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Zeng M, Zhang X, He L, Liu X, Liu H, Deng R, Qiu B, Liu F, Xiao H, Li Q, Li W, Liu C, Ge Y. Human papillomavirus infections among women with cervical lesions and cervical cancer in Yueyang, China: a cross-sectional study of 3674 women from 2019 to 2022. Virol J 2023; 20:254. [PMID: 37919730 PMCID: PMC10623875 DOI: 10.1186/s12985-023-02221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/28/2023] [Indexed: 11/04/2023] Open
Abstract
PURPOSE To investigate the distribution of the incidence and genotypes of human papillomavirus (HPV) among women with cervical cancer (CC) and precancerous cervical lesions in Yueyang City, China, to develop prevention and control strategies for CC. METHODS A total of 3674 patients with cervical lesions and cervical cancer who attended 7 hospitals in Yueyang City between September 2019 and September 2022 were included. They included 1910 cervical intraepithelial neoplasia (CIN) I, 718 CIN II, 576 CIN II and 470 CC, respectively. The HPV genotyping of the above patients was detected by Real time-PCR in the laboratory department of each hospital. RESULTS The total HPV prevalence was 74.69% (95% CI 73.28-76.09%) in 3674 patients. The incidence of high- and low-risk HPV was 73.46% and 7.21%, respectively. The prevalence of HPV in CIN I, CIN II, CIN III, and invasive CC (ICC) groups was 66.65% (1273/1910, 95% CI 64.53-68.77%), 80.78% (580/718, 95% CI 77.89-83.67%), 83.88% (483/576, 95% CI 80.84-86.87%), and 86.81% (408/470, 95% CI 83.74-89.88%), respectively. The top three HPV subtypes in ICC are HPV16, HPV52, and HPV58. The prevalence of HPV 16 increased with increasing disease severity, with this genotype being present in 12.57%, 20.89%, 36.98%, and 50.85% of CIN I, CIN II, CIN III, and ICC cases, respectively (p < 0.001). Single HPV infection was predominant in cervical lesions, with a prevalence of 48.50% (95% CI 46.89-50.12%). The HPV prevalence varied by age, being highest among women with ICC, CIN I, CIN II and CIN III aged ≥ 60 years, 50-59 years, 40-49 years, and 40-49 years, respectively. CONCLUSION The prevalence of HPV in patients with cervical lesions in Yueyang City was very high, with HPV 16, 52, 58, 53, and 51 being the five most common HPV genotypes in patients with cervical lesions.
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Affiliation(s)
- Min Zeng
- Department of Gynecology, Yueyang People's Hospital, Yueyang Hospital Affiliated to Hunan Normal University, Chongmei Liu. 263, Baling East Road, Yueyang, 414000, Hunan, China
| | - Xiaoyun Zhang
- Department of Gynecology, Yueyang People's Hospital, Yueyang Hospital Affiliated to Hunan Normal University, Chongmei Liu. 263, Baling East Road, Yueyang, 414000, Hunan, China
| | - LiLi He
- Pre-hospital Emergency Center, Yueyang Central Hospital, Yueyang, 414000, Hunan, China
| | - Xin Liu
- Department of Pathology, Miluo People's Hospital, Yueyang, 414000, Hunan, China
| | - Huawen Liu
- Department of Pathology, Pingjiang County Maternal and Child Health Center, Yueyang, 414000, Hunan, China
| | - Rui Deng
- Department of Clinical Laboratory, Yueyang People's Hospital, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang, 414000, Hunan, China
| | - Bo Qiu
- Department of Pathology, Miluo Maternal and Child Health Center, Yueyang, 414000, Hunan, China
| | - Fang Liu
- Department of Gynecology, Yueyang People's Hospital, Yueyang Hospital Affiliated to Hunan Normal University, Chongmei Liu. 263, Baling East Road, Yueyang, 414000, Hunan, China
| | - Hang Xiao
- Department of Gynecology, Yueyang People's Hospital, Yueyang Hospital Affiliated to Hunan Normal University, Chongmei Liu. 263, Baling East Road, Yueyang, 414000, Hunan, China
| | - Quanlv Li
- Department of Gynecology, Yueyang People's Hospital, Yueyang Hospital Affiliated to Hunan Normal University, Chongmei Liu. 263, Baling East Road, Yueyang, 414000, Hunan, China
| | - Wen Li
- Department of Gynecology, Yueyang People's Hospital, Yueyang Hospital Affiliated to Hunan Normal University, Chongmei Liu. 263, Baling East Road, Yueyang, 414000, Hunan, China
| | - Chongmei Liu
- Department of Gynecology, Yueyang People's Hospital, Yueyang Hospital Affiliated to Hunan Normal University, Chongmei Liu. 263, Baling East Road, Yueyang, 414000, Hunan, China.
| | - Yangqing Ge
- Department of Gynecology, Yueyang People's Hospital, Yueyang Hospital Affiliated to Hunan Normal University, Chongmei Liu. 263, Baling East Road, Yueyang, 414000, Hunan, China.
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Gartner DR, Islam JY, Margerison CE. Medicaid expansions and differences in guideline-adherent cervical cancer screening between American Indian and White women. Cancer Med 2023; 12:8700-8709. [PMID: 36629351 PMCID: PMC10134301 DOI: 10.1002/cam4.5593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although preventable through screening, cervical cancer incidence and mortality are higher among American Indian and Alaska Native women (AIAN) than White women. The Patient Protection and Affordable Care Act's (ACA) Medicaid expansions may uniquely impact access and use of cervical cancer screening among AIAN women and ultimately alleviate this disparity. METHODS Using Medicaid eligible AIAN (N = 4681) and White (N = 57,661) women aged 18-64 years from the 2010-2020 Behavioral Risk Factor Surveillance System, we implemented difference-in-differences regression to estimate the association between the Medicaid expansions and guideline-adherent cervical cancer screening and health care coverage. RESULTS The Medicaid expansions were not associated with guideline-adherent cervical cancer screening (AIAN: -1 percentage point [ppt] [95% confidence interval, CI: -4, 2 ppts]; White: 3 ppts [95% CI: -0, 6 ppts]), but were associated with a 2 ppt increase (95% CI: 0, 4 ppt) in having had a pap test in the last 5 years among White women. The Medicaid expansions were also associated with increases in having a health plan (AIAN: 5 ppts [95% CI: 1, 9]; White: 11 ppts [95% CI: 7, 15]) and decreases in avoiding medical care due to costs (AIAN: -8 ppts [95% CI: -13, -2]; White: -6 ppts [95% CI: -9, -4]). CONCLUSIONS While we observed improvements in health care coverage, we did not observe changes to guideline-adherent cervical cancer screening following the ACA's Medicaid expansions. Given the disproportionate burden of cervical cancer among AIAN women, identifying ways to improve cervical cancer screening uptake and delivery should be prioritized to reduce preventable deaths.
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Affiliation(s)
- Danielle R. Gartner
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Jessica Y. Islam
- Cancer Epidemiology ProgramH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Department of Oncologic SciencesUniversity of South FloridaTampaFloridaUSA
| | - Claire E. Margerison
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
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Sun W, Chen X, Fu S, Huang X. Feasibility of Sentinel Lymph Node Mapping With Carbon Nanoparticles in Cervical Cancer: A Retrospective Study. Cancer Control 2023; 30:10732748231195716. [PMID: 37624147 PMCID: PMC10467164 DOI: 10.1177/10732748231195716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION This retrospective study aims to investigate the feasibility of using carbon nanoparticles to detect sentinel lymph nodes (SLNs) in cervical cancer. METHODS This study involved 174 patients with cervical cancer. Cervix tissues adjacent to the cancer were injected with 1 mL of carbon nanoparticles (CNPs) at the 3 and 9 o'clock positions according to the instructions. The pelvic lymph nodes were then dissected, and the black-stained sentinel lymph nodes were sectioned for pathological examination. RESULTS Of 174 cases, 88.5% of patients (154/174) had at least 1 sentinel lymph node, and 131 patients (75.29%) had bilateral pelvic sentinel lymph nodes. The left pelvic lymph node was the most common sentinel lymph node (34.16%). At least 1 sentinel lymph node was observed in 285 out of 348 hemipelvises, with a detection rate of a side-specific sentinel lymph node of 81.89%. In total, 47 hemipelvises had metastasis of the lymph node, and 33 involved the sentinel lymph node, with a sensitivity of 70.21% and a false-negative rate of 29.79%. There were 238 hemipelvises with no metastasis of the lymph node, as well as negative sentinel lymph nodes, with a specificity of 100% and a negative predictive value of 94.44%. The univariate analysis demonstrated that risk factors included tumor size (OR .598, 95% CI: .369-.970) and deep stromal invasion (OR .381, 95% CI: .187-.779). The deep stromal invasion was the only variable for the false-negative detection of a sentinel lymph node. CONCLUSION Sentinel lymph node mapping with carbon nanoparticles might be applied to predict the metastasis of pelvic lymph nodes in cervical cancer. However, tumor size and deep stromal invasion might negative influence the detection rate of SLN.
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Affiliation(s)
- Wei Sun
- Department of Gynecology, The First Affiliated Hospital With Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
| | - Xing Chen
- Department of Gynecology, The First Affiliated Hospital With Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
| | - Shilong Fu
- Department of Gynecology, The First Affiliated Hospital With Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
| | - Xiaohao Huang
- Department of Gynecology, The First Affiliated Hospital With Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
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Molecular Regulation of Androgen Receptors in Major Female Reproductive System Cancers. Int J Mol Sci 2022; 23:ijms23147556. [PMID: 35886904 PMCID: PMC9322163 DOI: 10.3390/ijms23147556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
There are three main types of cancer in the female reproductive system, specifically ovarian cancer (OVCA), endometrial cancer (EC), and cervical cancer (CC). They are common malignant tumors in women worldwide, with high morbidity and mortality. In recent years, androgen receptors (ARs) have been found to be closely related to the occurrence, progression, prognosis, and drug resistance of these three types of tumors. This paper summarizes current views on the role of AR in female reproductive system cancer, the associations between female reproductive system cancers and AR expression and polymorphisms. AR regulates the downstream target genes transcriptional activity and the expression via interacting with coactivators/corepressors and upstream/downstream regulators and through the gene transcription mechanism of “classical A/AR signaling” or “non-classical AR signaling”, involving a large number of regulatory factors and signaling pathways. ARs take part in the processes of cancer cell proliferation, migration/invasion, cancer cell stemness, and chemotherapeutic drug resistance. These findings suggest that the AR and related regulators could target the treatment of female reproductive system cancer.
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Mo Y, Ma J, Zhang H, Shen J, Chen J, Hong J, Xu Y, Qian C. Prophylactic and Therapeutic HPV Vaccines: Current Scenario and Perspectives. Front Cell Infect Microbiol 2022; 12:909223. [PMID: 35860379 PMCID: PMC9289603 DOI: 10.3389/fcimb.2022.909223] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/06/2022] [Indexed: 12/20/2022] Open
Abstract
Persistent human papillomavirus (HPV) infection is recognized as the main cause of cervical cancer and other malignant cancers. Although early detection and treatment can be achieved by effective HPV screening methods and surgical procedures, the disease load has not been adequately mitigated yet, especially in the underdeveloped areas. Vaccine, being regarded as a more effective solution, is expected to prevent virus infection and the consequent diseases in the phases of both prevention and treatment. Currently, there are three licensed prophylactic vaccines for L1-VLPs, namely bivalent, quadrivalent and nonavalent vaccine. About 90% of HPV infections have been effectively prevented with the implementation of vaccines worldwide. However, no significant therapeutic effect has been observed on the already existed infections and lesions. Therapeutic vaccine designed for oncoprotein E6/E7 activates cellular immunity rather than focuses on neutralizing antibodies, which is considered as an ideal immune method to eliminate infection. In this review, we elaborate on the classification, mechanism, and clinical effects of HPV vaccines for disease prevention and treatment, in order to make improvements to the current situation of HPV vaccines by provoking new ideas.
