National Cancer Institute®
Last Modified: November 21, 2001
UI - 21277317
AU - Reid J
TI - Women's knowledge of Pap smears, risk factors for cervical cancer, and cervical cancer.
SO - J Obstet Gynecol Neonatal Nurs 2001 May-Jun;30(3):299-305
AD - Indiana University Southeast, New Albany 47150, USA.
OBJECTIVE: To review the literature on women's knowledge of Pap smears, risk factors for cervical cancer, and cervical cancer. DATA SOURCES: The review was based on a search of the relevant literature over a 10-year period using MEDLINE and CINAHL. DATA EXTRACTION: Articles from relevant, indexed journals and textbooks published within the past decade were included. Seminal articles were included as appropriate. DATA SYNTHESIS: Risk factors for the development of cervical cancer have been reevaluated. The case for human papillomavirus as the cause of cervical neoplasms has been strengthened. CONCLUSIONS: Cervical cancer is associated with early sexual debut, number of lifetime sexual partners, nonuse of condoms, and infection with human papillomavirus. Cigarette smoking facilitates development of cervical cancer.
UI - 21353209
AU - Khunamornpong S; Raungrongmorakot K; Siriaunkgul S
TI - Loop electrosurgical excision procedure (LEEP) at Maharaj Nakorn Chiang Mai Hospital: problems in pathologic evaluation.
SO - J Med Assoc Thai 2001 Apr;84(4):507-14
AD - Department of Pathology, Faculty of Medicine, Chiang Mai University, Thailand.
BACKGROUND: Loop electrosurgical excision procedure (LEEP) is widely used in diagnosis and management of cervical lesions. Difficulties in histopathologic evaluation of LEEP specimens, particularly for the margin status, have been reported to be a significant disadvantage of the procedure. METHOD: The histologic slides of the specimens from 163 patients who underwent LEEP at Maharaj Nakorn Chiang Mai Hospital from degree of thermal artefact and the margin status. Follow-up data after a 6-month-period were correlated with the margin status. RESULTS: Thermal artefact was present in all cases (mild 51.5%, moderate 36.2%, and severe 12.3%). In only one case, histologic diagnosis of the lesion was not possible due to severe thermal artefact. Nine cases (5.5%) had non-evaluable margins due to either thermal artefact (7 cases) or improper orientation of fragmented tissue (2 cases). Of 90 cases with subsequent surgical specimens, residual diseases were present in 4 of 21 (19.0%) with negative LEEP margins, in 31 of 64 (48.4%) with positive margins, and in 4 of 5 (80.0%) with non-evaluable margins. CONCLUSIONS: Pathologic evaluation of the specimens from LEEP was limited in only a minority of cases. Thermal artefact was not a critical disadvantage of LEEP. The positive or negative margin status was correlated with the risk of residual disease.
UI - 21372586
AU - Sironi S; Villa G; Rossi S; Bocciolone L; Maggioni A; Sonzogni A;
TI - Bellomi M [Magnetic resonance imaging in the evaluation of parametrial invasion of carcinoma of the cervix uteri: optimization of the study protocol]
SO - Radiol Med (Torino) 2001 Jun;101(6):477-84
AD - Divisione di Radiologia Diagnostica, Istituto Europeo di Oncologia, Milan, Italy.
PURPOSE: To determine the efficacy of three different MR sequences in the evaluation of parametrial invasion by early-stage cervical cancer. MATERIAL AND METHODS: Eighteen consecutive patients with cervical cancer clinically assessed as stage IB1 underwent MR imaging examination with the use of the following sequences: FSE T2-weighted, FSE fat-suppressed T2w, and SE fat-suppressed Gadolinium-enhanced T1w. In all cases, the presence or absence of parametrial invasion on both sides per each sequence used was evaluated. Subsequently all the sequences have been considered together for the evaluation of tumor invasion. Gold standard of the study was the histopathologic analysis of the surgical specimens. RESULTS: At histological examination, parametrial invasion by tumor was found in 6 out of 36 parametria evaluated. The accuracy achieved with each of the sequences used was as follows: 94% with FSE T2w; 86% with FSE fat-suppressed T2w; and 67% with SE fat-suppressed Gadolinium-enhanced T1w. The simultaneous evaluation of all 3 sequences obtained an accuracy level similar to that achieved with FSE T2w. The difference between the accuracy of T2w sequences and that of fat-suppressed contrast-enhanced T1w sequences was statistically significant (p<0.01). DISCUSSION AND CONCLUSIONS: Our data suggest that the MR imaging protocol for the evaluation of parametrial tumor invasion could be restricted to FSE T2w sequences. These proved to have the highest negative predictive value (97%) which allows a reliable selection of patients who can be surgically treated.
UI - 21411911
AU - Narayan K; Hicks RJ; Jobling T; Bernshaw D; McKenzie AF
TI - A comparison of MRI and PET scanning in surgically staged loco-regionally advanced cervical cancer: potential impact on treatment.
