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Taylor J, Nailer E, Cohen CR, Redman CWE, Sherman SM. HPV vaccination and cervical screening: the knowledge and attitudes of mothers of adolescent girls. Psychol Health 2022:1-18. [PMID: 35653227 DOI: 10.1080/08870446.2022.2081327] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Mothers play a significant role in decision making about human papillomavirus (HPV) vaccination for their daughters and about cervical screening attendance for themselves. This study had three objectives, to explore: (1) mothers' knowledge and attitudes about HPV and HPV vaccination, (2) their knowledge and attitudes about cervical cancer and screening, and (3) whether their daughter's HPV vaccination invitation was an opportunity to nudge mothers to attend screening. DESIGN 138 women from North Staffordshire completed a cross-sectional survey and 15 took part in follow-up focus groups. RESULTS Despite high self-reported engagement with both the cervical screening and HPV vaccination programmes, relatively low levels of knowledge and some uncertainty were evident. There was mixed opinion about the potential of using the vaccination invite as an opportunity to nudge mothers to attend cervical screening. CONCLUSION Even amongst women who do engage positively with the programmes, knowledge is not as complete and certain as it could be. Further research is needed with women who are less likely to accept the vaccination for their daughters. Women need to be better informed, which may go some way to reversing the decline in screening and maintaining high levels of vaccination.
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Affiliation(s)
- Jennifer Taylor
- School of Psychology, Keele University, Keele, UK
- School of Life Sciences & Education, Staffordshire University, Stoke-on-Trent, UK
| | - Emma Nailer
- School of Psychology, Keele University, Keele, UK
| | | | - Charles W E Redman
- Department of Obstetrics and Gynaecology, Royal Stoke University Hospital, Stoke on Trent, UK
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Redman CWE, Kesic V, Cruickshank ME, Gultekin M, Carcopino X, Castro Sanchez M, Grigore M, Jakobsson M, Kuppers V, Pedro A, Reich O, Leeson S, Tabuica U, Zodzika J, Ciavattini A, Jach R, Katsyuba M, Koiss R, Martin-Hirsch P, Tjalma WA, Nieminen P. European consensus statement on essential colposcopy. Eur J Obstet Gynecol Reprod Biol 2020; 256:57-62. [PMID: 33171418 DOI: 10.1016/j.ejogrb.2020.06.029] [Citation(s) in RCA: 5] [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: 04/14/2020] [Revised: 05/24/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
This European consensus statement on essential colposcopy provides standards for the general colposcopist seeing women referred for colposcopy with an abnormal cervical screening test (including cytology and HPV tests) or with a clinically suspicious cervix. The article gives guidance regarding the aims and conduct of colposcopy. Recommendations are provided on colposcopy technique, the management of common colposcopy issues, treatment and follow-up of after treatment of CIN or early stage cervical. Colposcopists should make an informed decision on the management of each individual that is referred and organize appropriate follow-up. Cervical cancer is still a major health issue and the quality of care can only improve if there is a structured guidance for women with an abnormal smear or suspicious cervix.
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Affiliation(s)
- C W E Redman
- Past-President European Federation of Colposcopy and University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - V Kesic
- Faculty of Medicine, University of Belgrade, Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia
| | - M E Cruickshank
- Aberdeen Centre for Women's Health Research, University of Aberdeen, UK.
| | - M Gultekin
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - X Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), University Avignon, CNRS, IRD, IMBE UMR 7263, Marseille, France
| | - M Castro Sanchez
- Department of Obstetrics and Gynaecology, University Hospital Puerto De Hierro Majadahonda, Madrid, Spain
| | - M Grigore
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Romania
| | - M Jakobsson
- HUS Hyvinkää Hospital, University of Helsinki, Finland
| | - V Kuppers
- Obstetrics and Gynecology Koenigsallee 64, Duesseldorf, Germany
| | - A Pedro
- Department of Obstetrics and Gynaecology, Cuf Sintra Hospital, Sintra, Portugal
| | - O Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Austria
| | - S Leeson
- Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Bangor, Wales, UK
| | - U Tabuica
- Department of Obstetrics and Gynecology, State University of Medicine and Pharmacy, Referral Center of Colposcopy, Chisinau, Moldavia
| | - J Zodzika
- Department of Obstetrics and Gynaecology, Riga Stradiņš University, Riga East Clinical University Hospital, Riga, Latvia
| | - A Ciavattini
- Department of Woman's Health Sciences, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - R Jach
- Clinic of Endocrynologic Gynecology, University Hospital UJ CM, Krakow, Poland
| | - M Katsyuba
- Department of Oncology, Kazan State Medical Academy, Kazan, Russian Federation
| | - R Koiss
- Department of Obstetrics and Gynecologic Oncology, St. Stephan Hospital, Budapest, Hungary
| | - P Martin-Hirsch
- Department of Obstetrics & Gynaecology, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire & Royal Preston Hospital, Preston, United Kingdom
| | - W A Tjalma
- Department of Obstetrics and Gynecology, Breast Clinic - Unit Gynecologic Oncology, Antwerp University Hospital and University of Antwerp, Belgium
| | - P Nieminen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and Helsinki University, Finland
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Verheijen RHM, Mahmood T, Donders G, Redman CWE, Wood P. EBCOG position statement: Gender neutral HPV vaccination for young adults. Eur J Obstet Gynecol Reprod Biol 2020; 246:187-189. [PMID: 31992466 DOI: 10.1016/j.ejogrb.2020.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/28/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
Human Papilloma Virus (HPV) has been implicated in the initiation of several types of cancers in both females and males. Therefore, it is imperative that national immunization programs should ensure that both young women and young men receive full immunization for herd immunity in their teenage years. A recent review confirmed that vaccination of boys and girls would be most cost-effective under the circumstances that both individual costs and coverage are low. By doing so, it would be possible to reduce the incidence of HPV-related malignancies to a large extent at later age in both sexes.
