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Amaral E, Cain JM, Hearing F, Lumsden MA. FIGO guidance for sustainable implementation of vaccination programs for women: Pregnancy and HPV. Int J Gynaecol Obstet 2023; 162 Suppl 1:3-23. [PMID: 37424377 DOI: 10.1002/ijgo.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Eliana Amaral
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
- Obstetrics & Gynecology Department, University of Campinas, São Paulo, Brazil
| | - Joanna M Cain
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
- Obstetrics & Gynecology Department (retired), University of Massachusetts, Worcester, Massachusetts, USA
| | - Francesca Hearing
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
| | - Mary Ann Lumsden
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
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Lidsky D, Cain JM, Hutchins-Delgado T, Lu TM. Inverse metal-assisted chemical etching of germanium with gold and hydrogen peroxide. Nanotechnology 2022; 34:065302. [PMID: 35835063 DOI: 10.1088/1361-6528/ac810c] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
Metal-assisted chemical etching (MACE) is a flexible technique for texturing the surface of semiconductors. In this work, we study the spatial variation of the etch profile, the effect of angular orientation relative to the crystallographic planes, and the effect of doping type. We employ gold in direct contact with germanium as the metal catalyst, and dilute hydrogen peroxide solution as the chemical etchant. With this catalyst-etchant combination, we observe inverse-MACE, where the area directly under gold is not etched, but the neighboring, exposed germanium experiences enhanced etching. This enhancement in etching decays exponentially with the lateral distance from the gold structure. An empirical formula for the gold-enhanced etching depth as a function of lateral distance from the edge of the gold film is extracted from the experimentally measured etch profiles. The lateral range of enhanced etching is approximately 10-20μm and is independent of etchant concentration. At length scales beyond a few microns, the etching enhancement is independent of the orientation with respect to the germanium crystallographic planes. The etch rate as a function of etchant concentration follows a power law with exponent smaller than 1. The observed etch rates and profiles are independent of whether the germanium substrate is n-type, p-type, or nearly intrinsic.
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Affiliation(s)
- D Lidsky
- Sandia National Laboratories, Albuquerque, NM 87185, United States of America
| | - J M Cain
- Sandia National Laboratories, Albuquerque, NM 87185, United States of America
| | - T Hutchins-Delgado
- Sandia National Laboratories, Albuquerque, NM 87185, United States of America
| | - T M Lu
- Sandia National Laboratories, Albuquerque, NM 87185, United States of America
- Center for Integrated Nanotechnologies, Sandia National Laboratories, Albuquerque, NM 87123, United States of America
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Cain JM. Answering the Call to Accelerate the Elimination of Cervical Cancer. Rev Bras Ginecol Obstet 2019; 41:67. [PMID: 30786303 PMCID: PMC10418345 DOI: 10.1055/s-0039-1679864] [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: 10/27/2022] Open
Affiliation(s)
- Joanna M. Cain
- School of Medicine, Department of Obstetrics and Gynecology, University of Massachusetts, Massachusetts, United States
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Moore Simas TA, Cain JM, Milner RJ, Meacham ME, Bannon AL, Levin LL, Amir N, Leung K, Ockene JK, Thorndyke LE. A Systematic Review of Development Programs Designed to Address Leadership in Academic Health Center Faculty. J Contin Educ Health Prof 2019; 39:42-48. [PMID: 30531408 DOI: 10.1097/ceh.0000000000000229] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION To describe Academic Health Center (AHC) faculty leadership development program characteristics and categorize leadership topics into thematic areas suggesting competency domains to guide programmatic curricular development. METHODS A systematic literature review was conducted (PubMed/MEDLINE, Scopus, Cumulative Index of Nursing and Allied Health Literature [CINAHL], and Journal Storage [JSTOR databases]). Eligible studies described programs with leadership development intent for faculty in AHCs. Information was extracted using a structured data form and process. RESULTS Six hundred ninety citations were screened; 25 publications describing 22 unique programs were eligible. The majority (73%) were institutionally based; mean class size was 18.5 (SD ± 10.2, range 4.5-48); and mean in-person time commitment was 110 hours (SD ± 101.2, range 16-416), commonly occurring in regular intervals over months to years (n = 10, 45%). Six programs provided per participant costs (mean $7,400, range $1000-$21,000). Didactic teaching was the primary instructional method (99.5%); a majority (68%) included project work. Fourteen thematic content areas were derived from 264 abstracted topics. The majority or near majority incorporated content regarding leadership skills, organizational strategy and alignment, management, self-assessment, and finance/budget. DISCUSSION Institutions and faculty invest significantly in leadership development programs, addressing perceived needs and with perceived benefit for both. The prevalence of common curricular content indicates that AHCs deem important faculty development in leadership, business, and self-assessment skills.
