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Daviu Cobián C, Oreskov JO, Blaakaer J, Jespersen E, Jørgensen TL, Ryg J, Herrstedt J, Høgdall C, Lund CM, Seibæk L, Vinther A, Ekmann-Gade AW, Schnack TH. Impact of FRAilty screening and Geriatric assessment and INtervention in older patients with epithelial Ovarian Cancer: A multicenter randomized clinical trial protocol (FRAGINOC). J Geriatr Oncol 2024; 15:101713. [PMID: 38326125 DOI: 10.1016/j.jgo.2024.101713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Radical surgery combined with chemotherapy is the only potential curative treatment of patients with advanced epithelial ovarian cancer (EOC). However, 43% of older Danish patients with EOC are not referred to surgery due to frailty, age, or fear of complications. Comprehensive geriatric assessment (CGA) has demonstrated ability to reduce frailty in older patients, but there is a knowledge gap regarding its effect before or during treatment in older adults with EOC. This protocol presents a randomized controlled trial (RCT), which evaluates the effect of CGA-based interventions including individualized physical exercise therapy in older adults with EOC during neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS This RCT will include patients aged ≥70 years with primary EOC referred to NACT. Patients will be randomized 1:1 to intervention or standard of care, along with neoadjuvant antineoplastic treatment. Stratification for performance status and center of inclusion will be performed. In the intervention arm, a geriatrician will perform CGA and corresponding geriatric interventions and patients will undergo an individualized home-based exercise program managed by a physiotherapist. All patients will be evaluated with Geriatric-8, modified Geriatric-8, clinical frailty scale, and physical tests at randomization. Predictive values (positive/negative) will be evaluated for CGA detected impairments. The primary endpoint is the proportion of patients referred to interval debulking surgery (IDS). Secondary endpoints include the proportion who complete oncological treatment, improvements in physical tests, quality of life measured by European Organization for Research and Treatment of Cancer-Quality of Life questionnaires at inclusion, after three cycles of chemotherapy, and at end of chemotherapy treatment. Furthermore, the association between results of geriatric screening tests, CGA, and physical tests with complication rate and progression free survival will be examined. The primary outcome will be analyzed with logistic regression in the intention-to-treat population. Power calculations reveal the need to enroll 216 patients. DISCUSSION The present study examines whether CGA-based interventions including individualized physical exercise can increase the referral rate for potential curative IDS in older patients with EOC. If successful, this will result in more patients undergoing surgery and completing chemotherapy, preventing complications, and ultimately improving quality of life and survival. The study setup may establish the basis for direct clinical implementation if proven effective.
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Affiliation(s)
- Cristina Daviu Cobián
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark; Department of Gynecology and Obstetrics, Odense University Hospital, Denmark.
| | - Jakob O Oreskov
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Eva Jespersen
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Trine L Jørgensen
- Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark; Department of Geriatric Medicine, Odense University Hospital, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Claus Høgdall
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Cecilia M Lund
- Department of Medicine, Herlev and Gentofte hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Lene Seibæk
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark; Hospital Secretariat and Communications, Research, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Anne Weng Ekmann-Gade
- Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark
| | - Tine H Schnack
- Department of Gynecology and Obstetrics, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
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Laschke A, Blaakaer J, Jensen CF, Larsen MB. Danish women's preferences regarding gynecological examination support international recommendations: A cross-sectional study. Int J Gynaecol Obstet 2023; 162:1068-1076. [PMID: 37158417 DOI: 10.1002/ijgo.14828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Gynecological examinations (GEs) are challenging for many women. Several recommendations and guidelines have emerged, partly based on common sense and clinicians' consensus. However, there is a lack of knowledge regarding women's opinions. Therefore, this study aimed to describe women's preferences and experiences in relation to GEs and investigate whether they are dependent on their socioeconomic status. METHODS In Denmark, GEs are typically performed by general practitioners or resident specialists in gynecology (RSGs) in gynecological hospital departments. This cross-sectional questionnaire and register study included approximately 3000 randomly selected patients who visited six RSGs from January 1, 2020, to March 1, 2021. The main outcome measurement involved women's preferences and experiences regarding GEs. RESULTS Overall, 37% of the women thought that a changing room was important, 20% preferred a garment to cover themselves, 18% preferred a separate examination room, and 13% thought that the presence of a chaperone was important. Compared with working and retired women, more women outside the workforce felt insufficiently informed, considered their experience with RSGs unprofessional, and found GEs painful. CONCLUSION Our results support existing recommendations regarding GEs and the related environment, confirming that privacy and modesty are factors to take into consideration as they are of concern for a relatively large group of women. Thus, providers should focus on women outside the workforce, because this group appears to feel vulnerable in this environment.
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Affiliation(s)
- Alexander Laschke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Speciallaegeselskabet Alexander Laschke ApS, Aabenraa, Denmark
| | - Jan Blaakaer
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
| | | | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
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Rivera-Izquierdo M, Maes-Carballo M, Jiménez-Moleón JJ, Martínez-Ruiz V, Blaakaer J, Olmedo-Requena R, Khan KS, Jørgensen JS. Gender bias in shared decision-making among cancer care guidelines: A systematic review. Health Expect 2023; 26:1019-1038. [PMID: 37016907 PMCID: PMC10154819 DOI: 10.1111/hex.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/09/2023] [Accepted: 03/03/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND In cancer care, the promotion and implementation of shared decision-making in clinical practice guidelines (CPG) and consensus statements may have potential differences by gender. OBJECTIVE To systematically analyse recommendations concerning shared decision-making in CPGs and consensus statements for the most frequent cancers exclusively among males (prostate) and females (endometrial). SEARCH STRATEGY We prospectively registered the protocol at PROSPERO (ID: RD42021241127). MEDLINE, EMBASE, Web of Science, Scopus and online sources (8 guideline databases and 65 professional society websites) were searched independently by two reviewers, without language restrictions. INCLUSION CRITERIA CPGs and consensus statements about the diagnosis or treatment of prostate and endometrial cancers were included from January 2015 to August 2021. DATA EXTRACTION AND SYNTHESIS Quality assessment deployed a previously developed 31-item tool and differences between the two cancers analysed. MAIN RESULTS A total of 176 documents met inclusion criteria, 97 for prostate cancer (84 CPGs and 13 consensus statements) and 79 for endometrial cancer (67 CPGs and 12 consensus statements). Shared decision-making was recommended more often in prostate cancer guidelines compared to endometrial cancer (46/97 vs. 13/79, 47.4% vs. 16.5%; p < .001). Compared to prostate cancer guidelines (mean 2.14 items, standard deviation 3.45), compliance with the shared-decision-making 31-item tool was lower for endometrial cancer guidelines (mean 0.48 items, standard deviation 1.29) (p < .001). Regarding advice on the implementation of shared decision-making, it was only reported in 3 (3.8%) endometrial cancer guidelines and in 16 (16.5%) prostate cancer guidelines (p < .001). DISCUSSION AND CONCLUSIONS We observed a significant gender bias as shared decision-making was systematically more often recommended in the prostate compared to endometrial cancer guidelines. These findings should encourage new CPGs and consensus statements to consider shared decision-making for improving cancer care regardless of the gender affected. PATIENT OR PUBLIC CONTRIBUTION The findings may inform future recommendations for professional associations and governments to update and develop high-quality clinical guidelines to consider patients' preferences and shared decision-making in cancer care.
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Affiliation(s)
- Mario Rivera-Izquierdo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Service of Preventive Medicine, Hospital Universitario San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain
| | - Marta Maes-Carballo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Academic Department of General Surgery, Complexo Hospitalario de Ourense, Ourense, Spain
- Academic Department of General Surgery, Hospital Público de Verín, Verín, Spain
| | - José J Jiménez-Moleón
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Virginia Martínez-Ruiz
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Jan Blaakaer
- Research Unit of Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Rocío Olmedo-Requena
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Khalid S Khan
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Jan S Jørgensen
- Research Unit of Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Daviu C, Blaakaer J, Eriksson AGZ, Herrstedt J, Vandborg MP, Rasmussen AMO, Fuglsang K. Nonepithelial ovarian cancer – the current clinical practice in the Nordic countries. Survey from the surgical subcommittee of the Nordic society of gynecological oncology (NSGO). Acta Oncol 2022; 61:939-945. [DOI: 10.1080/0284186x.2022.2088249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- C. Daviu
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ane Gerda Z. Eriksson
- Department of Gynecologic Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital; Oslo University Hospital, Oslo, Norway
| | - Jørn Herrstedt
- Department of Clinical Oncology, Zealand University Hospital, Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, Denmark
| | - M. P. Vandborg
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Katrine Fuglsang
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
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Hammer A, Blaakaer J, de Koning MNC, Steiniche T, Mejlgaard E, Svanholm H, Roensbo MT, Fuglsang K, Doorbar J, Andersen RH, Quint WGV, Gravitt PE. Evidence of latent HPV infection in older Danish women with a previous history of cervical dysplasia. Acta Obstet Gynecol Scand 2022; 101:608-615. [PMID: 35481603 DOI: 10.1111/aogs.14362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Understanding whether human papillomavirus (HPV) may establish latency in the uterine cervix is important. A better understanding of HPV natural history is useful for clinical counseling of women attending screening and to accurately inform health prevention strategies such as screening and HPV vaccination. We evaluated the extent of latent HPV infections in older women with a history of abnormal cytology. MATERIAL AND METHODS We conducted a cross-sectional study in Aarhus, Denmark, from March 2013 through April 2015. Women were enrolled if they underwent cervical amputation or total hysterectomy because of benign disease. Prior to surgery, women completed a questionnaire and a cervical smear was collected for HPV testing and morphological assessment. For evaluation of latency (i.e., no evidence of active HPV infection, but HPV detected in the tissue), we selected women with a history of abnormal cervical cytology or histology, as these women were considered at increased risk of harboring a latent infection. Cervical tissue underwent extensive HPV testing using the SPF10-DEIA-LipA25 assay. RESULTS Of 103 women enrolled, 26 were included in this analysis. Median age was 55 years (interquartile range [IQR] 52-65), and most women were postmenopausal and parous. The median number of sexual partners over the lifetime was six (IQR 3-10), and 85% reported no recent new sexual partner. Five women (19.2%) had evidence of active infection at the time of surgery, and 19 underwent latency evaluation. Of these, a latent infection was detected in 11 (57.9%), with HPV16 being the most prevalent type (50%). Nearly 80% (n = 14) of the 18 women with a history of previous low-grade or high-grade cytology with no treatment had an active or latent HPV infection, with latent infections predominating. HPV was detected in two of the six women with a history of high-grade cytology and subsequent excisional treatment, both as latent infections. CONCLUSIONS HPV can be detected in cervical tissue specimens without any evidence of an active HPV infection, indicative of a latent, immunologically controlled infection. Modeling studies should consider including a latent state in their model when estimating the appropriate age to stop screening and when evaluating the impact of HPV vaccination.