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Affiliation(s)
- Rene H M Verheijen
- Emeritus Professor of Gynaecological Oncology, Formerly Dept. of Gynaecological Oncology, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Tahir Mahmood
- EBCOG Standards of Care and Position Statements Working Group, Victoria Hospital, Kirkcaldy, Scotland, United Kingdom.
| | - Gilbert Donders
- Dept. of Obstetrics and Gynaecology, University Hospital Antwerp, Femicare Tienen, and Regional Hospital H Hart Tienen, Tienen, Belgium; International Society of infectious Diseases in Obstetrics and Gynaecology (ISIDOG)
| | | | - Paul Wood
- European Association of Paediatric andAdolescent Gynaecology (EURAPAG)
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Arbyn M, Redman CWE, Verdoodt F, Kyrgiou M, Tzafetas M, Ghaem-Maghami S, Petry KU, Leeson S, Bergeron C, Nieminen P, Gondry J, Reich O, Moss EL. Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis. Lancet Oncol 2017; 18:1665-1679. [PMID: 29126708 DOI: 10.1016/s1470-2045(17)30700-3] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Incomplete excision of cervical precancer is associated with therapeutic failure and is therefore considered as a quality indicator of clinical practice. Conversely, the risk of preterm birth is reported to correlate with size of cervical excision and therefore balancing the risk of adequate treatment with iatrogenic harm is challenging. We reviewed the literature with an aim to reveal whether incomplete excision, reflected by presence of precancerous tissue at the section margins, or post-treatment HPV testing are accurate predictors of treatment failure. METHODS We did a systematic review and meta-analysis to assess the risk of therapeutic failure associated with the histological status of the margins of the tissue excised to treat cervical precancer. We estimated the accuracy of the margin status to predict occurrence of residual or recurrent high-grade cervical intraepithelial neoplasia of grade two or worse (CIN2+) and compared it with post-treatment high-risk human papillomavirus (HPV) testing. We searched for published systematic reviews and new references from PubMed-MEDLINE, Embase, and CENTRAL and did also a new search spanning the period Jan 1, 1975, until Feb 1, 2016. Studies were eligible if women underwent treatment by excision of a histologically confirmed CIN2+ lesion, with verification of presence or absence of CIN at the resection margins; were tested by cytology or HPV assay between 3 months and 9 months after treatment; and had subsequent follow-up of at least 18 months post-treatment including histological confirmation of the occurrence of CIN2+. Primary endpoints were the proportion of positive section margins and the occurrence of treatment failure associated with the marginal status, in which treatment failure was defined as occurrence of residual or recurrent CIN2+. Information about positive resection margins and subsequent treatment failure was pooled using procedures for meta-analysis of binomial data and analysed using random-effects models. FINDINGS 97 studies were eligible for inclusion in the meta-analysis and included 44 446 women treated for cervical precancer. The proportion of positive margins was 23·1% (95% CI 20·4-25·9) overall and varied by treatment procedure (ranging from 17·8% [12·9-23·2] for laser conisation to 25·9% [22·3-29·6] for large loop excision of the transformation zone) and increased by the severity of the treated lesion. The overall risk of residual or recurrent CIN2+ was 6·6% (95% CI 4·9-8·4) and was increased with positive compared with negative resection margins (relative risk 4·8, 95% CI 3·2-7·2). The pooled sensitivity and specificity to predict residual or recurrent CIN2+ was 55·8% (95% CI 45·8-65·5) and 84·4% (79·5-88·4), respectively, for the margin status, and 91·0% (82·3-95·5) and 83·8% (77·7-88·7), respectively, for high-risk HPV testing. A negative high-risk HPV test post treatment was associated with a risk of CIN2+ of 0·8%, whereas this risk was 3·7% when margins were free. INTERPRETATION The risk of residual or recurrent CIN2+ is significantly greater with involved margins on excisional treatment; however, high-risk HPV post-treatment predicts treatment failure more accurately than margin status. FUNDING European Federation for Colposcopy and Institut national du Cancer (INCA).
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium.
| | | | - Freija Verdoodt
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Kyrgiou
- Division of Reproductive Biology, Department Cancer and Surgery, Imperial College, London, UK
| | - Menelaos Tzafetas
- Division of Reproductive Biology, Department Cancer and Surgery, Imperial College, London, UK
| | - Sadaf Ghaem-Maghami
- Division of Reproductive Biology, Department Cancer and Surgery, Imperial College, London, UK
| | - Karl-Ulrich Petry
- Department of Gynaecology and Obstetrics, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Simon Leeson
- Department of Gynaecology and Obstetrics, Betsi Cadwaladr University Health Board, Bangor, Gwyndd, UK
| | | | - Pekka Nieminen
- Department of Gynaecology and Obstetrics, Helsinki University Hospital, Helsinki, Finland
| | - Jean Gondry
- Service de gynécologie et obstétrique, CHU d'Amiens-Picardie, Amiens, France
| | - Olaf Reich
- Department of Gynaecology and Obstetrics, Medical University of Graz, Graz, Austria
| | - Esther L Moss
- Department of Cancer Studies, University of Leicester, Leicester, UK
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Hope KA, Moss E, Redman CWE, Sherman SM. Psycho-social influences upon older women's decision to attend cervical screening: A review of current evidence. Prev Med 2017; 101:60-66. [PMID: 28502577 DOI: 10.1016/j.ypmed.2017.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 04/28/2017] [Accepted: 05/07/2017] [Indexed: 10/19/2022]
Abstract
Cervical cancer is the fourth most common cancer in women worldwide (WHO, 2016). In many developed countries the incidence of cervical cancer has been significantly reduced by the introduction of organised screening programmes however, in the UK, a fall in screening coverage is becoming a cause for concern. Much research attention has been afforded to younger women but age stratified mortality and incidence data suggest that older women's screening attendance is also worthy of study. This paper provides a review of current evidence concerning the psycho-social influences that older women experience when deciding whether to attend cervical screening. Few studies have focussed on older women and there are significant methodological issues with those that have included them in their samples. Findings from these studies indicate several barriers which may deter older women from screening, such as embarrassment and logistical issues. Drivers to screening include reassurance and a sense of obligation. Physical, social and emotional changes that occur as women age may also have an impact on attendance. This review concludes that there is a clear need for better understanding of the perceptions of older women specifically with regard to cervical cancer and screening. Future research should inform the design of targeted interventions and provision of information to enable informed decision-making regarding cervical screening among older women.
