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Mooses K, Šavrova A, Pajusalu M, Oja M, Tamm S, Haug M, Padrik L, Laanpere M, Uusküla A, Kolde R. Using electronic health records to evaluate the adherence to cervical cancer prevention guidelines: A cross-sectional study. Prev Med 2024; 183:107982. [PMID: 38701952 DOI: 10.1016/j.ypmed.2024.107982] [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: 02/02/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE The fight against cervical cancer requires effective screening together with optimal and on-time treatment along the care continuum. We examined the impact of cervical cancer testing and treatment guidelines on testing practices, and follow-up adherence to guidelines. METHODS Data from Estonian electronic health records and healthcare provision claims for 50,702 women was used. The annual rates of PAP tests, HPV tests and colposcopies during two guideline periods (2nd version 2012-2014 vs 3rd version 2016-2019) were compared. To assess the adherence to guidelines, the subjects were classified as adherent, over- or undertested based on the timing of the appropriate follow-up test. RESULTS The number of PAP tests decreased and HPV tests increased during the 3rd guideline period (p < 0.01). During the 3rd guideline period, among 21-29-year-old women, the adherence to guidelines ranged from 38.7% (44.4…50.1) for ASC-US to 73.4% (62.6…84.3) for HSIL and among 30-59-year-old from 49.0% (45.9…52.2) for ASC-US to 65.7% (58.8…72.7) for ASCH. The highest rate of undertested women was for ASC-US (21-29y: 25.7%; 30-59y: 21.9%). The rates of over-tested women remained below 12% for all cervical pathologies observed. There were 55.2% (95% CI 49.7…60.8) of 21-24-year-olds and 57.1% (95% CI 53.6…60.6) of 25-29-year-old women who received HPV test not adherent to guidelines. CONCLUSIONS Our findings highlighted some shortcomings in guideline adherence, especially among women under 30. The insights gained from this study help to improve the quality of care and, thus, reduce cervical cancer incidence and mortality.
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Affiliation(s)
- Kerli Mooses
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
| | | | - Maarja Pajusalu
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
| | - Marek Oja
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
| | - Sirli Tamm
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
| | - Markus Haug
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
| | - Lee Padrik
- Tartu University Hospital Women's Clinic, L. Puusepa 8, 50406 Tartu, Estonia.
| | - Made Laanpere
- Tartu University Hospital Women's Clinic, L. Puusepa 8, 50406 Tartu, Estonia; Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia.
| | - Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia.
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Narva mnt 18, 51009 Tartu, Estonia.
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Perkins RB, Fuzzell L, Lake P, Brownstein NC, Fontenot HB, Michel A, Whitmer A, Vadaparampil ST. Factors Associated With Guideline-concordant and Excessive Cervical Cancer Screening: A Mixed Methods Study. Womens Health Issues 2024; 34:257-267. [PMID: 38383228 DOI: 10.1016/j.whi.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION National guidelines recommend cervical cancer screening with Papanicolaou (Pap) testing at 3-year intervals or with human papillomavirus (HPV) testing alone or HPV/Pap cotesting at 5-year intervals for average-risk individuals aged 30-65 years. METHODS We explored factors associated with clinician-reported guideline-concordant screening, as well as facilitators and barriers to appropriate cervical cancer screening. RESULTS A national sample of clinicians (N = 1,251) completed surveys; a subset (n = 55) completed interviews. Most (94%) reported that they screened average-risk patients aged 30-65 years with cotesting. Nearly all clinicians who were categorized as nonadherent to national guidelines were overscreening (98%). Guideline concordant screening was reported by 47% and 82% of those using cotesting and HPV testing, respectively (5-year intervals), and by 62% of those using Pap testing only (3-year intervals). Concordant screening was reported more often by clinicians who were aged <40 years, non-Hispanic, and practicing in the West or Midwest, and less often by obstetrician-gynecologists and private practice physicians. Concordant screening was facilitated by beliefs that updated guidelines were evidence-based and reduced harms, health care system dissemination of guidelines, and electronic medical record prompts. Barriers to concordant screening included using outdated guidelines, relying on personal judgment, concern about missing cancers, inappropriate patient risk assessment, and lack of support for guideline adoption through health care systems or electronic medical records. CONCLUSIONS Most clinicians screened with Pap/HPV cotesting and approximately one-half endorsed a 5-year screening interval. Clinician knowledge gaps include understanding the evidence underlying 5-year intervals and appropriate risk assessment to determine which patients should be screened more frequently. Education and tracking systems can promote guideline-concordant screening.