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Affiliation(s)
- Anne Hammer
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Gødstrup Hospital, Gødstrup, Denmark
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Torben Steiniche
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Else Mejlgaard
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Svanholm
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Mette T Roensbo
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Katrine Fuglsang
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - John Doorbar
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Rikke H Andersen
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Wim G V Quint
- DDL Diagnostic Laboratory, Viroclinics-DDL, Rijswijk, the Netherlands
| | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Beck A, Vind Thaysen H, Hasselholt Soegaard C, Blaakaer J, Seibaek L. What matters to you? An investigation of patients' perspectives on and acceptability of prehabilitation in major cancer surgery. Eur J Cancer Care (Engl) 2021; 30:e13475. [PMID: 34106493 DOI: 10.1111/ecc.13475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/26/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To understand perspectives on and acceptability of prehabilitation among patients undergoing complex abdominal cancer surgery (cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy). METHODS Seventy-nine patients admitted to a Danish colorectal or ovarian cancer centre participated in qualitative semi-structured interviews and/or registered their prehabilitation activities based on preoperative recommendations presented in a leaflet. Malterud's principles of systematic text condensation were used to analyse the interview data, and descriptive statistics were used to describe the activity registrations. RESULTS Five domains clarify central aspects of the patients' perspectives on and acceptability of prehabilitation: the preoperative period, attitudes towards prehabilitation, the actual prehabilitation performed, motivation to take action and the need for support. CONCLUSION Patients undergoing major abdominal cancer surgery are interested in and positive towards prehabilitation, but it has to be on their terms. The patients need support and supervision, but it has to be provided in a setting and in a way that are in line with the patient's preferences, resources and values. Thus, patient involvement is necessary to create prehabilitation programmes that are feasible and fit into patients' everyday lives.
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Affiliation(s)
- Anne Beck
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Jan Blaakaer
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Lene Seibaek
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
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Booth BB, Petersen LK, Blaakaer J, Johansen T, Mertz H, Kristensen CB, Lunde S, Dahl K, Bor P. Dynamic Spectral Imaging Colposcopy Versus Regular Colposcopy in Women Referred With High-Grade Cytology: A Nonrandomized Prospective Study. J Low Genit Tract Dis 2021; 25:113-118. [PMID: 33470739 PMCID: PMC7984761 DOI: 10.1097/lgt.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the sensitivity of dynamic spectral imaging (DSI) colposcopy compared with regular colposcopy for women referred with high-grade cervical cytology. METHODS In a prospective, nonrandomized, multicenter study, we included women referred for colposcopy at hospital gynecology clinics with high-grade cytology. Women were examined using either a regular or DSI colposcope. In both groups, colposcopists located 1 area viewed as most suspicious. In the DSI group, this was done before viewing the DSI map. Subsequently, an area was chosen based on the worst color of the DSI map, and further additional biopsies were taken. All women had 4 cervical biopsies taken, all analyzed separately. The main outcome was sensitivity to find cervical intraepithelial neoplasia grade 2 or worse (CIN2+). RESULTS A total of 261 women were examined using DSI colposcopy, and 156 women were examined using regular colposcopy. The sensitivity for finding CIN2+ when using the DSI technology as an adjunctive technology was found to be 82.2% (95% CI = 75.9-87.4), based on an average of 1.4 biopsies. This was corresponding in sensitivity to 2 biopsies taken using regular colposcopy (80.3%; 95% CI = 72.3-86.8). There was no difference in sensitivity for CIN+ between the groups when 3 or more biopsies were taken. CONCLUSIONS We found that the DSI colposcope may help direct biopsy placement; however, the improvement is based on small differences in needed biopsies and the clinical significance of this may be small. Multiple biopsies were still superior.
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Affiliation(s)
- Berit Bargum Booth
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Kjeld Petersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- OPEN Open Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tonje Johansen
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Henrik Mertz
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | | | - Søren Lunde
- Department of Gynecology and Obstetrics, Aalborg University Hospital, Aalborg, Denmark
| | - Katja Dahl
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Pinar Bor
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark
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Rasmussen LA, Jensen H, Virgilsen LF, Jeppesen MM, Blaakaer J, Hansen DG, Jensen PT, Mogensen O, Vedsted P. Identification of endometrial cancer recurrence - a validated algorithm based on nationwide Danish registries. Acta Oncol 2021; 60:452-458. [PMID: 33306454 DOI: 10.1080/0284186x.2020.1859133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Recurrence of endometrial cancer is not routinely registered in the Danish national health registers. The aim of this study was to develop and validate a register-based algorithm to identify women diagnosed with endometrial cancer recurrence in Denmark to facilitate register-based research in this field. MATERIAL AND METHODS We conducted a cohort study based on data from Danish health registers. The algorithm was designed to identify women with recurrence and estimate the accompanying diagnosis date, which was based on information from the Danish National Patient Registry and the Danish National Pathology Registry. Indicators of recurrence were pathology registrations and procedure or diagnosis codes suggesting recurrence and related treatment. The gold standard for endometrial cancer recurrence originated from a Danish nationwide study of 2612 women diagnosed with endometrial cancer, FIGO stage I-II during 2005-2009. Recurrence was suspected in 308 women based on pathology reports, and recurrence suspicion was confirmed or rejected in the 308 women based on reviews of the medical records. The algorithm was validated by comparing the recurrence status identified by the algorithm and the recurrence status in the gold standard. RESULTS After relevant exclusions, the final study population consisted of 268 women, hereof 160 (60%) with recurrence according to the gold standard. The algorithm displayed a sensitivity of 91.3% (95% confidence interval (CI): 85.8-95.1), a specificity of 91.7% (95% CI: 84.8-96.1) and a positive predictive value of 94.2% (95% CI: 89.3-97.3). The algorithm estimated the recurrence date within 30 days of the gold standard in 86% and within 60 days of the gold standard in 94% of the identified patients. DISCUSSION The algorithm demonstrated good performance; it could be a valuable tool for future research in endometrial cancer recurrence and may facilitate studies with potential impact on clinical practice.
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Affiliation(s)
- Linda A. Rasmussen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus, Denmark
| | - Henry Jensen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus, Denmark
| | - Line F. Virgilsen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus, Denmark
| | - Mette M. Jeppesen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jan Blaakaer
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Dorte G. Hansen
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Pernille T. Jensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Mogensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus, Denmark
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Mikkelsen MS, Petersen LK, Blaakaer J, Marinovskij E, Rosenkilde M, Andersen G, Bouchelouche K, Iversen LH. Assessment of peritoneal metastases with DW-MRI, CT, and FDG PET/CT before cytoreductive surgery for advanced stage epithelial ovarian cancer. Eur J Surg Oncol 2021; 47:2134-2141. [PMID: 33812768 DOI: 10.1016/j.ejso.2021.03.239] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preoperative assessment of peritoneal metastases is an important factor for treatment planning and selection of candidates for cytoreductive surgery (CRS) in primary advanced stage (FIGO stages III-IV) epithelial ovarian cancer (EOC). The primary aim was to evaluate the efficacy of DW-MRI, CT, and FDG PET/CT used for preoperative assessment of peritoneal cancer index (PCI). MATERIAL AND METHODS In this prospective observational cohort study, 50 advanced stage EOC patients were examined with DW-MRI and FDG PET/CT with contrast enhanced CT as part of the diagnostic program. All patients were deemed amenable for upfront CRS. Imaging PCI was determined for DW-MRI, CT, and FDG PET/CT by separate readers blinded to the surgical findings. The primary outcome was agreement between the imaging PCI and PCI determined at surgical exploration (the reference standard) evaluated with Bland-Altman statistics. RESULTS The median surgical PCI was 18 (range: 3-32). For all three imaging modalities, the imaging PCI most often underestimated the surgical PCI. The mean differences between the surgical PCI and the imaging PCI were 4.2 (95% CI: 2.6-5.8) for CT, 4.4 (95% CI: 2.9-5.8) for DW-MRI, and 5.3 (95% CI: 3.6-7.0) for FDG PET/CT, and no overall statistically significant differences were found between the imaging modalities (DW-MRI - CT, p = 0.83; DW-MRI - FDG PET/CT, p = 0.24; CT - FDG PET/CT, p = 0.06). CONCLUSION Neither DW-MRI nor CT nor FDG PET/CT was superior in preoperative assessment of the surgical PCI in patients scheduled for upfront CRS for advanced stage EOC.
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Affiliation(s)
- Mette Schou Mikkelsen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Lone Kjeld Petersen
- Open Patient Explorative Data Network, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 9 a, 3. Etage, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløvs Vej 15, 5000, Odense C, Denmark; Department of Gynecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Jan Blaakaer
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløvs Vej 15, 5000, Odense C, Denmark; Department of Gynecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Edvard Marinovskij
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mona Rosenkilde
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Gratien Andersen
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Lene Hjerrild Iversen
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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10
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Mremi A, Linde DS, Mchome B, Mlay J, Schledermann D, Blaakaer J, Rasch V. Acceptability and feasibility of self-sampling and follow-up attendance after text message delivery of human papillomavirus results: A cross-sectional study nested in a cohort in rural Tanzania. Acta Obstet Gynecol Scand 2021; 100:802-810. [PMID: 33555038 DOI: 10.1111/aogs.14117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The objective was to determine if self-collection of vaginal samples for human papillomavirus (HPV) testing was acceptable and feasible in rural Tanzania and to assess the extent of attendance at a follow-up appointment among women who tested HPV-positive after delivery of HPV results via text messages. MATERIAL AND METHODS A combined cross-sectional and cohort study was conducted among women aged 25-60 years from rural Kilimanjaro, Tanzania. Women were offered HPV self-sampling or traditional visual inspection of the cervix with acetic acid. If HPV self-sampling was preferred, participants received instructions on self-collection with an Evalyn Brush. A questionnaire was used to assess the acceptability and feasibility of the self-sampling procedure for the participants and delivery of HPV results via text messages. A mobile text message platform was used to send private text messages with the screening results to the participants. RESULTS A total of 1108 women were enrolled and self-collected an HPV sample; 11.8% tested positive for high-risk HPV. The majority (98.9%) agreed that they had no trouble in understanding the instructions on how to perform the self-collection and that they would recommend it to a friend (94.5%) or as a standard screening method in Tanzania (95.5%). A minority of women experienced bleeding (2.4%) or pain (6%) while collecting the sample, while some were worried that they would get hurt (12.7%) or felt embarrassed (3.5%). The majority (98.4%) of women would like to receive the screening test results via text messages. Eighty-two per cent of those who tested positive for high-risk HPV attended the follow-up appointment after receiving a text message reminder and an additional 16% attended after receiving both a text message and a phone call reminder whereas 2% did not attend follow up at all. Attendance was not influenced by age, marital status, education level, parity, or HIV status. CONCLUSIONS Human papillomavirus self-sampling and text-message feedback delivery are generally well-perceived and accepted among rural Tanzanian women, and the majority of HPV-positive women attended a follow-up appointment after receiving their HPV results and follow-up appointment via text messages. This screening method may have potential to be transferrable to other low-income countries with a high incidence of cervical cancer and so improve cervical cancer screening attendances.