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Affiliation(s)
- Tiffany A Moore Simas
- Dr. Moore Simas is Associate Professor, Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. Dr. Cain is Professor of Obstetrics & Gynecology and Director of Talent Management, Office of Faculty Affairs, University of Massachusetts Medical School, Worcester, MA. Dr. Milner is Professor of Neurology and Associate Vice Provost for Professional Development, Office of Faculty Affairs, University of Massachusetts Medical School, Worcester, MA. Ms. Meacham is Education and Outreach Coordinator with the National Networks of Libraries of Medicine, New England Region and Lamar Soutter Library, University of Massachusetts Medical School, Worcester, MA. Ms. Bannon is a medical student, University of Massachusetts Medical School, Worcester, MA. Mr. Levin is the Head of Education and Clinical Services, Lamar Soutter Library and Assistant Professor, Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, and Francis A. Countway Library of Medicine, Harvard Medical School, Boston, MA. Ms. Amir is a medical student, University of Massachusetts Medical School, Worcester, MA. Ms. Leung is a biostatistician, Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA. Dr. Ockene is Professor of Medicine and Associate Vice Provost for Gender and Equity, Office of Faculty Affairs, University of Massachusetts Medical School, Worcester, MA. Dr. Thorndyke is Professor of Medicine and Vice Provost of Faculty Affairs, Office of Faculty Affairs, University of Massachusetts Medical School, Worcester, MA
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Affiliation(s)
- Joanna M. Cain
- Department of Obstetrics and Gynecology; University of Massachusetts; Worcester MA USA
| | - Lynette Denny
- Department Obstetrics and Gynecology; University of Cape Town/Groote Schuur Hospital; Cape Town South Africa
- South African Medical Research Council/University of Cape Town Gynaecological Cancer Research Centre (SA MRC/UCT GCRC); Cape Town South Africa
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Cain JM, Felice ME, Ockene JK, Milner RJ, Congdon JL, Tosi S, Thorndyke LE. Meeting the Late-Career Needs of Faculty Transitioning Through Retirement: One Institution's Approach. Acad Med 2018; 93:435-439. [PMID: 28953562 DOI: 10.1097/acm.0000000000001905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PROBLEM Medical school faculty are aging, but few academic health centers are adequately prepared with policies, programs, and resources (PPR) to assist late-career faculty. The authors sought to examine cultural barriers to successful retirement and create alignment between individual and institutional needs and tasks through PPR that embrace the contributions of senior faculty while enabling retirement transitions at the University of Massachusetts Medical School, 2013-2017. APPROACH Faculty 50 or older were surveyed, programs at other institutions and from the literature (multiple fields) were reviewed, and senior faculty and leaders, including retired faculty, were engaged to develop and implement PPR. Cultural barriers were found to be significant, and a multipronged, multiyear strategy to address these barriers, which sequentially added PPR to support faculty, was put in place. A comprehensive framework of sequenced PPR was developed to address the needs and tasks of late-career transitions within three distinct phases: pre-retirement, retirement, and post-retirement. OUTCOMES This sequential introduction approach has led to important outcomes for all three of the retirement phases, including reduction of cultural barriers, a policy that has been useful in assessing viability of proposed phased retirement plans, transparent and realistic discussions about financial issues, and consideration of roles that retired faculty can provide. NEXT STEPS The authors are tracking the issues mentioned in consultations and efficacy of succession planning, and will be resurveying faculty to further refine their work. This framework approach could serve as a template for other academic health centers to address late-career faculty development.
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Affiliation(s)
- Joanna M Cain
- J.M. Cain is professor of obstetrics & gynecology and radiation oncology and director of faculty talent management, Office of Faculty Affairs, University of Massachusetts Medical School, Worcester, Massachusetts. M.E. Felice is professor of pediatrics and obstetrics & gynecology and retired department chair of pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts. J.K. Ockene is associate vice provost for gender and equity, professor of medicine, and chief, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts. R.J. Milner is professor of neurology and associate vice provost for professional development, Office of Faculty Affairs, University of Massachusetts Medical School, Worcester, Massachusetts. J.L. Congdon is administrative manager, Office of Faculty Affairs, University of Massachusetts Medical School, Worcester, Massachusetts. S. Tosi is associate professor of urology, University of Massachusetts Medical School, and senior vice president and chief medical officer, University Medical Group, University of Massachusetts Memorial Health System, Worcester, Massachusetts. L.E. Thorndyke is professor of medicine and vice provost for faculty affairs, University of Massachusetts Medical School, Worcester, Massachusetts
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Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts
| | - Joanna M Cain
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Boston
| | - Sarah Feldman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
| | - Joanna M Cain
- University of Massachusetts Medical School, Worcester, MA, USA
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Abstract
On a day-to-day basis, doctors must decide which treatments are most beneficial for their patients, and which make the most sense in terms of costs. In medical decision making, factors such as efficiency and cost-effectiveness can be particularly challenging to navigate because many of the most expensive procedures encountered in medical practice are also high-stake treatments for patients. One-hundred-six obstetricians-gynecologists (Obs/Gyns) completed a survey asking them to allocate the following resources in scenarios in which they are scarce: human papilloma virus (HPV) vaccinations, mammograms, and in vitro fertilization (IVF) treatments. Additional questions focused on how fairness and cost-effectiveness factored into the allocation decisions of each group. Results indicated that Obs/Gyns were more efficient in their distribution of HPV vaccinations and mammograms than in their distribution of IVF treatments. More efficient responding was associated with placing less emphasis on fairness in decision making. This study demonstrates the differences that exist in the emphasis that physicians place on medical evidence, cost, outcomes, and perceptions of fair (equal) allocation when faced with different costs and health impacts.