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Affiliation(s)
- Rebecca B Perkins
- Boston University, Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Lindsay Fuzzell
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and Behavior, Office of Community Outreach, Engagement, and Equity, Tampa, Florida
| | - Paige Lake
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and Behavior, Office of Community Outreach, Engagement, and Equity, Tampa, Florida
| | - Naomi C Brownstein
- Medical University of South Carolina, Public Health Sciences, Charleston, South Carolina
| | | | | | - Ashley Whitmer
- Boston University, Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and Behavior, Office of Community Outreach, Engagement, and Equity, Tampa, Florida
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McCarthy AM, Tiro JA, Hu E, Ehsan S, Chubak J, Kamineni A, Feldman S, Atlas SJ, Silver MI, Kobrin S, Haas JS. Factors associated with shorter-interval cervical cancer screening for young women in three United States healthcare systems. Prev Med Rep 2023; 35:102279. [PMID: 37361923 PMCID: PMC10285268 DOI: 10.1016/j.pmedr.2023.102279] [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: 02/21/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Frequently changing cervical cancer screening guidelines over the past two decades have been inconsistently adopted in the United States. Current guidelines set the recommended screening interval to three years for average-risk women aged 21-29 years. Few studies have evaluated how patient and provider factors are associated with implementation of cervical cancer screening intervals among younger women. This study evaluated multilevel factors associated with screening interval length among 69,939 women aged 21-29 years with an initial negative Pap screen between 2010 and 2015 across three large health systems in the U.S. Shorter-interval screening was defined as a second screening Pap within 2.5 years of an initial negative Pap. Mixed-effects logistic regression was performed for each site to identify provider and patient characteristics associated with shorter-interval screening. The odds of shorter-interval screening decreased over the study period across all sites, though the proportion of patients screened within 2.5 years remained between 7.5% and 20.7% across sites in 2014-2015. Patient factors including insurance, race/ethnicity, and pregnancy were associated with shorter-interval screening, though the patterns differed across sites. At one site, the variation in shorter-interval screening explained by the provider was 10.6%, whereas at the other two sites, the provider accounted for < 2% of the variation in shorter-interval screening. Our results highlight the heterogeneity in factors driving cervical cancer screening interval across health systems and point to the need for tailored approaches targeted to both providers and patients to improve guideline-concordant screening.
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Affiliation(s)
- Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jasmin A. Tiro
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ellen Hu
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah Ehsan
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven J. Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle I. Silver
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Sarah Kobrin
- Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD, USA
| | - Jennifer S. Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kulkarni A, Chen L, Gockley A, Khoury-Collado F, Hou J, Clair CST, Melamed A, Hershman DL, Wright JD. Patterns of cervical cancer screening follow-up in the era of prolonged screening intervals. Gynecol Oncol 2023; 175:53-59. [PMID: 37327539 DOI: 10.1016/j.ygyno.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Little is known as to how prolonged screening recommendations for cervical cancer have affected compliance. OBJECTIVE We examined compliance with repeat cervical cancer screening among U.S. women aged 30-64 who underwent index screening between 2013 and 2019. STUDY DESIGN The IBM Watson Health MarketScan Database was used to identify commercially-insured women 30-64 years old who underwent cervical cancer screening from 2013 to 2019. The cohort was limited to women with continuous insurance 12 months before and ≥ 2 months after index testing. Patients with prior hysterectomy, more frequent surveillance needs, or a history of abnormal cytology, histology, or HPV test were excluded. Index screening included cytology, co-testing, or primary HPV testing. Cumulative incidence curves described screening intervals. Compliance was considered if repeat screening occurred 2.5-4 years after index cytology and 4.5-6 years after index co-testing. Cause-specific hazard models examined factors associated with compliance. RESULTS Of 5,368,713 patients identified, co-testing was performed in 2,873,070 (53.5%), cytology in 2,422,480 (45.1%), and primary HPV testing in 73,163 (1.4%). The cumulative incidence of repeat screening among all women by seven years was 81.9%. Of those who underwent repeat screening, 85.7% with index cytology and 96.6% with index co-testing were rescreened early. Only, 12.2% with index cytology had appropriate rescreening and 2.1% had delayed rescreening. Among the index co-testing group, 3.2% had appropriate rescreening and 0.3% had delayed rescreening. CONCLUSION Appropriate cervical cancer follow-up screening is highly variable. The cumulative incidence rate of repeat screening was 81.9% and among women rescreened, the vast majority are tested earlier than recommended by current guidelines.
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Affiliation(s)
- Amita Kulkarni
- Columbia University College of Physicians and Surgeons, USA
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, USA
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - June Hou
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Caryn S T Clair
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA; Joseph L. Mailman School of Public Health, Columbia University, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA.