SO - Int J Gynecol Cancer 2001 Jul-Aug;11(4):263-71
AD - Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia, Monash Medical Center, Melbourne, Victoria, Australia.
The aim of this study was to assess whether positron emission tomography (PET) or magnetic resonance imaging (MRI) could obviate the need for surgical staging in patients with locally advanced cervical carcinoma being planned for radiotherapy (RT). Imaging findings were compared to surgical staging in 27 patients including three with recent resection of the primary tumor. Both PET and MRI visualized all 24 residual cervical tumors. Primary tumor volume, as measured by MRI scan, ranged from 1.25 cc to 140 cc. In 24 patients evaluable for pelvic nodal status, PET had sensitivity, specificity, and positive and negative predictive values of 83%, 92%, 91% and 85%, respectively, with 88% accuracy. MRI detected only six in 12 (50%) patients with confirmed pelvic nodal disease, all of which were also seen by CT and PET, with an overall accuracy of 75%. PET detected only four in seven (57%) cases with confirmed para-aortic (PA) involvement. All histologically confirmed sites not visualized on PET were <1 cm. Without surgical staging, six in 10 (60%) patients with histologically proven pelvic nodal disease would not have received pelvic boost if guided by MRI alone, compared to two in 10 (20%) patients guided by PET alone or in combination with MRI. All four patients with positive PA on PET were confirmed on histology or clinical follow-up, including one case that proved to be a false negative one on surgery. However, in three cases, PET would have yielded an inadequate radiation volume. In conclusion, the positive predictive value of PET in the pelvis and para-aortic region appears sufficient to obviate lymph nodal sampling, but sampling is still required to exclude small-volume disease cranial to sites of abnormality on PET. MRI has insufficient accuracy for nodal staging to impact management.
UI - 21415883
AU - Krivak TC; Rose GS; McBroom JW; Carlson JW; Winter WE 3rd; Kost ER
TI - Cervical adenocarcinoma in situ: a systematic review of therapeutic options and predictors of persistent or recurrent disease.
SO - Obstet Gynecol Surv 2001 Sep;56(9):567-75
AD - Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. TomKrivak@aol.com
The incidence of cervical adenocarcinoma in situ is increasing in frequency, and our limited knowledge about this lesion presents the physician with a therapeutic dilemma. Treatment for this lesion has included conservative therapy, large loop excision or cold-knife cone biopsy, or definitive therapy consisting of hysterectomy. But, rates of residual adenocarcinoma in situ after cone biopsy with negative margins vary from 0% to 40%, and residual disease rates as high as 80% have been noted when the margins are positive. Despite these recent data on follow-up after conservative therapy such as cone biopsy, it seems that this method is safe and gaining acceptance by many physicians and patients. However, the short follow-up duration and small number of patients limit the conclusions of many studies. The relative infrequency of this diagnosis has precluded extensive clinical experience with the natural history of this lesion.
UI - 21440183
AU - Khunamornpong S; Maleemonkol S; Siriaunkgul S; Pantusart A
TI - Well-Differentiated villoglandular adenocarcinoma of the uterine cervix: a report of 15 cases including two with lymph node metastasis.
SO - J Med Assoc Thai 2001 Jun;84(6):882-8
AD - Department of Pathology, Faculty of Medicine, Chiang Mai University, Thailand.
Well-differentiated villoglandular adenocarcinoma is a recently described subtype of cervical adenocarcinoma. The tumor of this type is reported to have distinct clinicopathologic features and excellent prognosis. However, lymph node metastases of this tumor have been described in few reports. Fifteen cases of well-differentiated villoglandular adenocarcinoma treated at Maharaj Nakorn Chiang Mai Hospital were retrospectively reviewed for both clinical and histopathological features. All patients underwent radical hysterectomy with pelvic lymphadenectomy. In the cases with lymph node metastasis, adjuvant radiation therapy was also given. The patients ranged in age from 22 to 53 years (mean, 39.3). Fourteen patients were FIGO stage IB and one was stage IIA. All patients had exophytic friable cervical masses. Tumor size known in 14 cases ranged from 1.5 to 4 cm (mean, 2.3). Eleven tumors (73.3%) were confined to the inner third of the cervical stroma with 9 of these (60%) showing only superficial invasion (depth < or = 3 mm). The tumors invaded deeply to the middle third in 3 cases (20.0%), and to the outer third in one (6.7%). Lymphatic invasion was observed in 3 cases, two of them had pelvic lymph node metastasis. Both patients had tumors involving deeper than the inner third of the cervical wall. The follow-up duration ranged from 21 to 144 months (mean, 67.5). Four of thirteen cases without nodal metastasis were lost to follow-up 36 to 59 months after surgery. All patients showed no evidence of disease at the last visit. Presence of lymphatic invasion and deep stromal involvement appeared to be the risk factors for lymph node metastasis of well-differentiated villoglandular adenocarcinoma.