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Affiliation(s)
- Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Center, Moshi, Tanzania.,Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ditte S Linde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.,Odense Patient Data Explorative Network (OPEN, Odense University Hospital, Odense, Denmark.,Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Joseph Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | | | - Jan Blaakaer
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Vibeke Rasch
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
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11
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Booth BB, Petersen LK, Blaakaer J, Johansen T, Mertz H, Dahl K, Bor P. Can the dynamic spectral imaging (DSI) color map improve colposcopy examination for precancerous cervical lesions? A prospective evaluation of the DSI color map in a multi-biopsy clinical setting. BMC Womens Health 2021; 21:21. [PMID: 33435974 PMCID: PMC7802273 DOI: 10.1186/s12905-020-01169-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022]
Abstract
Background Colposcopy serves as a subjective examination of the cervix with low sensitivity to detect cervical intraepithelial dysplasia (CIN) grade 2 or worse (CIN2 +). Dynamic spectral imaging (DSI) colposcopy has been developed to provide an objective element to cervix examinations and has been proven to increase sensitivity of detecting CIN2 + . We aimed to assess the performance of the DSI color map and compared it to histological diagnoses of cervical biopsies in determining the CIN grade present. Methods Women were included in a consecutive, prospective manner at Randers Regional Hospital, Denmark. Women were eligible to participate if they were referred for colposcopy due to abnormal cervical smear (threshold: ≥ ASCUS) or follow-up after previously diagnosed CIN. All women had four biopsies taken, one directed by colposcopists alone prior to viewing the DSI color map, one directed by the worst color on the respective DSI color map, and two additional biopsies. All biopsies were analyzed separately. We calculated sensitivity, specificity, positive predictive values, and negative predictive values (NPVs) with 95% confidence intervals (CIs). Results A total of 800 women were recruited. Of these, 529 (66.1%) were eligible for inclusion. The sensitivity of the DSI color map was found to be 48.1% (95% CI 41.1–55.1) in finding CIN grade 2 or worse (CIN2 +) when compared to the histological diagnosis of the DSI directed biopsy. This was 42.5% (95% CI 36.7–48.5) when compared to the final histological diagnosis of all four cervical biopsies and with an NPV of 53.5% (95% CI 50.5–56.5). Conclusion The worst color indicated by the DSI map might not consistently reflect the true grade of cervical dysplasia present. Thus, even though the DSI color map indicates low-grade changes, colposcopists should still consider taking biopsies from the area as high-grade changes might be present. Trial registration: NCT04249856, January 31 2020 (retrospectively registered).
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Affiliation(s)
- Berit Bargum Booth
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark. .,Department of Gynecology and Obstetrics, Randers Regional Hospital, Skovlyvej 15, 8390, Randers, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Lone Kjeld Petersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,OPEN Open Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tonje Johansen
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Henrik Mertz
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Katja Dahl
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Pinar Bor
- Department of Gynecology and Obstetrics, Randers Regional Hospital, Skovlyvej 15, 8390, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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Mikkelsen MS, Blaakaer J, Petersen LK, Schleiss LG, Iversen LH. Pharmacokinetics and toxicity of carboplatin used for hyperthermic intraperitoneal chemotherapy (HIPEC) in treatment of epithelial ovarian cancer. Pleura Peritoneum 2020; 5:20200137. [PMID: 33575463 PMCID: PMC7829861 DOI: 10.1515/pp-2020-0137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/06/2020] [Indexed: 12/03/2022] Open
Abstract
Objectives Carboplatin is frequently used in various doses for hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of epithelial ovarian cancer (EOC) although its pharmacokinetics, including focus on the perfusion time, has not been evaluated when used in modern era cytoreductive surgery (CRS). The aim was to evaluate the pharmacokinetics and hematological toxicity of carboplatin used for HIPEC with a perfusion time of 90 min. Methods Fifteen patients with stage III–IV primary EOC received CRS and 90 min of HIPEC with carboplatin at dose 800 mg/m2. For the pharmacokinetic analysis, perfusate and blood samples were obtained during HIPEC and up to 48 h after HIPEC (blood only). Hematological toxicity within 30 days was graded according to Common Terminology Criteria for Adverse Events. Severe toxicity (grades 3–5) is reported. Results Mean maximum concentration of carboplatin was 12 times higher in perfusate than plasma (mean CmaxPF=348 µg/mL (range: 279–595 µg/mL) versus mean CmaxPL=29 µg/mL (range: 21–39 µg/mL)). Mean terminal half-life of carboplatin in perfusate was 104 min (range: 63–190 min) and mean intraperitoneal-to-plasma area under the concentration-time curve (AUC) ratio was 12.3 (range: 7.4–17.2). Two patients (13%) had grade 3 neutropenia within 30 days. No grade 4–5 hematological toxicities were identified. Conclusions Carboplatin has a favorable pharmacokinetic profile for 90 min HIPEC administration, and the hematological toxicity was acceptable at dose 800 mg/m2. Large interindividual differences were found in the pharmacokinetic parameters, making risk of systemic exposure difficult to predict.
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Affiliation(s)
- Mette Schou Mikkelsen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Blaakaer
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Lone Kjeld Petersen
- Open Patient Explorative Data Network, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
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13
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Kjaer J, Jensen TS, Rolving N, Sørensen VN, Blaakaer J, Hammer A. Well-being of women referred due to suspected side effects after human papilloma virus vaccination. Dan Med J 2020; 67:A12190735. [PMID: 32741432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Due to increased reporting of presumed side effects following human papilloma virus (HPV) vaccination, the Danish Health Authority established five HPV clinics aiming to improve the diagnostics and treatment of affected women. Here, we aimed to describe characteristics of affected women 1-2 years after they attended an HPV clinic and to explore whether women who believed their symptoms were caused by the HPV vaccine were less likely to report symptom improvement than those who did not. METHODS A hospital-based, cross-sectional study was conducted at the HPV clinic in Silkeborg, 2017-2018. Information on symptoms, HPV vaccination, basic characteristics, etc. was retrieved using a validated questionnaire. Data were analysed descriptively and by logistic regression. RESULTS A total of 120 women were included. The median age at the first vaccine dose and the first visit to the clinic was 15 years (interquartile range (IQR): 13-23) and 23 years (IQR: 20-27), respectively. The median time from the first visit to the time the questionnaire was completed was 1.3 years (IQR: 1-1.6). At the time of the questionnaire, most women reported a wide range of symptoms, with physical symptoms being more common than psychological symptoms, and 70% of the reported symptoms had not improved over time. Of note, 90% believed that their symptoms were caused by the HPV vaccine. No difference in symptom improvement was found between women who believed that their symptoms occurred because of the HPV vaccine and those who did not. CONCLUSIONS Most women did not experience any improvement in their symptoms over time, and no association was found between lack of symptom improvement and believing that the HPV vaccine was causing the symptoms. FUNDING funded by the Danish Cancer Society. TRIAL REGISTRATION not relevant.
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14
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Beck A, Thaysen HV, Soegaard CH, Blaakaer J, Seibaek L. Investigating the experiences, thoughts, and feelings underlying and influencing prehabilitation among cancer patients: a qualitative perspective on the what, when, where, who, and why. Disabil Rehabil 2020; 44:202-209. [PMID: 32400218 DOI: 10.1080/09638288.2020.1762770] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: To investigate the experiences, thoughts, and feelings that underlie and influence prehabilitation among cancer patients due to undergo major abdominal surgery.Materials and methods: Prior to their surgery, sixteen patients with peritoneal carcinomatosis of colorectal or ovarian origin due to undergo major surgery received oral information and a leaflet with preoperative recommendations. They subsequently participated in individual, semi-structured interviews. Malterud's principles of systematic text condensation were used to analyse the interviews, and the concept of action competence inspired and framed the discussion.Results: Although the patients found themselves in an unpredictable and uncontrollable situation, they nevertheless knew what was important to them. These factors were contextualised in five themes that reflected the experiences, thoughts, and feelings that underlay and influenced their actions: "Perception of preparation," "The two-sided preoperative period," "Home or facility-based prehabilitation," "Stakeholders in prehabilitation," and "Reasons for taking action".Conclusions: The patients demonstrated action competence in relation to their preoperative preparation. However, in relation to the kind of prehabilitation that required lifestyle changes, their action competence needed to be developed and supported. To do so, it is necessary to ask questions that cover the patients' perspectives of the what, when, where, who, and why of prehabilitation.IMPLICATIONS FOR REHABILITATIONPatients undergoing major, abdominal cancer surgery have very clear opinions about what are important to them during the preoperative period, and this is not only limited to prehabilitation-related actions.In order to develop patients' action competence in relation to prehabilitation, patients need more support and supervision from health professionals.Qualitative in-depth knowledge concerning the what, when, where, who, and why of prehabilitation should be taken into account in the development of future prehabilitation programmes.
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Affiliation(s)
- Anne Beck
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Jan Blaakaer
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Lene Seibaek
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
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15
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Booth BB, Petersen LK, Blaakaer J, Johansen T, Mertz H, Dahl K, Bor P. Accuracy of colposcopy-directed biopsy vs dynamic spectral imaging directed biopsy in correctly identifying the grade of cervical dysplasia in women undergoing conization: A methodological study. Acta Obstet Gynecol Scand 2020; 99:1064-1070. [PMID: 32105344 DOI: 10.1111/aogs.13832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/05/2020] [Accepted: 02/23/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Dynamic spectral imaging (DSI) colposcopy has previously been found to improve sensitivity of CIN2+ detection. The aim of this study was to compare the histological diagnosis of colposcopic-directed biopsies (CDB) with that of DSI-directed biopsies in women undergoing conization, using the histological diagnosis of the conization specimen as gold standard. MATERIAL AND METHODS Women referred for colposcopy were included in a prospective cohort study at Randers Regional Hospital, Denmark, from January 2016 to February 2019. All women had four cervical punch biopsies taken. The first biopsy was taken from the area that appeared most abnormal by conventional colposcopy (ie, CDB) and the second biopsy from the area that appeared most abnormal using the DSI map. An additional two biopsies were taken either from other visible lesions or as random biopsies. Biopsies were analyzed separately. If any biopsies revealed cervical dysplasia of such a degree that excisional treatment was recommended, the patient was referred for conization. Subsequently, we compared the histological diagnosis of CDB and DSI-directed biopsies with that of the cone biopsy. RESULTS A total of 573 women were enrolled, 170 of which underwent conization. In women with an adequate colposcopy and representative biopsies (n = 124) there was an overall agreement rate between the worst biopsy diagnosis (of any four) and the conization diagnosis in 95.2% (95% CI 89.8-98.2) of women. CDB diagnosis agreed with the cone diagnosis in 80.6% (95% CI 72.6-87.2) of women. DSI-directed biopsy agreed with the cone diagnosis in 83.9% (95% CI 76.2-89.9) of women. The difference in detection rate between the CDB and the DSI-directed biopsy was, however, not significant (P = .54). Taking four biopsies increases the detection rate of cervical dysplasia to 95.2%, which was a significant increase from both CDB alone (P = .0008) and DSI-directed biopsy alone (P = .0053). CONCLUSIONS We found no significant difference in the ability to identify the cervical dysplasia grade between CDB and DSI-directed biopsies. A higher detection rate of cervical dysplasia was achieved with four biopsies than with one CDB biopsy or one DSI-directed biopsy.
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Affiliation(s)
- Berit Bargum Booth
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.,Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Kjeld Petersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,OPEN Open Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tonje Johansen
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Henrik Mertz
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Katja Dahl
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Pinar Bor
- Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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16
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Beck A, Vind Thaysen H, Hasselholt Soegaard C, Blaakaer J, Seibaek L. Prehabilitation in cancer care: patients' ability to prepare for major abdominal surgery. Scand J Caring Sci 2020; 35:143-155. [PMID: 32043644 DOI: 10.1111/scs.12828] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/21/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients' perspectives on standardised, multimodal prehabilitation programmes showed barriers to adherence. Further investigation of patients' ability to prepare is needed. AIM To investigate what patients with cancer who were due to undergo major abdominal surgery actually were able to do when provided with preoperative, home-based, multimodal recommendations presented in a leaflet. METHODS Patients from the colorectal- or ovarian cancer centre, who were scheduled for major abdominal surgery, received a leaflet with preoperative recommendations. On a daily basis, the patients filled in what they had completed in relation to these recommendations, so that adherence could be investigated. Additionally, face-to-face interviews were conducted to evaluate patients' experiences of using the leaflet. Malterud's principles of systematic text condensation were used to analyse the interviews. A convergent design was used to merge the quantitative and qualitative data into a combined interpretation presented in the discussion. RESULTS A total of 53 patients returned a completed leaflet, and five patients were interviewed. In the combined interpretation, patients' ability to prepare was presented through four major domains. The domains were adherence and the importance of support, manageable actions leading to change, preparation in a broader perspective and impediments to preparation and to symptom relief. CONCLUSIONS Patients prepared themselves in various ways, which were not limited to recommendations inspired by multimodal prehabilitation. Patients from the ovarian cancer centre increased their weekly exercise during the preoperative period, which indicates that the leaflet not only functioned as a data collection tool, but also motivated and supported the patients in prehabilitation-related actions. Patients' perspectives on prehabilitation need to be taken into account, when aiming to enhance patient-centredness and adherence.