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Affiliation(s)
- Kirsty A Hope
- School of Psychology, Keele University, Keele, Staffs ST5 5BG, UK
| | - Esther Moss
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Charles W E Redman
- Department of Obstetrics and Gynaecology, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, UK
| | - Susan M Sherman
- School of Psychology, Keele University, Keele, Staffs ST5 5BG, UK.
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Sherman SM, Nailer E, Minshall C, Coombes R, Cooper J, Redman CWE. Awareness and knowledge of HPV and cervical cancer in female students: A survey (with a cautionary note). J OBSTET GYNAECOL 2017; 36:76-80. [PMID: 26408400 DOI: 10.3109/01443615.2015.1041886] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We conducted a survey to explore levels of awareness and knowledge of human papillomavirus (HPV) and cervical cancer in 170 female students and whether mode of data collection (online vs. paper) affected the results. 27% of women named HPV as a cause of cervical cancer with online respondents more likely to do so. 75% of women had heard of HPV. More online respondents had heard of HPV than paper respondents. 127 women reported having heard of HPV, with a mean knowledge score of 2.989 (standard deviation [SD] 1.599). Online respondents scored higher (3.57, SD 1.316) than paper respondents (2.688, SD 1.591). Knowledge and awareness of HPV and its link to cervical cancer appear to have increased which may be related to the HPV vaccination programme. However, there is still a considerable number of women with little to no knowledge of HPV. Online surveys may result in an inflated estimation of awareness and knowledge.
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Sherman SM, Moss EL, Pearmain P, Redman CWE. Colposcopists' experiences of HPV Test of Cure for the follow up of cervical intra-epithelial neoplasia. Eur J Obstet Gynecol Reprod Biol 2016; 201:42-5. [PMID: 27042770 DOI: 10.1016/j.ejogrb.2016.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/23/2015] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To survey lead colposcopists in England to explore their views on the recently introduced HPV Test of Cure (TOC) following treatment for cervical intra-epithelial neoplasia (CIN) and to determine the extent to which it has impacted their clinical practice and affected their patients. METHODS An online survey was sent to lead colposcopists across England. Questions were asked focusing on the clinicians' confidence in the ability of TOC to guide follow up in various clinical scenarios and how the implementation of TOC had changed patient management. RESULTS There was a 50% (N=88) response rate. 90% of respondents indicated they were happy with the new procedure. In the follow-up questions, 20% indicated they were uncomfortable with the procedure when it was applied to women who were CIN2+ with incomplete excision at the endocervical margin. Open-ended questions elicited positive aspects of TOC including reduced follow-up, increased reassurance for patients and clinicians and a faster return to the call-recall system. Negative observations included concerns around HPV positive cases, possible false negatives and anxiety in those women who were originally subject to the pre-TOC guidelines and were now returned to call-recall "earlier" than originally indicated to them. 11% of respondents also indicated they work around the new guidelines to some extent. CONCLUSION Although clinicians are on the whole positive towards the introduction of TOC, concerns were raised which centre primarily around those patients with CIN2+ combined with positive endocervical margins, issues related to HPV positive cases and the possibility of a false negative HPV result. The possibility of patient anxiety due to return to routine screening earlier than originally expected was also identified as a concern.
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Affiliation(s)
- Susan M Sherman
- School of Psychology, Keele University, Keele, Staffordshire ST5 5BG, UK.
| | - Esther L Moss
- Department of Gynaecological Oncology, University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, UK
| | - Philippa Pearmain
- Screening QA Service (West Midlands), Public Health England, 5 St Phillip's Place, Birmingham B3 2PW, UK
| | - Charles W E Redman
- Department of Obstetrics and Gynaecology, Royal Stoke University Hospital, Stoke on Trent ST4 6QG, UK
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Sherman SM, Nailer E, Pearmain P, Todd RW, Redman CWE. Disclosing the results of the invasive cervical cancer review to patients: a survey of lead colposcopists across England. Cytopathology 2015; 27:237-41. [PMID: 26566859 DOI: 10.1111/cyt.12283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To survey lead colposcopists to explore the extent to which patients are currently being invited to discuss the results of their invasive cervical cancer review, the reasons why this might not be happening and the clinician experience. METHODS An online survey was sent to lead colposcopists across England. They were asked whether they offered the review to patients, if they did how they did so and what their experience was and if they did not, why not. RESULTS There was a 68.5% (N = 122) response rate, with 53% of respondents currently offering the review meetings. Patients were predominantly invited to the review meeting face to face and clinicians' experiences were mixed with a variety of positive and negative aspects of the meetings given. For those clinicians not currently offering a review meeting, there were a variety of reasons: 25% cited a lack of awareness of the guidelines, 19% time constraints, 12% a fear of causing additional distress and 2% a fear of litigation. Open-ended responses demonstrated a considerable amount of misunderstanding about the process. CONCLUSION Despite National Health Service Cervical Screening Programme guidelines, not all clinicians offer review meetings to patients and those who do offer them do not always offer them to all women. Patient research needs to be conducted to explore the value of the meetings further, and there is a need to do more to engage clinicians in the process.