UI - 21439137
AU - Kodama J; Hashimoto I; Seki N; Hongo A; Yoshinouchi M; Okuda H; Kudo T
TI - Thrombospondin-1 and -2 messenger RNA expression in invasive cervical cancer: correlation with angiogenesis and prognosis.
SO - Clin Cancer Res 2001 Sep;7(9):2826-31
AD - Department of Obstetrics and Gynecology, Okayama University Medical School, Okayama 700-8558, Japan. email@example.com
PURPOSE: TSP association with clinicopathological features, including microvessel count, regarding prognostic significance was examined in patients presenting with invasive cervical cancer. EXPERIMENTAL DESIGN: Gene expression of TSP-1 and TSP-2 was assessed by reverse transcription-PCR in 10 normal cervix and 78 invasive cervical cancer samples. RESULTS: TSP-1 and TSP-2 mRNA expression was detected in seven (70.0%) of the normal cervical specimens. TSP-2 mRNA expression in normal cervix was significantly higher than that in cases involving cervical cancer (P = 0.032). TSP-1 mRNA expression was significantly lower in tumors characterized by advanced stage (P = 0.047). Fifty-three patients displaying stage Ib-IIb cervical cancer underwent radical hysterectomy and pelvic lymphadenectomy. Expression of TSP-1 and TSP-2 mRNA was significantly lower in tumors exhibiting parametrial invasion (P = 0.016 and P = 0.049, respectively). Microvessel counts were significantly higher when decreased TSP-1 expression was evident (P = 0.029). The microvessel count in patients lacking TSP-2 mRNA expression was higher than that observed in patients displaying TSP-2 mRNA expression, although it was not statistically significant (P = 0.062). Subjects demonstrating TSP-1 mRNA expression exhibited significantly better prognosis than those lacking TSP-1 mRNA expression (P = 0.0038). Furthermore, TSP-1 mRNA expression was an independent prognostic factor in the multivariate analysis. CONCLUSIONS: These findings provide evidence that TSP-1 expression is of value as a prognostic factor in cervical cancer. The inverse correlation between TSP expression and microvessel count also indicates that decreased TSP expression may be associated with an angiogenic phenotype in this class of neoplasm.
UI - 21448902
AU - Green JA; Kirwan JM; Tierney JF; Symonds P; Fresco L; Collingwood M;
TI - Williams CJ Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis.
SO - Lancet 2001 Sep 8;358(9284):781-6
AD - Department of Medicine, University of Liverpool, L69 3GA, Liverpool, UK. J.A.Green@liverpool.ac.uk
BACKGROUND: The US National Cancer Institute alert in February, 1999, stated that concomitant chemotherapy and radiotherapy should be considered for all patients with cervical cancer. Our aim was to review the effects of chemoradiotherapy on overall and progression-free survival, local and distant control, and acute and late toxicity in patients with cervical cancer. METHODS: With the methodology of the Cochrane Collaboration, we did a systematic review of all known randomised controlled trials done between 1981 and 2000 (17 published, two unpublished) of chemoradiation for cervical cancer. FINDINGS: The trials included 4580 randomised patients, and 2865-3611 patients (62-78%) were available for analysis. Cisplatin was the most common agent used. The findings suggest that chemoradiation improves overall survival (hazard ratio 0.71, p<0.0001), whether platinum was used (0.70, p<0.0001) or not (0.81, p=0.20). A greater beneficial effect was seen in trials that included a high proportion of stage I and II patients (p=0.009). An improvement in progression-free survival was also seen with chemoradiation (0.61, p<0.0001). Thus, the absolute benefit in progression-free and overall survival was 16% (95% CI 13-19) and 12% (8-16), respectively. A significant benefit of chemoradiation on both local (odds ratio 0.61, p<0.0001) and distant recurrence (0.57, p<0.0001) was also recorded. Grade 3 or 4 haematological (odds ratio 1.49-8.60) and gastrointestinal (2.22) toxicities were significantly greater in the concomitant chemoradiation group than the control group. There was insufficient data to establish whether late toxicity was increased in the concomitant chemoradiation group. INTERPRETATION: Concomitant chemotherapy and radiotherapy improves overall and progression-free survival and reduces local and distant recurrence in selected patients with cervical cancer, which may give a cytotoxic and sensitisation effect.
UI - 99247953
AU - Sasieni P; Adams J
TI - Effect of screening on cervical cancer mortality in England and Wales: analysis of trends with an age period cohort model.
SO - BMJ 1999 May 8;318(7193):1244-5
AD - Department of Mathematics, Statistics and Epidemiology, Imperial Cancer Research Fund, London WC2A 3PX.
UI - 21190914
AU - Virmani AK; Muller C; Rathi A; Zoechbauer-Mueller S; Mathis M; Gazdar AF
TI - Aberrant methylation during cervical carcinogenesis.
SO - Clin Cancer Res 2001 Mar;7(3):584-9
AD - Hamon Center for Therapeutic Oncology Research, and Department of Pathology, University of Texas Southwestern Medical Center, Dallas 85930, USA.