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Cain JM, Iglesia CB, Dickens B, Montgomery O. Body enhancement through female genital cosmetic surgery creates ethical and rights dilemmas. Int J Gynaecol Obstet 2013; 122:169-72. [DOI: 10.1016/j.ijgo.2013.03.020] [Citation(s) in RCA: 20] [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: 01/09/2013] [Revised: 03/04/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
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Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain JM, Garcia FAR, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER, Chelmow D, Herzig A, Kim JJ, Kinney W, Herschel WL, Waldman J. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis 2012; 16:175-204. [PMID: 22418039 PMCID: PMC3915715 DOI: 10.1097/lgt.0b013e31824ca9d5] [Citation(s) in RCA: 237] [Impact Index Per Article: 19.8] [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: 01/29/2023]
Abstract
An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from six working groups, and a recent symposium co-sponsored by the ACS, American Society for Colposcopy and Cervical Pathology (ASCCP), and American Society for Clinical Pathology (ASCP), which was attended by 25 organizations. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (e.g., management of screen positives and screening interval for screen negatives) of women after screening, age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16/18 infections.
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Affiliation(s)
- Debbie Saslow
- Breast and Gynecologic Cancer, Cancer Control Science Department, American Cancer Society, Atlanta, GA 30303, USA.
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Cain JM, Storm C, Olver I. Making the decision to not attempt resuscitation. J Oncol Pract 2008; 4:99-100. [PMID: 20856788 DOI: 10.1200/jop.0828503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cain JM. Does intraperitoneal therapy have a role in recurrent ovarian cancer? World J Surg 2007; 31:1821. [PMID: 17623233 DOI: 10.1007/s00268-007-9144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pejovic T, Yates JE, Liu HY, Hays LE, Akkari Y, Torimaru Y, Keeble W, Rathbun RK, Rodgers WH, Bale AE, Ameziane N, Zwaan CM, Errami A, Thuillier P, Cappuccini F, Olson SB, Cain JM, Bagby GC. Cytogenetic instability in ovarian epithelial cells from women at risk of ovarian cancer. Cancer Res 2006; 66:9017-25. [PMID: 16982743 DOI: 10.1158/0008-5472.can-06-0222] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [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: 11/16/2022]
Abstract
Fanconi anemia is an inherited cancer predisposition disease characterized by cytogenetic and cellular hypersensitivity to cross-linking agents. Seeking evidence of Fanconi anemia protein dysfunction in women at risk of ovarian cancer, we screened ovarian surface epithelial cells from 25 primary cultures established from 22 patients using cross-linker hypersensitivity assays. Samples were obtained from (a) women at high risk for ovarian cancer with histologically normal ovaries, (b) ovarian cancer patients, and (c) a control group with no family history of breast or ovarian cancer. In chromosomal breakage assays, all control cells were mitomycin C (MMC) resistant, but eight samples (five of the six high-risk and three of the eight ovarian cancer) were hypersensitive. Lymphocytes from all eight patients were MMC resistant. Only one of the eight patients had a BRCA1 germ-line mutation and none had BRCA2 mutations, but FANCD2 was reduced in five of the eight. Ectopic expression of normal FANCD2 cDNA increased FANCD2 protein and induced MMC resistance in both hypersensitive lines tested. No FANCD2 coding region or promoter mutations were found, and there was no genomic loss or promoter methylation in any Fanconi anemia genes. Therefore, in high-risk women with no BRCA1 or BRCA2 mutations, tissue-restricted hypersensitivity to cross-linking agents is a frequent finding, and chromosomal breakage responses to MMC may be a sensitive screening strategy because cytogenetic instability identified in this way antedates the onset of carcinoma. Inherited mutations that result in tissue-specific FANCD2 gene suppression may represent a cause of familial ovarian cancer.
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Affiliation(s)
- Tanja Pejovic
- Department of Obstetrics and Gynecology, Center for Women's Health, Oregon Health & Science University Cancer Institute, Portland, OR 97239, USA.
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Abstract
OBJECTIVE To assist in predicting future leadership needs, this longitudinal study examines turnover and net retention rates among chairs at university obstetrics and gynecology departments between 1981 and 2005. METHODS A database of appointment dates and tenure of chairs at each of 125 Association of American Medical Colleges-approved United States medical schools was collated using membership listings from the Association of Professors of Gynecology and Obstetrics and from the Council of University Chairs in Obstetrics and Gynecology. Complete data from 118 departments were confirmed by selective correspondence at individual departments and further review by the investigators. RESULTS A total of 260 individuals (232 men, 28 women) became new chairs between 1981 and 2005. The annual turnover rate increased gradually from 6.0% to 12.7%. Five-year net retention rates remained steady between 1982 and 1997 but dropped after 1997 (85.6% compared with 63.2%; P=.03). A chair's tenure ranged widely (1 to 23 years; median 8 years), regardless of gender or school type, size, or location. Approximately one half of interim chairs became permanent chairs, usually at their own institution. The number of new women chairs increased from none in 1981 to 17 (15.2% of total chairs) in 2005. CONCLUSION Academic chair positions in obstetrics and gynecology experienced a doubling in annual turnover rates, while retention rates declined. The proportion of chairs occupied by women increased progressively. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- William F Rayburn
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico 87131, USA.
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Emmons SL, Nichols M, Schulkin J, James KE, Cain JM. The influence of physician gender on practice satisfaction among obstetrician gynecologists. Am J Obstet Gynecol 2006; 194:1728-38; discussion 1739. [PMID: 16635457 DOI: 10.1016/j.ajog.2006.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Revised: 06/09/2005] [Accepted: 03/04/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A survey was conducted to investigate the hypothesis that female gender would positively affect job satisfaction among obstetrician gynecologists. STUDY DESIGN A survey was sent to 500 randomized, age matched American College of Obstetrics and Gynecology members, 50% each men and women: 49.8% responded. Data were analyzed with the chi2 contingency test, Cochran's test for linear trends, Student t tests, and multiple regression. RESULTS Women considered their gender an asset in deciding on a career in obstetrics and gynecology, in obtaining jobs, and in maintaining their practices. Men considered that their gender limited their practice options and were more likely to report that they would not choose a career in obstetrics and gynecology if they could choose again. The only significant difference between men and women in measures of obtaining and maintaining a practice was that men were more likely to practice in small urban or rural settings. Men reported higher incomes. Both genders were equally satisfied with their jobs. CONCLUSION Although both genders considered female gender to be an asset in obstetrics and gynecology, this survey showed no difference in their ratings of overall career satisfaction.