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Affiliation(s)
- S M Sherman
- School of Psychology, Keele University, Keele, Staffordshire, UK
| | - E Nailer
- School of Psychology, Keele University, Keele, Staffordshire, UK
| | - P Pearmain
- West Midlands Cancer Screening QA Reference Centre, Public Health England, Birmingham, UK
| | - R W Todd
- Department of Obstetrics and Gynaecology, Royal Stoke University Hospital, Stoke on Trent, UK
| | - C W E Redman
- Department of Obstetrics and Gynaecology, Royal Stoke University Hospital, Stoke on Trent, UK
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Affiliation(s)
- Susan M Sherman
- School of Psychology, Keele University, Keele, Staffs ST5 5BG, UK
| | - Alejandra Castanon
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, UK
| | - Esther Moss
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Charles W E Redman
- Department of Obstetrics and Gynaecology, Royal Stoke University Hospital, Stoke on Trent, UK
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Simon AJ, Parry-Smith WR, Redman CWE, Kodampur M, Todd R, Satur C, Morgan R. Intravascular leiomyomatosis: A case report and review of the literature. J OBSTET GYNAECOL 2014; 35:539-40. [PMID: 25409202 DOI: 10.3109/01443615.2014.978847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A J Simon
- a School of Medicine, Keele University Medical School, Keele University , Stoke-on-Trent , UK
| | - W R Parry-Smith
- b Department of Emergency , University Hospital of North Staffordshire, The Royal Infirmary , Staffordshire, Stoke-on-Trent , UK
| | - C W E Redman
- c Department of Gynaecology , University Hospital of North Staffordshire, City General Hospital , Staffordshire, Stoke-on-Trent , UK
| | - M Kodampur
- c Department of Gynaecology , University Hospital of North Staffordshire, City General Hospital , Staffordshire, Stoke-on-Trent , UK
| | - R Todd
- c Department of Gynaecology , University Hospital of North Staffordshire, City General Hospital , Staffordshire, Stoke-on-Trent , UK
| | - C Satur
- d Cardiothoracic Surgery, University Hospital of North Staffordshire, City General Hospital , Staffordshire, Stoke-on-Trent , UK
| | - R Morgan
- e Vascular Surgery, University Hospital of North Staffordshire, City General Hospital , Staffordshire, Stoke-on-Trent , UK
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11
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Parry-Smith W, Thorpe D, Ogboro-Okor L, Underwood M, Ismaili E, Kodampur M, Todd R, Douce G, Redman CWE. Cytological follow-up after hysterectomy: is vaginal vault cytology sampling a clinical governance problem? The University Hospital of North Staffordshire approach. Cytopathology 2014; 26:188-93. [PMID: 25123422 DOI: 10.1111/cyt.12178] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Vaginal vault cytology sampling following hysterectomy is recommended for specific indications in national guidelines. However, clinical governance issues surround compliance with guidance. Our first study objective was to quantify how many patients undergoing hysterectomy at the University Hospital of North Staffordshire (UHNS) had vault cytology advice in their histology report and, if indicated, whether it was arranged. The second was to devise a vault cytology protocol based on local experience and national guidance. METHODS The local cancer registry was searched. Clinical, clerical and histological data for all patients undergoing hysterectomy were collected. RESULTS In total, 271 patients were identified from both the gynae-oncology and benign gynaecology teams. Of these, 24% (65/271) were gynae-oncology patients with a mean age of 69 years. The benign gynaecology team had 76% (206/271) of patients with a mean age of 55 years. Subsequently, 94% (256/271) had cytology follow-up advice in their histopathology report. Ultimately, from both cohorts, 39% (18/46) had follow-up cytology performed when indicated. CONCLUSION A high proportion of cases complied with national guidance. However, a disappointingly high number did not have vault cytology sampling when this was indicated. This is probably a result of the complex guidance that is misunderstood in both primary and secondary care. Vault follow-up of patients after hysterectomy rests with the team performing the surgery. Vault cytology, if indicated, should be performed in secondary care and follow-up should be planned. The protocol set out in this article should be followed to avoid unnecessary clinical governance failings.
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Affiliation(s)
- W Parry-Smith
- University Hospital of North Staffordshire, Staffordshire, UK
| | - D Thorpe
- University Hospital of North Staffordshire, Staffordshire, UK
| | - L Ogboro-Okor
- University Hospital of North Staffordshire, Staffordshire, UK
| | | | - E Ismaili
- University Hospital of North Staffordshire, Staffordshire, UK
| | - M Kodampur
- University Hospital of North Staffordshire, Staffordshire, UK
| | - R Todd
- University Hospital of North Staffordshire, Staffordshire, UK
| | - G Douce
- University Hospital of North Staffordshire, Staffordshire, UK
| | - C W E Redman
- University Hospital of North Staffordshire, Staffordshire, UK
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Moss EL, Arbyn M, Dollery E, Leeson S, Petry KU, Nieminen P, Redman CWE. European Federation of Colposcopy quality standards Delphi consultation. Eur J Obstet Gynecol Reprod Biol 2013; 170:255-8. [PMID: 23891389 DOI: 10.1016/j.ejogrb.2013.06.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 12/13/2012] [Revised: 05/11/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Optimization of colposcopy practice requires a program of quality assurance including the monitoring of performance indicators. The European Federation of Colposcopy (EFC) aimed to identify a list of quality indicators for colposcopic practice, which are relevant, reproducible and practical across all of the member countries. STUDY DESIGN A five-round Delphi consultation was conducted in 30 full, 5 associate and 4 potential member countries in order to determine a core list of quality indicators including optimal target ranges. RESULTS Six indicators were selected from a list of 37 proposed standards. Two further rounds of consultation were conducted to determine expert opinion on the target level for each of the standards. The six indicators identified and corresponding targets were: documentation of whether or not the squamocolumnar junction has been seen (100%); colposcopy prior to treatment for abnormal cervical cytology (100%); percentage of excisional treatments/conizations to contain cervical intra-epithelial neoplasia grade two or worse (≥85%); percentage of excised lesions/conizations with clear margins (≥80%); and two indicators concerned the number of cases to be colposcoped per year: ≥50 low-grade/minor and ≥50 high-grade/major cytological abnormalities. CONCLUSIONS A Delphi consultation identified six EFC quality indicators. These are a first step in an international attempt to optimize colposcopy practice throughout Europe. The current targets are based on expert opinion and may need adaptation in the future. Data are needed from European colposcopy settings to determine whether the indicators are achievable practice-based benchmarks and will help in improving and fine tuning the list of performance indicators and targets.