We studied the pattern of aberrant methylation during the multistage pathogenesis of cervical cancers. We analyzed a total of 73 patient samples and 10 cervical cancer cell lines. In addition, tissue samples [peripheral blood lymphocytes (n = 10) and buccal epithelial cells (n = 12)] were obtained from 22 healthy volunteers. On the basis of the results of preliminary analysis, the cervical samples were grouped into three categories: (a) nondysplasia/low-grade cervical intraepithelial neoplasia (CIN; n = 37); (b) high-grade CIN (n = 17); and (c) invasive cancer (n = 19). The methylation status of six genes was determined (p16, RARbeta, FHIT, GSTP1, MGMT, and hMLH1). Our main findings are as follows: (a) methylation was completely absent in control tissues; (b) the frequencies of methylation for all of the genes except hMLH1 were >20% in cervical cancers; (c) aberrant methylation commenced early during multistage pathogenesis and methylation of at least one gene was noted in 30% of the nondysplasia/low-grade CIN group; (d) an increasing trend for methylation was seen with increasing pathological change; (e) methylation of RARbeta and GSTP1 were early events, p16 and MGMT methylation were intermediate events, and FHIT methylation was a late, tumor-associated event; and (f) methylation occurred independently of other risk factors including papillomavirus infection, smoking history, or hormone use. Although our findings need to be extended to a larger series, they suggest that the pattern of aberrant methylation in women with or without dysplasia may help identify subgroups at increased risk for histological progression or cancer development.
UI - 21268054
AU - Lenczewski A; Terlikowski S; Famulski W; Sulkowska M; Kulikowski M
TI - Angiogenesis as a prognostic factor in invasive carcinoma of the uterine cervix.
SO - Folia Histochem Cytobiol 2001;39(2):165-6
AD - Department of Gynecology and Septic Obstetrics, Medical Academy, Bialystok, Poland.
The aim of the study was to evaluate angiogenesis as an independent prognostic factor and to determine the correlation between the angiogenic index (AI) and histologic grade of the neoplastic process in patients operated on for invasive carcinoma of the uterine cervix. Angiogenesis was assessed with immunohistochemical technique using a monoclonal antibody against human factor VIII--(F8/86 M0616, DAKO, Denmark). A positive correlation was revealed between the intensification of angiogenesis and the incidence of lymph node involvement and survival rate.
UI - 21371462
AU - Sapy T; Szikszay A; Konya J; Borsos A; Hernadi Z
TI - [Prevalence of human papillomavirus infections in our five-year data]
SO - Orv Hetil 2001 Jun 17;142(24):1265-8
AD - Debreceni Egyetem, Orvos- es Egeszsegtudomanyi Centrum, Altalanos Orvostudomanyi Kar, Szuleszeti- es Nogyogyaszati Klinika.
Human papillomavirus infection proved to be the most important risk factor for the development of cervical cancer and its preblastomatosis. Human papillomavirus was detected from 1996. June to 2000. September at 1635 patients, who had been positive by colposcopy and/or cytology in an earlier examination. The place of the study were our outpatients' departments and consultations by specialists of Debrecen University, Department of Obstetrics and Gynecology. Hybrid capture system was used to demonstrate the presence of the virus and managed to prove it in the 28.9% of cases. 3.1% of the patients (51 persons) had acquired low-risk, and 23.6% (386 persons) high risk virus types, however 2.1% of the woman (35 patients) were infected with both low-risk and high-risk human papillomavirus types at the same time. Long time decrease of virus prevalence was observed after the age of 35 year, and the significant degree and timing decrease of after the age of 30 year at patients infected with combination of low-risk and high-risk virus types, respectively. This observation is indicative of the correlation between colposcopic-, cytologic abnormalities and the persisting high-risk human papillomavirus infections.
UI - 21372301
AU - Sbragia L; Paek BW; Feldstein VA; Farrell JA; Harrison MR; Albanese CT;
TI - Farmer DL Outcome of prenatally diagnosed solid fetal tumors.
SO - J Pediatr Surg 2001 Aug;36(8):1244-7
AD - Fetal Treatment Center and the Department of Surgery, University of California San Francisco, CA 94143-0570, USA.