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Affiliation(s)
- Yicheng Mo
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Jiabing Ma
- IND Center, Chongqing Institute of Precision Medicine and Biotechnology Co., Ltd., Chongqing, China
| | - Hongtao Zhang
- IND Center, Chongqing Institute of Precision Medicine and Biotechnology Co., Ltd., Chongqing, China
| | - Junjie Shen
- IND Center, Chongqing Precision Biotech Co., Ltd., Chongqing, China
| | - Jun Chen
- IND Center, Chongqing Institute of Precision Medicine and Biotechnology Co., Ltd., Chongqing, China
| | - Juan Hong
- IND Center, Chongqing Institute of Precision Medicine and Biotechnology Co., Ltd., Chongqing, China
| | - Yanmin Xu
- IND Center, Chongqing Institute of Precision Medicine and Biotechnology Co., Ltd., Chongqing, China
- *Correspondence: Yanmin Xu, ; Cheng Qian,
| | - Cheng Qian
- Center for Precision Medicine of Cancer, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
- *Correspondence: Yanmin Xu, ; Cheng Qian,
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Explaining Correlates of Cervical Cancer Screening among Minority Women in the United States. PHARMACY 2022; 10:pharmacy10010030. [PMID: 35202079 PMCID: PMC8875364 DOI: 10.3390/pharmacy10010030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/01/2022] [Accepted: 02/12/2022] [Indexed: 12/09/2022] Open
Abstract
Globally, cervical cancer is the fourth leading cause of death among women. While overall cervical cancer rates have decreased over the last few decades, minority women continue to be disproportionately affected compared to White women. Given the paucity of theory-based interventions to promote Pap smear tests among minority women, this cross-sectional study attempts to examine the correlates of cervical cancer screening by Pap test using the Multi-theory Model (MTM) as a theoretical paradigm among minority women in the United States (U.S.). Structural Equation Modelling (SEM) was done for testing the construct validity of the survey instrument. Data were analyzed through bivariate and multivariate tests. In a sample of 364 minority women, nearly 31% (n = 112) of women reported not having received a Pap test within the past three years compared to the national rate (20.8%) for all women. The MTM constructs of participatory dialogue, behavioral confidence, and changes in the physical environment explained a substantial proportion of variance (49.5%) in starting the behavior of getting Pap tests, while the constructs of emotional transformation, practice for change, and changes in the social environment, along with lack of health insurance and annual household income of less than $25,000, significantly explained the variance (73.6%) of the likelihood to sustain the Pap test behavior of getting it every three years. Among those who have had a Pap smear (n = 252), healthcare insurance, emotional transformation, practice for change, and changes in the social environment predicted nearly 83.3% of the variance in sustaining Pap smear test uptake behavior (adjusted R2 = 0.833, F = 45.254, p < 0.001). This study validates the need for health promotion interventions based on MTM to be implemented to address the disparities of lower cervical cancer screenings among minority women.
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Boitano TK, Powell MA, Leath CA, Michael Straughn J, Scarinci IC. Barriers and facilitators affecting presentation in women with early versus advanced stage cervical cancer. Gynecol Oncol Rep 2022; 40:100950. [PMID: 35300052 PMCID: PMC8920856 DOI: 10.1016/j.gore.2022.100950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Structural and intrapersonal barriers to cervical cancer care persist but differ between early and advanced stage patients. Barriers in the early stage group were lack of knowledge, competing priorities, lack of insurance, and embarrassment. Barriers in the advanced stage group were lack of knowledge/risk, competing priorities, avoidance, fear of the healthcare system. Innovative methods to increase access to care and engagement with the healthcare system are needed.
Background This study was performed to evaluate the barriers and facilitators associated with patient presentation for early stage (ES) versus advanced stage (AS) cervical cancer (CC). Methods A mixed-method approach was used to collect quantitative (i.e., demographics and medical/screening histories) and qualitative data (individual interviews assessing patients’ perceptions regarding their general health, HPV and CC screening, and barriers and facilitators to CC care). Two separate investigators coded the interviews for major themes that occurred with an agreement that 50% or more of the themes would be included. Results Twenty-five women agreed to participate in the study with 80% completing the interview. Patients with ES disease were classified as Stage IA1-Stage IB3; patients with Stage IIA-IVB disease were classified with AS disease. Frequent barriers in the ES group were lack of knowledge, competing priorities, feeling healthy, lack of time or health insurance, and being embarrassed/uncomfortable. Frequent barriers in the AS group were lack of knowledge, competing priorities, avoidance/procrastination, fear of the healthcare system or finding something wrong, and lack of perceived risk to CC. Facilitators for ES included understanding the importance of the Pap test, having an abnormal Pap test, and knowing someone with CC. Having abnormal symptoms was the only facilitator for AS patients. Conclusions Structural and intrapersonal barriers to CC care persist but differ between ES and AS patients. Multi-level interventions are needed to address the wide array of issues that women highlighted in this study including potential innovative methods to increase access to care and engagement with the healthcare system.
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Exploring the barriers to Pap smear test in Iranian women: a qualitative study. BMC WOMENS HEALTH 2021; 21:287. [PMID: 34362366 PMCID: PMC8348840 DOI: 10.1186/s12905-021-01428-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cervical cancer is one of the most frequent types of cancer in females. The Pap smear is one of the most essential ways of diagnosing and screening for this malignancy, and any failure can be caused by a number of causes. The current study sought to investigate barriers to Pap smear in Iranian women. METHOD This qualitative content analysis study was conducted in Iran in 2019. Data was gathered through focus groups and individual semi-structured interviews with 32 women and health professionals. The interviewees were chosen using a combination of purposive and theoretical sampling. The data was then analyzed using the content analysis approach developed by Graneheim and Lundman. Guba and Lincoln's criteria for establishing trustworthiness were explored. RESULTS Data analysis resulted in the identification of four primary categories, seventeen subcategories, and 186 original concepts. The main categories include weakness of health system, difficult accessibility, low health literacy, and socio-cultural factors. CONCLUSION By informing women about the necessity and importance of Pap smear, providing the conditions, facilities, and equipment to facilitate the testing process, and paying more attention to cultural and social factors in cervical cancer and Pap smear planning, interventions, and policies, barriers to Pap testing can be eliminated.
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Li J, Gao JJ, Li N, Wang YW. Distribution of human papillomavirus genotypes in western China and their association with cervical cancer and precancerous lesions. Arch Virol 2021; 166:853-862. [PMID: 33486629 DOI: 10.1007/s00705-021-04960-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/29/2020] [Indexed: 01/24/2023]
Abstract
The aim of this study was to describe the distribution of human papillomavirus (HPV) genotypes among cervical cancers and pre-cancers in Shaanxi province of western China. A total of 17,341 women who were screened for cervical cancer from January 2014 to December 2016, using HPV genotyping and ThinPrep cytologic test were included. The prevalence and attribution of HPV genotypes were stratified by cervical lesion and age group. Of the subjects, 26.3% were infected with HPV, 28.0% of whom had multiple infections. The crude HPV prevalence increased from atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesions (ASCUS/LSIL, 64.3%) to high-grade squamous intraepithelial lesions (HSIL, 79.8%) and to invasive cervical cancer (ICC, 89.7%, P < 0.001). The three most prevalent genotypes were HPV 16 (8.0%), 58 (4.2%), and 52 (4.0%), and HPV 16, 31 and 33 were positively correlated with increased severity of cervical lesions. Additionally, the divalent vaccine genotypes HPV 16 and 18 accounted for 68.2% of ICC cases. Although 78.5% of ICC and 60.3% of HSIL cases were attributed to 9-valent vaccine genotypes, the other genotypes not covered by any vaccine still resulted in increases in coverage, with 1.5% for ICC, 5.3% for HSIL, and 13.5% for ASCUS/LSIL. HPV prevalence in western China was consistent with other regions of China. Early vaccination with 9-valent HPV vaccine is recommended in this locality for females younger than 26 years with no prior infection, while divalent the vaccine is more appropriate for women between 26 and 45 years, considering the efficacy, safety and cost-effectiveness of vaccines.
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Affiliation(s)
- Jiao Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Juan-Juan Gao
- Biobank, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Na Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Ya-Wen Wang
- Biobank, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
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Pollack LM, Ekwueme DU, Hung MC, Miller JW, Chang SH. Estimating the impact of increasing cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program among low-income women in the USA. Cancer Causes Control 2020; 31:691-702. [PMID: 32436037 PMCID: PMC7274897 DOI: 10.1007/s10552-020-01314-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free cervical cancer screening to low-income women. This study estimated the health benefits gained in terms of life years (LYs) saved and quality-adjusted life years (QALYs) gained if cervical cancer screening by the NBCCEDP increased to reach more eligible women. METHODS Data from Surveillance, Epidemiology, and End Results, NBCCEDP, and Medical Expenditure Panel Surveys were used. LYs saved and QALYs gained/100,000 women were estimated using modeling methods. They were used to predict additional health benefits gained if screening by the NBCCEDP increased from 6.5% up to 10-25% of the eligible women. RESULTS Overall, per 100,000 women screened by the NBCCEDP, 1,731 LYs were saved and 1,608 QALYs were gained. For white women, 1,926 LYs were saved and 1,780 QALYs were gained/100,000 women screened by the NBCCEDP. For black women, 1,506 LYs were saved and 1,300 QALYs were gained/100,000 women screened. If the proportion of eligible women screened by the NBCCEDP increased to 10-25%, the estimated health benefits would range from 6,626-34,896 LYs saved and 6,153-32,407 QALYs gained. CONCLUSIONS The reported estimates emphasize the value of cervical cancer screening program by extending LE in low-income women. Further, it demonstrates that screening a higher percentage of eligible women in the NBCCEDP may yield more health benefits.
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Affiliation(s)
- Lisa M Pollack
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, CDC, Atlanta, GA, 30341, USA
| | | | | | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA.
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Head KJ, Johnson NL, Scott SF, Zimet GD. Communicating Cervical Cancer Screening Results in Light of New Guidelines: Clinical Practices at Federally Qualified Health Centers. HEALTH COMMUNICATION 2020; 35:815-821. [PMID: 30945950 DOI: 10.1080/10410236.2019.1593079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
New guidelines for cervical cancer screening (CCS) incorporate both HPV and Pap tests, and there is a need to understand communication of these cotesting results to patients, especially in at-risk populations disproportionally affected by cervical cancer. This study used computer-assisted telephone interviews in 2017 at 51 federally qualified health centers (FQHCs) in Indiana to evaluate the characteristics of clinical communication CCS results to women. Results revealed that clinical communication practices varied on channel, timing, and content. Almost half of the clinics (n = 23, 45%) communicate results to patients by phone. Most clinics (n = 47, 92%) notify patients of results in two weeks or less. For cotesting, 70% (n = 36) always communicate Pap/HPV results at the same time. The majority of clinics (n = 42, 82%) explain the type of abnormal Pap test, while only 43% (n = 22) discuss the cervical cancer risk as indicated by the HPV test result. Even though 98% (n = 48) of participants rated their communication strategy as effective, qualitatively participants acknowledged difficulties in communicating cotesting results with their often transient and low health literate patients populations. These results indicate considerable variation and potential deficits in clinical communication of cotesting results in FQHCs, but several promising communication strategies were identified that may inform improved screening communication for other clinics.