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Affiliation(s)
- Esther L Moss
- Department of Gynaecological Oncology, University Hospitals of Leicester, Leicester, UK
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Underwood M, Arbyn M, Parry-Smith W, De Bellis-Ayres S, Todd R, Redman CWE, Moss EL. Accuracy of colposcopy-directed punch biopsies: a systematic review and meta-analysis. BJOG 2012; 119:1293-301. [DOI: 10.1111/j.1471-0528.2012.03444.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Prabakar I, Moss EL, Douce G, Parkes J, Redman CWE. Review of invasive cervical cancers and uptake of disclosure of results: an audit of procedures and response. Cytopathology 2012; 23:167-71. [PMID: 22494343 DOI: 10.1111/j.1365-2303.2012.00974.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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To audit the process and outcome of case reviews performed for invasive cervical cancers diagnosed between 2003 and 2007, and the timely disclosure of results to the respective patients. METHODS Invasive cervical cancer reviews were performed on all cases of cervical cancer diagnosed between 2003 and 2007. Following the review, women were classified into two categories: a group who developed invasive cancer despite adherence to the screening programme or in whom a management or diagnostic decision was determined to have been a principal factor in the development of their disease (Group A), and a second group who either had never undergone a cervical smear or had been established defaulters from the screening programme (Group B). RESULTS Ninety-seven of the 98 cases of invasive cervical cancer diagnosed in the 4-year study period were reviewed. Sixty of the 61 women in Group A were sent an invitation to discuss the results of their case review. Thirty-six (37%) were classified as Group B, and it was deemed neither appropriate nor possible to invite the patients for a review consultation. Of the women sent an invitation, only 24 (40%) chose to attend. CONCLUSION A policy of selective invitation for the disclosure of invasive review results is feasible. Less than one-half of patients diagnosed with cervical cancer appear to want to know how they developed cervical cancer despite previously participating in a screening programme.
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Affiliation(s)
- I Prabakar
- Abacus Clinics for Sexual and Reproductive Healthcare, Liverpool Community Health, Central Abacus, Citrus House, Liverpool, UK
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Affiliation(s)
- E L Moss
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, West Midlands Cervical Screening QA Reference Centre, University of Birmingham, Birmingham, UK
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Abstract
OBJECTIVE To investigate the diagnosis, review and management of women identified as having a cytology/histology discrepancy. METHODS A review of all patients diagnosed with a discrepancy between referral smear and cervical histology was performed between January 2003 and December 2004. Cases were followed for a minimum of 4 years and patient management and outcome reviewed. RESULTS A significant discrepancy was identified in 79 cases, 0.1% of all smears (n = 80,926) analysed during the study period. A discrepancy between cytology and histology, obtained from large loop excision of the transformation zone (LLETZ), was confirmed by multidisciplinary review in 42 cases (53.2%). In 37 cases (46.8%) the cytological and/or histological diagnosis was revised; the cytology was significantly more likely than the histology to be amended (chi square P = 0.005), most often because cytology had been overcalled. Of the confirmed discrepancy cases, 33 (78.6%) were due to high-grade squamous cell or glandular abnormalities on cytology with a negative, inflammatory or human papillomavirus (HPV) infection on histology (HGC/NH). HGC/NH cases were managed by cytological follow-up in 29 (87.9%), of which 72.4% of the smears were negative when performed at least 6 months post-excision. During the 4-year follow-up period six women with a confirmed HGC/NH underwent a repeat cervical excision (hysterectomy or LLETZ), and of these, HPV effect was seen in two cases but no cervical intraepithelial neoplasia was detected in any of the histological specimens. CONCLUSION Cytology overcall was responsible for the majority of cytology/histology discrepancies. A confirmed discrepancy is not an indication for a further excisional biopsy but follow-up is essential because a small percentage of patients may have disease that has been missed.
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Affiliation(s)
- E L Moss
- Academic Department of Obstetrics and Gynaecology, University Hospital of North Staffordshire, Stoke on Trent, UK
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Moss EL, Askew S, Jones PW, Redman CWE, Pearmain P. Implementing the national invasive cervical cancer audit: correlation between local and regional classification. J Med Screen 2011; 17:190-4. [PMID: 21258129 DOI: 10.1258/jms.2010.010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the accuracy of information recorded regionally and locally on the screening classification of cervical cancer cases using the national invasive cervical cancer audit categories. METHODS Comparison of the audit categorization of all cervical cancer cases diagnosed at the University Hospital of North Staffordshire (UHNS) between January 2003 and December 2006 with the classification assigned by the West Midlands Cervical Screening Quality Assurance Reference Centre (WMQARC). RESULTS Eighty-seven cases of cervical cancer were diagnosed during the three-year study period. There was agreement between the UHNS and WMQARC classification of cases in 52 cases (59.7%), moderate agreement κ = 0.51 (95% CI 0.39-0.63). The greatest disparity was seen in the classification of lapsed attenders, with nine of the 26 cases categorized as 'lapsed' by the UHNS being assigned to the 'lost to follow-up' category by WMQARC. Three cases were deemed unclassifiable by WMQARC using the national classification since the women were over the age of 70 years but had previously been enrolled in the screening programme, and currently there is no national category for these women. CONCLUSIONS Accurate and consistent classification of invasive cervical cancer cases is essential in order to obtain useful information on the efficiency of the national screening programme at a local, regional and national level. The use of a national algorithm would provide reassurance that all data used in the national evaluation of the NHS Cervical Screening Programme are consistent, meaning that robust conclusions could then be drawn from the data.
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Affiliation(s)
- E L Moss
- University Hospital of North Staffordshire, Stoke on Trent, UK
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Moss EL, Owen G, Jones PW, Sarhanis P, Nordin A, Luesley D, Redman CWE. The British Gynaecological Cancer Society Delphi consultation exercise on expected standards of practice for doctors specializing in the area of gynecological oncology. Int J Gynecol Cancer 2010; 20:488-91. [PMID: 20686369 DOI: 10.1111/igc.0b013e3181a835a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine a set of auditable standards applicable to physicians working in the area of gynecological oncology, which could be implemented as accreditation criteria for the revalidation procedure. DESIGN A 3-round Delphi consultation exercise. SETTING British Gynaecological Cancer Society (BGCS) members and delegates at the 2006 and 2007 Annual BGCS conferences Population 35 BGCS members, 72 delegates attending the 2006 BGCS conference and 120 delegates attending the 2007 conference. METHODS A preliminary Delphi consultation of members was performed electronically to determine the contents of the final Delphi questionnaires. Prioritization was achieved by scoring each parameter on a 5-point Likert scale. MAIN OUTCOME MEASURE The mean score awarded to each benchmarking parameter and the identification of parameters scoring 4 or above 75% or more of the respondents. RESULTS The first round contained responses from 68 participants in stage 1 and 72 in stage 2. The second round included 120 participants. Nine of the auditable standards in first round and 10 in the second round achieved a score of 4 or above 75% or more of the participants and were therefore considered to be essential for revalidation. The selected criteria focused on an individual clinician's caseload and performance, multidisciplinary team working and continued professional development. CONCLUSIONS This study has used the Delphi technique to identify auditable standards which could be used in the revalidation process of physicians working in the area of gynecological cancer.