BACKGROUND/PURPOSE: In the last 10 years, the ability to diagnose fetal tumors in the prenatal period has improved greatly because of technical advances in imaging. Early diagnosis and determination of tumor may affect prognosis. METHODS: The authors retrospectively reviewed the records of 1316 fetuses who underwent sonographic evaluation for congenital defects at University of California-San Francisco over a 6-year period. Of these, 16 had fetal tumors and were followed up at our institution. There were solid or predominantely solid with small cystic component masses in one of 3 locations: cervical, mediastinal, or abdominal. Excluded from our study were those fetuses with either sacrococcygeal teratoma, congenital cystic adenomatoid malformation of the lung, or ovarian cyst, because these defects have been extensively reviewed elsewhere. In addition, masses that were primarily cystic also were excluded. Data collected included diagnosis, gestational age at diagnosis and at delivery, mode of delivery, fetal and neonatal survival, and disease confirmation. RESULTS: Of the 16 fetuses, 4 had mediastinal tumors: 2 with pericardial teratomas (both of whom died in utero) and 2 with cardiac rhabdomyomas (1 died; the other presented tuberous sclerosis and is alive at 2 years of age). Four patients had cervical tumors (3 died; 1 survived and is alive and well), and 8 had abdominal tumors (3 with liver tumors, 4 with a left adrenal mass, and 1 with retroperitoneal teratoma). All eight patients with an abdominal tumor are alive and well. CONCLUSIONS: Fetal tumors are rare, and the prognosis seems to depend on their location and size. Although easier to detect, cervical and mediastinal tumors have a worse prognosis. Abdominal masses are more difficult to detect but have a better prognosis. Copyright 2001 by W.B. Saunders Company.
UI - 21427139
AU - Follen M; Meyskens FL Jr; Atkinson EN; Schottenfeld D
TI - Why most randomized phase II cervical cancer chemoprevention trials are uninformative: lessons for the future.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1293-6
AD - Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA. firstname.lastname@example.org
UI - 21427143
AU - Berumen J; Ordonez RM; Lazcano E; Salmeron J; Galvan SC; Estrada RA;
TI - Yunes E; Garcia-Carranca A; Gonzalez-Lira G; Madrigal-de la Campa A Asian-American variants of human papillomavirus 16 and risk for cervical cancer: a case-control study.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1325-30
AD - Laboratorio Multidisciplinario de Investigacion, Escuela Militar de Graduados de Sanidad y Escuela Medico Militar, Universidad del Ejercito y Fuerza Aerea, Mexico D.F. email@example.com
BACKGROUND: Human papillomavirus 16 (HPV16) has a number of variants, each with a different geographic distribution and some that are associated more often with invasive neoplasias. We investigated whether the high incidence of cervical cancer in Mexico (50 cases per 100 000 women) may be associated with a high prevalence of oncogenic HPV16 variants. METHODS: Cervical samples were collected from 181 case patients with cervical cancer and from 181 age-matched control subjects, all from Mexico City. HPV16 was detected with an E6/E7 gene-specific polymerase chain reaction, and variant HPV classes and subclasses were identified by sequencing regions of the E6 and L1/MY genes. Clinical data and data on tumor characteristics were also collected. All statistical tests were two-sided. RESULTS: HPV16 was detected in cervical scrapes from 50.8% (92 of 181) of case patients and from 11% (20 of 181) of control subjects. All HPV16-positive samples, except one, contained European (E) or Asian-American (AA) variants. AA and E variants were found statistically significantly more often in case patients (AA = 23.2% [42 of 181]; E = 27.1% [49 of 181]) than in control subjects (AA = 1.1% [two of 181]; E = 10% [18 of 181]) (P<.001 for case versus control subjects for either E or AA variants, chi2 test). However, the frequency of AA variants was 21 times higher in cancer patients than in control subjects, whereas that ratio for E variants was only 2.7 (P =.006, chi2 test). The odds ratio (OR) for cervical cancer associated with AA variants (OR = 27.0; 95% confidence interval [CI] = 6.4 to 113.7) was higher than that associated with E variants (OR = 3.4; 95% CI = 1.9 to 6.0). AA-positive case patients (46.2 +/- 12.5 years [mean +/- standard deviation]) were 7.7 years younger than E-positive case patients (53.9 +/- 12.2 years) (P =.004, Student's t test). AA variants were associated with squamous cell carcinomas and adenocarcinomas, but E variants were associated with only squamous cell carcinomas (P =.014, Fisher's exact test). CONCLUSIONS: The high frequency of HPV16 AA variants, which appear to be more oncogenic than E variants, might contribute to the high incidence of cervical cancer in Mexico.
UI - 21427149
AU - Bosch FX; Munoz N; de Sanjose S; Franco EL; Lowy DR; Schiffman M;
TI - Franceschi S; Kjaer SK; Meijer CJ; Frazer IH; Cuzick J Re: Cervical carcinoma and human papillomavirus: on the road to preventing a major human cancer.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1349-50
UI - 21433768
AU - Philips Z; Whynes DK
TI - Early withdrawal from cervical cancer screening: the question of cost-effectiveness.
SO - Eur J Cancer 2001 Sep;37(14):1775-80
AD - Health Economics Unit, Trent Institute for Health Services Research, University of Nottingham, Nottingham, UK.