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Affiliation(s)
- Sandra L Emmons
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
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Schenker JG, Cain JM. International Medical Ethics: The FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health. Int J Gynaecol Obstet 2004; 86:267-75. [PMID: 15289116 DOI: 10.1016/j.ijgo.2004.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- J G Schenker
- Department of Obstetrics and Gynecology, Hadassah University, Medical School, Jerusalem, Israel
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Cain JM. On the Meaning of Editorial Board Service for Obstetrics & Gynecology. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200309000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cain JM. Conflict of interest in health care: a subtle but significant issue in women's health. Curr Womens Health Rep 2003; 3:87-8. [PMID: 12628077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Joanna M Cain
- Center for Women's Health, Oregon Health & Sciences University, Portland 97201, USA.
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Abstract
The genomic revolution inherently changes the paradigms that have informed the interactions between patient and physician. These changes obligate physicians both to continually learn about the advances occurring in genetic testing and to review their interactions in light of the changing ethical issues these advances uncover. Particular areas for concern are the use of genetic testing for predisposition genes. The issues differ between uses for adults, for children and for pre-implantation genetics. Furthermore, there are issues of justice raised by limited access to these technologies, research confidentiality, potential discrimination and the meaning of individuality in an era of potential genetic cloning. These changes require obstetrician/gynaecologists to advocate for the best interests of both their patients and those who may not be able to voice their interests, for example children-to-be and research subjects in developing countries.
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Affiliation(s)
- Karen Adams
- L-466, OHSU, Department of Obstetrics/Gynecology, 3181 SW Sam Jackson Park Road, Portland, Oregon 97201, USA
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Cain JM, Donoghue GD, Magrane DM, Rusch RB. Why is it so important to ensure that women's health, gender-based competencies are woven into the fabric of undergraduate medical education? Am J Obstet Gynecol 2002; 187:S1-3. [PMID: 12235427 DOI: 10.1067/mob.2002.127354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Joanna M Cain
- Association of Professors of Gynecology and Obstetrics Women's Healthcare Education Office, MD 21114-2423, USA
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Affiliation(s)
- Joanna M Cain
- Association of Professors of Gynecology and Obstetrics Women's Healthcare Education Office, Crofton, Md. 21114-2423, USA
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Cain JM. Ethical guidelines regarding privacy and confidentiality in reproductive medicine. Testing for genetic predisposition to adult onset disease. Guidelines in emergency contraception. Int J Gynaecol Obstet 2002; 77:171-5. [PMID: 12031571 DOI: 10.1016/s0020-7292(02)00013-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joanna M Cain
- Department of Obstetrics and Gynecology, Oregon Health Sciences University, Portland, OR 97201, USA.
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Cain JM, Zaino R, Shearer D, Bennett RA, Olt G, Weisz J. Expression of a retinol dehydrogenase (hRoDH-4), a member of the retinol/steroid dehydrogenase family implicated in retinoic acid biosynthesis, in normal and neoplastic endometria. Am J Obstet Gynecol 2002; 186:675-83. [PMID: 11967490 DOI: 10.1067/mob.2002.122127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/22/2022]
Abstract
OBJECTIVE Retinoic acid plays an essential role in epithelial differentiation, and retinoid homeostasis is disrupted in cancers of epithelial origin. The goal of this study was to determine whether hRoDH-4, an enzyme that can catalyze the first and rate-limiting step in retinoic acid biosynthesis, is expressed in normal endometrium and, if so, whether its expression is altered in endometrial cancer. STUDY DESIGN Proliferative, secretory, hyperplastic, and neoplastic endometria were examined by immunocytochemistry for hRoDH-4 protein and by reverse transcriptase-polymerase chain reaction for the hRoDH-4 transcript. RESULTS In proliferative and secretory glandular epithelia, immunoreactive hRoDH-4 was uniformly present. In endometrial cancers, hRoDH-4 immunoreactivity was markedly reduced in many neoplastic epithelial cells. Expression of hRoDH-4 in normal and neoplastic endometrium was confirmed by findings on reverse transcriptase-polymerase chain reaction. CONCLUSION These findings are consistent with the hypothesis that altered expression of enzymes essential for in situ retinoic acid biosynthesis is an important phenotypic change associated with the development of endometrial cancer.
