vaccination. A cross-sectional survey was conducted at the Chinese University of Hong Kong in August 2006. The survey was a self-administered questionnaire comprising questions regarding general health, sexual behaviour, knowledge about HPV and cervical cancer, and attitudes towards vaccination. χ2, anova and logistic regression tests were used to identify associations between categories. Of 992 students, 63 (6.5%) reported having had sexual intercourse, 22.4% of whom had had more than one sexual partner and 36.5% had had unprotected sexual intercourse. A total of 70.8% of participants were willing to accept the HPV vaccine, with ‘willingness’ independently associated with age, having had sexual intercourse and beliefs regarding the effectiveness of vaccination (P < 0.05). Understanding the role of these influences can aid in the design of successful HPV education, prevention and vaccination programs.
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Derchain SF, Sarian LO, Naud P, Roteli-Martins C, Longatto-Filho A, Tatti S, Branca M, Erzen M, Serpa-Hammes L, Matos J, Gontijo RC, Bragança JF, Lima TP, Maeda MYS, Lörincz A, Dores GB, Costa S, Syrjänen S, Syrjänen K. Safety of screening with Human papillomavirus testing for cervical cancer at three-year intervals in a high-risk population: experience from the LAMS study. J Med Screen 2008; 15:97-104. [PMID: 18573778 DOI: 10.1258/jms.2008.007061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess whether human papillomavirus (HPV) testing is a safe enough approach to warrant extension of the screening intervals of baseline Papanicolaou (Pap)-/HPV- women in low-income settings. METHODS Of the >1000 women prospectively followed up as part of the Latin American Screening (LAMS) Study in São Paulo, Campinas, Porto Alegre) and Buenos Aires, 470 women with both baseline cytology and Hybrid Capture 2 (HC2) results available were included in this analysis. These baseline Pap-negative and HC2- or HC2+ women were controlled at six-month intervals with colposcopy, HC2 and Pap to assess the cumulative risk of incident Pap smear abnormalities and their predictive factors. RESULTS Of the 470 women, 324 (68.9%) were high-risk HPV (hrHPV) positive and 146 (31.1%) were negative. Having two or more lifetime sex partners (odds ratio [OR] = 2.63; 95% CI 1.70-3.51) and women using hormonal contraception (OR = 2.21; 95% CI 1.40-3.51) were at increased risk for baseline hrHPV infection. Baseline hrHPV+ women had a significantly increased risk of incident abnormal Pap smears during the follow-up. Survival curves deviate from each other starting at month 24 onwards, when hrHPV+ women start rapidly accumulating incident Pap smear abnormalities, including atypical squamous cells (ASC) or worse (log-rank; P < 0.001), low-grade squamous intraepithelial lesions (LSIL) or worse (P < 0.001) and high-grade squamous intraepithelial lesions (HSIL) (P = 0.03). Among the baseline hrHPV- women, the acquisition of incident hrHPV during the follow-up period significantly increased the risk of incident cytological abnormalities (hazard ratio = 3.5; 95% CI 1.1-11.7). CONCLUSION These data implicate that HPV testing for hrHPV types might be a safe enough approach to warrant extension of the screening interval of hrHPV-/Pap-women even in low-resource settings. Although some women will inevitably contract hrHPV, the process to develop HSIL will be long enough to enable their detection at the next screening round (e.g. after three years).
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Affiliation(s)
- S F Derchain
- Alexander Fleming, 848, Nova Campinas, Campinas, São Paulo, Brazil
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Lee PWH, Kwan TTC, Tam KF, Chan KKL, Young PMC, Lo SST, Cheung ANY, Ngan HYS. Beliefs about cervical cancer and human papillomavirus (HPV) and acceptability of HPV vaccination among Chinese women in Hong Kong. Prev Med 2007; 45:130-4. [PMID: 17707077 DOI: 10.1016/j.ypmed.2007.07.013] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 07/09/2007] [Accepted: 07/10/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the knowledge and beliefs on cervical cancer and HPV infection and to evaluate the acceptability of HPV vaccination among Chinese women. METHODS Seven focus groups were conducted with ethnic Chinese women aged 18-25 (n=20), 26-35 (n=13), and 36 and above (n=16) in a community women's health clinic in Hong Kong in 2006. The discussions were audio taped, transcribed and analyzed. Recurrent themes related to cervical cancer, HPV infection and vaccination were highlighted. RESULTS Diverse conceptions on likely causes of cervical cancer were noted, covering biological, psychological, environmental, lifestyle and sexual factors. Most women had not heard of HPV and its mode of transmission. The participants had difficulties understanding and accepting the linkage between cervical cancer and the sexually transmitted HPV infection. HPV infection was seen as personally stigmatizing with significant adverse impact on self-esteem and significant relationships. Participants favored HPV vaccination both for themselves and their teenage daughters if authoritative endorsement was provided. CONCLUSION Inadequate knowledge and misconceptions on cervical cancer and HPV were common. Most participants welcomed and favored having HPV vaccination. Apart from promoting HPV vaccination, cervical cancer prevention should also include strategies to promote knowledge and minimize the stigmatizing effect of a sexually transmitted HPV infection.
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Affiliation(s)
- Peter W H Lee
- Division of Clinical Health Psychology, Department of Psychiatry, The University of Hong Kong, Hong Kong.
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