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The impact of the 2015 ACOG screening guidelines on the diagnosis of postpartum depression among privately insured women. J Affect Disord 2023; 328:103-107. [PMID: 36764363 DOI: 10.1016/j.jad.2023.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/25/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Postpartum depression (PPD), is underdiagnosed and undertreated. In 2015, the American College of Obstetricians and Gynecologists (ACOG) recommended that women be screened for PPD at least once during the perinatal period. The effect of the recommendation on PPD diagnosis is unknown. METHODS Using the MerativeTM MarketScan® database, PPD prevalence was identified in privately insured women ages 13-45 with a live birth between 2013 and 2016. Postpartum depression was defined as an ICD diagnosis code for PPD or other depression, or a new pharmacy claim for an antidepressant medication during the first 12 months following delivery. Multivariable logistic regression was used to estimate the likelihood of PPD both before and after the ACOG PPD Committee Opinion. RESULTS The study included 244,624 women ages 13-45 who had a live birth in 2013 through 2016. PPD prevalence before and after the 2015 ACOG Committee Opinion was 15.1 % and 17.2 %, respectively. The likelihood of PPD was not statistically different following the 2015 Committee Opinion (adjusted OR, 1.00, 95 % CI, 0.97-1.03) when controlling for age, year, delivery complications, and geographic region. LIMITATIONS Sociodemographic variables are not included in the MarketScan database and therefore could not be analyzed as covariates. Re-defining a PPD diagnosis as above interfered with the ability to measure a prior history of mood disorders as a covariate. CONCLUSION Implementation of the ACOG recommendations was not associated with a significant increase in PPD diagnosis. This suggests that physician organization recommendations alone are not sufficient to increase detection of PPD.
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Temporal Trends in Cervical Cancer Screening Practices and Associated Downstream Abnormalities and Procedures Among Women With Insurance in the United States. Obstet Gynecol 2022; 140:55-64. [DOI: 10.1097/aog.0000000000004838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
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Thiel de Bocanegra H, Dehlendorf C, Kuppermann M, Vangala SS, Moscicki AB. Impact of an educational tool on young women's knowledge of cervical cancer screening recommendations. Cancer Causes Control 2022; 33:813-821. [PMID: 35312891 PMCID: PMC9085671 DOI: 10.1007/s10552-022-01569-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/03/2022] [Indexed: 10/27/2022]
Abstract
PURPOSE Current cervical cancer screening guidelines recommend 3-year screening intervals, in contrast to the previous recommendation of annual screening, to prevent over screening and overtreatment. We evaluated the impact of viewing a tablet-based educational tool prior to seeing a clinician on young women's knowledge and understanding of cervical cancer screening, HPV vaccination follow-up of abnormal pap smears, and comfort in communicating with their providers. METHODS This cross-sectional study was part of a cluster-randomized study of fourteen primary care clinics from January 2015 to December 2016. We developed the cervical cancer education tool in English and Spanish using a community-based approach that included formative work and cognitive interviewing. Clinics were randomized to use the intervention (tablet-based patient education tool) or to participate as a control group. We administered surveys to a convenience sample of 229 English- or Spanish-speaking women aged 19 to 35 years in these clinics. We used descriptive analyses and logistic regression models with cluster-robust standard errors to compare differences among the two groups. RESULTS Compared to women seen in control clinics, women seen in intervention clinics demonstrated greater knowledge regarding human papilloma virus (HPV (p = 0.004) and understanding (p < 0.001) of cervical cancer screening. Comfort in communicating with providers was not statistically different (p = 0.053). Women in the intervention group felt that the tool helped them understand that an abnormal Pap smear does not require immediate treatment (61.5%). CONCLUSION Innovative online patient education that is offered prior to patients' interaction with their clinicians can improve their knowledge about cervical cancer prevention and treatment.
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Affiliation(s)
- Heike Thiel de Bocanegra
- Department of Obstetrics and Gynecology, School of Medicine, University of California, Irvine, 333 City Boulevard West, Suite 1400, Orange, CA, 92868, USA.