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Affiliation(s)
- Joanna M Cain
- Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, USA
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Cain JM. Women's health: we are only at the foothills. Curr Womens Health Rep 2001; 1:1. [PMID: 12112945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Cain JM, Schulkin J, Parisi V, Power ML, Holzman GB, Williams S. Effects of perceptions and mentorship on pursuing a career in academic medicine in obstetrics and gynecology. Acad Med 2001; 76:628-34. [PMID: 11401809 DOI: 10.1097/00001888-200106000-00015] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE To understand the perceptions of residents and Fellows in obstetrics and gynecology about the impacts of race or ethnicity, gender, and mentorship experiences on pursuing careers in academic medicine. METHOD Two surveys were administered: one to a sample of 2,000 Fellows of the American College of Obstetricians and Gynecologists, and one to the 4,814 obstetrics and gynecology residents taking the 1998 in-training examination. The questionnaires asked about demographics, perceptions about careers in academic medicine, and residents' experiences with mentorship. RESULTS Response rates were 96.8% for residents and 40.6% for FELLOWS: Of the residents, 26.1% indicated they would not consider a career in academic medicine. First-year women residents were more inclined to pursue careers in academic medicine than were first-year men (p =.042), but their interest declined during residency. Women residents (43%)-especially minorities-felt that men were mentored and recruited more for faculty positions, while men (38%) felt that women were mentored and recruited more. Fellows' reports of recruitment did not differ by gender. Most white residents did not perceive racial or ethnic bias in mentoring or recruiting, while most non-white residents did. Almost one third of non-white women residents felt that supervisors were more likely to condescend to women and minority individuals. CONCLUSIONS It is likely that neither men nor women residents in obstetrics and gynecology receive adequate mentorship for careers in academic medicine. Perceptions of bias are a serious barrier to developing racial, ethnic, and gender diversity in leadership positions.
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Affiliation(s)
- J M Cain
- Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey 17033, USA
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Abstract
In obstetrics and gynaecology we care for women who will die during pregnancy, for women who have fatal diseases such as autoimmune diseases or renal, liver, or cardiac failure where our care is tangential but critical to palliation, and for women dying with gynaecological malignancies. Understanding the history of the development of hospice and palliative care, as well as the ethical framework for these choices, may allow us to understand better the difficulties we face in our modern settings in making the choice to turn our goals from prolonging life to maximal comfort on the path to death. Obstetrician gynaecologists have a responsibility to be a voice of advocacy for maximal palliative care for not only the women they care for, but also for women worldwide because of their diminished social status and poverty.
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Affiliation(s)
- J M Cain
- Department of Obstetrics and Gynecology, The Pennsylvania State University, College of Medicine, H103, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Cain JM. Practical aspects of hospice care at home. Best Pract Res Clin Obstet Gynaecol 2001; 15:305-11. [PMID: 11358404 DOI: 10.1053/beog.2000.0170] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While much of hospice care, from a medical professional viewpoint, is concentrated on the physiology and pharmacology of maximal symptom management in hospital or at home, families and those caring for the day-to-day aspects of dying face different barriers to care. Achieving an environment that is both the safest and the most efficient for care at home is not often considered and the elements of achieving that environment are the focus of this chapter. What general equipment needs, what 'nursing' skills and what practical advice can we give to families and care-givers who care for dying patients at home? It is important that physicians understand the details of home care planning and needs so they can provide the best counsel for patients and their families as they make choices about terminal care.
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Affiliation(s)
- J M Cain
- The Pennsylvania State University College of Medicine, H103 Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Cain JM. A conference on setting the agenda for rural women’s health. Womens Health Issues 2001. [DOI: 10.1016/s1049-3867(00)00091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Affiliation(s)
- J M Cain
- Department of Obstetrics and Gynecology, Penn State College of Medicine, University Park, PA, USA
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Affiliation(s)
- T C Wright
- Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Affiliation(s)
- J M Cain
- FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health, London, UK. International Federation of Gynecology and Obstetrics
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Abstract
The fundamental denial of basic human rights to reproductive choice, freedom from violence, and economic and educational development for women remains the major underpinning ethical issue in worldwide women's healthcare. The ability to choose when to have children, whether to have prenatal diagnosis or to make uncoerced choices at the end of life all hinge on the independence of each woman's ability to make choices about their own healthcare within the constraints of the health resources available to them. Technologic advances increase the complexity of assuring that the rights and best interest of the woman, the fetus or child, and society itself are balanced equitably in both the healthcare setting as well as the development of national or international policies and standards. The obstetrician/gynecologist, as an advocate for women's health worldwide, has an ethical obligation to assure human rights are extended to women and the obligation to assure that the care received is the best available.
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Affiliation(s)
- J M Cain
- FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health, FIGO Secretariat, London, UK
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Abstract
The Pap smear has been the classic screening strategy for preventing cervical cancer for 50 years. The finding that infection with human papillomavirus is associated with an increased risk of cervical cancer has prompted the development of new strategies for cervical cancer screening and prevention. In their Policy Forum, Cain and Howett discuss the introduction of HPV testing, anti-HPV microbicidal agents and vaccination against HPV. They point out the benefits but also the potential for over and under treatment and the need for considerable improvements in public education.
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Affiliation(s)
- J M Cain
- Departments of Obstetrics and Gynecology, The Pennsylvania State University, College of Medicine MB103 HOSPITAL, Hershey, PA 17033,
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Schenker JG, Cain JM. FIGO Committee Report. FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health. International Federation of Gynecology and Obstetrics. Int J Gynaecol Obstet 1999; 64:317-22. [PMID: 10366059 DOI: 10.1016/s0020-7292(98)00266-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Seewaldt VL, Cain JM, Goff BA, Tamimi H, Greer B, Figge D. A retrospective review of paclitaxel-associated gastrointestinal necrosis in patients with epithelial ovarian cancer. Gynecol Oncol 1997; 67:137-40. [PMID: 9367696 DOI: 10.1006/gyno.1997.4842] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [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: 02/05/2023]
Abstract
Seven patients with gastrointestinal necrosis following paclitaxel chemotherapy are reported. Four of seven patients had platinum refractory disease, while 3/7 patients received primary paclitaxel therapy. Complications occurred 5 to 16 days following paclitaxel therapy. The most common clinical presentation was fever (7/7 patients), neutropenia (6/7 patients), and abdominal pain (6/7 patients). All seven patients developed gastrointestinal necrosis following the first cycle of paclitaxel chemotherapy. The exact mechanism by which this complication occurs is poorly understood. We postulate that gastrointestinal necrosis may be the result of a direct drug effect on the gastrointestinal epithelium and might involve a synergistic interaction between compromised bowel and paclitaxel-induced mitotic arrest. We observe that the incidence of gastrointestinal necrosis in patients with platinum refractory disease is 4 of 108 patients (3.7%). The incidence of this complication in patients receiving primary paclitaxel at our institution is 3 of approximately 128 patients (2.3%). Eighteen cases to date have been identified in the literature. A high index of suspicion of this complication should be considered for patients presenting with neutropenic fever and abdominal pain following paclitaxel chemotherapy.