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Affiliation(s)
- Anne Beck
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Jan Blaakaer
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Lene Seibaek
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
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17
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Vinkenes E, Nielsen MA, Blaakaer J. Is there evidence for efficacy of human papillomavirus vaccination in solid organ transplant recipients? Eur J Obstet Gynecol Reprod Biol X 2019; 4:100015. [PMID: 31673683 PMCID: PMC6817653 DOI: 10.1016/j.eurox.2019.100015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 11/25/2022] Open
Abstract
Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide and is associated with precancerous lesions and cancers of the cervix, vulva, vagina, penis, anus, tonsils and base of the tongue. Several studies show an increased risk of HPV-associated cancers in solid organ transplant recipients (SOTR). The aims of this review are to investigate the evidence of efficacy for the HPV vaccination in transplant recipients and to discuss the known national guidelines. A systematic literature search has been conducted to identify studies where SOTR received the HPV vaccination to evaluate the efficacy of the HPV vaccine on this population. The primary outcome was antibody response against the HPV genotypes included in the vaccines and the secondary outcome was national guidelines recommending HPV vaccination of SOTR. Three cohort studies evaluated immunogenicity. Two studies found suboptimal effect of the HPV vaccine, while an early terminated study detected 100% seropositivity. We have identified four national guidelines in the following countries; United States of America, Canada, Australia and Ireland, along with a recommendation from the World Health Organization (WHO). The results from the three studies were inconclusive due to the small sample sizes and the diverging results. Recommendations of HPV vaccination of SOTR is based on the knowledge about safety and efficiency in the general population and the safety of other inactivated (not live) vaccines in SOTR. Theoretically, the nonavalent vaccine should be recommended as the first choice in SOTR without age- or sex restrictions.
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Affiliation(s)
- Emeline Vinkenes
- Odense University Hospital, Dept. of Obstetrics. & Gyn, Sdr. Boulevard 29, Odense 5000 C, Denmark
| | - Martine A Nielsen
- Odense University Hospital, Dept. of Obstetrics. & Gyn, Sdr. Boulevard 29, Odense 5000 C, Denmark
| | - Jan Blaakaer
- Odense University Hospital, Dept. of Obstetrics. & Gyn, Sdr. Boulevard 29, Odense 5000 C, Denmark
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18
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Mikkelsen MS, Christiansen T, Petersen LK, Blaakaer J, Iversen LH. Morbidity after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with carboplatin used for ovarian, tubal, and primary peritoneal cancer. J Surg Oncol 2019; 120:550-557. [PMID: 31267569 DOI: 10.1002/jso.25603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/07/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Hypertherm intraperitoneal chemotherapy (HIPEC) is increasingly used in the treatment of ovarian, tubal, and primary peritoneal cancer (OC). The aim was to evaluate short-term morbidity of cytoreductive surgery (CRS) and carboplatin HIPEC. METHODS Prospective feasibility study performed from January 2016 to December 2017. Twenty-five patients with primary OC (FIGO III-IV) received upfront or interval CRS combined with carboplatin HIPEC at dose 800 mg/m 2 . Primary outcome measurements: grade 3 to 5 adverse events within 30 days according to Common Terminology Criteria for Adverse Events. Secondary outcome measurements: reoperation rate, length of hospital stay, readmission rate, and time from surgery to systemic chemotherapy administration. RESULTS No deaths (grade 5) or grade 4 adverse events were observed. Eleven patients (44.0%) experienced at least one grade 3 adverse event, the most common being an infection (28.0%) and neutropenia (12.0%). The reoperation rate was 8.0%. The median hospital stay was 14 days (range 9-25 days), and five patients (25.0%) were readmitted within 30 days after surgery. Median time from surgery to the administration of the first dose of systemic chemotherapy was 41 days (range 24-81 days). CONCLUSION Our small-scale prospective study supports that CRS and carboplatin HIPEC used for primary advanced-stage OC is feasible with acceptable morbidity.
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Affiliation(s)
- Mette Schou Mikkelsen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Thora Christiansen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Kjeld Petersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
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Ingerslev K, Høgdall E, Skovrider-Ruminski W, Schnack TH, Lidang M, Høgdall C, Blaakaer J. The prevalence of EBV and CMV DNA in epithelial ovarian cancer. Infect Agent Cancer 2019; 14:7. [PMID: 30858874 PMCID: PMC6390605 DOI: 10.1186/s13027-019-0223-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background The underlying cause of epithelial ovarian cancer (EOC) is unknown. It has been theorized that infectious agents could contribute to ovarian tumorigenesis. Objective To investigate the potential role of oncogenic viral infection in EOC, we examined the prevalence of Epstein-Barr Virus (EBV) DNA and cytomegalovirus (CMV) DNA in EOC tissue samples. Methods Formalin-fixed, paraffin-imbedded (FFPE) tumor tissue samples from 198 patients included in the Danish Pelvic Mass Study were studied: 163 with serous adenocarcinomas, 15 with endometrioid adenocarcinomas, 11 with mucinous adenocarcinomas, and nine with clear-cell carcinomas. For controls in the EBV analysis, we used 176 tissue samples from patients diagnosed with benign mucinous cystadenomas. EBV and CMV genotyping was performed by real-time polymerase chain reaction with CMV and EBV CE-IVD approved kits. In-situ hybridization (ISH) was performed on the EBV positive samples. Results Sufficient DNA material was obtained in 191 and 174 tissue samples from cases and controls, respectively. Ten of 191 case samples (5.2%) and one of 174 control samples (0.5%) were positive for EBV DNA (P value = 0.011). CMV DNA was detected in only one case sample (0.5%). ISH confirmed that three of the samples were of stromal origin, while the remaining seven tested negative for EBV. Conclusions This study is the first to demonstrate a higher prevalence of EBV DNA in tissue samples from patients with EOC than in a benign control group. However, the cellular origin of seven of the samples could not be determined by ISH analysis. Our study did not support an association between CMV and EOC.
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Affiliation(s)
- Kasper Ingerslev
- 1Department of Gynecology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Estrid Høgdall
- 2Department of Pathology, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | | | - Tine Henrichsen Schnack
- 3Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Marianne Lidang
- 2Department of Pathology, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Claus Høgdall
- 3Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Jan Blaakaer
- 1Department of Gynecology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
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20
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Rask L, Høgdall CK, Kjaer SK, Christensen L, Jensen A, Blaakaer J, Christensen IJ, Høgdall EVS. Association of CD31 and p53 With Survival of Ovarian Cancer Patients. Anticancer Res 2019; 39:567-576. [PMID: 30711931 DOI: 10.21873/anticanres.13149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM New markers for ovarian cancer are needed. This study aimed to examine the expression of tumour cell p53 and endothelial cell CD31 proteins and correlate them to clinicopathological factors. PATIENTS AND METHODS Expression of proteins was immunohistochemically assessed using tissue sections from 585-599 ovarian cancer patients from the Danish MALOVA study. RESULTS High CD31 expression was found in poorly differentiated tumours (p=0.0006), and high p53 expression was found in poorly differentiated cancers (p<0.0001), high clinical stage (p<0.0001), non-radical surgery (p<0.0001) and high serum CA-125 values (p<0.0001). CD31 expression showed no prognostic survival value, but high hazard ratios were found for patients with high p53 expression (HR=2.313, p<0.0001). An interaction was found between p53 and stage of cancer, suggesting a prognostic impact of p53 in low-stage, but not in advanced-stage cancer. CONCLUSION More than 5% of p53 tissue expression may predict shorter survival of ovarian cancer patients and may be useful for predicting the risk of disease progression in low-stage patients following primary surgery. CD31 has no strong prognostic value.
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Affiliation(s)
- Lene Rask
- Department of Pathology, Herlev-og Gentofte Hospital, University of Copenhagen, Herlev, Denmark.,Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Claus K Høgdall
- Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne K Kjaer
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lise Christensen
- Department of Pathology, Herlev-og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Allan Jensen
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Ib Jarle Christensen
- Department of Pathology, Herlev-og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Estrid V S Høgdall
- Department of Pathology, Herlev-og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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21
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Hammer A, de Koning MN, Blaakaer J, Steiniche T, Doorbar J, Griffin H, Mejlgaard E, Svanholm H, Quint WG, Gravitt PE. Whole tissue cervical mapping of HPV infection: Molecular evidence for focal latent HPV infection in humans. Papillomavirus Res 2019; 7:82-87. [PMID: 30772498 PMCID: PMC6389775 DOI: 10.1016/j.pvr.2019.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 12/27/2022]
Abstract
In this study, we aimed to provide molecular evidence of HPV latency in humans and discuss potential challenges of conducting studies on latency. We analyzed the entire cervix of two women who underwent hysterectomy unrelated to cervical abnormality. The cervices were sectioned into 242 and 186 sets respectively, and each set was tested separately for HPV using the SPF10-PCR-DEIA-LiPA25 system. To identify whether there was any evidence of transforming or productive infection, we used the biomarkers E4 and P16INK4a to stain slides immediately adjacent to HPV-positive sections. HPV was detected in both cervices. In patient 1, 1/242 sets was positive for HPV31. In patient 2, 13/186 sets were positive for HPV18 and 1/186 was positive for HPV53. The infection was very focal in both patients, and there was no sign of a transforming or productive infection, as evaluated by the markers E4 and P16INK4a. Had we only analyzed one set from each block, the probability of detecting the infection would have been 32.3% and 2%, respectively.Our findings support the idea that HPV may be able to establish latency in the human cervix; however, the risk associated with a latent HPV infection remains unclear.
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Affiliation(s)
- Anne Hammer
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | | | - Jan Blaakaer
- Department of Obstetrics and Gynecology, Odense University Hospital, Denmark
| | - Torben Steiniche
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Pathology, Aarhus University Hospital, Denmark
| | - John Doorbar
- Department of Pathology, University of Cambridge, United Kingdom
| | - Heather Griffin
- Department of Pathology, University of Cambridge, United Kingdom
| | - Else Mejlgaard
- Department of Pathology, Aarhus University Hospital, Denmark
| | | | - Wim Gv Quint
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - Patti E Gravitt
- Department of Global Health, Milken Institute School of Public Health, the George Washington University, USA
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22
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Rask L, Høgdall CK, Kjaer SK, Christensen L, Jensen A, Blaakaer J, Christensen IJ, Høgdall EVS. Association of CD31 and p53 With Survival of Ovarian Cancer Patients. Anticancer Res 2019. [PMID: 30711931 DOI: 10.21873/anticanres.13149] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM New markers for ovarian cancer are needed. This study aimed to examine the expression of tumour cell p53 and endothelial cell CD31 proteins and correlate them to clinicopathological factors. PATIENTS AND METHODS Expression of proteins was immunohistochemically assessed using tissue sections from 585-599 ovarian cancer patients from the Danish MALOVA study. RESULTS High CD31 expression was found in poorly differentiated tumours (p=0.0006), and high p53 expression was found in poorly differentiated cancers (p<0.0001), high clinical stage (p<0.0001), non-radical surgery (p<0.0001) and high serum CA-125 values (p<0.0001). CD31 expression showed no prognostic survival value, but high hazard ratios were found for patients with high p53 expression (HR=2.313, p<0.0001). An interaction was found between p53 and stage of cancer, suggesting a prognostic impact of p53 in low-stage, but not in advanced-stage cancer. CONCLUSION More than 5% of p53 tissue expression may predict shorter survival of ovarian cancer patients and may be useful for predicting the risk of disease progression in low-stage patients following primary surgery. CD31 has no strong prognostic value.
