Associations between smoking, screening, and death caused by cervical cancer in Korean women

Disturbance of Bcl-2, Bax, Caspase-3, Ki-67 and C-myc expression in acute and subchronic exposure to benzo(a)pyrene in cervix

Epidemiological studies have demonstrated that cigarette smoking is an important cofactor or an independent risk factor for the development of cervical cancer. Benzo(a)pyrene (BaP) is one of the most potent tobacco smoke carcinogens in tobacco smoke. BaP induced DNA damage and over expression in p53 cervical tissue of mice as demonstrated in our previous study. Here we present the findings of exposure to BaP on the expression of Bcl-2, C-myc, Ki-67, Caspase-3 and Bax genes in mouse cervix. Acute intraperitoneal administration of BaP (12.5, 25, 50, 100mg/kg body weight) to ICR female mice induced a significant increase in Bcl-2, C-myc, Ki-67 mRNA and protein level till 72h except in Bcl-2 at 24h with 12.5, 25, 50mg/kg as well as at 48h with 12.5mg/kg body weight post treatment. A significant increase was also seen in Caspase-3 and Bax mRNA and protein level with peak level at 24h and gradual decrease till 72h, however, the expression of caspase-3 increased while that of Bax decreased with increasing dose of Bap after 24h. In sub chronic intraperitoneal and oral gavage administration of BaP (2.5, 5, 10mg/kg body weight), similar significant increase was observed for all the examined genes as compared to the control and vehicle groups, however the expression of Bax decreased in a dose dependent manner. The findings of this study will help in further understanding the molecular mechanism of BaP induced carcinogenesis of cervical cancer.

Cancer incidence in the vicinity of nuclear power plants in Taiwan: a population-based study

Numerous antinuclear demonstrations reveal that the public is anxious about the potential health effects caused by nuclear power plants. The purpose of this study is to address the question "Is there a higher cancer incidence rate in the vicinity of nuclear power plants in Taiwan?" The Taiwan Cancer Registry database from 1979 to 2003 was used to compare the standardized incidence rate of the top four cancers with strong evidence for radiation risks between the "plant-vicinity" with those "non-plant-vicinity" groups. All cancer sites, five-leading cancers in Taiwan, and gender-specific cancers were also studied. We also adopted different observation time to compare the incidence rate of cancers between two groups to explore the impact of the observation period. The incidences of leukemia, thyroid, lung, and breast cancer were not significantly different between two groups, but cervix uteri cancer showed higher incidence rates in the plant-vicinity group. The incidence of cervical cancer was not consistently associated with the duration of plant operation, according to a multiyear period comparison. Although there was higher incidence in cervix cancer in the plant-vicinity group, our findings did not provide the crucial evidence that nuclear power plants were the causal factor for some cancers with strong evidence for radiation risks.

Association between serum folate level and cervical cancer: a meta-analysis

PURPOSE

The aim of this study was to evaluate the association between serum folate level and cervical cancer.

METHODS

PubMed, Medline, Springer, Elsevier Science Direct, Cochrane Library and Google scholar were searched for relevant trials. Rev.Man5.1 and Stata 11.0 software were applied for this meta-analysis. Odds Ratio (OR) and 95 % confidence intervals (95 % CI) were collected and calculated in a fixed-effects model or a random-effects model when appropriate. Subgroup analysis was performed by sample size, participant's geographical location and definition of deficient serum folate level.

RESULTS

A total of 6 case-control studies including 2383 participants were included in the meta-analysis. The overall meta-analysis showed that there were significant differences between cases and controls, suggesting that deficient serum folate level was associated with the increased risk of cervical cancer. After stratification subgroup analysis, significant difference was also found in subgroup with sample size <500 as well as in Asian population, but not in subgroup with sample size ≥500, American populations as well as different definition of deficient serum folate level (<6.4 ng/ml or others).