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Affiliation(s)
- V L Seewaldt
- Division of Medical and Gynecologic Oncology, University of Washington, Seattle, Washington 98195, USA
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Affiliation(s)
- J M Cain
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey 17033, USA
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Abstract
BACKGROUND On January 1, 1992, Congress implemented a Medicare payment system based on relative value units (RVUs). The total RVU (which is made up of work, practice, and malpractice RVUs) is multiplied by a dollar conversion factor to set the reimbursement for all procedures covered by Medicare. In a previous study, we found that significant gender bias exists in Medicare reimbursement for female-specific services. Recently, HCFA approved increases (beginning January 1997) in the work RVU for many gynecologic procedures. This study was undertaken to compare work and total RVUs for gender-specific procedures effective January 1, 1997. METHODS Using the May 1996 Federal Register, we compared work and total RVUs for 24 pairs of gender-specific procedures. The groups were matched so that the amount of work and level of difficulty would be similar, if not identical. We validated our selection of procedures for comparison by also evaluating the average time required to perform these procedures. RESULTS Comparison of work RVUs for the 24 paired procedures revealed that in 19 cases (80%), male-specific procedures had a higher RVU; in 3 cases (12%), female-specific procedures were higher; and in 2 cases, there was no difference. On average, work RVUs were 49% higher for urologic procedures than for gynecologic procedures. Comparison of total RVUs revealed that in 20 cases (83%), urologic procedures had a higher total RVU and in 3 cases (12%), gynecologic procedures were higher. On average, male-specific surgeries are reimbursed at an amount which is 37% higher than that for female-specific surgeries. CONCLUSION Recent increases in work RVUs for many gynecologic procedures have resulted in improved reimbursement. However, even with these improvements, significant gender bias still exists in the Medicare reimbursement of female-specific procedures. This gender bias is further magnified as more private insurance carriers use the system to set reimbursement.
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Affiliation(s)
- B A Goff
- University of Washington Medical Center, Department of Obstetrics and Gynecology, Seattle 98195, USA
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Abstract
PURPOSE On January 1, 1992, Congress implemented a Medicare payment system based on relative value units (RVU). The RVU multiplied by a dollar conversion factor sets the reimbursement for all procedures covered by Medicare and many other private insurers. This study was undertaken to evaluate discrepancies in federal reimbursement for gender-specific procedures. METHODS Using the December 1995 Federal Register and the regional Medicare conversion factor ($40.08/RVU), we compared the work RVU and total reimbursement of 24 groups of gender-specific surgical procedures. The groups were matched as carefully as possible so that the amount of work and level of difficulty would be similar, if not identical. Some examples of comparisons are as follows: biopsy of male vs female genitals, hysterectomy vs prostatectomy, staging for ovarian vs testicular cancer, and exenteration for cervical vs prostate cancer. RESULTS In the 24 matched procedures, the male-specific procedures were reimbursed at a higher amount in 19 (79%) cases. The female-specific procedures were reimbursed at a higher amount in 3 (12%) cases (P = 0.004). There was no difference in reimbursement for two of the comparisons. Overall, we found that male-specific procedures are reimbursed at an amount which is 44% higher than female-specific procedures. Comparison of work RVU revealed that male-specific procedures were assigned higher values in 19 cases and, overall, male gender-related surgeries had work RVU that were 50% higher than female gender-related surgeries. CONCLUSION There is significant gender bias against the Medicare reimbursement of female-specific services. This results in a lower net reimbursement for gynecologic procedures. In addition, since many private sector insurance carriers now use the resource-based relative value scale system, this gender bias is further potentiated.