In countries such as the UK, mass population screening for cervical cancer has been undertaken since the 1960s. Although of established effectiveness, no formal evaluation of the screening protocol was carried out prior to its implementation. On the basis of a published mathematical modelling exercise, it has been speculated that withdrawing women from the screening programme at an earlier age than at present, whilst leading to a higher rate of invasive cervical cancer (ICC), could reduce resource use. Using estimates of screening and treatment costs, and of expected life-years lost following earlier withdrawal, we simulated cost-effectiveness ratios for various scenarios described by the model. Median cost savings resulting from a life-year lost never exceeded pound10000 for any scenario, although the estimates were particularly sensitive to the assumed age at cancer presentation and the rate of cancer progression. Our findings seem to offer little economic support for the early withdrawal of subjects from the cervical screening programme.
UI - 21461554
AU - Golijow CD; Abba M; Mouron SA; Gomez MA; Guercci A; Dulout FN
TI - Detection of c-erbB-2 gene amplification in cervical scrapes positive for human papillomavirus (HPV).
SO - Cancer Invest 2001;19(7):678-83
AD - Centro de Investigaciones en Genetica Basica y Aplicada (CIGEBA), Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, Argentina. firstname.lastname@example.org
c-erbB-2 gene amplification has been described in a variety of human cancers, but it has been poorly studied in noncancerous cytological samples from genital specimens positive for human papillomavirus (HPV). Furthermore, the relationship between this genetic event and the presence of high-risk and low-risk HPV types is poorly studied. Eighty-four noncancerous cytological samples from exocervical specimens that were positive for HPV types 6, 16, and 18 were analyzed for c-erbB-2 gene amplification using the genomic differential polymerase chain reaction with the single copy reference gene. An association between c-erbB-2 gene amplification and the group corresponding to HPV type 6 was found. Within the low-risk HPV group, c-erbB-2 amplification was associated to cervical intraepithelial neoplasia of grade I (CIN I). Because in the samples analyzed, most of the CIN I stage was characterized by a koilocytotic pattern, c-erbB-2 amplification could be related to this kind of cellular alteration. It would be important to study c-erbB-2 gene amplification and also gene expression in different CIN stages in order to determine its role and significance in cervical cancer.
UI - 21463152
AU - Esajas MD; Duk JM; de Bruijn HW; Aalders JG; Willemse PH; Sluiter W;
TI - Pras B; ten Hoor K; Hollema H; van der Zee AG Clinical value of routine serum squamous cell carcinoma antigen in follow-up of patients with early-stage cervical cancer.
SO - J Clin Oncol 2001 Oct 1;19(19):3960-6
AD - Department of Obstetrics and Gynecology, University Hospital Groningen, Groningen, The Netherlands.
PURPOSE: To investigate the contribution to recurrence detection and survival of serum squamous cell carcinoma antigen (SCC-ag) analysis in the follow-up of early-stage cervical cancer patients. PATIENTS AND METHODS: Follow-up data were evaluated in patients with early-stage squamous cell cervical cancer treated by radical hysterectomy and pelvic lymphadenectomy with or without radiotherapy. Routine serum SCC-ag determination was performed at each follow-up visit. RESULTS: Recurrent disease occurred in 35 (16%) of 225 patients and was preceded or accompanied by serum SCC-ag elevation 26 times (sensitivity, 74%). In five (14%) of these 35 patients, elevated serum SCC-ag was the first measured clinical indicator. Desite salvage therapy, all five patients died of disease. In the other 31 patients (21 with serum SCC-ag elevation), either symptoms and/or positive signs led to recurrence detection. Median survival time after recurrence was worse (9 months; range, 2 to 112+) for patients with an elevated serum SCC-ag value at recurrence in comparison with patients with normal serum SCC-ag values (20 months; range, 4 to 96; P <.01). In 23 of the 190 patients without recurrences, serum SCC-ag values became falsely elevated. In 16 of these 23 patients, the repeat sample after 6 weeks showed a normal SCC-ag, and in seven patients benign (especially skin) disorders were found. CONCLUSION: Serum SCC-ag analysis results in earlier recurrence detection in a small proportion (14%) of patients but did not contribute to better survival. As long as treatment possibilities for recurrent cervical cancer patients are not improved, serum SCC-ag analysis should not be carried out in routine follow-up.
UI - 21154420
AU - Stoler MH; Schiffman M; Atypical Squamous Cells of Undetermined
TI - Significance-Low-grade Squamous Intraepithelial Lesion Triage Study (ALTS) Group Interobserver reproducibility of cervical cytologic and histologic interpretations: realistic estimates from the ASCUS-LSIL Triage Study.