| | - Christine Dehlendorf
- Department of Family & Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, USA.,Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, USA.,Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, USA.,Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Sitaram S Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA
| | - Anna-Barbara Moscicki
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA
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8
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Dillon J, Chen L, Melamed A, St Clair CM, Hou JY, Khoury-Collado F, Gockley A, Accordino M, Hershman DL, Wright JD. Patterns of cervical cancer screening among Medicaid beneficiaries. BJOG 2021; 129:1104-1111. [PMID: 34882962 DOI: 10.1111/1471-0528.17050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cervical cancer screening guidelines have evolved over time with the incorporation of human papillomavirus (HPV) testing along with cytology. Current screening guidelines recommend cytological screening every 3 years or HPV testing with or without cytology every 5 years in women age 30-65 years. We examined the use of cervical cancer screening among average-risk Medicaid beneficiaries. DESIGN Retrospective cohort study. POPULATION Women age 30-64 years at average risk for cervical cancer who underwent cervical cancer screening with cytology, co-testing or primary HPV testing from 2013 to 2016. METHODS The IBM Watson Health Multi-State Medicaid MarketScan Database was used. Subsequent screening rates within 3 years of the index test were examined. MAIN OUTCOME MEASURE The rate of repeat cervical cancer screening was analysed using a cumulative incidence function. RESULTS A total of 265 083 patients were identified. Overall, 43.1% (n = 114 312) had index co-testing, 55.2% (n = 146 309) had cytology and 1.7% (n = 4462) had primary HPV testing. The cumulative incidence of early, repeat cervical cancer screening was 3.9% at 12 months, 22.7% at 24 months and 33.3% at 36 months. During the period from 12 to 24 months after follow up, 20.9% of women underwent repeat screening while 19.4% underwent repeat screening 24-36 months after the index test. Among women who did not undergo repeat cervical cancer screening, a yearly gynaecological examination was performed in only 16 627 (10.7%) during year 2 and in 11 116 (8.8%) during year 3. CONCLUSION Among average-risk Medicaid beneficiaries, cervical cancer screening is frequently overused. Women who do not undergo cervical cancer screening are unlikely to undergo routine gynaecological examination. TWEETABLE ABSTRACT Among average-risk Medicaid beneficiaries, cervical cancer screening is frequently overused.
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Affiliation(s)
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Caryn M St Clair
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - June Y Hou
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Melissa Accordino
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
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Vash-Margita A, Kobernik EK, Flagler EN, Quint EH, Dalton VK. National Trends in Cervical Cancer Screening in Adolescents. J Pediatr Adolesc Gynecol 2021; 34:717-724. [PMID: 33601068 DOI: 10.1016/j.jpag.2021.02.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/07/2021] [Accepted: 02/07/2021] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE To characterize patterns of cervical cancer screening among adolescents ages 14-20 years before and after the 2009 American College of Obstetrics and Gynecology recommendations. DESIGN Retrospective cohort study. SETTING National Ambulatory Medical Care Survey 2005-2016 data. PARTICIPANTS Female adolescents and young women ages 14-26 years. INTERVENTIONS Multivariable logistic regression models identified independent predictors of unindicated cervical cancer screening at office-based visits among adolescents ages 14-20 years. MAIN OUTCOME MEASURES Cervical cancer screening in women ages 14-20 and 21-26 years in 2 time periods: 2005-2008 and 2009-2016. RESULTS Between 2005 and 2016, 11,768 office visits were among adolescents ages 14-20 years. Overall, the cervical cancer screening rate for young women ages 14-20 years was 4.0%, which decreased from 4.5% to 0.4% (P = .008) during the study period. Adolescents who received cervical cancer screening during an office visit were older (18-20 years: 24.1% vs 14-17 years: 8.2%; P < .001), had a preventive care visit (preventive care: 79.7% vs other visit types: 20.3%; P < .001), and saw an obstetrician/gynecologist (obstetrician/gynecologist: 74.81% vs other specialties: 25.1%; P < .001). After adjusting for age, year, period, insurance status, region, and provider type, screening for cervical cancer was associated with living in the Southern region of the United States (adjusted odds ratio, 1.88; 95% confidence interval, 1.09-3.25; P = .02) and public insurance (adjusted odds ratio, 0.47, 95% confidence interval, 0.34-0.64; P < .001). CONCLUSION Despite recommendations, cervical cancer screening continued to occur in the adolescent population-especially older adolescents-creating unnecessary costs and potential harms. These findings show a slow uptake of guidelines nationally and the need for initiatives that encourage implementation of performance measures for providers, including ongoing provider and patient education.