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Affiliation(s)
- Lene Rask
- Department of Pathology, Herlev-og Gentofte Hospital, University of Copenhagen, Herlev, Denmark.,Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Claus K Høgdall
- Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne K Kjaer
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lise Christensen
- Department of Pathology, Herlev-og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Allan Jensen
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Ib Jarle Christensen
- Department of Pathology, Herlev-og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Estrid V S Høgdall
- Department of Pathology, Herlev-og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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23
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Hammer A, Soegaard V, Maimburg RD, Blaakaer J. Cervical cancer screening history prior to a diagnosis of cervical cancer in Danish women aged 60 years and older-A national cohort study. Cancer Med 2019; 8:418-427. [PMID: 30600650 PMCID: PMC6346234 DOI: 10.1002/cam4.1926] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 01/28/2023] Open
Abstract
The incidence and mortality of cervical cancer are high in Danish women aged 60 years and older who are about to exit the cervical cancer screening program. The present study aimed to describe the screening history in women ≥60 years old, diagnosed with cervical cancer in Denmark, 2009‐2013. We retrieved information on cases of cervical cancer and previous cervical cancer screening from national registries. During the study period, a total of 1907 women were diagnosed with cervical cancer, 574 (30.1%) of which were ≥60 years old. The majority of women were diagnosed with squamous cell carcinoma (73.7%) and advanced‐stage disease (ASD, ie, ≥FIGO IIB; 63.1%). The proportion of ASD increased with age, from 51.9% in women aged 60‐64% to 76.7% in women aged 75‐79. Among screened women (n = 377), 22.8% had a cervical cytology within 5 years of diagnosis, 73.3% of which were normal, and 45.1% were diagnosed with ASD. Women who had been sufficiently screened prior to screening exit (≥2 normal cytology test in the age interval 50‐59) accounted for 18.1%. Of note, 53.8% of the sufficiently screened women were diagnosed with ASD. Sufficiently screened women were less likely to be diagnosed with ASD compared to never‐screened women (53.8% vs 67.5%, P < 0.020), but no difference was observed between sufficiently and insufficiently screened women (53.8% vs 63.4%, P = 0.091). Our findings suggest that cancer in older women may occur due to insufficient screening prior to screening exit, a low sensitivity of screening, and premature screening exit.
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Affiliation(s)
- Anne Hammer
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Vibeke Soegaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Randers Regional Hospital, Randers, Denmark
| | - Rikke D Maimburg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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24
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Fuglsang K, Blaakaer J, Petersen LK, Mejlgaard E, Hammer A, Steiniche T. Detection of high-risk human papillomavirus DNA in tissue from primary cervical cancer tumor, pelvic lymph nodes and recurrent disease. Papillomavirus Res 2018; 7:15-20. [PMID: 30557633 PMCID: PMC6313832 DOI: 10.1016/j.pvr.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 12/08/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023]
Abstract
Objectives The present study investigated Human Papillomavirus (HPV) DNA genotyping in primary tumor, pelvic lymph nodes (PLN) and recurrence in early-stage cervical cancer patients. Methods We conducted a hospital-based case-control study. From 2003 to 2015, 282 patients underwent surgery for cervical cancer in the Department of Gynecology, Aarhus University Hospital, Denmark. Twenty-nine recurrent cases were identified. HPV DNA genotyping was performed on formalin-fixed, paraffin-embedded tissue specimens from the primary tumor, PLN, and recurrent disease. Results In the primary tumor, HPV DNA was detectable in 18(72%) of 25 tissue specimens from recurrent cases and in 15(83%) of 18 controls. HPV DNA-positive PLN was significantly associated with recurrence, 83%(95%CI: 52–98%), compared to patients with HPV-negative PLN, 38%(95%CI: 18–62%)(p < 0.05). HPV DNA genotyping was positive in eight of 12(67%) patients with recurrent disease. The genotype was identical in all three tissues types. The positive predictive value for recurrence was the same for detection of HPV-DNA and metastases in the PLN, with reasonable sensitivity. The negative predictive value for recurrence, however, was best for HPV-DNA, 62%(95%CI: 38–98%). Conclusions In conclusion, our data suggest that the presence of HPV in pelvic lymph nodes is associated with an increased risk of recurrence.
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Affiliation(s)
- Katrine Fuglsang
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Lone Kjeld Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Else Mejlgaard
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Hammer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
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25
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Fuglsang K, Haldorsen IS, Avall-Lundqvist E, Lindahl G, Roed H, Woie K, Pakarinen P, Thoroddsen A, Anttila M, Blaakaer J. Cervical cancer staging, pretreatment planning, and surgical treatment in the Nordic countries-Survey from the Surgical Subcommittee of the Nordic Society of Gynecological Oncology. Acta Obstet Gynecol Scand 2018; 97:1178-1184. [DOI: 10.1111/aogs.13388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Katrine Fuglsang
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | | | - Elisabeth Avall-Lundqvist
- Department of Oncology; Linköping University; Linköping Sweden
- Department of Clinical and Experimental Medicine; Linköping, University; Linköping Sweden
| | - Gabriel Lindahl
- Department of Oncology; Linköping University; Linköping Sweden
| | - Henrik Roed
- Department of Oncology; Rigshospitalet University Hospital; Copenhagen Denmark
| | - Kathrine Woie
- Department of Obstetrics and Gynecology; Haukeland University Hospital; Bergen Norway
| | - Päivi Pakarinen
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Asgeir Thoroddsen
- Department of Obstetrics and Gynecology; Reykjavik University Hospital; Reykjavik Iceland
| | - Maarit Anttila
- Department of Gynecology; Kuopio University Hospital; Kuopio Finland
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology; Odense University Hospital; Odense Denmark
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26
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Roensbo MT, Blaakaer J, Skov K, Hammer A. Cervical HPV prevalence and genotype distribution in immunosuppressed Danish women. Acta Obstet Gynecol Scand 2017; 97:142-150. [PMID: 29156081 DOI: 10.1111/aogs.13261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Women receiving immunosuppressive treatment due to organ transplantation are at increased risk of Human papilloma virus (HPV)-related diseases, including cervical neoplasia. This pilot study aimed to describe the cervical HPV prevalence and genotype distribution in immunosuppressed Danish women. MATERIAL AND METHODS We included women who underwent renal (RTR) or bone marrow transplantation (BMTR) in 2009-2012 or 2014 at Aarhus University Hospital, Denmark. Women undergoing transplantation in 2009-2012 had one cervical cytology performed, whereas women undergoing transplantation in 2014 had three, one before and two after transplantation. The samples were examined for cytological abnormalities and tested for HPV using Cobas® HPV Test and CLART® HPV2 Test. RESULTS Of 94 eligible cases we included 60 RTR and BMTR. The overall prevalence of high-risk HPV was 15.0 [95% confidence interval (CI) 7.1-26.6] and the prevalence was higher among BMTR (29.4; 95% CI 10.3-56.0) than RTR (9.3%, 95% CI 2.6-22.1), although this was not statistically significant (p = 0.10). The distribution of high-risk HPV was broad, with HPV 45 as the most common genotype (3.3%). The prevalences of high-risk HPV types included in the bivalent/quadrivalent and the nonavalent vaccines were 1.7 and 8.3%, respectively. The prevalence of low-grade and high-grade cytological abnormalities was 6.7 and 5.0%, respectively. CONCLUSIONS Immunosuppressed women were infected with a broad range of high-risk HPV genotypes and the prevalence of cytological abnormalities was higher than found in previous studies of the general population. The nonavalent HPV vaccine will offer immunosuppressed individuals a greater protection against HPV-related diseases compared with the bivalent/quadrivalent HPV vaccines.
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Affiliation(s)
- Mette T Roensbo
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Emergency, Viborg Hospital, Viborg, Denmark
| | - Jan Blaakaer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Karin Skov
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Hammer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Herning Hospital, Herning, Denmark
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27
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Ambühl LMM, Leonhard AK, Widen Zakhary C, Jørgensen A, Blaakaer J, Dybkaer K, Baandrup U, Uldbjerg N, Sørensen S. Human papillomavirus infects placental trophoblast and Hofbauer cells, but appears not to play a causal role in miscarriage and preterm labor. Acta Obstet Gynecol Scand 2017; 96:1188-1196. [PMID: 28699189 DOI: 10.1111/aogs.13190] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/19/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Recently, an association between human papillomavirus infection and both spontaneous abortion and spontaneous preterm delivery was suggested. However, the reported human papillomavirus prevalence in pregnant women varies considerably and reliable conclusions are difficult. We aimed to investigate human papillomavirus infection in placental tissue of a Danish study cohort. Furthermore, we studied the cellular localization of human papillomavirus. MATERIAL AND METHODS In this prospective case-control study, placental tissue was analyzed for human papillomavirus infection by nested PCR in the following four study groups: full-term delivery (n = 103), spontaneous preterm delivery (n = 69), elective abortion (n = 54), and spontaneous abortion (n = 44). Moreover, human papillomavirus cellular target was identified using in situ hybridization. RESULTS Human papillomavirus prevalence in placental tissue was 8.7% in full-term deliveries, 8.8% in spontaneous preterm deliveries, 10.9% in spontaneous abortions, and 20.4% in elective abortions. Twelve different human papillomavirus types were detected, and placental human papillomavirus infection was associated to a disease history of cervical cancer. Human papillomavirus DNA was identified in trophoblast cells, cells of the placental villi mesenchyme including Hofbauer cells, and in parts of the encasing endometrium. CONCLUSION Placental human papillomavirus infections are not likely to constitute a risk factor for spontaneous preterm labor or spontaneous abortions in the Danish population, although an effect of human papillomavirus DNA in placental cells cannot be excluded.