SO - JAMA 2001 Mar 21;285(11):1500-5
AD - University of Virginia Health System, Division of Surgical Pathology and Cytopathology, Box 800214, Charlottesville, VA 22908, USA. email@example.com
CONTEXT: Despite a critical presumption of reliability, standards of interpathologist agreement have not been well defined for interpretation of cervical pathology specimens. OBJECTIVE: To determine the reproducibility of cytologic, colposcopic histologic, and loop electrosurgical excision procedure (LEEP) histologic cervical specimen interpretations among multiple well-trained observers. DESIGN AND SETTING: The Atypical Squamous Cells of Undetermined Significance-Low-grade Squamous Intraepithelial Lesion (ASCUS-LSIL) Triage Study (ALTS), an ongoing US multicenter clinical trial. SUBJECTS: From women enrolled in ALTS during 1996-1998, 4948 monolayer cytologic slides, 2237 colposcopic biopsies, and 535 LEEP specimens were interpreted by 7 clinical center and 4 Pathology Quality Control Group (QC) pathologists. MAIN OUTCOME MEASURES: kappa Values calculated for comparison of the original clinical center interpretation and the first QC reviewer's masked interpretation of specimens. RESULTS: For all 3 specimen types, the clinical center pathologists rendered significantly more severe interpretations than did reviewing QC pathologists. The reproducibility of monolayer cytologic interpretations was moderate (kappa = 0.46; 95% confidence interval [CI], 0.44-0.48) and equivalent to the reproducibility of punch biopsy histopathologic interpretations (kappa = 0.46; 95% CI, 0.43-0.49) and LEEP histopathologic interpretations (kappa = 0.49; 95% CI, 0.44-0.55). The lack of reproducibility of histopathology was most evident for less severe interpretations. CONCLUSIONS: Interpretive variability is substantial for all types of cervical specimens. Histopathology of cervical biopsies is not more reproducible than monolayer cytology, and even the interpretation of LEEP results is variable. Given the degree of irreproducibility that exists among well-trained pathologists, realistic performance expectations should guide use of their interpretations.
UI - 21405252
AU - Brenna SM; Hardy E; Zeferino LC; Namura I
TI - [Knowledge, attitudes, and practices related to the Pap smear among women with cervical cancer]
SO - Cad Saude Publica 2001 Jul-Aug;17(4):909-14
AD - Divisao Medica, Hospital-Maternidade Leonor Mendes de Barros, Secretaria de Estado da Saude, Sao Paulo, SP, 03015-000, Brasil. firstname.lastname@example.org
Despite screening programs, Brazil has a high cervical cancer mortality rate. The objective of this cross-sectional study was to analyze knowledge, attitudes, and practices related to the Pap smear and to understand why women fail to submit to this screening test. A structured questionnaire was used to interview 138 women: 90 with high grade intraepithelial neoplasia and 48 with invasive cervical cancer. Inadequate practices were more frequent among women with invasive cancer. In terms of difficulties in obtaining medical care, more than 80% of women reported lack of motivation, 60% reported that physicians failed to conduct a complete physical examination, and some 50% reported that physicians' schedules were busy. Having a Pap smear usually depended on a physician's request and the woman being symptomatic. Women over than 56 years old showed more frequent inadequate knowledge, attitudes and practices. However, those with more schooling were more knowledgeable of the Pap smear procedure. Age and less schooling could be barriers against women participating in screening programs, but socioeconomic problems must also be considered for improving practices related to the Pap smear.
UI - 21414282
AU - Hiatt RA; Pasick RJ; Stewart S; Bloom J; Davis P; Gardiner P; Johnston
TI - M; Luce J; Schorr K; Brunner W; Stroud F Community-based cancer screening for underserved women: design and baseline findings from the Breast and Cervical Cancer Intervention Study.
SO - Prev Med 2001 Sep;33(3):190-203
AD - Northern California Cancer Center, Union City, California 94587, USA.
BACKGROUND: Underutilization of breast and cervical cancer screening has been observed in many ethnic groups and underserved populations. Effective community-based interventions are needed to eliminate disparities in screening rates and thus to improve prospects for survival. METHODS: The Breast and Cervical Cancer Intervention Study was a controlled trial of three interventions in the San Francisco Bay Area from 1993 to 1996: (1) community-based lay health worker outreach; (2) clinic-based provider training and reminder system; and (3) patient navigator for follow-up of abnormal screening results. Study design and a description of the interventions are reported along with baseline results of a household survey conducted in four languages among 1599 women, aged 40-75. RESULTS: Seventy-six percent of women ages 40 and over had had at least one mammogram, and most had had a clinical breast examination (88%) and Pap smear (89%). Rates were significantly lower for non-English-speaking Latinas and Chinese women (56 and 32%, respectively, for mammography), and maintenance screening (three mammograms in the past 5 years) varied from 7% (non-English-speaking Chinese) to 53% (Blacks). Pap smear screening in the past 3 years was low among non-English-speaking Latinas (72%) and markedly lower among non-English-speaking Chinese women (24%). The strongest predictors of screening behavior were having private health insurance and frequent use of medical services. Having a regular clinic and speaking English were also important. Race/ethnicity, education, household income, and employment status were, overall, not significant predictors of screening behavior. CONCLUSIONS: These baseline results support the importance of cancer screening interventions targeted to persons of foreign origin, particularly those less acculturated. Copyright 2001 American Health Foundation and Academic Press.
UI - 21435379
AU - Egbert N; Parrott R
TI - Self-efficacy and rural women's performance of breast and cervical cancer detection practices.
