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Harris CJ, Rowell EE, Jayasinghe Y, Cost C, Childress KJ, Frederick NN, McNally O, Appiah L, Anazodo A. Pediatric, adolescent, and young adult breast and reproductive tumors. Pediatr Blood Cancer 2023; 70 Suppl 5:e29422. [PMID: 36458682 DOI: 10.1002/pbc.29422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 12/04/2022]
Abstract
Tumors of the breast and reproductive organs that occur in children, adolescents, and young adults (AYA) have different biological features and can present special challenges. Although prognosis for these tumors is generally favorable, the long-term effects of treatment can be debilitating. Treatments are often multimodal and may include surgery as well as chemotherapy and/or radiation, which can cause considerable distress and anxiety related to loss of femininity or masculinity, concern over future fertility, or sexual dysfunction. Thus, tumors of the reproductive organs in pediatric/AYA patients require special consideration of the treatment effects beyond the intended oncologic outcome. Multidisciplinary teams should be involved in their care and address issues of fertility, sexual dysfunction, and psychosexual concerns before treatment begins. This review addresses histology, risk factors, prognosis, staging and treatment of gynecologic, breast and testicular cancers in pediatric and AYA patients.
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Affiliation(s)
- Courtney J Harris
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Erin E Rowell
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Yasmin Jayasinghe
- Royal Women's Hospital, Parkville, Victoria, Australia
- Royal Children's Hospital, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Carrye Cost
- Children's Hospital Colorado, Aurora, Colorado
| | - Krista J Childress
- Children's Healthcare of Atlanta, Atlanta, Georgia
- Emory University, Atlanta, Georgia
| | - Natasha N Frederick
- Department of Pediatrics and the Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Orla McNally
- Royal Women's Hospital, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | | | - Antoinette Anazodo
- Sydney Children's Hospital, Sydney, New South Wales, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's, University of New South Wales, High St Kensington, New South Wales, Australia
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Pre-Vaccination Human Papillomavirus Genotypes and HPV16 Variants among Women Aged 25 Years or Less with Cervical Cancer. Pathogens 2023; 12:pathogens12030451. [PMID: 36986373 PMCID: PMC10051959 DOI: 10.3390/pathogens12030451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/25/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
Background: In 2007, Australia introduced a national human papillomavirus (HPV) vaccination program. In 2017, the onset of cervical screening changed from 18 to 25 years of age, utilising human papillomavirus (HPV) nucleic acid testing. The objective of the study is to describe the HPV genotypes and HPV16 variants in biopsies from women ≤ 25 years of age with cervical carcinoma (CC) (cases), compared with those aged >25 years (controls), in a pre-vaccination cohort. Methods: HPV genotyping of archival paraffin blocks (n = 96) was performed using the INNO-LiPA HPV Genotyping assay. HPV16-positive samples were analysed for variants by type-specific PCR spanning L1, E2 and E6 regions. Results: HPV16 was the commonest genotype in cases (54.5%, 12/22) and controls (66.7%, 46/69) (p = 0.30), followed by HPV18 (36.3%, 8/22 vs. 17.3% 12/69, respectively) (p = 0.08). Furthermore, 90% (20/22) of cases and 84.1% (58/69) of controls were positive for HPV16 or 18 (p = 0.42); 100% (22/22) of cases and 95.7% (66/69) of controls had at least one genotype targeted by the nonavalent vaccine (p = 0.3). The majority of HPV16 variants (87.3%, 48/55) were of European lineage. The proportion of unique nucleotide substitutions was significantly higher in cases (83.3%, 10/12) compared with controls (34.1%, 15/44), (p < 0.003, χ2, OR 9.7, 95%CI 1.7–97.7). Conclusions: Virological factors may account for the differences in CCs observed in younger compared with older women. All CCs in young women in this study had preventable 9vHPV types, which is important messaging for health provider adherence to new cervical screening guidelines.
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Hu Z, Kaminga AC, Yang J, Liu J, Xu H. Adverse childhood experiences and risk of cancer during adulthood: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2021; 117:105088. [PMID: 33971569 DOI: 10.1016/j.chiabu.2021.105088] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Research findings on the relationship between adverse childhood experiences (ACEs) and the risk of cancer were inconsistent. OBJECTIVE The purpose of this study was to perform a quantitative synthesis of the preceding research findings. PARTICIPANTS AND SETTING System review and meta-analysis. METHODS Electronic database of PubMed, Embase, Web of Science and Cochrane Library were systematically searched to identify relevant observational studies published not later than September 9, 2020. Specifically, original articles that reported the risk of cancer in adult populations that experienced ACEs before the age of 18 were selected. All pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using a random-effects model. Publication bias was examined using funnel plots, and sensitivity analysis was used to explore the stability of the pooled results. RESULTS A total of 18 studies involving 406,210 participants were included in this review. Individuals with 2 or 3 kinds of ACEs (OR = 1.35, 95%CI:1.12,1.62) or at least 4 ACEs (OR = 2.17, 95%CI: 1.76,2.68) were at increased risk of cancer when compared with individuals with no ACEs. Of the different types of ACEs examined, physical abuse (OR = 1.23, 95%CI:1.05,1.43), sexual abuse (OR = 1.26, 95%CI:1.02,1.56), exposure to intimate partner violence (OR = 1.26, 95%CI:1.12,1.41) and financial difficulties in the family (OR = 1.16, 95%CI:1.00,1.33) were associated with the risk of any cancer. CONCLUSIONS These findings suggest that multiple ACEs may be a risk factor for cancer development. Therefore, prevention of ACEs and interventions for supporting those affected by ACEs are necessary.