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Affiliation(s)
- Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
| | - Nicole L Johnson
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
| | - Susanna Foxworthy Scott
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
- Division of Clinical Pharmacology, Indiana University School of Medicine
| | - Gregory D Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine
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Sabik LM, Vichare AM, Dahman B, Bradley CJ. Co-payment policies and breast and cervical cancer screening in Medicaid. AMERICAN JOURNAL OF MANAGED CARE 2020; 26:69-74. [PMID: 32059094 DOI: 10.37765/ajmc.2020.42395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study investigated the relationship between state Medicaid co-payment policies and cancer screening for Medicaid-enrolled women. STUDY DESIGN Cross-sectional analysis of administrative claims and enrollment data. METHODS Our data included Medicaid Analytic eXtract (MAX) outpatient claims files across 43 states in 2003, 2008, and 2010, the years for which both MAX data and state cost-sharing data were available. Data on enrollee demographics and screening services from enrollment and claims files were merged with state-year data on co-payment policies and county-level controls from the Area Health Resources File. Participants were nonelderly, nondisabled, nonpregnant women in the recommended age range for each screening service (50-64 years for mammograms; 21-64 years for Pap tests) enrolled in fee-for-service Medicaid. The main independent variable is whether an enrollee faced cost sharing for preventive services. We examined 3 categories of cost sharing: co-payments for all visits, including for preventive services; co-payments for outpatient visits but waived for preventive services; and no co-payments. The main outcome measure was receipt of mammogram or Pap test within a 12-month period. RESULTS Medicaid enrollees with co-payments for preventive services were less likely to receive both screening mammograms and Pap tests than enrollees in states not requiring cost sharing for preventive services. CONCLUSIONS Co-payments for preventive services discourage breast and cervical cancer screening among Medicaid enrollees. The effect is larger for breast cancer screening, which is costlier and requires an additional visit. Considering this evidence, cost sharing for preventive services may lead to adverse health consequences and greater long-term costs.
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Affiliation(s)
- Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh, 130 De Soto St, A613, Pittsburgh, PA 15261.
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Du Q, Wang W, Liu T, Shang C, Huang J, Liao Y, Qin S, Chen Y, Liu P, Liu J, Yao S. High Expression of Integrin α3 Predicts Poor Prognosis and Promotes Tumor Metastasis and Angiogenesis by Activating the c-Src/Extracellular Signal-Regulated Protein Kinase/Focal Adhesion Kinase Signaling Pathway in Cervical Cancer. Front Oncol 2020; 10:36. [PMID: 32117712 PMCID: PMC7033469 DOI: 10.3389/fonc.2020.00036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/09/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Cervical cancer remains a leading cause of death in women due to metastasis to distant tissues and organs. Integrins are involved in cancer metastasis. However, whether integrin α3 participates in cervical cancer metastasis is under investigation. In this study, we explored the effect and detailed mechanism through which integrin α3 regulates cervical cell migration, invasion, and angiogenesis. Methods: First, we explored the mRNA and protein expression levels of integrin α3 in cervical cancer cell lines and tissue samples obtained from patients. After knocking down the expression of integrin α3 using shRNA, the proliferation, migration, and invasion of cervical cancer cells, as well as the possible signaling pathways involved, were investigated in vitro. In addition, tube formation, proliferation, and migration of human umbilical vein endothelial cells were tested to identify their effect on angiogenesis. Zebrafish tumor migration and nude mouse lung metastasis models were utilized for the in vivo analysis. Results: We examined samples from 142 patients with cervical cancer and 20 normal cervixes. Integrin α3 was highly expressed in patients and predicted poor overall survival and disease-free survival. In SiHa cells, treatment with integrin α3 shRNA induced the phosphorylation of protein focal adhesion kinase and enhanced focal adhesion. These events were mediated by the activation of c-Src and extracellular signal-regulated protein kinase cascades. Consequently, integrin α3 increased the migratory ability of SiHa cells. In addition, knockdown of integrin α3 decreased the tube formation, proliferation, and migration of human umbilical vein endothelial cells, as well as the levels of matrix metalloproteinase-9, indicating its effect on angiogenesis. Stable transfection with integrin α3 shRNA reduced the migratory ability of SiHa cells in the zebrafish model and diminished lung metastasis in the xenograft mouse model. Conclusion: Integrin α3 recruits the c-Src/extracellular signal-regulated protein kinase cascade, leading to phosphorylation of focal adhesion kinase. Moreover, it regulates focal adhesion, endowing cervical cancer cells with potentiated migratory and invasive ability, and promotes angiogenesis via matrix metalloproteinase-9. Our findings may shed light on the mechanism involved in cervical cancer metastasis and highlight integrin α3 as a candidate prognostic biomarker and therapeutic target in patients with cervical cancer.
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Affiliation(s)
- Qiqiao Du
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tianyu Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chunliang Shang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Jiaming Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuandong Liao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuhang Qin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yili Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Pan Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Junxiu Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Olusola P, Ousley K, Ndetan H, Singh KP, Banerjee HN, Dasgupta S. Cervical Cancer Prevention in Racially Disparate Rural Populations. MEDICINES (BASEL, SWITZERLAND) 2019; 6:medicines6030093. [PMID: 31487904 PMCID: PMC6789706 DOI: 10.3390/medicines6030093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/27/2019] [Accepted: 08/31/2019] [Indexed: 06/10/2023]
Abstract
Background: Undergoing a timely Pap smear, high-risk human papilloma virus (HPV)- and colposcopy-based testing can reduce HPV-associated cervical cancer (CC) development in women. However, in rural areas, women and minorities without insurance do not undergo periodic assessment and remain at greater risk of HPV infection and CC. Methods: In this study, 173 women from rural East Texas with various ethnic backgrounds were examined thorough HPV/Pap-based testing and colposcopic assessment. Results: Of the 113 informative cases, 77% (87/113) were positive for high-risk HPV infection and 23% of subjects (26/113) were negative. Associations between HPV positivity with young age (p = 0.002), and a low number of pregnancy (p = 0.004) and births (p = 0.005) were evident. Women with long-term use of contraceptives (OR 1.93, 95% CI, 0.80-4.69) were associated with increased risk of HPV infection. African-American women had a higher risk of abnormal Pap outcome compared to Caucasians (OR 5.31, 95% CI, 0.67-42.0). HPV seemed to be a predictor of abnormal Pap outcome (OR 1.77, 95% CI, 0.48-6.44) in these subjects. Unmarried/widowed/divorced women had an increased abnormal Pap test outcome compared to married women or women living with a partner (p = 0.01), with over 278% increased odds (OR 3.78 at 95% CI, 1.29-11.10). Insured women undergoing periodic checkups were detected early with high-risk HPV infection and abnormal Pap test/colposcopic outcome. Conclusions: Comprehensive and timely screening of uninsured women and minorities in rural East Texas are warranted, which could potentially prevent the onset of HPV-associated CC.
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Affiliation(s)
- Patti Olusola
- Department of Family Medicine, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
| | - Kia Ousley
- Department of Family Medicine, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
| | - Harrison Ndetan
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
| | - Karan P Singh
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
| | - Hirendra Nath Banerjee
- Department of Natural, Pharmacy and Health Sciences, Elizabeth City State University, Elizabeth City, NC 27909, USA.
| | - Santanu Dasgupta
- Department of Medicine, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
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Olusola P, Banerjee HN, Philley JV, Dasgupta S. Human Papilloma Virus-Associated Cervical Cancer and Health Disparities. Cells 2019; 8:E622. [PMID: 31234354 PMCID: PMC6628030 DOI: 10.3390/cells8060622] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/15/2019] [Accepted: 06/19/2019] [Indexed: 12/25/2022] Open
Abstract
Cervical cancer develops through persistent infection with high-risk human papilloma virus (hrHPV) and is a leading cause of death among women worldwide and in the United States. Periodic surveillance through hrHPV and Pap smear-based testing has remarkably reduced cervical cancer incidence worldwide and in the USA. However, considerable discordance in the occurrence and outcome of cervical cancer in various populations exists. Lack of adequate health insurance appears to act as a major socioeconomic burden for obtaining cervical cancer preventive screening in a timely manner, which results in disparate cervical cancer incidence. On the other hand, cervical cancer is aggressive and often detected in advanced stages, including African American and Hispanic/Latina women. In this context, our knowledge of the underlying molecular mechanism and genetic basis behind the disparate cervical cancer outcome is limited. In this review, we shed light on our current understanding and knowledge of racially disparate outcomes in cervical cancer.
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Affiliation(s)
- Patti Olusola
- Departments of Family Medicine, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
| | - Hirendra Nath Banerjee
- Natural, Pharmacy and Health Sciences, Elizabeth City State University, North Carolina, Elizabeth City, NC 27909, USA.
| | - Julie V Philley
- Medicine, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
| | - Santanu Dasgupta
- Medicine, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA.
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Tang JA, Lango MN. Diverging incidence trends for larynx and tonsil cancer in low socioeconomic regions of the US. Oral Oncol 2019; 91:65-68. [PMID: 30926064 DOI: 10.1016/j.oraloncology.2019.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Oropharynx cancer incidence trends in low socioeconomic (SES) regions of the United States (US) have not been well described. Our objective was to describe tonsil cancer incidence trends in low SES regions, and compare observed trends with those for larynx cancer. MATERIALS AND METHODS Age-adjusted incidence rates and trends for tonsil and larynx squamous cell carcinomas (2000-14) from Surveillance, Epidemiology, and End Results (SEER 18) were evaluated using SEER*Stat and Joinpoint 4.5.0.1. Annual percentage changes (APCs) were compared between low and high SES counties. The laryngeal cancer cohort was included as a comparator reflecting a tobacco-related malignancy. RESULTS Tonsil cancer incidence trends increased at least as much in low SES as in high SES counties (APC/AAPC 4.4, 95%CI 2.4-6.4 versus APC/AAPC 2.9, 95%CI 2.4-3.3). Pairwise comparison confirmed no differences between incidence trends across SES quintiles for tonsil cancer incidence rates. In contrast, age-adjusted incidence rates of larynx cancer decreased in high SES counties (APC/AAPC -2.4, 95%CI -2.4 to -2.0, p < 0.001) and were stable in low SES counties (APC/AAPC -0.9, 95%CI -1.9 to 0.2, p = 0.10). Compared with larynx cancer patients, tonsil cancer patients in low SES regions were significantly more likely to be younger and white. CONCLUSION In low SES US counties, tonsil cancer incidence rates increased from 2000 to 2014, while larynx cancer rates did not change, reflecting diverging trends for larynx and tonsil cancers. Tonsil cancer incidence rates are increasing in most US regions regardless of regional socioeconomic status. Prevention efforts should take these findings into account.
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Affiliation(s)
- Jessica A Tang
- Department of Otolaryngology, Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
| | - Miriam N Lango
- Department of Surgical Oncology, Division of Head and Neck Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, United States.