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Affiliation(s)
- Esther L Moss
- University Hospital of North Staffordshire, Stoke on Trent, Staffordshire, UK
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Moss EL, Pearmain P, Askew S, Owen G, Reynolds TM, Prabakar IM, Douce G, Parkes J, Menon V, Todd RW, Redman CWE. Implementing the national invasive cervical cancer audit: a local perspective. BJOG 2010; 117:1411-6. [PMID: 20716252 DOI: 10.1111/j.1471-0528.2010.02679.x] [Citation(s) in RCA: 10] [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: 11/28/2022]
Abstract
OBJECTIVE To monitor the effectiveness of the cervical screening programme and identify suboptimal management in order to improve patient care. DESIGN Retrospective study. SETTING A university hospital serving a population of 1 million people. POPULATION All women diagnosed with a cervical cancer between 2003 and 2006. METHODS Analysis of data from invasive cervical cancer reviews. MAIN OUTCOME MEASURE Categorisation of cervical cancer cases according to the Invasive Cervical Cancer Audit classification. RESULTS Eighty-seven women were diagnosed with cervical cancer during the 3-year study period. The 'lapsed attender' group accounted for the greatest number of cases (30%), followed by screen detected (26%), interval cancers (13%), never attended (12%), lost to follow-up (10%) and never invited (9%). Women who had never attended for cytology presented with higher stage disease, stage-II or above, compared with the screen-detected cases: 60% were stage II or above, compared with 13.0%, Chi-square P = 0.018. The most frequently identified screening programme problem was patient compliance, which was determined to be the principle contributing factor in 39 cases (45%) and a secondary factor in a further ten cases. CONCLUSIONS The categorisation of cervical cancer cases has the potential of yielding invaluable information for improving programme effectiveness. Patient compliance is the greatest challenge to the screening programme, and the need for regular screening and adherence to follow-up regimens needs to be reinforced in order to maximise the efficacy of the national screening programme.
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Affiliation(s)
- E L Moss
- University Hospital of North Staffordshire, Stoke on Trent, UK
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Abstract
The objective of this study was to develop a European competence-based colposcopy core curriculum using the Delphi technique. Thirty expert colposcopists from 21 countries participated. A four-round iterative questionnaire was used. Competencies were rated using a five-point Likert scale. Competences rated as 4 or more by at least 90% of the respondents were regarded as necessary for the core curriculum. Eighteen participants took part in all four rounds, and 27 were active in each of the last three rounds. Fifty-one core competences were selected from a list of 76 competences collated by the group as a whole. The majority (n = 44) of the selected core competences received a score of 4 or greater in each round. Overall, there was some evidence of increasing consensus but the individual shift in opinion was slight. The Delphi technique was an effective tool for obtaining an expert consensus and enabled group "ownership" of the identified core curriculum.
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Affiliation(s)
- C W E Redman
- The Academic Unit, Maternity Building, North Staffordshire Hospital, Stoke-on-Trent ST4 6QG, UK.
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Thangaratinam S, Walker P, Freeman-Wang T, Luesley D, Cruickshank M, Redman CWE. Identifying the performance criteria for appraisal of colposcopists: benchmarking Delphi. BJOG 2007; 114:1288-91. [PMID: 17877682 DOI: 10.1111/j.1471-0528.2007.01442.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Colposcopy forms an essential part of National Health Service Cervical Screening Programme (NHSCSP). With an increased emphasis on accountability and improved performance, there is a need to identify the performance criteria that are essential to be satisfied by the colposcopists at the time of appraisal. OBJECTIVE To identify the performance criteria essential for appraisal of colposcopists by two-generational Delphi survey. DESIGN Delphi survey. SETTING Annual British Society for Colposcopy and Cervical Pathology conference (BSCCP 2005, Edinburgh, UK). POPULATION Four hundred and ninety-nine delegates attending the above conference. METHOD A two-generational Delphi survey was undertaken to identify the criteria needed for appraisal. The participants were asked to rate the relevance of quality items that might be considered necessary for appraisal of performance of colposcopists. After the first round, the results were presented, and the respondents were given the chance to reflect on their response and change it if necessary. MAIN OUTCOME MEASURES Criteria considered to be essential for appraisal of colposcopists in areas of training, diagnostic and therapeutic aspects and communication. RESULTS In the first round, 306/499 (61%) participants returned the completed questionnaire. Sixty percent (187/306) of participants returned their questionnaire in the second round. In addition to BSCCP certification, four other criteria were identified, which were quality of recorded findings, biopsy rate when atypia noted, proportion of biopsies histologically adequate and proportion of normal initial posttreatment follow-up smears. CONCLUSION This Delphi survey has been the first to identify criteria to be used in the annual appraisal of professionals. It has resulted in a number of criteria that could be considered for the appraisal and possible revalidation of colposcopists practising in UK.
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Byrom J, Douce G, Jones PW, Tucker H, Millinship J, Dhar K, Redman CWE. Should punch biopsies be used when high-grade disease is suspected at initial colposcopic assessment? A prospective study. Int J Gynecol Cancer 2006; 16:253-6. [PMID: 16445640 DOI: 10.1111/j.1525-1438.2006.00344.x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The reliability and applicability of colposcopically directed cervical punch biopsy was assessed in a sample of 170 paired punch and large loop excision of cervical transformation zone (LLETZ) specimens obtained from previously untreated women who had been selected for treatment on the basis of cytology and/or colposcopic findings and in whom the entire cervical transformation zone was visible. A single punch biopsy was taken immediately before the LLETZ, and all the specimens were reviewed by a single pathologist. Nine (5.3%) punch biopsies were inadequate. In terms of whether or not there was cervical intraepithelial neoplasia (CIN), the chance-corrected kappa analysis rated overall agreement as poor (kappa = 0.21, 95% confidence limits 0.02-0.39), whereas in terms of histologic grade, it was fair to moderate (kappa = 0.32, 95% confidence limits 0.23-0.42). Punch biopsy tended to underestimate the disease. The sensitivity and specificity of colposcopically directed punch biopsy for the detection of high-grade CIN was 74% and 91%, respectively, with positive- and negative predictive values of 97% and 48%, respectively. Two microinvasive and two intraepithelial glandular lesions were missed on punch biopsy. Punch biopsy should be avoided when high-grade disease is suspected.