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Affiliation(s)
- Zhao Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Atipatsa Chiwanda Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China; Department of Mathematics and Statistics, Mzuzu University, Luwinga, Mzuzu, Malawi
| | - Jun Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jiefeng Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
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Andersson S, Belkić K, Mints M, Östensson E. Acceptance of Self-Sampling Among Long-Term Cervical Screening Non-Attenders with HPV-Positive Results: Promising Opportunity for Specific Cancer Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:126-133. [PMID: 31522376 PMCID: PMC7835166 DOI: 10.1007/s13187-019-01608-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This study aims to investigate acceptance of vaginal self-sampling for high-risk human papilloma virus (HPV) among long-term screening non-attenders at increased cervical cancer risk and to identify leverage points to promote screening adherence among these women. Forty-three long-term screening non-attenders performed home vaginal self-sampling for HPV, had positive HPV results, and subsequently attended gynecologic examination. Sixteen (37.2%) had high-grade cervical intraepithelial neoplasia (CIN2 or 3), and two had invasive cervical cancer. Forty-one of these women completed a questionnaire concerning Specific Knowledge about HPV, CIN, and cervical cancer, potential barriers to screening and views about self-sampling. Results were compared with 479 women treated for CIN2+ who attended gynecologic follow-up and also performed self-sampling. Significant multivariate predictors of long-term non-attender status compared with referents were low Specific Knowledge, high confidence in self-sampling, and potential barriers-refraining from activity to attend gynecologic examination, needing another's help to attend, and long travel time. Non-attenders citing fear/refraining from gynecologic examination as why they preferred self-sampling significantly more often had lowest Specific Knowledge compared with other non-attenders. All non-attenders could envision themselves doing self-sampling again while only 74% of referents endorsed this statement (p = 0.0003). We conclude that HPV self-sampling is an acceptable option for women at increased cervical cancer risk who have been long-term screening non-attenders. Educational outreach to enhance Specific Knowledge about HPV, CIN and cervical cancer is critical. Those non-attenders who explicitly avoid gynecologic examinations need special attention. Trial Registry: Clinicaltrials.gov NCT02750124.
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Affiliation(s)
- Sonia Andersson
- Department of Women's and Children's Health, Karolinska University Hospital and Institute, Stockholm, Sweden
| | - Karen Belkić
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
- Claremont Graduate University, Claremont, CA, USA.
- Keck School of Medicine, University of Southern California, Los Angeles, USA.
| | - Miriam Mints
- Department of Women's and Children's Health, Karolinska University Hospital and Institute, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebrö University, Örebrö, Sweden
| | - Ellinor Östensson
- Department of Women's and Children's Health, Karolinska University Hospital and Institute, Stockholm, Sweden
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Hindin P, Btoush R, Carmody DP. History of Childhood Abuse and Risk for Cervical Cancer Among Women in Low-Income Areas. J Womens Health (Larchmt) 2018; 28:23-29. [PMID: 30265615 DOI: 10.1089/jwh.2018.6926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to examine pathways through which childhood abuse increases the risk of cervical cancer, including smoking, stress, risky sexual behavior, and not having a Papanicolaou (Pap) test. MATERIALS AND METHODS This is a descriptive, correlational study. The sample included 410 women, recruited from a large, multisite women's health center that serves low-income communities in New Jersey. Data were analyzed using path models and conditional regression analysis. RESULTS Overall, 15% and 12% of the women in the study reported history of physical and sexual childhood abuse, respectively. There was a significant association between child abuse history and failure to receive a Pap test (χ2 = 5.34, p = 0.021). History of childhood abuse was associated with 44% lower odds of having a Pap test. The findings indicate a significant association between child abuse history and cervical cancer risk (χ2 = 7.65, p = 0.006, Cramer's V = 0.138). History of childhood abuse was associated with 96% higher odds of being at risk of cervical cancer. Both physical and sexual abuses were associated with higher levels of smoking, risky sexual behavior, perceived stress, and cervical cancer risk. In the conditional regression analysis, the effect of risky sexual behavior on the likelihood of cervical cancer risk showed an increased risk with higher risky sexual behavior scores only for those with a history of childhood abuse. CONCLUSION Childhood abuse increases the risk of cervical cancer in adulthood, through failure to receive a Pap test and higher levels of smoking, perceived stress, and most importantly, risky sexual behavior. More importantly, the combination of childhood abuse and risky sexual behavior plays a greater role in increasing cervical cancer risk.
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Affiliation(s)
| | - Rula Btoush
- School of Nursing, Rutgers University, Newark, New Jersey
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A Discussion of High-Risk HPV in a 6-Year-Old Female Survivor of Child Sexual Abuse. Case Rep Obstet Gynecol 2017; 2017:6014026. [PMID: 28620555 PMCID: PMC5460386 DOI: 10.1155/2017/6014026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/27/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background Human papilloma viruses (HPVs) cause a variety of clinical manifestations in children including skin warts, laryngeal papillomas, and condyloma acuminatum. Whereas the mode of transmission is well understood and management of HPV infection is clearly defined by guidelines in adults, less is known about the mode of transmission, natural history of disease, and appropriate management of high-risk anogenital HPV infections in children. Case The patient is a previously healthy 6-year-old female who presented with multiple vaginal lesions causing pain and discomfort and was diagnosed with HPV 18 positive CIN I. Summary and Conclusion Children infected with high-risk HPV subtypes remain a vulnerable patient population, and there is minimal literature on the natural history of disease and effects of overtreatment. Based on a literature review, conservative management, HPV vaccination, and consideration of the cervical cancer screening guidelines for adolescent females are an appropriate treatment course until more studies are reported on cervical cancer screening in survivors of child sexual abuse.
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