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Goodarzi E, Khazaei Z, Sohrabivafa M, Mansori K, Naemi H. Incidence and mortality of cervix cancer and their relationship with the human development index in 185 countries in the world: An ecology study in 2018. ADVANCES IN HUMAN BIOLOGY 2019. [DOI: 10.4103/aihb.aihb_15_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Dabeski D, Dabeski A, Antovska V, Trajanova M, Todorovska I, Sima A. Human papillomavirus infections in women with and without squamous cell abnormalities of the uterine cervix. SCRIPTA MEDICA 2019. [DOI: 10.5937/scriptamed50-21910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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19
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Wang J. Analysis of the application values of different combination schemes of liquid-based cytology and high-risk human papilloma virus test in the screening of high-grade cervical lesions. ACTA ACUST UNITED AC 2018; 52:e7517. [PMID: 30484489 PMCID: PMC6262752 DOI: 10.1590/1414-431x20187517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/23/2018] [Indexed: 11/22/2022]
Abstract
The aim of this study was to explore the value of different combination schemes of liquid-based cytology (LBC) and high-risk human papilloma virus (HPV) test in the screening of high-grade (≥CIN 2) cervical lesions. From 5727 women who had undergone examinations with LBC and high-risk HPV test, 1884 patients with positive results of either or both LBC and HPV test were included in this study and underwent cervical biopsy. Based on the pathological examination results, comparisons of the assessment indicators of all diagnostic tests were made, and the application values of LBC and high-risk HPV test and different combination schemes of the two in the screening of high-grade (≥CIN II) cervical lesions were estimated. Compared with the single test method, the sensitivity and negative predictive value of the combination scheme of LBC+HPV (with one positive result) were increased significantly (98.7% and 99.7%), but the specificity (60.8%) and accuracy rate (65.4%) dropped significantly (P<0.05). The sensitivity of LBC+HPV (with two positive results) was the lowest (80.7%), but the specificity and accuracy rate were the highest (83.5% and 83.1%, P<0.05). Z test showed that differences in the screening efficiency of four schemes were not statistically significant (P>0.05). Both LBC and HPV test were effective methods in the screening of high-grade cervical lesions; combination of the two tests did not improve the screening efficiency, but the scheme of LBC+HPV (with two positive results) significantly increased the sensitivity and negative predictive value, which was of better cost-benefit value.
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Affiliation(s)
- Jian Wang
- Department of Obstetrics and Gynecology, Institution Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, China
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20
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Liao L, Cheng H, Zeng F, Zhou W, Ding Y. Prevalence and distribution of human papillomavirus genotypes among women with high-grade squamous intraepithelial lesion and invasive cervical cancer in Ganzhou, China. J Clin Lab Anal 2018; 33:e22708. [PMID: 30390349 DOI: 10.1002/jcla.22708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/26/2018] [Accepted: 10/11/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection can lead to the development of cervical cancer. This study assessed the genotype distribution of HPV of high-grade squamous intraepithelial lesion (HSIL) and invasive cervical cancer (ICC) in Ganzhou population. METHODS A total of 935 females who got HPV testing from January 2016 to July 2018 in the maternal and child health hospital of Ganzhou were enrolled in the study, including 806 HSIL and 129 ICC. HPV detection and genotyping were tested by HPV Geno-Array test kit. RESULTS The overall HPV-positive rate was 74.0% in Ganzhou. Among the HSIL and ICC patients, the positive rates of HPV detection were 75.6% and 64.3%. Among the HSIL individuals, the most prevalent hr-HPV genotype was HPV 16. And the 4 common subtypes in decreasing order were HPV 52, 58, 33, and 18. Of the ICC patients, the most frequently hr-HPV subtype was HPV 16 followed by 18, 52, 58, and 59. Among the squamous cell carcinoma (SCC) patients, for hr-HPV genotypes, HPV 16, 18, 52, 58, and 59 were five most common subtypes. In patients with adenocarcinoma (ADC), the most common hr-HPV genotype was HPV 18, followed by HPV 16, 52, 56, 68, 73. And, we found U-shaped and S-shaped curves in the HPV distribution of different age groups. CONCLUSION The prevalence and distribution of HPV genotypes in Ganzhou differed from other regions of China and Western countries. These results can serve as valuable reference for HPV vaccination programs for Ganzhou women.
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Affiliation(s)
- Linhong Liao
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Department of Pathology, Maternal and child health hospital of Ganzhou City, Guangzhou, China
| | - Hui Cheng
- Department of emergency, People's hospital of Ganzhou City, Guangzhou, China
| | - Fansheng Zeng
- Department of Pathology, Maternal and child health hospital of Ganzhou City, Guangzhou, China
| | - Weijie Zhou
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Department of Pathology, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Molecular Oncologic Pathology, Guangzhou, China
| | - Yanqing Ding
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Department of Pathology, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Molecular Oncologic Pathology, Guangzhou, China
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Cheng Y, Jiang S, Yuan J, Liu J, Simoncini T. Vascular endothelial growth factor C promotes cervical cancer cell invasiveness via regulation of microRNA-326/cortactin expression. Gynecol Endocrinol 2018; 34:853-858. [PMID: 29658350 DOI: 10.1080/09513590.2018.1458304] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Vascular endothelial growth factor C (VEGF-C) accelerates cervical cancer metastasis, while the detailed mechanism remains largely unknown. Recent evidence indicates that microRNA play a crucial role in controlling cancer cell invasiveness. In the present study, we investigated the role of miR-326 in VEGF-C-induced cervical cancer cell invasion. VEGF-C expression was higher and miR-326 was much lower in primary cervical cancer specimens than that in non-cancerous specimens, and a negative correlation between VEGF-C and miR-326 was found. On cervical carcinoma cell line SiHa cells, treatment with VEGF-C downregulated miR-326 level and increased cortactin protein expression. Transfection with miR-326 mimic reversed cortactin expression induced by VEGF-C, suggesting that VEGF-C increased cortactin via downregulation of miR-326. VEGF-C activated c-Src and c-Src inhibitor PP2 abolished VEGF-C effect on miR-326 and cortactin expression, implying that VEGF-C regulated miR-326/cortactin via c-Src signaling. VEGF-C promoted SiHa cell invasion index, which was largely inhibited by transfection with miR-326 antagonist or by siRNA against cortactin. In conclusion, our findings implied that VEGF-C reduced miR-326 expression and increased cortactin expression through c-Src signaling, leading to enhanced cervical cancer invasiveness. This may shed light on potential therapeutic strategies for cervical cancer therapy.
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Affiliation(s)
- Yang Cheng
- a Department of Gynecology and Obstetrics , Guangzhou First People's Hospital , Guangdong , Guangzhou , China
| | - Shuyi Jiang
- a Department of Gynecology and Obstetrics , Guangzhou First People's Hospital , Guangdong , Guangzhou , China
| | - Jin Yuan
- a Department of Gynecology and Obstetrics , Guangzhou First People's Hospital , Guangdong , Guangzhou , China
| | - Junxiu Liu
- b Department of Gynecology and Obstetrics , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , Guangdong Province , China
| | - Tommaso Simoncini
- c Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
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Abstract
Women with disabilities are underscreened for cervical cancer compared with the general population, likely because, in part, of both emotional and physical challenges associated with Pap testing. Women with certain disabilities often require an examination under anesthesia to undergo a speculum examination. However, anesthesia is not without risks and the perioperative experience can be burdensome to patients and caregivers. Either self-collected or provider-collected samples for human papillomavirus (HPV) testing might be better tolerated by patients, and recent evidence suggests that it is a suitable primary screening strategy. The Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology published an Interim Guidance Report outlining using primary HPV testing as an option for women 25 years and older. More recently, the US Preventive Services Task Force released a recommendation statement that included the option to use oncogenic HPV testing alone for women aged 30 to 65 years. We encourage clinical researchers and professional organizations to evaluate primary HPV screening among women with disabilities to advise providers about how to best perform cervical cancer screening without the need for a speculum examination. We cannot ignore the screening disparity experienced by this population, and advocating for screening approaches that reduce patient and caregiver burden would be a step in the right direction.
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Akinlotan MA, Weston C, Bolin JN. Individual- and county-level predictors of cervical cancer screening: a multi-level analysis. Public Health 2018; 160:116-124. [PMID: 29803186 DOI: 10.1016/j.puhe.2018.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/08/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Despite the gains in cervical cancer screening, there remain persistent socio-economic, geographical, racial, and ethnic disparities. This study examines the combined effect of individual- and county-level characteristics on the use of cervical cancer screening tests such as Papanicolaou (Pap) tests in Texas. STUDY DESIGN Cross-sectional study. METHODS Individual-level information was obtained from 2014-2015 Texas Behavioral Risk Factor Surveillance System (BRFSS). Using the county of residence of the study population, the BRFSS data were linked to the American Community Survey (2010-2014) and the Area Health Resources File (2015). Women aged between 21 and 65 years, with no history of hysterectomy, and residing in 47 counties in Texas were included in the study (n = 4276). Multi-level logistic regression was used to assess the independent influences of individual- and county-level covariates on receipt of a Pap test in the past 3 years. RESULTS The odds of timely Pap testing were lower among women aged greater than 50 years, single women, and those with low education and income (<$25,000). Black women who reside in counties with higher percentages of Hispanics (quartile 4) were less likely to be screened compared with black women living in counties with a low Hispanic population (adjusted odds ratio [OR] = 0.08 [95% confidence interval [CI]: 0.02-0.37]). County-level socio-economic status, although associated with timely screening in bivariate analysis, was not a significant predictor of screening after controlling for individual characteristics. CONCLUSIONS There are significant disparities in the uptake of cervical cancer screening across Texas counties. Individual-level socio-economic disparities as well as the number of obstetric-gynecologic physicians in a county are predictors of these disparities.
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Affiliation(s)
- M A Akinlotan
- Department of Health Policy & Management, Texas A&M School of Public Health, TAMU 1266, College Station, TX 77843 - 1266, USA.
| | - C Weston
- College of Nursing, Texas A&M University, 8447 Riverside Parkway, Bryan, TX 77807-1359, USA
| | - J N Bolin
- Department of Health Policy & Management, Texas A&M School of Public Health, TAMU 1266, College Station, TX 77843 - 1266, USA
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Pfaendler KS, Chang J, Ziogas A, Bristow RE, Penner KR. Disparities in Adherence to National Comprehensive Cancer Network Treatment Guidelines and Survival for Stage IB-IIA Cervical Cancer in California. Obstet Gynecol 2018; 131:899-908. [PMID: 29630020 PMCID: PMC5912990 DOI: 10.1097/aog.0000000000002591] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the association of sociodemographic and hospital characteristics with adherence to National Comprehensive Cancer Network treatment guidelines for stage IB-IIA cervical cancer and to analyze the relationship between adherent care and survival. METHODS This is a retrospective population-based cohort study of patients with stage IB-IIA invasive cervical cancer reported to the California Cancer Registry from January 1, 1995, through December 31, 2009. Adherence to National Comprehensive Cancer Network guideline care was defined by year- and stage-appropriate surgical procedures, radiation, and chemotherapy. Multivariate logistic regression, Kaplan-Meier estimate, and Cox proportional hazard models were used to examine associations between patient, tumor, and treatment characteristics and National Comprehensive Cancer Network guideline adherence and cervical cancer-specific 5-year survival. RESULTS A total of 6,063 patients were identified. Forty-seven percent received National Comprehensive Cancer Network guideline-adherent care, and 18.8% were treated in high-volume centers (20 or more patients/year). On multivariate analysis, lowest socioeconomic status (adjusted odds ratio [OR] 0.69, 95% CI 0.57-0.84), low-middle socioeconomic status (adjusted OR 0.76, 95% CI 0.64-0.92), and Charlson-Deyo comorbidity score 1 or higher (adjusted OR 0.78, 95% CI 0.69-0.89) were patient characteristics associated with receipt of nonguideline care. Receiving adherent care was less common in low-volume centers (45.9%) than in high-volume centers (50.9%) (effect size 0.90, 95% CI 0.84-0.96). Death from cervical cancer was more common in the nonadherent group (13.3%) than in the adherent group (8.6%) (effect size 1.55, 95% CI 1.34-1.80). Black race (adjusted hazard ratio 1.56, 95% CI 1.08-2.27), Medicaid payer status (adjusted hazard ratio 1.47, 95% CI 1.15-1.87), and Charlson-Deyo comorbidity score 1 or higher (adjusted hazard ratio 2.07, 95% CI 1.68-2.56) were all associated with increased risk of dying from cervical cancer. CONCLUSION Among patients with early-stage cervical cancer, National Comprehensive Cancer Network guideline-nonadherent care was independently associated with increased cervical cancer-specific mortality along with black race and Medicaid payer status. Nonadherence was more prevalent in patients with older age, lower socioeconomic status, and receipt of care in low-volume centers. Attention should be paid to increase guideline adherence.