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Affiliation(s)
- Alla Vash-Margita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| | - Emily K Kobernik
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Emily N Flagler
- The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Vanessa K Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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Wright JD, Chen L, Tergas AI, Melamed A, St. Clair CM, Hou JY, Khoury-Collado F, Gockley A, Accordino M, Hershman DL. Overuse of Cervical Cancer Screening Tests Among Women With Average Risk in the United States From 2013 to 2014. JAMA Netw Open 2021; 4:e218373. [PMID: 33914050 PMCID: PMC8085723 DOI: 10.1001/jamanetworkopen.2021.8373] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE While cervical cancer screening with cytologic and human papillomavirus (HPV) testing has reduced mortality from cervical cancer, overuse of these tests is associated with downstream psychological and medical consequences, as well as significant costs. Guidelines now recommend less frequent testing, although adherence to these recommendations is uncertain. OBJECTIVE To determine the frequency of overuse of cervical cancer screening tests. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 2 299 177 women aged 30 to 65 years recorded in the MarketScan database who underwent cervical cancer screening with cervical cytologic testing, cotesting, or primary HPV testing in 2013 through 2014. Women were followed-up for 3 years, and use of repeat testing during this period was noted. Clinical and demographic characteristics associated with overuse of screening and the association between screening and performance of routine gynecologic examinations were recorded. Data were analyzed from June 15 to September 15, 2020. MAIN OUTCOMES AND MEASURES Cumulative performance of overuse of cervical cancer screening with repeat cytologic or HPV testing within 36 months of the index screening test. RESULTS A total of 2 299 177 women with a median (interquartile range) age of 47 (39-54) years were identified. Initial cervical cancer screening consisted of cytologic testing alone in 1 286 179 women (55.9%), cotesting in 991 583 women (43.1%) and HPV testing in 21 415 women (0.9%). The cumulative incidence of repeat cervical cancer screening was 17.7% (95% CI, 17.6%-17.7%) at 12 months, 51.1% (95% CI, 51.0%-51.2%) at 24 months and 65.8% (65.7%-65.8%) at 36 months. Repeat screening was less common in older women (32 198 women [60.2%] aged 60-64 years vs 194 665 women [67.8%] aged 30-39 years; P < .001), women with medical comorbidities (125 197 women [64.1%] with ≥2 comorbidities vs 423 012 women [64.7%] with no comorbidities; P < .001), women screened in 2014 (176 734 women [53.4%] in 2014 vs 555 767 women [69.4%] in 2013; P < .001), and those screened with cotesting (277 032 women [56.9%] for cotesting vs 450 438 [71.2%] for cytologic testing; P < .001). In contrast, overuse of testing was more common in the Northeastern US (143 916 women [68.1%] in the Northeast vs 81 552 women [51.6%] in the West; P < .001), in women with more frequent outpatient visits (238 510 women [71.1%] with ≥6 visits vs 279 412 [58.7%] with ≤2 visits; P < .001). Women with a sexually transmitted infection after their index testing were also more likely to undergo repeat testing (adjusted odds ratio, 1.42 [95% CI, 1.21-1.68]). Women who did not undergo repeat screening were significantly less likely to undergo a gynecological exam after the index screening test: during year 2 of follow-up, 657 749 women (96.7%) who underwent repeating screening had a gynecological examination compared with 203 566 women (26.2%) who did not undergo a gynecological examination. CONCLUSIONS AND RELEVANCE These findings suggest that among commercially insured women with average risk, cervical cancer screening tests were frequently overused.
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Affiliation(s)
- Jason D. Wright
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Ana I. Tergas
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
- Joseph L. Mailman School of Public Health, Columbia University, New York, New York
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Caryn M. St. Clair
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
| | - June Y. Hou
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
| | - Melissa Accordino
- Columbia University College of Physicians and Surgeons, New York, New York
- New York Presbyterian Hospital, New York, New York
- Joseph L. Mailman School of Public Health, Columbia University, New York, New York
| | - Dawn L. Hershman
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
- Joseph L. Mailman School of Public Health, Columbia University, New York, New York
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11
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Mignot S, Ringa V, Vigoureux S, Zins M, Panjo H, Saulnier PJ, Fritel X. Correlates of premature pap test screening, under 25 years old: analysis of data from the CONSTANCES cohort study. BMC Public Health 2021; 21:595. [PMID: 33765986 PMCID: PMC7993455 DOI: 10.1186/s12889-021-10603-4] [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: 08/17/2020] [Accepted: 03/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background Many countries currently recommend that screening for cervical cancer begin at the age of 25 years. Premature screening (before that age) could lead to unnecessary follow-up examinations and procedures that turn out to be useless. Our objective is to ascertain if the use of particular contraceptive methods are associated with premature screening. Methods This cross-sectional study based on the CONSTANCES cohort enabled us to include 4297 women younger than 25 years. The factors associated with premature screening were modeled by logistic regression. Missing data were handled by multiple imputations. The multivariate analyses were adjusted for sex life, social and demographic characteristics, and health status. Results Nearly half (48.5%) the women younger than 25 years had already undergone premature screening. Women not using contraceptives (aOR 0.3, 95% CI 0.3–0.5) and those using nonmedicalized contraceptives (condom, spermicide, etc.) (aOR 0.5, 95% CI 0.4–0.6) had premature screening less often than women using birth control pills. Higher risks of premature screening were observed in 20-year-old women (aOR 2.7, 95% CI 2.2–3.3) and in those with more than 5 lifetime partners (aOR 2.5, 95% CI 2.0–3.1), compared respectively with women who were younger and those with 5 or fewer lifetime partners. Conclusion Young women using contraceptives that require a doctor’s prescription are exposed to premature screening more often than those not using contraception and those with nonmedicalized contraceptives.