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Affiliation(s)
- Lea M M Ambühl
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne K Leonhard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Carina Widen Zakhary
- Department of Obstetrics and Gynecology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Annemette Jørgensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Karen Dybkaer
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulrik Baandrup
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Suzette Sørensen
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Hald AK, Blaakaer J. The possible role of human papillomavirus infection in the development of lichen sclerosus. Int J Dermatol 2017; 57:139-146. [DOI: 10.1111/ijd.13697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/02/2017] [Accepted: 06/09/2017] [Indexed: 12/26/2022]
Affiliation(s)
| | - Jan Blaakaer
- Department of Obstetrics and Gynaecology; Odense University Hospital; Odense Denmark
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29
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Ingerslev K, Hogdall E, Schnack TH, Skovrider-Ruminski W, Hogdall C, Blaakaer J. The potential role of infectious agents and pelvic inflammatory disease in ovarian carcinogenesis. Infect Agent Cancer 2017; 12:25. [PMID: 28529540 PMCID: PMC5437405 DOI: 10.1186/s13027-017-0134-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/26/2017] [Indexed: 12/27/2022] Open
Abstract
Background The etiological cause of ovarian cancer is poorly understood. It has been theorized that bacterial or viral infection as well as pelvic inflammatory disease could play a role in ovarian carcinogenesis. Aim To review the literature on studies examining the association between ovarian cancer and bacterial or viral infection or pelvic inflammatory disease. Methods Database search through MEDLINE, applying the medical subject headings: “Ovarian neoplasms”, AND “Chlamydia infections”, “Neisseria gonorrhoeae”, “Mycoplasma genitalium”, “Papillomaviridae”, or “pelvic inflammatory disease”. Corresponding searches were performed in EMBASE, and Web of Science. The literature search identified 935 articles of which 40 were eligible for inclusion in this review. Results Seven studies examined the association between bacterial infection and ovarian cancer. A single study found a significant association between chlamydial infection and ovarian cancer, while another study identified Mycoplasma genitalium in a large proportion of ovarian cancer cases. The remaining studies found no association. Human papillomavirus detection rates varied from 0 to 67% and were generally higher in the Asian studies than in studies from Western countries. Cytomegalovirus was the only other virus to be detected and was found in 50% of cases in a case-control study. The association between ovarian cancer and pelvic inflammatory disease was examined in seven epidemiological studies, two of which, reported a statistically significant association. Conclusions Data indicate a potential association between pelvic inflammatory disease and ovarian cancer. An association between ovarian cancer and high-risk human papillomavirus genotypes may exist in Asia, whereas an association in Western countries seems unlikely due to the low reported prevalence. Potential carcinogenic bacteria were found, but results were inconsistent, and further research is warranted. Electronic supplementary material The online version of this article (doi:10.1186/s13027-017-0134-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kasper Ingerslev
- Department of Gynaecology and Obstetrics, Odense University Hospital, Denmark, Soendre Blvd. 29, 5000 Odense C, Denmark
| | - Estrid Hogdall
- Department of Pathology, Herlev and Gentofte Hospital, Denmark, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Tine Henrichsen Schnack
- Gynaecologic Clinic, Copenhagen University Hospital, Denmark, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | | | - Claus Hogdall
- Gynaecologic Clinic, Copenhagen University Hospital, Denmark, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jan Blaakaer
- Department of Gynaecology and Obstetrics, Odense University Hospital, Denmark, Soendre Blvd. 29, 5000 Odense C, Denmark
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Hammer A, Kahlert J, Rositch A, Pedersen L, Gravitt P, Blaakaer J, Soegaard M. The temporal and age-dependent patterns of hysterectomy-corrected cervical cancer incidence rates in Denmark: a population-based cohort study. Acta Obstet Gynecol Scand 2016; 96:150-157. [DOI: 10.1111/aogs.13057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Anne Hammer
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - Johnny Kahlert
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | - Anne Rositch
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | - Lars Pedersen
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | - Patti Gravitt
- Department of Global Health; George Washington University; Washington DC USA
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - Mette Soegaard
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
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Thomsen LH, Schnack TH, Buchardi K, Hummelshoj L, Missmer SA, Forman A, Blaakaer J. Risk factors of epithelial ovarian carcinomas among women with endometriosis: a systematic review. Acta Obstet Gynecol Scand 2016; 96:761-778. [DOI: 10.1111/aogs.13010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Line H. Thomsen
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | - Tine H. Schnack
- Gynecologic and Obstetric Department; Rigshospitalet University Hospital of Copenhagen; Copenhagen Denmark
| | | | | | - Stacey A. Missmer
- Department of Obstetrics; Gynecology and Reproductive Biology College of Human Medicine; Michigan State University; Boston MA USA
- Department of Epidemiology; Harvard T.H. Chan School of Public Health; Boston MA USA
| | - Axel Forman
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
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Hammer A, Rositch A, Qeadan F, Gravitt PE, Blaakaer J. Age-specific prevalence of HPV16/18 genotypes in cervical cancer: A systematic review and meta-analysis. Int J Cancer 2016; 138:2795-803. [DOI: 10.1002/ijc.29959] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/29/2015] [Accepted: 11/25/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Anne Hammer
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - Anne Rositch
- Johns Hopkins Bloomberg School of Public Health; MD
| | - Fares Qeadan
- Department of Internal Medicine; University of New Mexico Health Sciences Center; NM
| | - Patti E Gravitt
- Department of Pathology; University of New Mexico Health Sciences Center; NM
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
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Hammer A, Mejlgaard E, Gravitt P, Høgdall E, Christiansen P, Steiniche T, Blaakaer J. HPV genotype distribution in older Danish women undergoing surgery due to cervical cancer. Acta Obstet Gynecol Scand 2015; 94:1262-8. [DOI: 10.1111/aogs.12731] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/10/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Anne Hammer
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - Else Mejlgaard
- Department of Pathology; Aarhus University Hospital; Aarhus Denmark
| | - Patti Gravitt
- Department of Pathology; University of New Mexico; Albuquerque NM USA
| | - Estrid Høgdall
- Department of Pathology; Copenhagen University Hospital; Herlev Denmark
| | | | - Torben Steiniche
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Pathology; Aarhus University Hospital; Aarhus Denmark
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
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Hammer A, Rositch AF, Kahlert J, Gravitt PE, Blaakaer J, Søgaard M. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates. Am J Obstet Gynecol 2015; 213:23-29. [PMID: 25724402 DOI: 10.1016/j.ajog.2015.02.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/03/2015] [Accepted: 02/19/2015] [Indexed: 11/26/2022]
Abstract
Despite the fact that hysterectomy is the most common surgical procedure worldwide in gynecology, national reporting of the incidence rate of gynecological cancers rarely removes the proportion no longer at risk of the disease from the population-at-risk-denominator (ie, women who have had a hysterectomy). The incidence rate of gynecological cancers is thus likely underestimated. Because hysterectomy, as well as oophorectomy, incidence varies across countries, age, and over time, meaningful comparison of gynecological cancer incidence rates may be compromised. Without accurate estimates of gynecological cancer incidence rates, performed via removing the proportion of hysterectomized or oophorectomized women from the population-at-risk-denominator, the impact of prevention strategies may be masked or misinterpreted. Furthermore, because national cervical cancer screening guidelines are at least in part based on the national reporting of cervical cancer incidence, it is important that the incidence rate reflects the true population at risk.
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Roensbo MT, Hammer A, Blaakaer J. Can Dynamic Spectral Imaging System colposcopy replace conventional colposcopy in the detection of high-grade cervical lesions? Acta Obstet Gynecol Scand 2015; 94:781-785. [DOI: 10.1111/aogs.12646] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Mette T. Roensbo
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Anne Hammer
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
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Heeran MC, Rask L, Høgdall CK, Kjaer SK, Christensen L, Jensen A, Blaakaer J, Jarle Christensen IB, Høgdall EVS. Tetranectin positive expression in tumour tissue leads to longer survival in Danish women with ovarian cancer. Results from the 'Malova' ovarian cancer study. APMIS 2015; 123:401-9. [PMID: 25846370 DOI: 10.1111/apm.12368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/27/2014] [Indexed: 11/30/2022]
Abstract
The primary objective of this study was to analyse Tetranectin (TN) expression in tumour tissues and TN serum concentration in 758 women with epithelial ovarian tumours. The second was to evaluate, whether TN tissue expression levels correlate with clinico-pathological parameters and prognosis of the disease. Using tissue arrays we analysed the expression levels in tissues from 166 women with borderline ovarian tumours (BOTs) and 592 women with ovarian cancer (OC). A panel of three antibodies was used for immunohistochemistry: a polyclonal and two monoclonal antibodies. Serum TN was measured using the polyclonal antibody A-371. Univariate survival analyses stratified for chemotherapy showed that positive tissue TN as demonstrated by the polyclonal antibody indicated a significantly longer overall survival (OS) (p = 0.0001) as well as cancer specific survival (CSS) (p < 0.0001). High serum TN was likewise found to imply longer OS (p < 0.0001) and CSS (p < 0.0001), whereas tissue staining with the two monoclonal antibodies failed to demonstrate any significant correlation with either survival type. Univariate Kaplan-Meier survival analysis performed on all OC cases showed a significantly longer OS (p = 0.0009) and CSS (p = 0.0006) for women with TN positive tumour tissue and in women with high serum TN levels (p < 0.0001 for both). However, in the multivariate Cox regression analysis, only serum TN was found to be an independent prognostic factor for OS (p = 0.01) and not for CSS (p = 0.08). In conclusion, our results predict that a positive TN expression of both tumour tissue and serum points to a more favourable outcome for OC patients.
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Affiliation(s)
- Mel C Heeran
- Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark; Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
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Dahl L, Wittrup I, Petersen LK, Blaakaer J, Væggemose U. Paradoxes of follow-up - health professionals' views on follow-up after surgical treatment in gynecological cancer. Acta Oncol 2015; 54:194-9. [PMID: 25017380 DOI: 10.3109/0284186x.2014.935475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evidence now reveals that attending a follow-up program may not improve survival for low-stage gynecological cancer patients. The aim of this study was to explore health professionals' experiences with the follow-up programs and their views on follow-up in the future. METHODS A qualitative approach was undertaken with semi-structured focus group interviews. Three focus group interviews were conducted at neutral ground. One group with onco-gynecologists, one group with specialist nurses, and one mixed group. The main themes of the interviewguide were: Existing follow-up program, life after cancer and future follow-up. The interviews were transcribed verbatim. Patterns and themes were uncovered from the data inspired by interpretive description. RESULTS The doctors described most advantages, such as: Quality control of their own work, detection of sequelae after surgery, and credit and appraisal from the patients. A disadvantage was the inadequate use of the nurses' main competencies. Some dilemmas were described by the nurses as well as doctors: First, both groups were aware of the existing evidence that attendance of follow-up programs may not improve survival and yet, health professionals still performed the follow-ups and most often did not address this paradox for the patients. Second, the existing follow-up program seemed to bring the patients comfort and security on one hand, but on the other hand it seemed to induce insecurity and anxiety. The health professionals agreed that future follow-up should be individualized with focus on the single patients' needs and psychological wellbeing. The health professionals identified a great challenge in communicating the evidence and the forthcoming changes in the follow-up programs to the patients. CONCLUSIONS This study revealed that the existing follow-up regime contains several dilemmas. According to the health professionals, future follow-up must be more individualized, and a shift in focus is needed from relapse to quality of life after cancer.
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Affiliation(s)
- Lotte Dahl
- Department of Gynecology and Obstetrics, Aarhus University Hospital , Skejby , Denmark
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Meyer SI, Fuglsang K, Blaakaer J. Cell-mediated immune response: a clinical review of the therapeutic potential of human papillomavirus vaccination. Acta Obstet Gynecol Scand 2014; 93:1209-18. [DOI: 10.1111/aogs.12480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 08/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Sonja Izquierdo Meyer
- Department of Obstetrics and Gynecology; Aarhus University Hospital, Skejby; Aarhus Denmark
| | - Katrine Fuglsang
- Department of Obstetrics and Gynecology; Aarhus University Hospital, Skejby; Aarhus Denmark
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology; Aarhus University Hospital, Skejby; Aarhus Denmark
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Dahl L, Væggemose U, Blaakaer J, Petersen LK, Wittrup I. [Gynaecological cancer patients' view on follow-up programmes differ from health professionals']. Ugeskr Laeger 2014; 176:1855-1858. [PMID: 25292327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Evidence shows that survival after low-stage gynaecological cancer is not improved by follow-up programmes. Using a qualitative approach this study explores reassurance in follow-up after cancer from both patients' and health professionals' viewpoints. Patients associated the purpose of follow-up with a guarantee of no recurrence of cancer. Paradoxically, the health professionals were aware that this is not evident. However, patients were not informed about this. This may generate false reassurance and poor utilization of resources.