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Affiliation(s)
- Krista S Pfaendler
- University of California Irvine Medical Center, Orange, and the University of California, Irvine, Irvine, California
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Abstract
The major impediment to increased human papillomavirus (HPV) vaccination coverage in young males and females is lack of health care provider recommendation. Despite its efficacy in preventing cervical cancer, HPV vaccination in females (49.5%) and males (37.5%) ages 13 through 17 falls well below the Centers for Disease Control and Prevention's (CDC) Healthy People 2020 target of 80% coverage. Parents' willingness to vaccinate their child has been shown to be much higher when physicians share personal vaccination decisions for their own children as well as what other parents have done at that particular clinic. Furthermore, the vaccine must be presented presumptively as a "bundle" along with the rest of the standard adolescent vaccine panel. Multiple exemplars presented including in several European countries, low-income countries and Rwanda, demonstrate that school-based health care systems dramatically increase vaccination coverage. Finally, acceptability for vaccination of males must improve by increasing provider recommendation and by presenting the HPV vaccine as a penile, anal and oropharyngeal cancer prevention therapy in males and not merely a vaccine to prevent cervical cancers in females. Paediatricians, obstetrician/gynaecologists and primary care physicians should consider these data as a call-to-action. Key messages • Despite recent efforts in the US, only 49.5% of females and only 37.5% of males ages 13 through 17 have received all recommended HPV vaccine doses. These numbers fall well below the 80% target set forth by the Healthy People 2020 initiative. • According to the CDC, if health care providers increase HPV vaccination rates in eligible recipients to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years. Furthermore, for every year that the vaccination rate does not increase, an additional 4400 women will develop cervical cancer. • First and foremost, healthcare providers (HCPs) must make a strong recommendation to vaccinate patients and these recommendations must become routine, including for males. • It is clear that HPV vaccination rates improve significantly when vaccine administration occurs at designated, well-organized sites such as school-based vaccination programmes. Furthermore, HPV vaccination should be a high school requirement and offered in the standard adolescent vaccine panel as a bundle with Tdap and MenACWY vaccines in order to promote maximum adherence. • Finally, research on immunogenicity and antibody titre longevity needs to be done in newborns. The HPV vaccine may be recommended in the newborn panel of vaccines to avoid any issues of sexualization and misplaced fears of sexual disinhibition, akin to the success of the Hepatitis B vaccine in the 1980s. • The HPV vaccine is a vaccine against cancer and should be aggressively marketed as such. As healthcare providers, we need to make every effort to overcome barriers, real or perceived, to protecting our population from potential morbidity and mortality associated with this virus.
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Affiliation(s)
- Aria C Attia
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Judith Wolf
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Ana E Núñez
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
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Zeng X, Zhang X, Li C, Wang X, Jerwick J, Xu T, Ning Y, Wang Y, Zhang L, Zhang Z, Ma Y, Zhou C. Ultrahigh-resolution optical coherence microscopy accurately classifies precancerous and cancerous human cervix free of labeling. Am J Cancer Res 2018; 8:3099-3110. [PMID: 29896305 PMCID: PMC5996360 DOI: 10.7150/thno.24599] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/13/2018] [Indexed: 12/16/2022] Open
Abstract
Cervical cancer remains the fourth most common cause of cancer worldwide and the third leading cause of cancer deaths for women in developing countries. Traditional screening tools, such as human papillomavirus and Pap tests, cannot provide results in real-time and cannot localize suspicious regions. Colposcopy-directed biopsies are invasive in nature and only a few sites of the cervix may be chosen for investigation. A non-invasive, label-free and real-time imaging method with a resolution approaching that of histopathology is desirable for early detection of the disease. Methods: Ultrahigh-resolution optical coherence microscopy (OCM) is an emerging imaging technique used to obtain 3-dimensional (3-D) “optical biopsies” of biological samples with cellular resolution. In this study, 497 3-D OCM datasets from 159 specimens were collected from 92 patients. Results: Distinctive patterns for normal cervix, squamocolumnar junction, ectropion, low-grade and high-grade squamous intraepithelial lesions (LSIL and HSIL) and invasive cervical lesions were clearly observed from OCM images, which matched well with corresponding histological slides. OCM images demonstrated a sensitivity of 80% (95% confidence interval, CI, 72%-86%) and a specificity of 89% (95% CI, 84%-93%) for detecting high-risk lesions (HSIL and invasive lesions) when blindly tested by three investigators. A substantial inter-observer agreement was observed (κ=0.627), which showed high diagnostic consistency among three investigators. Conclusion: These results laid the foundation for future non-invasive optical evaluation of cervical tissue in vivo, which could lead to a less invasive and more effective screening and “see-and-treat” strategy for the management of cervical cancer.
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Akinlotan M, Bolin JN, Helduser J, Ojinnaka C, Lichorad A, McClellan D. Cervical Cancer Screening Barriers and Risk Factor Knowledge Among Uninsured Women. J Community Health 2018; 42:770-778. [PMID: 28155005 PMCID: PMC5494033 DOI: 10.1007/s10900-017-0316-9] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A steady decline in cervical cancer incidence and mortality in the United States has been attributed to increased uptake of cervical cancer screening tests such as Papanicolau (Pap) tests. However, disparities in Pap test compliance exist, and may be due in part to perceived barriers or lack of knowledge about risk factors for cervical cancer. This study aimed to assess correlates of cervical cancer risk factor knowledge and examine socio-demographic predictors of self-reported barriers to screening among a group of low-income uninsured women. Survey and procedure data from 433 women, who received grant-funded cervical cancer screenings over a span of 33 months, were examined for this project. Data included demographics, knowledge of risk factors, and agreement on potential barriers to screening. Descriptive analysis showed significant correlation between educational attainment and knowledge of risk factors (r = 0.1381, P < 0.01). Multivariate analyses revealed that compared to Whites, Hispanics had increased odds of identifying fear of finding cancer (OR 1.56, 95% CI 1.00–2.43), language barriers (OR 4.72, 95% CI 2.62–8.50), and male physicians (OR 2.16, 95% CI 1.32–3.55) as barriers. Hispanics (OR 1.99, 95% CI 1.16–3.44) and Blacks (OR 2.06, 95% CI 1.15–3.68) had a two-fold increase in odds of agreeing that lack of knowledge was a barrier. Identified barriers varied with age, marital status and previous screening. Programs aimed at conducting free or subsidized screenings for medically underserved women should include culturally relevant education and patient care in order to reduce barriers and improve screening compliance for safety-net populations.
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Affiliation(s)
- Marvellous Akinlotan
- Department of Health Policy & Management, Texas A&M School of Public Health, TAMU 1266, College Station, TX, 77843-1266, USA.
| | - Jane N Bolin
- Department of Health Policy & Management, Texas A&M School of Public Health, TAMU 1266, College Station, TX, 77843-1266, USA
| | - Janet Helduser
- Department of Health Policy & Management, Texas A&M School of Public Health, TAMU 1266, College Station, TX, 77843-1266, USA
| | - Chinedum Ojinnaka
- Department of Health Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - Anna Lichorad
- Department of Clinical Translational Medicine, College of Medicine, Texas A&M Health Science Center, 2900 E. 29th Street, Bryan, TX, 77802, USA
| | - David McClellan
- Department of Clinical Translational Medicine, College of Medicine, Texas A&M Health Science Center, 2900 E. 29th Street, Bryan, TX, 77802, USA
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McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer Sana, Familia Fuerte: The Effects of a Culturally-Relevant, Community-Based, <i>Promotores</i> Program to Increase Cervical Cancer Screening among Latinas. J Health Care Poor Underserved 2018; 27:568-79. [PMID: 27180696 DOI: 10.1353/hpu.2016.0094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Although cervical cancer can be prevented through screening and follow-up, Latinas' rate of Pap tests remains low due to knowledge gaps and cultural and attitudinal factors. METHODS This study used a single-group pre-/post-test design to evaluate the effectiveness of Mujer Sana, Familia Fuerte (Healthy Woman, Strong Family), an intervention intended to improve Latinas' cervical cancer prevention knowledge, attitudes, self-efficacy to obtain a Pap test, and intention to get tested. The intervention is delivered through a single session by promotores de salud, who use a culturally competent, linguistically appropriate toolkit. A total of 5,211 Latinas participated in the study. RESULTS The evaluation indicated that participants had increases in knowledge, positive attitudes, self-efficacy, and intention to test. CONCLUSION Latinas have a low rate of cervical cancer screening but a high rate of cervical cancer, and Mujer Sana, Familia Fuerte shows promise as a public health practice for use with this population.
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Li K, Yin R, Wang D, Li Q. Human papillomavirus subtypes distribution among 2309 cervical cancer patients in West China. Oncotarget 2018; 8:28502-28509. [PMID: 28415708 PMCID: PMC5438668 DOI: 10.18632/oncotarget.16093] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/01/2017] [Indexed: 11/25/2022] Open
Abstract
Objective The prevalence of cervical Human Papillomavirus (HPV) infection in cervical cancer varies greatly worldwide, and HPV prevalence and genotypes in China are limited. The objective is to analyze the prevalence of HPV subtypes in cervical cancer patients in west China as well as the relationships between different histological types of cervical cancer and HPV subtypes. Results 2309 cases were included. 90.86% were infected with HPV, and the remaining 9.13% were negative. The most common subtypes were HPV16, HPV18, HPV58, HPV53, and HPV33. HPV16 and HPV18 appeared to be the most prevalent HPV subtypes across all age groups, while the prevalence of the other subtypes varied between age groups. A logistic regression analysis revealed that the occurrence of cervical squamous cell carcinoma and adenocarcinoma was most closely correlated to a persistent infection with HPV16 or HPV18, with P < 0.05. Materials and Methods The prevalence of 27 HPV subtypes in 2309 cervical cancer patients who received treatment at our hospital between June 2011 and January 2016 was analyzed based on the results of HPV testing using Liquid suspension chip technology (Luminex 200). Conclusions HPV16 and HPV18 were the most prevalent HPV subtypes among the cervical cancer patients, followed by HPV58, HPV53, and HPV33. 9.13% of the cases appeared to not be associated with HPV. This suggests that HPV testing without the use of cytology may overlook some special types of cervical cancer that account for approximately 10% of all cervical cancer cases.