CONCLUSIONS

Based on our meta-analysis, deficiency of serum folate level was associated with the increased risk of cervical cancer among Asian populations.

Smokers With Cervix Cancer Have More Uterine Corpus Invasive Disease and an Increased Risk of Recurrence After Treatment With Chemoradiation

Background

Smoking is a risk factor for cervix cancer and causes hypoxemia, which promotes tumor infiltration and potentially impacts on treatment outcome. We performed a retrospective study to determine if smokers had an increased risk of uterine corpus infiltration, which is associated with more advanced disease and/or treatment failure after primary chemoradiation.

Methods

Results from a prospective database of patients treated with primary chemoradiation for locally advanced cervix cancer with a pretreatment MRI were analyzed. Smoking status was assessed by self-report at presentation.

Results

Smoking status was recorded for 346 of the 362 patients with 98 current smokers (28%), 56 ex-smokers (16%), and 192 nonsmokers (55%). Median age was 58 years with ever-smokers having a younger age at diagnosis than nonsmokers. Histologic type, International Federation of Gynecology and Obstetrics stage, tumor volume, and nodal involvement were similar across groups, as were toxicities of treatment. Ever-smokers were more likely to have corpus uterine invasion than nonsmokers. Ever-smokers had more recurrences than nonsmokers, with nonsmokers having a longer median overall survival (50.1 vs 38.7 months, P = 0.004) and relapse-free survival (46.8 vs 28.5 months, P = 0.003). In multifactor analysis, ever-smoking status was a significant predictor of developing corpus invasive disease and of inferior relapse-free and overall survival after treatment.

Conclusions

Smokers have a greater risk for developing corpus invasive cervix cancer. Although nonsmokers have an older age at diagnosis, they live longer and have fewer recurrences after a diagnosis of locally advanced carcinoma of the cervix.

Factors associated with the use of uterine cervical cancer screening services in korean elderly women

Background

The Papanicolaou (Pap) smear test is an effective screening test for the early detection of uterine cervical cancer. The Pap test still plays an important role in Korean elderly women, as uterine cervical cancer remains a frequent form of cancer and an important cause of death. However, the participation rate and other factors related to the Pap test in Korean elderly women have been studied insufficiently.

Methods

This study included 654 individuals aged 65 and over who completed a cervical cancer screening questionnaire from the Third Korean National Health and Nutrition Examination Survey 2005. Using multiple logistic regression, odds ratios and confidence intervals for the association between attendance of the Pap test and sociodemographic or health-related factors were calculated.

Results

One hundred and eleven individuals (17.0%) of the study population showed compliance with Pap testing within the previous 2 years. We recognized that the most elderly women (75 years and over) or those with lower levels of education were less likely to have had the test.

Conclusion

Primary health care providers need to make efforts to improve attendance rates of Pap smear screening in Korean elderly women, individually taking into account previous Pap results, life expectancy, risk factors for cervical cancer, and preferences. More attention will especially be needed among the eldest elderly or less educated elderly women.

Vaginal delivery and low immunity are strongly associated with high-grade cervical intraepithelial neoplasia in a high-risk population

OBJECTIVE

To test the association between high-grade cervical intraepithelial neoplasia (CIN), including CIN 2 and CIN 3, and the main risk factors established in the literature, such as age, early onset of sexual activity, use of hormonal contraception, smoking, sexually transmitted diseases, immunosuppression, the number of deliveries, and abortions.

MATERIALS AND METHODS

A cross-sectional study using medical records of 531 women examined for a period of 2 years in a referral center in southern Brazil.

RESULTS

Multivariate logistic regression analysis confirmed the following risk factors for high-grade CIN: smoking (odds ratio [OR] = 1.92, with 95% confidence interval [CI] = 1.13-3.27), immunosuppression (OR = 3.45, 95% CI = 1.61-7.43), abortion (OR = 2.15, 95% CI = 1.07-4.35) and 2 or more abdominal deliveries (OR = 3.46, 95% CI = 1.90-6.27).