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Affiliation(s)
- Lotte Dahl
- Gynækologisk Afdeling Y, Aarhus Universitetshospital, Brendstrupgaardsvej 100, 8200 Aarhus N. E-mail:
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Lydiksen L, Jensen-Fangel S, Blaakaer J. Is it possible to define an optimal time for chemotherapy after surgery for ovarian cancer? Gynecol Oncol 2014; 133:454-9. [DOI: 10.1016/j.ygyno.2014.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/31/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
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Svolgaard O, Lidegaard O, Nielsen MLS, Nedergaard L, Mosgaard BJ, Lidang M, Mogensen O, Kock K, Blaakaer J, Staehr E, Andersen ES, Grove A, Høgdall C. Lymphadenectomy in surgical stage I epithelial ovarian cancer. Acta Obstet Gynecol Scand 2014; 93:256-60. [PMID: 24447203 DOI: 10.1111/aogs.12322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 12/11/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the extent of lymphadenectomy performed in women presenting with epithelial ovarian cancer macroscopically confined to the ovary. Furthermore, the effect of lymphadenectomy on overall survival is evaluated. DESIGN A prospective nationwide case-only study. SETTING Denmark 2005-2011. SAMPLE All women registered in the nationwide Danish Gynecologic Cancer Database from 1 January 2005 to 1 May 2011, presenting with a tumor macroscopically confined to the ovary without visible evidence of abdominal spread at the time of the initial exploration (surgical stage I). METHOD Descriptive and survival analyses of data from Danish Gynecologic Cancer Database. MAIN OUTCOME MEASURES The annual proportion of women with surgical stage I disease who received lymphadenectomy and the survival in the two groups. RESULTS Of 2361 women with epithelial ovarian cancer, 627 were identified with surgical stage I. Lymphadenectomy was performed in 216 women (34%) of whom 13 (6%) had lymph node metastases. At 5-year follow up 85% remained alive in the lymphadenectomy group compared with 80% in the control group (p = 0.064). The lymphadenectomy fraction increased from 24% in 2005 to 55% in 2011. When univariate and multivariate analyses were conducted only an insignificant difference in the survival probability was found between lymphadenectomy and no lymphadenectomy in women presenting with tumor macroscopically confined to the ovary. CONCLUSION Although increasing, the number of women with surgical stage I disease in Denmark who receive lymphadenectomy remains low, but this did not seem to make a difference to survival.
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Affiliation(s)
- Olivia Svolgaard
- Department of Gynecology, Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Heeran MC, Høgdall CK, Kjaer SK, Christensen L, Jensen A, Blaakaer J, Christensen IBJ, Høgdall EV. Prognostic value of tissue protein expression levels of MIB-1 (Ki-67) in Danish ovarian cancer patients. From the ‘MALOVA’ ovarian cancer study. APMIS 2013; 121:1177-86. [DOI: 10.1111/apm.12071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 02/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Mel C. Heeran
- Department of Pathology; Herlev Hospital; Aarhus Denmark
| | - Claus K. Høgdall
- The Gynaecologic Clinic; The Juliane Marie Centre; Rigshospitalet; University of Copenhagen; Aarhus Denmark
| | - Susanne K. Kjaer
- The Gynaecologic Clinic; The Juliane Marie Centre; Rigshospitalet; University of Copenhagen; Aarhus Denmark
- Danish Cancer Society Research Center; Virus, Lifestyle and Genes; Aarhus Denmark
| | - Lise Christensen
- Department of Pathology; Rigshospitalet; University of Copenhagen; Aarhus Denmark
| | - Allan Jensen
- Danish Cancer Society Research Center; Virus, Lifestyle and Genes; Aarhus Denmark
| | - Jan Blaakaer
- Department of Gynecology & Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | - IB Jarle Christensen
- The Finsen Laboratory; Rigshospitalet and Biotech Research and Innovation Centre (BRIC); University of Copenhagen; Copenhagen Denmark
| | - Estrid V.S. Høgdall
- Department of Pathology; Herlev Hospital; Aarhus Denmark
- Danish Cancer Society Research Center; Virus, Lifestyle and Genes; Aarhus Denmark
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Ammundsen HB, Faber MT, Jensen A, Høgdall E, Blaakaer J, Høgdall C, Kjaer SK. Use of analgesic drugs and risk of ovarian cancer: results from a Danish case-control study. Acta Obstet Gynecol Scand 2012; 91:1094-102. [PMID: 22646488 DOI: 10.1111/j.1600-0412.2012.01472.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The role of analgesic drug use in development of ovarian cancer is not fully understood. We examined the association between analgesic use and risk of ovarian cancer. In addition, we examined whether the association differed according to histological types. DESIGN Population-based case-control study. SETTING Denmark in the period 1995-1999. POPULATION We included 756 women with epithelial ovarian cancer and 1564 randomly selected control women aged 35-79 years. METHODS Information on analgesic drug use was collected from personal interviews. Analgesic drugs were divided into the following categories: any analgesics; aspirin; non-aspirin non-steroidal anti-inflammatory drugs; paracetamol; and other analgesic drugs. The association between analgesic drug use and ovarian cancer risk was analysed using multiple logistic regression models. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. MAIN OUTCOME MEASURES Epithelial ovarian cancer. RESULTS Women with a regular use of any analgesics (OR = 0.79; 95% CI 0.62 - 1.01) or aspirin (OR = 0.68; 95% CI 0.46 - 1.02) had a decreased risk of ovarian cancer, although not statistically significant. Regular use of non-aspirin non-steroidal anti-inflammatory drugs, paracetamol or other analgesics did not decrease ovarian cancer risk. Use of any analgesics (OR = 0.72; 95% CI 0.53-0.98) or aspirin (OR = 0.60; 95% CI 0.36-1.00) resulted in a statistically significant decreased risk of serous ovarian cancer but not mucinous or other ovarian tumors. CONCLUSION In accordance with most previous studies, our results indicate a possible inverse association between analgesic use, particularly aspirin, and ovarian cancer risk.
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Seibaek L, Blaakaer J, Petersen LK, Hounsgaard L. Ovarian cancer surgery: health and coping during the perioperative period. Support Care Cancer 2012; 21:575-82. [PMID: 22875414 DOI: 10.1007/s00520-012-1556-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The study objective was to survey general health and coping in women undergoing ovarian cancer surgery, and subsequently to develop and test a supportive care intervention. METHODS/MATERIALS Women who underwent surgery on the suspicion of ovarian cancer participated in a follow-up questionnaire study in which the Short Form-36 Questionnaire was used to survey general health twice during the perioperative period and the Life Orientation Questionnaire (SOC) was used once to define the postoperative coping capacity. An evidence-based, preoperative supportive care programme was subsequently developed and tested. This consisted of lean methodology applied to clinical pathways, preoperative optimisation, and psychosocial care and support. RESULTS From 294 women allocated to three study groups, a total of 546 Short Form-36 questionnaires and 253 SOC questionnaires were available for analysis. The overall response rate was 86 %. The presence of ascites, a pelvic mass, and a Risk of Malignancy Index >200 proved to be appropriate clinical markers for intensified preoperative care. Concerning physical health, levels were low throughout the perioperative period; the majority however stayed within standard levels. Concerning mental health, levels were below standard during the entire period, but did improve with time, also in women in whom the potential cancer diagnosis was refuted. The preoperative differences between these groups leveled out postoperatively in terms of physical health. At the end of the perioperative period, the coping capacity was close to normal. CONCLUSIONS A need for supportive care during the perioperative period was identified. This should be adjusted to the nature of the disease and the extent of the treatment. Participation in a preoperative supportive programme supported physical health during the perioperative period; however, further support of mental health seemed required.
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Affiliation(s)
- Lene Seibaek
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
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Heeran MC, Høgdall CK, Kjaer SK, Christensen L, Blaakaer J, Christensen IJ, Hogdall EVS. Limited prognostic value of tissue protein expression levels of cyclin E in Danish ovarian cancer patients: from the Danish 'MALOVA' ovarian cancer study. APMIS 2012; 120:846-54. [PMID: 22958293 DOI: 10.1111/j.1600-0463.2012.02913.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 04/02/2012] [Indexed: 11/29/2022]
Abstract
The primary objective of this study was to assess the expression of cyclin E in tumour tissues from 661 patients with epithelial ovarian tumours. The second was to evaluate whether cyclin E tissue expression levels correlate with clinico-pathological parameters and prognosis of the disease. Using tissue arrays (TA), we analysed the cyclin E expression levels in tissues from 168 women with borderline ovarian tumours (BOT) (147 stage I, 4 stage II, 17 stage III) and 493 Ovarian cancer (OC) patients (127 stage I, 45 stage II, 276 stage III, 45 stage IV). Using a 10% cut-off level for cyclin E overexpression, 20% of the BOTs were positive with a higher proportion of serous than mucinous tumours. Sixty-two per cent of the OCs were positive for cyclin E expression with the highest percentage found in clear cell carcinomas. Results based on univariate and multivariate survival analyses with a 10% cut-off value showed that cyclin E had no independent prognostic value. In conclusion, we found cyclin E expression in tumour tissue to be of limited prognostic value to Danish OC patients.
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Affiliation(s)
- Mel C Heeran
- Department of Pathology, Herlev Hospital, University of Copenhagen, Denmark
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Faber MT, Jensen A, Søgaard M, Høgdall E, Høgdall C, Blaakaer J, Kjaer SK. Use of dairy products, lactose, and calcium and risk of ovarian cancer - results from a Danish case-control study. Acta Oncol 2012; 51:454-64. [PMID: 22397392 DOI: 10.3109/0284186x.2011.636754] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A number of epidemiological studies have examined the association between use of dairy products and risk of ovarian cancer, but results are conflicting. Using data from a large Danish population-based case-control study we here further examined the association between dairy consumption, lactose, and calcium and risk of overall ovarian cancer and histological types of ovarian cancer. MATERIAL AND METHODS In the period 1995-1999 we included 554 women with epithelial ovarian cancer and 1554 randomly selected age-matched controls (35-79 years). All women participated in a detailed personal interview that included questions about dairy consumption. Data were analysed using multiple logistic regression models. RESULTS Total dairy intake was associated with ovarian cancer risk (OR = 1.11; 95% CI: 1.07-1.15 per 100 ml/day). The association was strongest for milk [OR = 1.14; 95% CI: 1.03-1.27 per glass (200 ml)/day], soured milk products [OR = 1.49; 95% CI: 1.22-1.81 per portion (250 ml)/day] and yoghurt [OR = 1.65; 95% CI: 1.22-2.23 per portion (250 ml)/day]. In contrast, intake of cheese was associated with a decreased risk [OR = 0.70; 95% CI: 0.55-0.89 for > 1 portion (100 ml)/day compared with no intake]. Intake of lactose, but not calcium, was also associated with an increased ovarian cancer risk (OR = 1.24; 95% CI: 1.10-1.40 per 10 g of lactose/day). Similar risk patterns were observed for the different histological types of ovarian cancer, indicating virtually identical aetiologies with regard to dairy intake, lactose, and calcium. CONCLUSIONS Our results indicate that intake of dairy products is associated with a modest increased risk of ovarian cancer. In addition, ovarian cancer development was associated with lactose intake.