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Affiliation(s)
- Kemin Li
- Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Laboratory of Molecular Epidemiology of Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Rutie Yin
- Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Laboratory of Molecular Epidemiology of Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Danqing Wang
- Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Laboratory of Molecular Epidemiology of Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Qingli Li
- Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Laboratory of Molecular Epidemiology of Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
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30
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Yang DX, Soulos PR, Davis B, Gross CP, Yu JB. Impact of Widespread Cervical Cancer Screening: Number of Cancers Prevented and Changes in Race-specific Incidence. Am J Clin Oncol 2018; 41:289-294. [PMID: 26808257 PMCID: PMC4958036 DOI: 10.1097/coc.0000000000000264] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES With recent approval of standalone HPV testing and increasing uptake of HPV vaccination, some have postulated that we are moving toward a "post-Pap" era of cervical cancer prevention. However, the total number cases that have been prevented by Pap smear screening as well as its impact on racial disparities are unknown. METHODS We estimated national cervical cancer incidence from 1976 to 2009 using the Surveillance, Epidemiology, and End Result database. Screening data were obtained from the literature and National Cancer Institute Progress Reports. We examined early, late, and race-specific trends in cancer incidence, and calculated the estimated number of cancers prevented over the past 3 decades. RESULTS From 1976 to 2009, there was a significant decrease in the incidence of early-stage cervical cancer, from 9.8 to 4.9 cases per 100,000 women (P<0.001). Late-stage disease incidence also decreased, from 5.3 to 3.7 cases per 100,000 women (P<0.001). The incidence among black women decreased from 26.9 to 9.7 cases per 100,000 women (P<0.001), a greater decline compared with that of white women and women of other races. After adjusting for "prescreening era" rates of cervical cancer, we estimate that Pap smears were associated with a reduction of between 105,000 and 492,000 cases of cervical cancer over the past 3 decades in the United States. CONCLUSIONS A large number of early-stage and late-stage cervical cancers were prevented and racial disparity in cancer rates were reduced during an era of widespread Pap smear screening.
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Affiliation(s)
- Daniel X. Yang
- Yale University School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Pamela R. Soulos
- Yale University School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Brigette Davis
- Yale University School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Cary P. Gross
- Yale University School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - James B. Yu
- Yale University School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
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Wu C, Zhu X, Kang Y, Cao Y, Lu P, Zhou W, Zhou H, Zhang Y, Song Y. Epidemiology of Humanpapilloma virus infection among women in Fujian, China. BMC Public Health 2017; 18:95. [PMID: 28774274 PMCID: PMC5543557 DOI: 10.1186/s12889-017-4651-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/30/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection is the main etiological factor for the development of cervical cancer. Here we assessed the prevalence and distribution of HPV genotypes in Fujian population. METHODS A total of 8678 women aging from 17 to 84 years olds were recruited from the Fujian Medical University Union Hospital in Fujian Province. Every woman had a face-to-face interview. Cervical samples were collected from each participant and HPV screening was conducted using microarray hybridization. RESULTS Our study showed that the HPV prevalence in Fujian province was 38.3%. Among the positive individuals, 70.6% were detected for single HPV infection, 29.4% for multiple HPV infections. Further analysis showed that the prevalence of HPV infection significantly increased from 2009 to 2015. The four most common high risk human papillomavirus (HR-HPV) genotypes were HPV16 (8.5%), HPV52 (7.9%), HPV58 (6.2%), HPV 53 (3.5%), collectively accounting for 60.5% of all detected HPV infection. Age subgroup analysis showed two peaks for the frequencies of overall and multiple HPV infections, one for the group of women under 25 years old, and the other for the group over 55 years old. CONCLUSIONS HPV infection is becoming serious in Fujian province, which indicates the imperative to implement a HPV vaccination and screening program for this region.
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Affiliation(s)
- Conglian Wu
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.,Department of Laboratory Medicine, The First Hospital of Quanzhou Affiliated to Fujian Medical University, 248-252 East Street, Quanzhou, Fujian, 362000, China
| | - Xianjin Zhu
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Yanli Kang
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Yinping Cao
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Pingxia Lu
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Wenjuan Zhou
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Hong Zhou
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Yang Zhang
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Yanfang Song
- Department of Laboratory Medicine, Affiliated Renmin Hospital of Fujian University of Traditional Chinese Medicine; Fujian province key Laboratory of Integrated Traditional and Western Immunity Nephrology, 602 Bayiqi Road, Fuzhou, 350001, China.
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Peng J, Yuan Y, Shen F, Wang Y, Chen L, Liao DJ, Tan Y. Cervical Cancers Manifest a High Rate of Infection by a High-Risk Human Papilloma Virus Subtype but a Very Low Rate of Infection by a Low-Risk Subtype in the Guiyang District of China. J Cancer 2017; 8:1263-1270. [PMID: 28607602 PMCID: PMC5463442 DOI: 10.7150/jca.17120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 03/31/2017] [Indexed: 11/05/2022] Open
Abstract
The prevalence of infection by different genotypes of human papillomavirus (HPV) varies among different geographic areas. We studied the prevalence of infection by 21 HPV genotypes in cervical tissue specimens from 4213 women in the Guiyang district, that is located in the southwest of China and is dominated by minor ethnicities of Chinese, and 2074 cases in our cohort had pathological diagnosis available. The overall infection rate was 36.98%. Most (72.08%) infectors were positive for only one HPV subtype, with the remaining being cases infected by two or more subtypes. Infections by the HPV subtypes 16, 52 and 58 were the most prevalent, having rates of 34.66%, 16.03%% and 15.53%, respectively. The most common cervical lesions in HPV infections were genital warts, cervical cancer (CC) and cervical intraepithelial neoplasia (CIN). Age and age at first sexual activity were independent risk factors for HPV infections that in turn cause certain cervical lesions. Intriguingly, while 94.90% of the CC patients were infected by oncogenically high-risk (HR) HPV subtypes, only 2.75% and 2.29% of these patients were infected by oncogenically low-risk (LR) subtypes or other-subtypes with their oncogenicity unclear. The rates of infection by LR-HPVs and other-HPVs were also low, being 4.63% and 6.76%, respectively, in the patients with CIN that is a precursor lesion of CC, lower than the 8.54% and 18.20%, respectively, in the women without a cervical lesion. Our data provides an important foundation for prevention, diagnosis and treatment of HPV infection in Guiyang district and suggests that development of vaccines for prevention and treatment of CC in this area should first target the HPV subtypes 16, 52 and 58, but not subtype 18 as for many other places. It deserves study whether infections by certain LR-HPVs and other-HPVs may serve as attenuated live vaccines for prevention of CC.
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Affiliation(s)
- Juan Peng
- Central Laboratory, Guizhou Medical University Hospital, Guiyang, Guizhou 550004, P. R. China.,Blood Transfusion Department, TaiHe Hospital Affiliated to HuBei University of Medicine, ShiYan, HuBei 442000, P. R. China
| | - Yan Yuan
- Central Laboratory, Guizhou Medical University Hospital, Guiyang, Guizhou 550004, P. R. China.,Laboratory Medicine, People's Hospital of Guizhou Province, Guiyang, Guizhou 550002, P. R. China
| | - Feng Shen
- Central Laboratory, Guizhou Medical University Hospital, Guiyang, Guizhou 550004, P. R. China
| | - Yan Wang
- Central Laboratory, Guizhou Medical University Hospital, Guiyang, Guizhou 550004, P. R. China
| | - Lichan Chen
- Hormel Institute, University of Minnesota, Austin, MN 55912, USA
| | - D Joshua Liao
- Department of Pathology, Guizhou Medical University Hospital, Guizhou 550004, P.R. China
| | - Yujie Tan
- Central Laboratory, Guizhou Medical University Hospital, Guiyang, Guizhou 550004, P. R. China.,Laboratory Medicine, Baiyun Hospital Affiliated to Guizhou Medical University Hospital, Guiyang, Guizhou 550014, P. R. China
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Kobetz E, Seay J, Amofah A, Pierre L, Bispo JB, Trevil D, Gonzalez M, Poitevien M, Koru-Sengul T, Carrasquillo O. Mailed HPV self-sampling for cervical cancer screening among underserved minority women: study protocol for a randomized controlled trial. Trials 2017; 18:19. [PMID: 28086983 PMCID: PMC5237204 DOI: 10.1186/s13063-016-1721-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Underserved ethnic minority women experience significant disparities in cervical cancer incidence and mortality, mainly due to lack of cervical cancer screening. Barriers to Pap smear screening include lack of knowledge, lack of health insurance and access, and cultural beliefs regarding disease prevention. In our previous SUCCESS trial, we demonstrated that HPV self-sampling delivered by a community health worker (CHW) is efficacious in circumventing these barriers. This approach increased screening uptake relative to navigation to Pap smear screening. SUCCESS trial participants, as well as our community partners, provided feedback that women may prefer the HPV self-sampler to be delivered through the mail, such that they would not need to schedule an appointment with the CHW. Thus, our current trial aims to elucidate the efficacy of the HPV self-sampling method when delivered via mail. Design We are conducting a randomized controlled trial among 600 Haitian, Hispanic, and African-American women from the South Florida communities of Little Haiti, Hialeah, and South Dade. Women between the ages of 30 and 65 years who have not had a Pap smear within the past 3 years are eligible for the study. Women are recruited by CHWs and complete a structured interview to assess multilevel determinants of cervical cancer risk. Women are then randomized to receive HPV self-sampling delivered by either the CHW (group 1) or via mail (group 2). The primary outcome is completion of HPV self-sampling within 6 months post enrollment. Discussion Our trial is among the first to examine the efficacy of the mailed HPV self-sampling approach. If found to be efficacious, this approach may represent a cost-effective strategy for cervical cancer screening within underserved and underscreened minority groups. Trial registration ClinicalTrials.gov, NCT02202109. Registered on 9 July 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1721-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erin Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Room 610B, Miami, FL, 33136, USA. .,Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA. .,Health Choice Network, 9064 NW 13th Terrace, Miami, FL, 33172, USA.
| | - Julia Seay
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Room 610B, Miami, FL, 33136, USA.,Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Anthony Amofah
- Health Choice Network, 9064 NW 13th Terrace, Miami, FL, 33172, USA
| | - Larry Pierre
- Center for Haitian Studies, 8260 NE 2nd Avenue, Miami, FL, 33138, USA
| | - Jordan Baeker Bispo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Dinah Trevil
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Room 610B, Miami, FL, 33136, USA
| | - Martha Gonzalez
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Room 610B, Miami, FL, 33136, USA
| | - Martine Poitevien
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Room 610B, Miami, FL, 33136, USA
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Olveen Carrasquillo
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Room 610B, Miami, FL, 33136, USA.,Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
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Abboud S, De Penning E, Brawner BM, Menon U, Glanz K, Sommers MS. Cervical Cancer Screening Among Arab Women in the United States: An Integrative Review. Oncol Nurs Forum 2017; 44:E20-E33. [PMID: 27991600 PMCID: PMC5553625 DOI: 10.1188/17.onf.e20-e33] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Arab American women are an ethnic minority and immigrant population in the United States with unique and nuanced sociocultural factors that influence preventive health behaviors. The aims of this article are to evaluate and synthesize the existing evidence on cervical cancer screening behaviors, as well as determine factors that influence these behaviors, among Arab American women.
. LITERATURE SEARCH Extensive literature searches were performed using PubMed, CINAHL®, Scopus, Embase, and Cochrane databases; articles published through October 2015 were sought.