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Affiliation(s)
- Stéphanie Mignot
- Department of General Practice, University of Poitiers, France: 3 rue de la Milétrie, 86000, Poitiers, France.
| | - Virginie Ringa
- CESP Centre for research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University Paris-Saclay, University Paris-Sud, UVSQ, Villejuif, Ined, France
| | - Solène Vigoureux
- CESP Centre for research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University Paris-Saclay, University Paris-Sud, UVSQ, Villejuif, Ined, France.,Obstetrics & Gynecology department, Hôpital Bicêtre, GHU Sud, AP-HP, Faculty of Medicine, Univ of Paris Sud, F-94276, Le Kremlin Bicêtre, France
| | - Marie Zins
- Epidemiological Population-Based Cohorts Unit, INSERM UMS 11,Villejuif, France, University of Paris-Descartes, Paris, France
| | - Henri Panjo
- CESP Centre for research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University Paris-Saclay, University Paris-Sud, UVSQ, Villejuif, Ined, France
| | - Pierre-Jean Saulnier
- Clinical Investigation Centre CIC1402 INSERM, School of Medicine, Poitiers University, CHU Poitiers (University Hospital), 86000, Poitiers, France
| | - Xavier Fritel
- Clinical Research Centree CIC1402, INSERM, Department of Obstetrics, Gynecology, and Reproductive Medicine Poitiers University Hospital Centre, University of Poitiers, Poitiers, France
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12
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Wang C, Liddy C, Afkham A, Islam S, Shehata F, Posner G, Keely E. Pathology perspective on gynaecologic malignancy screening questions in electronic consultation. J Telemed Telecare 2019; 27:123-130. [PMID: 31364473 DOI: 10.1177/1357633x19864825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The electronic consultation service, eConsult, is an asynchronous web-based platform for provider-to-provider consultation with specialists. This study described the utilization of eConsult by primary care providers to obtain specialist opinion in gynaecologic malignancy screening, with a specific focus on pathology-related inquiries. METHODS This is a cross-sectional retrospective review of eConsults submitted to obstetrics/gynaecology between September 2011 and December 2016. All questions pertaining to gynaecologic cancer screening and their pathologies were included. Each question was classified based on a pre-determined taxonomy. The mandatory primary care providers' exit surveys were analysed to determine eConsult's influence on patient care, primary care providers' referral patterns, primary care providers' satisfaction and educational value. RESULTS In total, 1,357 electronic consultations were submitted to the obstetrics and gynaecology service during the study period, of which 329 met inclusion criteria. Indications for a screening test based on patient risk factors made up 36% of consults pertaining to gynaecologic malignancy screening and 17% were inquiries about test intervals based on previous results. Primary care providers pointed out gaps in current screening guidelines. In total, 38% of primary care providers reported the eConsult service helped avoid a specialist referral, whereas 47% of primary care providers received new or additional courses of action. Pathology report interpretation accounted for 5% of eConsults and 6% of primary care providers wished for clarification of incidental pathology findings. CONCLUSION This study uncovered areas of uncertainty among primary care providers regarding gynaecologic cancer screening and gaps in current clinical guidelines. Furthermore, the role of pathology consultants in an eConsult platform is explored and may be extrapolated into practice.