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Affiliation(s)
- B A Goff
- University of Washington Medical Center, Department of Obstetrics and Gynecology, Seattle 98195, USA
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Abstract
OBJECTIVE To determine if immunoreactive inhibin assayed in serum from women with granulosa cell tumors correlated with tumor burden, reflected response to treatment, or predicted recurrent disease. STUDY DESIGN Serum samples were collected following bilateral oophorectomy (BSO) with or without other indicated surgery in 15 patients with granulosa cell tumors. Inhibin radioimmunoassay (RIA-Inh) was performed on all samples and results were correlated with tumor burden, disease status, and treatment response. RESULTS Fifteen patients had serum assayed for inhibin with levels ranging from 0 to 7470 U/liter. In 4 patients with measurable recurrent disease, inhibin levels correlated directly with tumor burden (r2 = 0.96). Four patients had serum drawn during clinical remission and in all 4 patients elevated inhibin levels predated recurrence by a median interval of 11.5 months (range 7-20). The remaining 7 were treated for primary disease and were in clinical remission with a median follow-up of 33 months (range 9-53). Four of these 7 patients were surgically staged: 2 were FIGO Stage I and inhibin levels fell to 0 U/liter; 2 patients had metastatic disease (Stage IIc and IIIa) and their inhibin levels were found to be elevated following complete resection. The remaining 3 were not surgically staged, and all had elevated inhibin levels while in clinical remission, suggesting occult disease. Of the 15 total patients, 1 who was treated with chemotherapy for recurrent disease was followed with serial inhibin levels. She showed a complete response to therapy with inhibin levels falling from 975 to 0 U/liter with 15 months follow-up. CONCLUSIONS Serum inhibin levels reflect tumor burden and may be valuable in assessing response to chemotherapy or predicting recurrent disease in women with granulosa cell tumors who have had BSO. Serum inhibin level evaluation should be incorporated into large-group trials of therapy for granulosa cell tumors.
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Affiliation(s)
- J F Boggess
- Division of Gynecologic Oncology, University of Washington, Seattle 98195, USA
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Cain JM, Collins C, Petersdorf S, Figge DC, Tamimi HK, Greer BE, Livingston RB. Phase II study of high-dose cisplatin, etoposide, and cyclophosphamide for refractory ovarian cancer. Am J Obstet Gynecol 1996; 174:1688-94; discussion 1694. [PMID: 8678128 DOI: 10.1016/s0002-9378(96)70198-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 02/01/2023]
Abstract
OBJECTIVES A phase II trial of high-dose cyclophosphamide, etoposide, and cisplatin was done. STUDY DESIGN Forty-eight patients with progressive or persistent disease and previous cisplatin-based chemotherapy and no paclitaxel therapy were entered for treatment on the basis of two cycles of cyclophosphamide (4500 mg/m2), etoposide (750 mg/m2), and cisplatin (120 mg/m2). RESULT Seventy-four cycles were delivered. Six patients died during treatment (12.5%). Of 28 with measurable disease, there was a 25% response rate and 32% had stable disease. Median time to recurrence and survival were significantly different for minimal versus bulky disease (p = 0.0089, p = 0.0008, log rank) and for platinum-sensitive versus platinum-resistant disease (p = 0.18, p = 0.0012, log-rank). The number of prior regimens was not correlated with time to progression or survival. CONCLUSION This study shows little advantage for high-dose protocols except for patients with a response to platinating agents and minimal residual disease.
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Affiliation(s)
- J M Cain
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, USA
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Goff BA, Sainz de la Cuesta R, Muntz HG, Fleischhacker D, Ek M, Rice LW, Nikrui N, Tamimi HK, Cain JM, Greer BE, Fuller AF. Clear cell carcinoma of the ovary: a distinct histologic type with poor prognosis and resistance to platinum-based chemotherapy in stage III disease. Gynecol Oncol 1996; 60:412-7. [PMID: 8774649 DOI: 10.1006/gyno.1996.0065] [Citation(s) in RCA: 242] [Impact Index Per Article: 8.6] [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: 02/02/2023]
Abstract
Between 1982 and 1992, 24 women with Stage III clear cell ovarian cancer were identified from the tumor registry. Thirty-four women with Stage III papillary serous tumors treated between 1987 and 1989 were used as a comparison. All patients underwent cytoreductive surgery followed by conventional platinum-based chemotherapy. In the women with clear cell histology, nine (37.5%) had endometriosis in the surgical specimen compared with one (3%) in the papillary serous group (P = 0.002). Ten women (42%) with clear cell histology experienced a thromboembolic event during the course of treatment, compared to six (18%) in the papillary serous group (P = 0.05). In the group with clear cell histology, overall, 70% of women had progressive disease. Fifty-two percent experienced clinical progression while receiving platinum-based chemotherapy. In addition, four patients were found to have progressive disease at second-look laparotomy. Only two patients had a pathologic complete response. In the group with papillary serous histology, 29% overall had progressive disease while on chemotherapy (P = 0.005). The median survival for the women with clear cell histology was 12 months compared to 22 months for those with papillary serous (P = 0.02). For women with clear cell histology, univariate analysis was used to evaluate prognostic factors. Age less than 50 was a poor prognostic factor (P = 0.045). The presence of endometriosis, thromboembolic event, or optimal cytoreduction were not prognostic factors (P = 0.67, P = 0.34, P = 0.39). Patients with advanced clear cell ovarian cancer have a poor response to conventional platinum-based chemotherapy and overall prognosis is poor.
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Affiliation(s)
- B A Goff
- Vincent Memorial Gynecologic Oncology Division, Harvard Medical School, Boston, Massachusetts 02114, USA
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Swisher EM, Gown AM, Skelly M, Ek M, Tamimi HK, Cain JM, Greer BE, Muntz HG, Goff BA. The expression of epidermal growth factor receptor, HER-2/Neu, p53, and Ki-67 antigen in uterine malignant mixed mesodermal tumors and adenosarcoma. Gynecol Oncol 1996; 60:81-8. [PMID: 8557233 DOI: 10.1006/gyno.1996.0015] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.9] [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: 01/31/2023]
Abstract
Uterine malignant mixed mesodermal tumors (MMMT) are highly malignant tumors containing both malignant glands and stroma, while adenosarcomas (AS) are less aggressive tumors composed of malignant stroma and benign glands. Immunohistochemistry was used to grade overexpression of p53 protein, HER-2/neu protein, epidermal growth factor receptor (EGFR), and Ki-67 antigen in both the glands and stroma of tissue from 20 women with MMMT and 6 women with AS. EGFR was overexpressed in 2 AS and 9 MMMT, and was more commonly found in the sarcomatous component than the carcinomatous component in MMMT (P = 0.03). p53 was not found in any AS samples and was strongly present in 6 MMMT samples with a random distribution between the malignant components. HER-2/neu protein was not overexpressed in any AS or primary MMMT. Ki-67 antigen, a marker of cell proliferation, was found at higher levels in MMMT than AS samples (P = 0.03) and high Ki-67 antigen expression correlated with a decreased survival in patients with MMMT (P = 0.004). Independent characterization of oncogene proteins in the malignant components of these heterogeneous tumors may provide insight into the histogenesis and behavior of these malignancies.