. DATA EVALUATION Of 17 articles, 14 explicitly identified Arab and/or Muslim women and cervical cancer screening in either the title or the abstract; the remaining three focused on cancer attitudes and behaviors in Arab Americans in general but measured cervical cancer screening. Eleven articles reported different aspects of one intervention. Because of methodologic heterogeneity, the current authors synthesized results narratively.
. SYNTHESIS Key factors influencing cervical cancer screening were identified as the following. CONCLUSIONS Cervical cancer screening rates among Arab American women are comparable to other ethnic minorities and lower than non-Hispanic White women. Findings are inconsistent regarding factors influencing cervical cancer screening behaviors in this underrepresented group.
. IMPLICATIONS FOR RESEARCH Significant need exists for more research to better understand cervical cancer prevention behaviors in this group to inform culturally relevant interventions. Healthcare providers play a crucial role in increasing cervical cancer screening awareness and recommendations for Arab American women.
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Khan HM, Gabbidon K, Saxena A, Abdool-Ghany F, Dodge JM, Lenzmeier T. Disparities in Cervical Cancer Characteristics and Survival Between White Hispanics and White Non-Hispanic Women. J Womens Health (Larchmt) 2016; 25:1052-1058. [DOI: 10.1089/jwh.2015.5585] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Hafiz M.R. Khan
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kemesha Gabbidon
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida
| | - Anshul Saxena
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida
| | | | - John M. Dodge
- Department of Public Health, Texas Tech University Health Sciences Center, Abilene, Texas
| | - Taylor Lenzmeier
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, Texas
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Obulaney PA, Gilliland I, Cassells H. Increasing Cervical Cancer and Human Papillomavirus Prevention Knowledge and HPV Vaccine Uptake through Mother/Daughter Education. J Community Health Nurs 2016; 33:54-66; quiz 66-7. [DOI: 10.1080/07370016.2016.1120595] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Majidi A, Ghiasvand R, Hadji M, Nahvijou A, Mousavi AS, Pakgohar M, Khodakarami N, Abedini M, Amouzegar Hashemi F, Rahnamaye Farzami M, Shahsiah R, Sajedinejhad S, Mohagheghi MA, Nadali F, Rashidian A, Weiderpass E, Mogensen O, Zendehdel K. Priority Setting for Improvement of Cervical Cancer Prevention in Iran. Int J Health Policy Manag 2015; 5:225-32. [PMID: 27239863 DOI: 10.15171/ijhpm.2015.201] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 11/06/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide. Organized cervical screening and vaccination against human papilloma virus (HPV) have been successful interventions for prevention of invasive cervical cancer (ICC). Because of cultural and religious considerations, ICC has low incidence in Iran and many other Muslim countries. There is no organized cervical screening in these countries. Therefore, ICC is usually diagnosed in advanced stages with poor prognosis in these countries. We performed a priority setting exercise and suggested priorities for prevention of ICC in this setting. METHODS We invited experts and researchers to a workshop and asked them to list important suggestions for ICC prevention in Iran. After merging similar items and removing the duplicates, we asked the experts to rank the list of suggested items. We used a strategy grid and Go-zone analysis to determine final list of priorities for ICC prevention in Iran. RESULTS From 26 final items suggested as priorities for prevention of ICC, the most important priorities were developing national guidelines for cervical screening and quality control protocol for patient follow-up and management of precancerous lesions. In addition, we emphasized considering insurance coverage for cervical screening, public awareness, and research priorities, and establishment of a cervical screening registry. CONCLUSION A comprehensive approach and implementation of organized cervical screening program is necessary for prevention of ICC in Iran and other low incidence Muslim countries. Because of high cost for vaccination and low incidence of cervical cancer, we do not recommend HPV vaccination for the time being in Iran.
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Affiliation(s)
- Azam Majidi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghiasvand
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Maryam Hadji
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam-Sadat Mousavi
- Department of Genecology Oncology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Pakgohar
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Khodakarami
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Deputy of Public Health, Maternal Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Farnaz Amouzegar Hashemi
- Radiotherapy Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Shahsiah
- Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Sajedinejhad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mohagheghi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nadali
- Faculty of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.,Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.,Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
| | - Ole Mogensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Cancer Model Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
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Temkin SM, Seibel NL. Are we missing an opportunity for cancer prevention? Human papillomavirus vaccination for survivors of pediatric and young adult cancers. Cancer 2015; 121:3395-402. [DOI: 10.1002/cncr.29515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/13/2015] [Accepted: 05/18/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Sarah M. Temkin
- Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention; National Cancer Institute; Bethesda Maryland
| | - Nita L. Seibel
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis; National Cancer Institute; Bethesda Maryland
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Haugsdal ML, Ryan GL. HPV and Cervical Dysplasia in Adolescents: A Progressive March Toward Prevention. J Pediatr Adolesc Gynecol 2015; 28:127-31. [PMID: 25532683 DOI: 10.1016/j.jpag.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 12/19/2022]
Abstract
Cervical cancer caused by infection with the human papillomavirus is the second most common malignancy among women worldwide. Over the course of the past century our understanding of the virus and the disease has expanded exponentially through landmark studies and pioneers of academic medicine. It has all led to the current evidence-based guidelines for prevention of cervical dysplasia and invasive carcinoma in adolescent females that will significantly lessen morbidity and mortality and may eradicate the disease completely. Unfortunately, the greatest challenge to this may be overcoming common misunderstandings and other barriers to compliance with these guidelines among practitioners, patients, and the general public.
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Affiliation(s)
- Michael L Haugsdal
- University of Iowa Carver College of Medicine, Department of Obstetrics & Gynecology, Iowa City, IA
| | - Ginny L Ryan
- University of Iowa Carver College of Medicine, Department of Obstetrics & Gynecology, Iowa City, IA.
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Miller JW, Royalty J, Henley J, White A, Richardson LC. Breast and cervical cancers diagnosed and stage at diagnosis among women served through the National Breast and Cervical Cancer Early Detection Program. Cancer Causes Control 2015; 26:741-7. [PMID: 25724415 PMCID: PMC4797940 DOI: 10.1007/s10552-015-0543-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/20/2015] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess cancers diagnosed and the stage of cancer at the time of diagnosis among low-income, under-insured, or uninsured women who received services through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS Using the NBCCEDP database, we examined the number and percent of women diagnosed during 2009-2011 with in situ breast cancer, invasive breast cancer, and invasive cervical cancer by demographic and clinical characteristics, including age, race and ethnicity, test indication (screening or diagnostic), symptoms (for breast cancer), and screening history (for cervical cancer). We examined these characteristics by stage at diagnosis, a new variable included in the database obtained by linking with state-based central cancer registries. RESULTS There were 11,569 women diagnosed with invasive breast cancer, 1,988 with in situ breast cancer, and 583 with invasive cervical cancer through the NBCCEDP. Women who reported breast symptoms or who had diagnostic mammography were more likely to be diagnosed with breast cancer, and at a later stage, than those who did not have symptoms or who had screening mammography. Women who had been rarely or never screened for cervical cancer were more likely to be diagnosed with cervical cancer, and at a later stage, than women who received regular screenings. CONCLUSIONS Women served through the NBCCEDP who have not had prior screening or who have symptoms were more often diagnosed with late-stage disease.
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Affiliation(s)
- Jacqueline W Miller
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F-76, Atlanta, GA, 30341, USA,
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41
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Tangka FKL, Howard DH, Royalty J, Dalzell LP, Miller J, O'Hara BJ, Sabatino SA, Joseph K, Kenney K, Guy GP, Hall IJ. Cervical cancer screening of underserved women in the United States: results from the National Breast and Cervical Cancer Early Detection Program, 1997-2012. Cancer Causes Control 2015; 26:671-86. [PMID: 25783455 PMCID: PMC4429146 DOI: 10.1007/s10552-015-0524-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/08/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast and cervical cancer screens to low-income, uninsured, and underinsured women. We describe the number and proportion of women eligible for cervical cancer screening services and the proportion of eligible women screened over the period 1997-2012. METHODS Low-income, uninsured, and underinsured women aged 18-64 years who have not had a hysterectomy are eligible for cervical cancer screening through the NBCCEDP. We estimated the number of low-income, uninsured women using data from the US Census Bureau. We adjusted our estimates for hysterectomy status using the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. We used data from the NBCCEDP to describe the number of women receiving NBCCEDP-funded screening and calculated the proportion of eligible women who received screening through the NBCCEDP at the national level (by age group, race/ethnicity) and at the state level by age group. We used the Medical Expenditure Panel Survey to estimate the proportion of NBCCEDP-eligible women who were screened outside the NBCCEDP and the proportion that are not screened. RESULTS We estimate that in 2010-2012, 705,970 women aged 18-64 years, 6.5 % (705,970 of 9.8 million) of the eligible population, received NBCCEDP-funded Pap tests. We estimate that 60.2 % of eligible women aged 18-64 years were screened outside the NBCCEDP and 33.3 % were not screened. The NBCCEDP provided 623,603 screens to women aged 40-64 years, an estimated 16.5 % of the eligible population, and 83,660 screens to women aged 18-39 years, representing an estimated 1.2 % of the eligible population. The estimated proportions of eligible women screened in each state ranged from 1.5 to 32.7 % and 5 % to 73.2 % among the 18-64 and 40-64 years age groups, respectively. Changes in the proportion of eligible women screened over the study period were nonsignificant. CONCLUSIONS Although the program provided cervical screening to over 700,000 women between 2010 and 2012, it served a small percent of those eligible. The proportion of women screened varied substantially across age groups, racial/ethnic groups, and states. Many low-income, uninsured women are not being screened.
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Affiliation(s)
- Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Mailstop F-76, Atlanta, GA, 30341-3717, USA,
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42
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Stewart Massad L, Evans CT, Weber KM, D'Souza G, Hessol NA, Wright RL, Colie C, Strickler HD, Wilson TE. Changes in knowledge of cervical cancer following introduction of human papillomavirus vaccine among women at high risk for cervical cancer. Gynecol Oncol Rep 2015; 12:37-40. [PMID: 25870859 PMCID: PMC4392650 DOI: 10.1016/j.gore.2015.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/28/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To describe changes in knowledge of cervical cancer prevention, human papillomavirus (HPV), and HPV vaccination among women at high risk for cervical cancer in the first five years after introduction of HPV vaccination. METHODS In 2007, 2008-9, and 2011, women in a multicenter U.S. cohort study completed 44-item self-report questionnaires assessing knowledge of cervical cancer prevention, HPV, and HPV vaccination. Results across time were assessed for individuals, and three study enrollment cohorts were compared. Knowledge scores were correlated with demographic variables, measures of education and attention, and medical factors. Associations were assessed in multivariable models. RESULTS In all, 974 women completed three serial questionnaires; most were minority, low income, and current or former smokers. The group included 652 (67%) HIV infected and 322 (33%) uninfected. Summary knowledge scores (possible range 0-24) increased from 2007 (12.8, S.D. 5.8) to 2008-9 (13.9, S.D. 5.3, P < 0.001) and to 2011 (14.3, S.D 5.2, P < 0.0001 vs 2007 and <0.04 vs 2008-9). Higher knowledge scores at first and follow-up administration of questionnaires, higher income, and higher education level were associated with improved knowledge score at third administration. Women not previously surveyed had scores similar to those of the longitudinal group at baseline. CONCLUSION Substantial gaps in understanding of HPV and cervical cancer prevention exist despite years of health education. While more effective educational interventions may help, optimal cancer prevention may require opt-out vaccination programs that do not require nuanced understanding.
