CERVICAL CANCER SCREENING

P4 Medicine or O4 Medicine? Hippocrates Provides the Answer

Background

The term P4 medicine (predictive, preventative, personalized, participatory) was coined by Dr. Leroy Hood of the Institute for Systems Biology to demonstrate his framework to detect and prevent disease through extensive biomarker testing, close monitoring, deep statistical analysis, and patient health coaching.

Methods

In 2017, this group published the results of their “100 Person Wellness Project.” They performed whole genome sequencing and 218 clinical laboratory tests, measured 643 metabolites and 262 proteins, quantified 4616 operational taxonomic units in the microbiome, and monitored exercise in 108 participants for 9 months. The study was also interventional, as members were paired with a coach who gave lifestyle and supplement counseling to improve biomarker levels between each sampling period.

Results

Using this study as a basis, we here analyze the Hippocratic roots and the advantages and disadvantages of P4 medicine. We introduce O4 medicine (overtesting, overdiagnosis, overtreatment, overcharging) as a counterpoint to P4 medicine to highlight the drawbacks, including possible harms and cost.

Conclusions

We hope this analysis will contribute to the discussion about the best use of limited health-care resources to produce maximum benefit for all patients.

Trends in Solid Tumor Incidence in Ukraine 30 Years After Chernobyl

PURPOSE

There is limited knowledge of the long-term health effects of the Chernobyl nuclear power plant accident that occurred more than 30 years ago in Ukraine. This study describes trends in the incidence of solid organ malignancy in Ukraine and the five regions most affected by the radioactive fallout.

METHODS

The National Cancer Registry of Ukraine was queried for age-standardized incidence rates (ASIRs) of solid organ malignancy in Ukraine and the regions of Kyiv, Chernihiv, Zhytomyr, Rivne, and Volyn covering the period of 1999 to 2016. Joinpoint analysis was used to calculate the average annual percentage of change.

RESULTS

The highest burdens of cancer incidence in Ukraine were seen in the lung, stomach, breast, and prostate. We observed significant increases in the ASIRs of colon (average annual percentage of change, 1.5 [95% CI, 1.3 to 1.7]), rectal (0.9 [95% CI, 0.6 to 1.2]), kidney (2.3 [95% CI, 1.8 to 2.9]), thyroid (4.2 [95% CI, 3.1 to 5.3]), breast (1 [95% CI, 0.6 to 1.4]), cervical (0.7 [95% CI, 0.3 to 1.2]), and prostate (3.9 [95% CI, 3.6 to 4.2]) cancers, with decreases in stomach (−2.4 [95% CI, −2.5 to −2.3]) and lung (−1.8 [95% CI, −2.1 to −1.5]) cancers. ASIRs in the affected regions were similar to nationwide rates, with the exception of those for Kyiv.

CONCLUSION

The incidence rates of many solid organ malignancies in Ukraine are rising. However, the rates of solid organ malignancy in the five regions most affected by fallout did not substantially differ from national patterns, with the exception of those for Kyiv. Ongoing monitoring of cancer incidence in Ukraine is necessary to understand how best to decrease disease burden nationwide and to elucidate the causes of regional variations in ASIRs, such as access to diagnostics and environmental exposures.

Cervical cancer: Biomarkers for diagnosis and treatment

Cervical cancer is a major gynecological cancer which involves uncontrolled cell division and tissue invasiveness of the female uterine cervix. With the availability of new technologies researchers have increased their efforts to develop novel biomarkers for early diagnosis, and evaluation and monitoring of therapeutic treatments. This approach will help in the development of early diagnosis and in increasing treatment efficacy with decreased recurrence. The present review explains the currently available biomarkers for cervical cancer diagnosis and prognosis. Apart from the currently available biomarkers the review also explains strategies for the development of biomarkers based on cellular and molecular approaches such as DNA, protein and other metabolic markers with suitable clinical examples. The investigations of specific proteins, enzymes and metabolites will establish more useful biomarkers for accurate detection and management of gynecological cancers especially cervical cancer.

Screening for cervical neoplasia: a community-based trial comparing Pap staining, human papilloma virus testing, and the new bi-functional Celldetect® stain

Although cytological screening for cervical neoplasia has lowered mortality rates, current screening methods are plagued by sub-optimal sensitivity and/or specificity. The purpose of this study was to compare the performance of the new CellDetect® staining technology as a potential screening tool. This initial, non-blinded study, utilized samples are taken at a community-based clinic. The diagnostic results using CellDetect® were compared with the performance of Pap staining and human papilloma virus (HPV) testing on the same material, as well as the follow-up biopsies. These data were statistically analyzed in terms of sensitivity, specificity, predictive value (N.P.V and P.P.V), and inter-observer agreement. Bi-functional CellDetect® staining revealed morphological details and tinctorial properties that permitted recognition of neoplasia even at low magnification. Performance-wise, CellDetect® demonstrated non-inferiority for all statistical parameters to both Pap and HPV tests. Importantly, superior sensitivity compared with Pap staining was observed, as well as higher specificity than HPV testing with near equivalent sensitivity. We conclude that CellDetect® is a promising approach to early detection of cervical cancer because of its bi-functional capabilities that afford high sensitivity and specificity. The data suggest that this new methodology warrants further and more extensive clinical evaluation.

Screening for gynecologic cancer

Screening for cervical cancer with the Pap test has significantly reduced mortality from the disease. Although screening for ovarian and endometrial cancer is desirable, suggested strategies have not demonstrated efficacy. For the present time, educating patients with regard to the symptoms associated with these diseases and prompt evaluation of women who present with these symptoms helps limit unnecessary diagnostic delay.

Screening and epidemiological trends in cervical cancer

The developed or less developed countries where basic conditions for the screening of cervical cancer are quite different in terms of essential factors such as accuracy of cytology, cost effectiveness and development of new methods of diagnosis. Considering these factors the screening program made by annual Pap smear with adjunctive cervicography and HPV DNA test in the women aged from 20 to 69 years may have universal validity.

The quality of cervical cancer screening: a primary care perspective

The bulk of cervical cancer screening is performed by primary care providers; mostly nurses and physicians. The literature regarding the quality of this screening is largely described from three perspectives; clinical, laboratory, and public health. This article describes the primary care perspective regarding issues of quality in cervical cancer screening and suggests areas for improvement. The authors discuss how effectiveness of the test, sampling methods, interpretation by the laboratory, and reporting results impact on the quality of cervical cancer screening. Other factors which influence the quality of screening such as access to care, recall intervals, communication with the patient, costs of testing, and organizational issues are also reviewed.

Office gynecology for the primary care physician, part I: vaginitis, the Papanicolaou smear, contraception, and postmenopausal estrogen replacement

Many routine gynecologic problems can be managed easily in the primary care physician's office. Most cases of vaginitis are due to one of several organisms that are easy to diagnose and treat with information from the history, physical examination, and wet mount. The technique of performing a Papanicolaou smear and the interpretation of results are described, as are various methods of birth control and their efficacies and risks. Last, the risks and benefits of estrogen replacement therapy and modalities for beginning therapy are discussed.

Prevention and early detection of cancer in women

Cancer remains a significant problem for women. When detected early, cancer is more easily treated and the possibility of long-term cure is greatest. Nurses play an important role in the prevention and early detection of cancer in women. Nurses can serve as role models to women by incorporating cancer prevention and detection practices into their personal health behaviors. Nurses also have many opportunities to incorporate primary, secondary, and tertiary prevention methods into their practice, regardless of the setting. The impact on quality of life and decreased mortality as a result of implementation of prevention and early detection practices is significant.