SO - J Health Commun 2001 Jul-Sep;6(3):219-33
AD - School of Communication Studies, Kent State University, Kent, Ohio 44242, USA. email@example.com
Self-efficacy has become an important variable in multiple areas of human performance, including health behavior modification (Bandura, 1997). This study explores variables that lead to women's perceived self-efficacy in performing regular detection practices for breast and cervical cancer. A sample of southeastern U.S. farm women (N = 206) completed surveys that assessed their perceived and actual knowledge of women's cancer detection practices, as well as their perceived social norms and perceived barriers related to obtaining these tests. Regression analyses of these data revealed that perceived peer norms and the barriers of time and embarrassment were significant predictors of women's confidence in their ability to follow through with cancer detection practices. Perceived knowledge and perceived family norms significantly predicted women's perceptions of difficulty associated with cancer detection practices as well as women's confidence in their skills to perform breast self-examination (BSE). Time was also a significant barrier to confidence in performing BSE. Implications for health communication campaigns are discussed.
UI - 21429178
AU - Bener A; Denic S; Alwash R
TI - Screening for cervical cancer among Arab women.
SO - Int J Gynaecol Obstet 2001 Sep;74(3):305-7
AD - Department of Community Medicine, Faculty of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates. firstname.lastname@example.org
UI - 21438051
AU - Pannu HK; Corl FM; Fishman EK
TI - CT evaluation of cervical cancer: spectrum of disease.
SO - Radiographics 2001 Sep-Oct;21(5):1155-68
AD - Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md, USA. email@example.com
Invasive cervical cancer is the third most common gynecologic malignancy. The prognosis is based on the stage, size, and histologic grade of the primary tumor and the status of the lymph nodes. Assessment of the stage of disease is important in determining whether the patient may benefit from surgery or will receive radiation therapy. The official clinical staging system of the International Federation of Gynecology and Obstetrics has led to errors of 65%-90% in stage III and IV disease; the result has been unofficial extended staging with cross-sectional imaging modalities such as computed tomography (CT). CT is useful in staging advanced disease and in monitoring patients for recurrence. The primary tumor is heterogeneous and hypoattenuating relative to normal stroma on contrast material-enhanced scans. Obliteration of the periureteral fat plane and a soft-tissue mass are the most reliable signs of parametrial extension. Less than 3 mm separation of the tumor from the pelvic muscles and vascular encasement are signs of pelvic side wall invasion. Lymphatic spread is along the external and internal iliac nodal chains and the presacral route to the paraaortic nodes. Distant metastases are seen with primary or recurrent disease and can involve the liver, lung, and bone.
UI - 21459467
AU - Gupta DK; Komaromy-Hiller G; Raab SS; Nath ME
TI - Interobserver and intraobserver variability in the cytologic diagnosis of normal and abnormal metaplastic squamous cells in pap smears.
SO - Acta Cytol 2001 Sep-Oct;45(5):697-703
AD - Department of Pathology, Shadyside Hospital and University of Pittsburgh Medical Center, Pennsylvania 15213, USA. firstname.lastname@example.org
OBJECTIVE: Interoberver variability has important implications for patient care, diagnostic error and medical litigation. In the management of any cervical epithelial abnormality, its biologic significance as well as diagnostic reproducibility is very important. Interobserver variability has not been measured adequately for metaplastic squamous lesions. We analyzed interobserver and intraobserver variability and diagnostic accuracy in the diagnosis of dysplastic metaplastic cells. STUDY DESIGN: Sixty Pap smears from patients with abnormalities of metaplastic squamous cells of varying severity were selected from the files of Lankenau Hospital, Wynnewood, Pennsylvania, U.S.A., diagnosed between 1990 and 1996. These were reviewed by four observers with different levels of cytology experience. Each of the observers blindly and independently reviewed all Pap smears. Tabulated results were analyzed to determine interobserver and intraobserver variability and diagnostic accuracy. RESULTS: Statistically significant interobserver reproducibility was found between both inexperienced observers as well as between observers 1 (experienced) and 3 (inexperienced) and between observers 2 (experienced) and 4 (inexperienced). The observed degree of agreement between both experienced observers (1 and 2) reflected random rating rather than reproducibility. There was no difference in interobserver reproducibility in low vs. high grade lesions. Intraobserver reproducibility had no significant correlation with experience of the observer. The sensitivity ranged from 0.69 to 0.97 (mean, 0.79), while the specificity ranged from 0.09 to 0.46 (mean, 0.30). Mean diagnostic accuracy was better in benign and low grade squamous intraepithelial lesions in comparison to high grade squamous intraepithelial lesions. CONCLUSION: There was good interobserver agreement in classifying squamous metaplastic lesions. The agreement did not correlate with grade of dysplasia or experience of the cytopathologists. These findings should be considered in making treatment, quality assurance and legal decisions. A larger study is indicated to study interobserver and in