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Affiliation(s)
- Carol Wang
- Department of Medicine, University of Ottawa, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa, Canada.,Bruyère Research Institute, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Canada
| | - Amir Afkham
- Champlain Local Health Integration Network, Canada
| | - Shahidul Islam
- Department of Pathology and Laboratory Medicine, University of Ottawa, Canada
| | - Fady Shehata
- Department of Obstetrics and Gynecology, University of Ottawa, Canada
| | - Glen Posner
- Department of Obstetrics and Gynecology, University of Ottawa, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Canada
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13
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Screening for Sexually Transmitted Infections After Cervical Cancer Screening Guideline and Medicaid Policy Changes: A Population-based Analysis. Med Care 2019; 56:561-568. [PMID: 29781922 DOI: 10.1097/mlr.0000000000000925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infection (STI) screening prevents complications and is cost-effective. Annual screening is recommended in sexually active women below 25 years and older women at increased risk. Cervical cancer (CC) screening guideline changes in 2009 and 2012 recommended less frequent screening, causing concern that STI screening would decrease. Pennsylvania Medicaid implemented a family planning program in 2007 which covered women's health services (including STI testing) for uninsured women. It is unclear how STI screening was affected by these countervailing forces. OBJECTIVE The main objective of this study was to assess STI screening before and after CC screening guideline changes and family planning program implementation, and to determine factors associated with STI screening. RESEARCH DESIGN This study was an observational cross-sectional study of Pennsylvania Medicaid administrative claims from 2007 to 2013. SUBJECTS Sixteen-year-old to 30-year-old women enrolled in Pennsylvania Medicaid. MEASURES Annual STI screening, defined as receipt of ≥1 STI test in respective 1-year periods. RESULTS Our population included 1,226,079 women-years for 467,143 women. STI screening increased by 48% between 2007 and 2011, and stabilized by 2013. Odds for STI screening were higher among black compared with white women [adjusted odds ratio (AOR), 2.56; 95% confidence interval (CI), 2.60-3.10]; Hispanic compared with non-Hispanic women (AOR, 1.42; 95% CI, 1.39-1.46); family planning program enrollees (AOR, 1.42; 95% CI, 1.40-1.45); and urban compared with rural residents (AOR, 1.05; 95% CI, 1.03-1.06). CONCLUSIONS STI screening dramatically increased between 2007 and 2011. Potential reasons are family planning program implementation, increased urine/vaginal testing, and reporting improvements. It is reassuring that STI screening did not decrease despite CC screening guideline changes. Between 2011 and 2013, rates stabilized at 45% among all women and 60% among sexually active women below 25 years, suggesting opportunities for improvement.
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14
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Abstract
OBJECTIVE Guidelines recommend 3-year cervical cancer screening intervals to avoid unnecessary invasive procedures; however, regular testing remains critical. We evaluated trends in cervical cancer screening among low-income women receiving family planning-related services and their association with patient and provider characteristics. MATERIALS AND METHODS Using claims and enrollment data from California's publicly funded family planning program, we identified 540,026 women with a clinician visit at 216 sites between 2011 and 2015. We calculated guideline adherent cervical cancer testing rates for 6-month periods among women aged 21 to 24, 25 to 29, and 30 to 64 years. We also calculated guideline adherent chlamydia testing for women aged 21 to 24 years. RESULTS Having a 3-year cervical cancer screening test declined for all age groups. The odds of cervical cancer screening declined for women aged 21 to 24 years by an estimated 11% every 6 months (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.89-0.90), a significantly greater decline than for the other age groups. Among women aged 21 to 29 years, the decrease was significantly larger for Latina (ratio of ORs = 0.95, 95% CI = 0.95-0.96) and Spanish-speaking (ratio of ORs = 0.95, 95% CI = 0.95-0.96) women compared with non-Latina and non-Spanish-speaking women. A smaller decline was seen for chlamydia screening. CONCLUSIONS Changes in screening interval guidelines are associated with overall decreased screening. This trend was strongest among women aged 21 to 24 years, even as they continued to be screened appropriately for chlamydia, suggesting many missed opportunities. Efforts to reduce unnecessary cervical cancer screening should be monitored to maintain appropriate screening rates to avoid advanced-stage diagnoses and higher health care costs.
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15
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Rendle KA, Schiffman M, Cheung LC, Kinney WK, Fetterman B, Poitras NE, Lorey T, Castle PE. Adherence patterns to extended cervical screening intervals in women undergoing human papillomavirus (HPV) and cytology cotesting. Prev Med 2018; 109:44-50. [PMID: 29288782 DOI: 10.1016/j.ypmed.2017.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 02/03/2023]
Abstract
Although guidelines have recommended extended interval cervical screening using concurrent human papillomavirus (HPV) and cytology ("cotesting") for over a decade, little is known about its adoption into routine care. Using longitudinal medical record data (2003-2015) from Kaiser Permanente Northern California (KPNC), which adopted triennial cotesting in 2003, we examined adherence to extended interval screening. We analyzed predictors of screening intervals among 491,588 women undergoing routine screening, categorizing interval length into early (<2.5years), adherent (2.5<3.5years), or late (3.5<6.0years). We also examined repeated early screening in a subgroup of 50,691 women. Predictors examined included: cohort year (defined by baseline cotest, 2003-2009), race/ethnicity, and baseline age. Compared to the 2003 cohort, women in the 2009 cohort were significantly less likely to screen early (aOR=0.22, 95% CI=0.21, 0.23) or late (aOR=0.47, 95% CI=0.45, 0.49). African American (AA) and Hispanic women were less adherent overall than Non-Hispanic White women, with increased early [(AA: aOR=1.21, 95%CI=1.17, 1.25) (Hispanic: aOR=1.08, 95%CI=1.06, 1.11)] and late screening [(AA: aOR=1.23, 95%CI=1.19, 1.27) (Hispanic: aOR=1.06, 95%CI=1.03, 1.08)]. Asian women were slightly more likely to screen early (aOR=1.03, 95%CI=1.01, 1.05), and less likely to screen late (aOR=0.92, 95% CI=0.90, 0.94). Women aged 60-64years were most likely to screen early for two consecutive intervals (aOR=2.09, 95%CI=1.91, 2.29). Our study found that widespread and rapid adoption of extended interval cervical cancer screening is possible, at least in this managed care setting. Further research examining multilevel drivers promoting or restricting extended interval screening across diverse healthcare settings is needed.