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Affiliation(s)
- J Byrom
- Colposcopy Clinic and Pathology Department, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
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Howells REJ, Dhar KK, Hoban PR, Jones PW, Fryer AA, Redman CWE, Strange RC. Association between glutathione-S-transferase GSTP1 genotypes, GSTP1 over-expression, and outcome in epithelial ovarian cancer. Int J Gynecol Cancer 2004; 14:242-50. [PMID: 15086723 DOI: 10.1111/j.1048-891x.2004.014207.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [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: 12/30/2022] Open
Abstract
Ovarian cancer accounts for the majority of deaths from gynaecological malignancy, and polymorphisms in genes encoding the glutathione-S-transferase (GST) GSTP1 detoxifying enzymes may lead to variation in detoxification of carcinogens. We describe a study involving 81 women with invasive epithelial ovarian cancer. A number of important clinical variables and outcome data were obtained. GSTP1 genotyping was undertaken using PCR-based techniques, and GSTP1 expression was quantified using immunohistochemistry (IHC). A Cox's proportional hazard regression model was used to analyze the effects on outcome. We also independently examined 11 women with borderline or low malignant potential (LMP) tumors using IHC only. The mean age of the women was 61.5 years +/- 12 (1 SD) (range 36-88 years), the median overall survival was 26 months, and median progression free interval (PFI) 21 months. There was a significant association between GSTP1 (Val(104)/Val(104)) genotypes, and reduced survival (P = 0.05) and the GTP1 (Ile(104)/Val(104)) genotype appeared to have the best outcome (HR = 0.34, P = 0.045, 95% CI = 0.12-0.98). There was no significant association between the GSTP1 genotypes and any clinico-pathological parameters; there were also no associations between GSTP1 genotypes and response to postoperative chemotherapy. Specific nuclear GSTP1 over-expression was associated with less residual disease (P = 0.05); specific cytoplasmic GSTP1 over-expression with more favourable performance status (P = 0.014)). We found that 10/11 (91%) of the LMP (borderline) tumors over-expressed nuclear GSTP1 compared to only 52% of the invasive tumors (chi(2) ((1)) = 5.95, P = 0.015). There was no significant association between the level of GSTP1 expression and response to postoperative chemotherapy. The overall level of GSTP1 expression and the subcellular localization of GSTP1 expression were not associated with either survival or PFI. There was a significant association between the GSTP1 (Ile(104)/Ile(104)) genotypes and increased overall GSTP1 expression (P = 0.049), and the GSTP1 (Ile(104)/Val(104)) genotypes and reduced overall GSTP1 expression (P = 0.046). We speculate that GSTP1 Ile(104)/Val(104) genotypes are associated with improved outcome because the protein/enzyme, which is expressed, may provide a better balance between the effects of detoxification of carcinogens and the effects of metabolism of chemotherapy agents. In addition, over-expression of nuclear GSTP1 appears to be associated with more favorable ovarian tumor characteristics. In our preliminary study, we also reported a relationship between overall GSTP1 expression and certain GSTP1 genotypes. As far as we are aware, this is the first time that a relationship between the GSTP1 genotypes, GSTP1 expression and outcome has been described in ovarian cancer. Whether the genotype directly determines GSTP1 expression is at present unclear and the precise mechanism of this interaction is unknown.
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Affiliation(s)
- R E J Howells
- Department of Obstetrics and Gynaecology, North Staffordshire Hospital, Stoke-on-Trent, Staffordshire, UK.
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Byrom J, Dunn PDJ, Hughes GM, Lockett J, Johnson A, Neale J, Redman CWE. Colposcopy information leaflets: what women want to know and when they want to receive this information. J Med Screen 2004; 10:143-7. [PMID: 14561267 DOI: 10.1177/096914130301000309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/16/2022]
Abstract
OBJECTIVES To evaluate whether the information leaflets produced by UK colposcopy clinics provide women with the information they desire and to determine when they would like to receive this information. DESIGN Questionnaire study and structured evaluation. SETTING The colposcopy clinic of a UK cancer centre. PARTICIPANTS Forty-two women attending a pre-colposcopy counselling session and 100 consecutive women attending the colposcopy clinic. METHODS Thirty-eight standards derived from the concerns/questions asked by women attending a pre-colposcopy counselling session were used to assess locally produced colposcopy clinic leaflets from UK colposcopy clinics, the leaflets produced by the Royal College of Obstetricians and Gynaecologists and the National Health Service Cervical Screening Programme (NHSCSP), and two "leaflets" obtained from internet sites. The Gunning fog test was used to assess the leaflets' readability. A questionnaire survey of 100 women attending the colposcopy clinic was used to determine when women wanted to receive information about colposcopy. MAIN OUTCOME MEASURES Percentage of questions answered by a given leaflet and Gunning fog scores for readability. RESULTS The information leaflets of 128 colposcopy clinics were received and assessed. Thirty-two clinics only sent women the NHSCSP leaflet. No leaflet answered all 38 questions. Less than half (36/100) of the leaflets answered more than 50% of the questions. In addition to the lack of advice given, different leaflets frequently gave conflicting advice. The average Gunning fog score was 9.7 (range 5.5-15.5). The majority of women (70%) wanted to receive information about colposcopy at or prior to the time of receiving their abnormal smear test result, although only 42% of women actually received information at this time. CONCLUSIONS Many UK colposcopy clinics do not appear to be providing women with the information they require to understand their condition and the procedure that they are about to undergo. Furthermore, this information is often not provided at the appropriate time in the screening process.