CONCLUSIONS

Cervical cancer screening should give special attention to the women with the above profile of risk factors by shortening the time interval between the screens.

A common carcinogen benzo[a]pyrene causes p53 overexpression in mouse cervix via DNA damage

Benzo[a]pyrene (BaP) is cytotoxic and/or genotoxic to lung, stomach and skin tissue in the body. However, the effect of BaP on cervical tissue remains unclear. The present study detected DNA damage and the expression of the p53 gene in BaP-induced cervical tissue in female mice. Animals were intraperitoneally injected and orally gavaged with BaP at the doses of 2.5, 5, and 10mg/kg twice a week for 14 weeks. The single-cell gel electrophoresis (SCGE) assay was used to detect the DNA damage. Immunohistochemistry (IHC) and in situ hybridization (ISH) were used to detect the expression of p53 protein and p53 mRNA, respectively. The results showed that BaP induced a significant and dose-dependent increase of the number of cells with DNA damaged and the tail length as well as Comet tail moment in cervical tissue. The expression level of p53 protein and mRNA was increased. The results demonstrate that BaP may show toxic effect on the cervix by increasing DNA damage and the expression of the p53 gene.

Development and validation of the Excess Mortality Ratio-adjusted Injury Severity Score Using the International Classification of Diseases 10th Edition

OBJECTIVES

This study aimed to develop and validate a new method for measuring injury severity, the excess mortality ratio-adjusted Injury Severity Score (EMR-ISS), using the International Classification of Diseases 10th Edition (ICD-10).

METHODS

An injury severity grade similar to the Abbreviated Injury Scale (AIS) was converted from the ICD-10 codes on the basis of quintiles of the EMR for each ICD-10 code. Like the New Injury Severity Score (NISS), the EMR-ISS was calculated from three maximum severity grades using data from the Korean National Injury Database. The EMR-ISS was then validated using the Hosmer-Lemeshow goodness-of-fit chi-square (HL chi-square, with lower values preferable), the area under the receiver operating characteristic curve (AUC-ROC), and the Pearson correlation coefficient to compare it with the International Classification of Diseases 9th Edition-based Injury Severity Score (ICISS). Nationwide hospital discharge abstract data (DAD) from stratified-sample general hospitals (n = 150) in 2004 were used for an external validation.

RESULTS

The total number of study subjects was 29,282,531, with five subgroups of particular interest identified for further study: traumatic brain injury (TBI, n = 3,768,670), traumatic chest injury (TCI,n = 1,169,828), poisoning (n = 251,565), burns (n = 869,020), and DAD (n = 26,374). The HL chi-square was lower for EMR-ISS than for ICISS in all groups: 42,410.8 versus 55,721.9 in total injury, 7,139.6 versus 20,653.9 in TBI, 6,603.3 versus 4,531.8 in TCI, 2,741.2 versus 9,112.0 in poisoning, 764.4 versus 4,532.1 in burns, and 28.1 versus 49.4 in DAD. The AUC-ROC for death was greater for EMR-ISS than for ICISS: 0.920 versus 0.728 in total injury, 0.907 versus 0.898 in TBI, 0.675 versus 0.799 in TCI, 0.857 versus 0.900 in poisoning, 0.735 versus 0.682 in burns, and 0.850 versus 0.876 in DAD. The Pearson correlation coefficient between the two scores was )0.68 in total injury, )0.76 in TBI, )0.86 in TCI, )0.69 in poisoning,)0.58 in burns, and )0.75 in DAD.

CONCLUSIONS

The EMR-ISS showed better calibration and discrimination power for prediction of death than the ICISS in most injury groups. The EMR-ISS appears to be a feasible tool for passive injury surveillance of large data sets, such as insurance data sets or community injury registries containing diagnosis codes. Additional further studies for external validation on prospectively collected data sets should be considered.