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Affiliation(s)
- Katharine A Rendle
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States.
| | - Mark Schiffman
- Clinical Genetics Branch, Division of Clinical Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States.
| | - Li C Cheung
- Biostatistics Branch, Division of Clinical Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States.
| | - Walter K Kinney
- Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA, United States.
| | - Barbara Fetterman
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Nancy E Poitras
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Thomas Lorey
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Philip E Castle
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States.
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16
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Xu X, Zou L, Yao Q, Zhang Y, Gan L, Tang L. Silencing DEK downregulates cervical cancer tumorigenesis and metastasis via the DEK/p-Ser9-GSK-3β/p-Tyr216-GSK-3β/β-catenin axis. Oncol Rep 2017; 38:1035-1042. [PMID: 28627610 DOI: 10.3892/or.2017.5721] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/06/2017] [Indexed: 11/05/2022] Open
Abstract
Cervical cancer is the second most common gynecological malignancy. The mechanisms of the genesis and progression of cervical cancer are complicated and not thoroughly understood. DEK is reported as an oncogene in various cancers, such as acute myeloid leukemia, bladder cancer, breast cancer and hepatocellular cancer. However, its role in cervical cancer has not been well studied. In our study, we confirmed the DEK protein as an oncoprotein in cervical cancer tissues which is correlated to cervical cancer FIGO staging and tumor type. Moreover, in vitro loss of DEK inhibited cervical cancer cell proliferation, migration and invasion. We proved that silencing DEK downregulated Wnt/β-catenin and MMP-9, and silencing DEK increased GSK-3β activity via regulating its phosphorylation instead of translation. Silencing DEK reduced p-Ser9-GSK-3β and increased p-Tyr216-GSK-3β, which resulted in β-catenin degradation. Finally, the xenograft model in nude mice proved that silencing DEK impaired cervical cancer cell tumorigenicity. This research unveiled the function of DEK in tumorigenesis and metastasis via the DEK/p-Ser9-GSK-3β/p-Tyr216-GSK-3β/β-catenin axis in cervical cancer and gave insights into DEK-targeting therapy for patients suffering from cervical cancer.
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MESH Headings
- Adenocarcinoma/metabolism
- Adenocarcinoma/prevention & control
- Adenocarcinoma/secondary
- Animals
- Apoptosis
- Biomarkers, Tumor
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/prevention & control
- Carcinoma, Squamous Cell/secondary
- Case-Control Studies
- Cell Proliferation
- Cell Transformation, Neoplastic
- Chromosomal Proteins, Non-Histone/antagonists & inhibitors
- Chromosomal Proteins, Non-Histone/genetics
- Chromosomal Proteins, Non-Histone/metabolism
- Female
- Follow-Up Studies
- Gene Silencing
- Glycogen Synthase Kinase 3 beta/antagonists & inhibitors
- Glycogen Synthase Kinase 3 beta/genetics
- Glycogen Synthase Kinase 3 beta/metabolism
- Humans
- Lymphatic Metastasis
- Mice
- Mice, Inbred BALB C
- Mice, Nude
- Middle Aged
- Neoplasm Invasiveness
- Oncogene Proteins/antagonists & inhibitors
- Oncogene Proteins/genetics
- Oncogene Proteins/metabolism
- Phosphorylation
- Poly-ADP-Ribose Binding Proteins/antagonists & inhibitors
- Poly-ADP-Ribose Binding Proteins/genetics
- Poly-ADP-Ribose Binding Proteins/metabolism
- Prognosis
- Tumor Cells, Cultured
- Uterine Cervical Neoplasms/metabolism
- Uterine Cervical Neoplasms/pathology
- Uterine Cervical Neoplasms/prevention & control
- Xenograft Model Antitumor Assays
- beta Catenin/antagonists & inhibitors
- beta Catenin/genetics
- beta Catenin/metabolism
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Affiliation(s)
- Xiaoyang Xu
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Lin Zou
- Laboratory of Molecular Diagnosis, The Children's Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
| | - Qiuhui Yao
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, P.R. China
| | - Yanbo Zhang
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, P.R. China
| | - Li Gan
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, P.R. China
| | - Liangdan Tang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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