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Affiliation(s)
- J Byrom
- Academic Department of Obstetrics and Gynaecology, Third Floor, Birmingham Women's Hospital, Edgbaston, UK. jbyrom
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Byrom J, Dunn PDJ, Hughes GM, Lockett J, Johnson A, Neale J, Redman CWE. Colposcopy information leaflets: what women want to know and when they want to receive this information. J Med Screen 2003. [DOI: 10.1258/096914103769011058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Nursing staff at a specialist hospital unit held five precolposcopy counselling and educational sessions; 47 women attended. We undertook a content analysis of the issues raised by the women. Our analysis confirms that there are significant fears concerning the procedure itself and underlying fears about cervical cancer. Women usually addressed these fears in an indirect manner. We still know little and most women have high anxiety when they receive abnormal Pap smear test results. Educational sessions can be useful in allaying fears and improving knowledge of the colposcopy procedure. We provide examples of how and why sessions are useful.
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Affiliation(s)
- Janeine Neale
- Department of Psychology, Staffordshire University, Stoke-on-Trent, Staffordshire, UK
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Dhar KK, Byrom J, Todd RW, Redman CWE. In conisation with pelvic lymphadenectomy adequate for FIGO stage 1B1 cervical cancer? Case report and review of the literature. J OBSTET GYNAECOL 2003; 23:81-3. [PMID: 12647711] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- K K Dhar
- Academic Department of Obstetrics and Gynaecology, North Staffordshire Hospitals, Stoke-on-Trent, UK
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Byrom J, Clarke T, Neale J, Dunn PDJ, Hughes GM, Redman CWE, Pitts M. Can pre-colposcopy sessions reduce anxiety at the time of colposcopy? A prospective randomised study. J OBSTET GYNAECOL 2002; 22:415-20. [PMID: 12521468 DOI: 10.1080/01443610220141407] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [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: 10/27/2022]
Abstract
The main objective of this prospective randomised study was to evaluate whether offering pre-colposcopy group sessions reduces anxiety at the time of colposcopy. We also examined whether this strategy improved knowledge about abnormal smears and colposcopy and improved satisfaction with the colposcopy service provided. One hundred and forty-seven women undergoing colposcopy for the first time were randomised into two groups. The control group (n = 75) received conventional management. The study group (n = 72), in addition to conventional management, were invited to attend a pre-colposcopy group session led by a trained colposcopy nurse. Questionnaires were used to determine state anxiety inventory scores and knowledge scores at the time of randomisation, immediately before colposcopy and 6 weeks after the clinic visit. Satisfaction questionnaires were completed 6 weeks after the clinic visit. We found that women attending colposcopy clinics are anxious. Those women who attended the pre-colposcopy session had improved knowledge scores (P = 0.039) at the time of colposcopy and satisfaction (P = 0.037). However, the intervention failed to significantly reduce anxiety at the time of colposcopy (P > 0.05).
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Affiliation(s)
- Jennifer Byrom
- Colposcopy Clinic, Department of Obstetrics and Gynaecology, City General Hospital, Stoke-on-Trent, Staffordshire, Australia
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Abstract
OBJECTIVE To assess the ability of computed tomography in predicting whether suspected ovarian cancer could be fully excised at primary laparotomy. DESIGN Retrospective analysis of patient notes and pre-operative computed tomography scans. Setting A UK NHS cancer centre. POPULATION Seventy-seven women who underwent laparotomy for an ovarian tumour and who had had a pre-operative computed tomography scan. METHODS Women who had a computed tomography scan before laparotomy for an ovarian tumour were identified. Analysis was undertaken to determine the accuracy of computed tomography in predicting malignancy, stage and residual disease. The computed tomography parameters significantly associated with residual disease were determined by a chi2 analysis. These parameters, in addition to age and CA125, were used to generate a predictive model. This model was further refined by stepwise logistic regression and a clinical scoring index was generated. MAIN OUTCOME MEASURES To identify those computed tomography parameters significantly associated with residual disease and to use these with CA125 and age to generate a useful clinical scoring index to predict residual disease in suspected ovarian cancer. RESULTS Seventy-seven women underwent a laparotomy for an ovarian tumour and had a pre-operative computed tomography scan. Fifty-one of these women had malignant disease and twenty-five of these women had residual disease remaining. The sensitivity of computed tomography in predicting malignancy was 90% with a specificity of 85% and the overall accuracy of computed tomography for predicting stage of disease was 73% (37/51). The overall sensitivity of computed tomography in predicting residual disease was 88%, the specificity was 92% and the positive predictive value was 85%. The parameters on computed tomography that were significantly (P < 0.05) associated with residual disease were ascites, omental cake, mesenteric disease, paracolic gutter deposits, diaphragmatic deposits and pleural effusion. The predictive model generated was more accurate than computed tomography alone (sensitivity 88%, specificity 98%, positive predictive value 95%). Using stepwise logistic regression enabled the predictive model to be simplified to include mesenteric disease, omental cake, age and CA125 without any change in sensitivity or specificity and this model was used to generate a scoring index. CONCLUSION This study shows that prediction of resectability by computed tomography is excellent and is further improved by the generation of a predictive model, which can be used to generate a simple scoring index. This scoring system now needs to be tested prospectively to ensure that its performance remains as good in an independent sample population.
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Affiliation(s)
- J Byrom
- Academic Department of Obstetrics and Gynaecology, City General Hospital, Stoke-on-Trent, UK
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Luesley DM, Cullimore J, Redman CWE, Lawton FG, Emens JM, Rollason TP, Williams DR, Buxton EJ. Loop diathermy excision of the cervical transformation zone in patients with abnormal cervical smears. Int J Gynaecol Obstet 1991. [DOI: 10.1016/0020-7292(91)90411-w] [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: 11/26/2022]
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Luesley DM, Cullimore J, Redman CWE, Lawton FG, Williams DR, Buxton EJ, Rollason TP, Emens JM. Inadvertent duplicate publication: Loop diathermy excision. West J Med 1990. [DOI: 10.1136/bmj.301.6757.906] [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: 11/04/2022]
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Redman CWE, Buxton EJ. Differential defence rates. West J Med 1989. [DOI: 10.1136/bmj.298.6666.114-c] [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: 11/03/2022]
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