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Affiliation(s)
- E M Swisher
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle 98195, USA
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Stelzer KJ, Koh WJ, Greer BE, Cain JM, Tamimi HK, Figge DC, Goff BA, Griffin TW. The use of intraoperative radiation therapy in radical salvage for recurrent cervical cancer: outcome and toxicity. Am J Obstet Gynecol 1995; 172:1881-6; discussion 1886-8. [PMID: 7778648 DOI: 10.1016/0002-9378(95)91427-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [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: 01/27/2023]
Abstract
OBJECTIVE Our purpose was to evaluate the contribution of intraoperative radiation therapy in the management of recurrent cervical cancer. STUDY DESIGN Twenty-two patients were treated with electron beam intraoperative radiation therapy for recurrent cervical cancers that were confined to the pelvis but were too extensive to be adequately treated by radical surgery alone. All patients underwent extensive surgical dissection for exposure and maximal tumor resection. Doses of intraoperative radiation therapy ranged from 14 to 27.8 Gy (median 22 Gy). Twelve patients received intraoperative radiation therapy to address gross residual disease, and 10 patients were treated for microscopically positive or close surgical margins. RESULTS The five-year disease-specific survival and local control rates were 43% and 48%, respectively. There were trends toward better local control and disease-specific survival in patients with microscopic residual disease compared with those with gross residual disease. Seven patients had peripheral neuropathy related to treatment, and four of these cases resolved. CONCLUSION In carefully selected cases intraoperative radiation therapy contributes to radical salvage of patients with recurrent cervical cancer involving the pelvic wall.
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Affiliation(s)
- K J Stelzer
- Department of Radiation Oncology, University of Washington Medical Center, Seattle 98195, USA
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Seewaldt VL, Cain JM, Greer BE, Tamimi HK, Figge DC, Livingston RB. Reviving the pelvic examination for evaluating the status of ovarian carcinoma. J Clin Oncol 1995; 13:799. [PMID: 7884443 DOI: 10.1200/jco.1995.13.3.799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Seewaldt VL, Figge DC, Greer BE, Tamimi HK, Brown WS, Cain JM. Primary central nervous system recurrence after paclitaxel therapy for epithelial ovarian malignancy. Gynecol Oncol 1994; 55:456-8. [PMID: 7835788 DOI: 10.1006/gyno.1994.1322] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 01/27/2023]
Abstract
Paclitaxel is currently being utilized to treat neoplasms which have a significant incidence of central nervous system metastases. It is, however, unclear as to whether paclitaxel crosses the blood-brain barrier. In this report, the authors describe a patient with refractory epithelial ovarian cancer treated with paclitaxel at 135 mg/m2/24 hr every 21 days. The patient achieved a complete clinical response of all abdominal and pelvic disease, but simultaneously developed central nervous system metastases. Paclitaxel was effective against the patient's abdominal and pelvic disease but was not protective against central nervous system metastasis.
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Affiliation(s)
- V L Seewaldt
- University of Washington Medical Center, Department of Medical Oncology, Seattle 98195
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Goff BA, Kato D, Schmidt RA, Ek M, Ferry JA, Muntz HG, Cain JM, Tamimi HK, Figge DC, Greer BE. Uterine papillary serous carcinoma: patterns of metastatic spread. Gynecol Oncol 1994; 54:264-8. [PMID: 8088602 DOI: 10.1006/gyno.1994.1208] [Citation(s) in RCA: 318] [Impact Index Per Article: 10.6] [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: 01/28/2023]
Abstract
Uterine papillary serous carcinoma (UPSC) is a distinct histologic type of endometrial cancer which is associated with a high relapse rate and poor prognosis. Between 1983 and 1993, 50 patients with UPSC of the endometrium were surgically staged. Thirty-three patients had pure UPSC and 17 had UPSC admixed with other histologies. Extrauterine disease was found in 36 women (72%). Lymph node metastases were present in 36% of women without myometrial invasion, 50% with inner one-half invasion, and 40% with outer one-half invasion. Similarly, the presence of intraperitoneal disease or positive washings did not correlate with increasing myometrial invasion. Grade and histology (mixed vs pure) were also not predictive of extrauterine disease. Patients with lymphatic/vascular space invasion (LVSI) were more likely to have extrauterine disease (85%); however, even without LVSI the incidence of extrauterine disease was 58% (P = 0.05). Unlike endometrioid adenocarcinomas, grade and depth of myometrial invasion were not significant predictors for extrauterine disease. This study reinforces the need for complete surgical staging in all patients with UPSC regardless of depth of invasion.
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Affiliation(s)
- B A Goff
- Department of Obstetrics and Gynecology, University of Washington, Seattle 98195
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