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Affiliation(s)
- L. Stewart Massad
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, United States
| | - Charlesnika T. Evans
- Department of Preventive Medicine and Center for Healthcare Studies, Northwestern University, Chicago, IL, United States
- Department of Veterans Affairs Hines Jr. VA Hospital, Hines, IL, United States
| | - Kathleen M. Weber
- The CORE Center at John H. Stroger Jr. Hospital of Cook County, Chicago, IL, United States
| | - Gypsyamber D'Souza
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Nancy A. Hessol
- Departments of Clinical Pharmacy and Medicine, University of California, San Francisco, CA, United States
| | - Rodney L. Wright
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - Christine Colie
- Department of Obstetrics & Gynecology, Georgetown University School of Medicine, Washington, DC, United States
| | - Howard D. Strickler
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Tracey E. Wilson
- Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY, United States
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43
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Bellinger JD, Millegan W, Abdalla AE. “I'm Not Ashamed to Talk on It!”: African-American Women's Decisions About Cervical Cancer Prevention and Control in South Carolina. Womens Health Issues 2015; 25:120-7. [DOI: 10.1016/j.whi.2014.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 10/23/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
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Khan HMR, Gabbidon K, Abdool-Ghany F, Saxena A, Gomez E, Stewart TSJ. Health Disparities between Black Hispanic and Black Non-Hispanic Cervical Cancer Cases in the USA. Asian Pac J Cancer Prev 2014; 15:9719-23. [DOI: 10.7314/apjcp.2014.15.22.9719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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45
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Miller JW, Hanson V, Johnson GD, Royalty JE, Richardson LC. From cancer screening to treatment: service delivery and referral in the National Breast and Cervical Cancer Early Detection Program. Cancer 2014; 120 Suppl 16:2549-56. [PMID: 25099897 DOI: 10.1002/cncr.28823] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 02/06/2023]
Abstract
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast and cervical cancer screening and diagnostic services to low-income and underserved women through a network of providers and health care organizations. Although the program serves women 40-64 years old for breast cancer screening and 21-64 years old for cervical cancer screening, the priority populations are women 50-64 years old for breast cancer and women who have never or rarely been screened for cervical cancer. From 1991 through 2011, the NBCCEDP provided screening and diagnostic services to more than 4.3 million women, diagnosing 54,276 breast cancers, 2554 cervical cancers, and 123,563 precancerous cervical lesions. A critical component of providing screening services is to ensure that all women with abnormal screening results receive appropriate and timely diagnostic evaluations. Case management is provided to assist women with overcoming barriers that would delay or prevent follow-up care. Women diagnosed with cancer receive treatment through the states' Breast and Cervical Cancer Treatment Programs (a special waiver for Medicaid) if they are eligible. The NBCCEDP has performance measures that serve as benchmarks to monitor the completeness and timeliness of care. More than 90% of the women receive complete diagnostic care and initiate treatment less than 30 days from the time of their diagnosis. Provision of effective screening and diagnostic services depends on effective program management, networks of providers throughout the community, and the use of evidence-based knowledge, procedures, and technologies.
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Affiliation(s)
- Jacqueline W Miller
- Divison of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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46
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Stang A, Hawk H, Knowlton R, Gershman ST, Kuss O. Hysterectomy-corrected incidence rates of cervical and uterine cancers in Massachusetts, 1995 to 2010. Ann Epidemiol 2014; 24:849-54. [DOI: 10.1016/j.annepidem.2014.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 05/14/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
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ARAB M, NOGHABAEI G. Comparison of Age- Standard Incidence Rate Trends of Gynecologic and Breast Cancer in Iran and Other Countries. IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:1372-9. [PMID: 26060699 PMCID: PMC4441890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/25/2014] [Indexed: 12/02/2022]
Abstract
BACKGROUND Female cancer, especially breast and gynecologic cancers are considered multistage disease, highly influenced by risk and protective factors and/or screening preventive modalities. Consequences of all these factors result in the trend of change over time. METHODS In this comparative study, based on data of national cancer registry of Iran 2004 published by Iranian Ministry of Health, age - standard incidence rate (ASR) according to the world population was calculated in all reported gynecologic and breast cancers. Source of all subjects are pathologic based. In the next step, the calculated ASR of Iran and those of the other countries in 2004 were compared to GLOBOCAN ASR reports of 2008. RESULTS In Iran ASR of breast cancer 2004 (24.93) changed to 18.4 in 2008. Ovarian cancer ASR of 2004, 3.07 was 3.1 in 2008. Endometrial cancer ASR in 2004 (2.29) was 1.7 in 2008. Cervical cancer ASR of 1.71 in 2004 was 2.2 in 2008. CONCLUSIONS In Iran incidence trend of breast and endometrium are decreasing in the same direction of USA and Australia. Increasing trend of ovary and cervix ASR in Iran is in the inverse direction of USA and Australia which are decreasing. Future studies to find out the same trend or any changes, might develop these findings and improve consequent practical decisions based on results of this study and complementary future studies.
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Affiliation(s)
- Maliheh ARAB
- 1. Dept. of Gynecology-Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Giti NOGHABAEI
- 2. Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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48
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Ekwueme DU, Uzunangelov VJ, Hoerger TJ, Miller JW, Saraiya M, Benard VB, Hall IJ, Royalty J, Li C, Myers ER. Impact of the National Breast and Cervical Cancer Early Detection Program on cervical cancer mortality among uninsured low-income women in the U.S., 1991-2007. Am J Prev Med 2014; 47:300-8. [PMID: 25015564 DOI: 10.1016/j.amepre.2014.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 04/12/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The benefits of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) on cervical cancer screening for participating uninsured low-income women have never been measured. PURPOSE To estimate the benefits in life-years (LYs) gained; quality-adjusted life-years (QALYs) gained; and deaths averted. METHODS A cervical cancer simulation model was constructed based on an existing cohort model. The model was applied to NBCCEDP participants aged 18-64 years. Screening habits for uninsured low-income women were estimated using National Health Interview Survey data from 1990 to 2005 and NBCCEDP data from 1991 to 2007. The study was conducted during 2011-2012 and covered all 68 NBCCEDP grantees in 50 states, the District of Columbia, five U.S. territories, and 12 tribal organizations. Separate simulations were performed for the following three scenarios: (1) women who received NBCCEDP (Program) screening; (2) women who received screening without the program (No Program); and (3) women who received no screening (No Screening). RESULTS Among 1.8 million women screened in 1991-2007, the Program added 10,369 LYs gained compared to No Program, and 101,509 LYs gained compared to No Screening. The Program prevented 325 women from dying of cervical cancer relative to No Program, and 3,829 relative to No Screening. During this time period, the Program accounted for 15,589 QALYs gained when compared with No Program, and 121,529 QALYs gained when compared with No Screening. CONCLUSIONS These estimates suggest that NBCCEDP cervical cancer screening has reduced mortality among medically underserved low-income women who participated in the program.
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Affiliation(s)
| | | | | | | | - Mona Saraiya
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Vicki B Benard
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Ingrid J Hall
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Janet Royalty
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Chunyu Li
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Evan R Myers
- Department of Obstetrics & Gynecology, Duke University, Durham, North Carolina
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Andrade CEMC, Scapulatempo-Neto C, Longatto-Filho A, Vieira MA, Tsunoda AT, Da Silva IDCG, Fregnani JHTG. Prognostic scores after surgical treatment for cervical intraepithelial neoplasia: a proposed model and possible implications for post-operative follow-up. Acta Obstet Gynecol Scand 2014; 93:941-8. [PMID: 24974761 DOI: 10.1111/aogs.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 06/18/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To develop a prognostic model for women who underwent surgical treatment for cervical intraepithelial neoplasia. DESIGN Cohort study. Patient inclusion and follow-up occurred retrospectively and prospectively. SETTING Barretos Cancer Hospital, Barretos, São Paulo, Brazil. POPULATION Women (n = 242) diagnosed with cervical intraepithelial neoplasia who were submitted to conization. METHODS Immediately prior to surgical treatment, a cervical cytology sample was collected from each individual included in the study by endocervical brushing and stored in a preservative solution with methanol. A human papilloma virus-DNA test was conducted using an aliquot of the endocervical brushings. The surgical specimens were subjected to immunohistochemical analysis of p16 (immunohistochemical analysis 4a) protein expression. MAIN OUTCOME MEASURES Two-year disease-free survival rates calculated for each study variable. Identified variables in the multivariate Cox model were used for elaboration of prognostic scores. RESULTS Variables associated with outcome included age (p = 0.033), tobacco use (p < 0.001), final histopathological diagnosis (p = 0.007), surgical margins (p < 0.001), high-risk human papilloma virus status (p = 0.008), human papilloma virus-16 status (p < 0.001) and immunoexpression of p16 in the cytoplasm (p = 0.049). By the Cox model, independent risk factors for disease recurrence/persistence were: tobacco use (hazard risk = 3.0; 95% confidence interval 1.6-5.6), positive surgical margins (hazard risk = 3.2; 95% confidence interval 1.6-6.1), human papilloma virus-16 (hazard risk = 3.3; 95% confidence interval 1.6-6.9) and age over 45 years (hazard risk = 2.7; 95% confidence interval 1.1-6.6). CONCLUSIONS Establishment of a prognostic score can represent a valuable tool for determining the risk of cervical intraepithelial neoplasia recurrence after conization. The use of clinical (age and tobacco use), pathological (surgical margins) and molecular (human papilloma virus-16 genotyping) factors can facilitate more appropriate patient follow up according to risk stratification.
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Affiliation(s)
- Carlos E M C Andrade
- Gynecologic Oncology, Barretos Cancer Hospital/Pio XII Foundation, Barretos, São Paulo, Brazil
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Liu J, Cheng Y, He M, Yao S. Vascular endothelial growth factor C enhances cervical cancer cell invasiveness via upregulation of galectin-3 protein. Gynecol Endocrinol 2014; 30:461-5. [PMID: 24650367 DOI: 10.3109/09513590.2014.898054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Vascular endothelial growth factor C (VEGF-C) promotes cervical cancer metastasis, while the detailed mechanism remains obscure. Recent evidence shows that galectin-3 (Gal-3), a glycan binding protein, interacts with the VEGF receptors and reinforces their signal transduction. In this study, we investigated the role of Gal-3 in VEGF-C-induced cervical cancer cell invasion. On cervical carcinoma cell line SiHa cells, silencing of Gal-3 expression with specific siRNA largely impaired VEGF-C-enhanced cell invasion. Treatment with VEGF-C for 12-48 h enhanced Gal-3 protein expression, which was inhibited by the addition of NF-κB inhibitor pyrrolidine dithiocarbamate (PDTC). Moreover, the silencing of NF-κB subunit p65 expression with specific siRNA attenuated VEGF-C-enhanced Gal-3 expression, suggesting that NF-κB is the key intermediate. Under VEGF-C stimulation, an enhanced interaction between VEGF receptor-3 (VEGF-R3) and Gal-3 was found, which may possibly lead to VEGF-R3 activation since exogenous Gal-3 induced VEGF-R3 phosphorylation in a dose- and time-dependent manner. In conclusion, our findings implied that VEGF-C enhanced cervical cancer invasiveness via upregulation of Gal-3 protein through NF-κB pathway, which may shed light on potential therapeutic strategies for cervical cancer therapy.
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Affiliation(s)
- Junxiu Liu
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Sun Yat-Sen University , Guangdong, Guangzhou , China and
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