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Affiliation(s)
- Mette T Faber
- Institute of Epidemiology, Danish Cancer Society, Copenhagen, Denmark
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Seibaek L, Petersen LK, Blaakaer J, Hounsgaard L. Hoping for the best, preparing for the worst: the lived experiences of women undergoing ovarian cancer surgery. Eur J Cancer Care (Engl) 2011; 21:360-71. [PMID: 22092927 DOI: 10.1111/j.1365-2354.2011.01313.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this study, the lived experiences of women undergoing ovarian cancer surgery were explored, aiming to provide a patient perspective on being newly diagnosed and starting treatment for ovarian cancer. The study period ran from the first visit in the outpatient clinic, till 8 weeks later, when the women had either begun chemotherapy or completed their recovery. Ten women participated in two qualitative research interviews each, before and after surgery. By applying a phenomenological-hermeneutic text interpretation methodology, the findings were systematically identified, put into meaning-structures, interpreted and discussed. This process constituted the theme: 'Hoping for the best, preparing for the worst'. Final diagnostics and treatment start were extensive life events, where life itself was threatened, although hope and will were present. The women intuitively prepared themselves for the diagnosis and treatment. However, the ability to prepare was influenced by personal lifestyle, social conditions, coping strategies, and experiences of hope. The ability to prepare could be strengthened by providing adjusted information, psychosocial support and physical optimisation during the perioperative period. By offering targeted family counselling and taking good care of the women's general health and well-being, hope could be sustained and early cancer rehabilitation initiated.
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Affiliation(s)
- L Seibaek
- Research Unit of Nursing, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
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Munksgaard PS, Blaakaer J. The association between endometriosis and gynecological cancers and breast cancer: a review of epidemiological data. Gynecol Oncol 2011; 123:157-63. [PMID: 21742370 DOI: 10.1016/j.ygyno.2011.06.017] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/10/2011] [Accepted: 06/14/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This article critically reviews the literature on the association between endometriosis and gynecological cancers and breast cancer, based on epidemiologic data. METHODS Literature review of the English language literature based on searching in the MEDLINE (PubMed) database and additional collection of reports by systematically reviewing all references from retrieved papers. RESULTS Data from large cohort and case-control studies indicate that endometriosis patients only have an increased risk of ovarian cancer among the gynecological malignancies and breast cancer, although most of the observed associations are modest. Data on the association between endometriosis and breast cancer are inconsistent. Endometriosis patients have a reduced risk of cervical cancer, and there is no association between endometriosis and endometrial cancer. Endometriosis-associated ovarian cancer seems to be a distinct clinical entity; patients are younger, diagnosed in earlier stages, have lower grade lesions and a better survival. Further, endometriosis-associated ovarian cancers are predominantly clear cell and endometrioid histologic subtypes. CONCLUSIONS Endometriosis seems to be a precursor of epithelial ovarian cancer, especially clear cell and endometrioid adenocarcinomas. However, current evidence is insufficient to draw any definitive conclusions whether this association represents causality or the sharing of similar risk factors and/or antecedent mechanisms.
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Seibaek L, Petersen LK, Blaakaer J, Hounsgaard L. Symptom interpretation and health care seeking in ovarian cancer. BMC Womens Health 2011; 11:31. [PMID: 21699682 PMCID: PMC3135550 DOI: 10.1186/1472-6874-11-31] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 06/23/2011] [Indexed: 12/28/2022]
Abstract
Background Ovarian cancer is the leading cause of death among women suffering from gynaecological malignancies in the Western world. Worldwide, approximately 200,000 women are diagnosed with the disease each year. This article deals with the health care seeking and symptom interpretation process among Danish women, who have a very high mortality rate. Methods The health seeking and symptom interpretation process was analysed via combining study methods. The material consisted of registry data dealing with the use of public health care and hospital services of Danish women, newly diagnosed with ovarian cancer. These results were combined with findings from semi-structured qualitative research interviews on women's bodily experiences with symptom development. Results A number of 663 Danish women with ovarian cancer attended 27 different kinds of primary health care providers in a total of 14,009 visits during 2007. The women also had 6,214 contacts with various hospitals, and obtained 562 different diagnoses. From the main theme "Women's experiences with the onset of symptoms" three sub-themes were identified: "Bodily sensations", "From bodily sensation to symptom", and "Health seeking and treatment start". In all cases the General Practitioner represented the first contact to public health care, acting as gate-keeper to specialist and hospital referral. The women were major users of public health care throughout the diagnostic process and subsequent treatment. All women held personal knowledge concerning the onset of their symptoms. The early symptoms of ovarian cancer might be uncharacteristic and non-disease-specific when interpreted as personal experiences, but they had similarities when analysed together. Conclusions Diagnostic delay in ovarian cancer seems far from being exclusively a medical problem, as the delay proved to be influenced by organisational, cultural, and social factors, too. Initiatives facilitating the diagnostic process and research concerning the selection of individuals for further investigation are indicated. The way in which the women interpreted their symptoms was influenced by their personal experiences, their cultural, and their social background. This became crucial to the diagnostic process. These issues need to be explored through further research on women's experiences during the diagnostic process.
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Affiliation(s)
- Lene Seibaek
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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50
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Notaridou M, Quaye L, Dafou D, Jones C, Song H, Høgdall E, Kjaer SK, Christensen L, Høgdall C, Blaakaer J, McGuire V, Wu AH, Van Den Berg DJ, Pike MC, Gentry-Maharaj A, Wozniak E, Sher T, Jacobs IJ, Tyrer J, Schildkraut JM, Moorman PG, Iversen ES, Jakubowska A, Mędrek K, Lubiński J, Ness RB, Moysich KB, Lurie G, Wilkens LR, Carney ME, Wang-Gohrke S, Doherty JA, Rossing MA, Beckmann MW, Thiel FC, Ekici AB, Chen X, Beesley J, Gronwald J, Fasching PA, Chang-Claude J, Goodman MT, Chenevix-Trench G, Berchuck A, Pearce CL, Whittemore AS, Menon U, Pharoah PD, Gayther SA, Ramus SJ. Common alleles in candidate susceptibility genes associated with risk and development of epithelial ovarian cancer. Int J Cancer 2011; 128:2063-74. [PMID: 20635389 PMCID: PMC3098608 DOI: 10.1002/ijc.25554] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 05/26/2010] [Accepted: 06/24/2010] [Indexed: 12/26/2022]
Abstract
Common germline genetic variation in the population is associated with susceptibility to epithelial ovarian cancer. Microcell-mediated chromosome transfer and expression microarray analysis identified nine genes associated with functional suppression of tumorogenicity in ovarian cancer cell lines; AIFM2, AKTIP, AXIN2, CASP5, FILIP1L, RBBP8, RGC32, RUVBL1 and STAG3. Sixty-three tagging single nucleotide polymorphisms (tSNPs) in these genes were genotyped in 1,799 invasive ovarian cancer cases and 3,045 controls to look for associations with disease risk. Two SNPs in RUVBL1, rs13063604 and rs7650365, were associated with increased risk of serous ovarian cancer [HetOR = 1.42 (1.15-1.74) and the HomOR = 1.63 (1.10-1.42), p-trend = 0.0002] and [HetOR = 0.97 (0.80-1.17), HomOR = 0.74 (0.58-0.93), p-trend = 0.009], respectively. We genotyped rs13063604 and rs7650365 in an additional 4,590 cases and 6,031 controls from ten sites from the United States, Europe and Australia; however, neither SNP was significant in Stage 2. We also evaluated the potential role of tSNPs in these nine genes in ovarian cancer development by testing for allele-specific loss of heterozygosity (LOH) in 286 primary ovarian tumours. We found frequent LOH for tSNPs in AXIN2, AKTIP and RGC32 (64, 46 and 34%, respectively) and one SNP, rs1637001, in STAG3 showed significant allele-specific LOH with loss of the common allele in 94% of informative tumours (p = 0.015). Array comparative genomic hybridisation indicated that this nonrandom allelic imbalance was due to amplification of the rare allele. In conclusion, we show evidence for the involvement of a common allele of STAG3 in the development of epithelial ovarian cancer.
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Affiliation(s)
- Maria Notaridou
- Gynaecological Oncology Unit, UCL EGA Institute for Women’s Health, University College London, United Kingdom
| | - Lydia Quaye
- Gynaecological Oncology Unit, UCL EGA Institute for Women’s Health, University College London, United Kingdom
| | - Dimitra Dafou
- Department of Medical and Molecular Genetics, King’s College London School of Medicine, Guy’s Hospital, London, United Kingdom
| | - Chris Jones
- Gynaecological Oncology Unit, UCL EGA Institute for Women’s Health, University College London, United Kingdom
| | - Honglin Song
- CR-UK Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Estrid Høgdall
- Department of Viruses, Hormones and Cancer, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
| | - Susanne K. Kjaer
- Department of Viruses, Hormones and Cancer, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
| | - Lise Christensen
- Department of Pathology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Claus Høgdall
- The Gynaecologic Clinic, The Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Jan Blaakaer
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Valerie McGuire
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Anna H. Wu
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA
| | - David J. Van Den Berg
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA
| | - Malcolm C. Pike
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA
| | - Aleksandra Gentry-Maharaj
- Gynaecological Oncology Unit, UCL EGA Institute for Women’s Health, University College London, United Kingdom
| | - Eva Wozniak
- Gynaecological Oncology Unit, UCL EGA Institute for Women’s Health, University College London, United Kingdom
| | - Tanya Sher
- Gynaecological Oncology Unit, UCL EGA Institute for Women’s Health, University College London, United Kingdom
| | - Ian J. Jacobs
- Gynaecological Oncology Unit, UCL EGA Institute for Women’s Health, University College London, United Kingdom
| | - Jonathan Tyrer
- CR-UK Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | | | - Patricia G. Moorman
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC
| | - Edwin S. Iversen
- Department of Statistical Science, Duke University, Medical Center, Durham, NC
| | - Anna Jakubowska
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Mędrek
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | - Jan Lubiński
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | | | - Kirsten B. Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY
| | - Galina Lurie
- Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI
| | - Lynne R. Wilkens
- Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI
| | - Michael E. Carney
- Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI
| | - Shan Wang-Gohrke
- Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany
| | - Jennifer A. Doherty
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary Anne Rossing
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - Falk C. Thiel
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - Arif B. Ekici
- Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Xiaoqing Chen
- Genetics and Population Health, The Queensland Institute of Medical Research, Post Office Royal Brisbane Hospital, Australia
| | - Jonathan Beesley
- Genetics and Population Health, The Queensland Institute of Medical Research, Post Office Royal Brisbane Hospital, Australia
| | | | - Jacek Gronwald
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
- Division of Hematology and Oncology, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Marc T. Goodman
- Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI
| | - Georgia Chenevix-Trench
- Genetics and Population Health, The Queensland Institute of Medical Research, Post Office Royal Brisbane Hospital, Australia
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology/Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, 27710
| | - C. Leigh Pearce
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA
| | - Alice S. Whittemore
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Usha Menon
- Gynaecological Oncology Unit, UCL EGA Institute for Women’s Health, University College London, United Kingdom
| | - Paul D.P. Pharoah
- CR-UK Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Simon A. Gayther
- Gynaecological Oncology Unit, UCL EGA Institute for Women’s Health, University College London, United Kingdom
| | - Susan J. Ramus
- Gynaecological Oncology Unit, UCL EGA Institute for Women’s Health, University College London, United Kingdom
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