National Cancer Institute®
Last Modified: March 1, 2002
UI - 11481905
AU - Szentirmay Z; Cseh J; Pulay T; Kasler M
TI - [Human papillomavirus and cervical cancer: genetic background of the neoplastic process]
SO - Orv Hetil 2001 Jul 8;142(27):1429-36
AD - Orszagos Onkologiai Intezet, Budapest.
In a 2-year period, 136 HPV positive cytological samples of the cervix uteri were analyzed at the Department of Molecular Pathology, National Institute of Oncology, Hungary. Comparison with the international data obtained from the literature revealed that the Hungarian epidemiological data bore closest resemblance to the European ones except some differences. The HPV18 is rather seldom encountered in this country. Similarly low occurrence was noted only in Japan. However, the 14.1% occurrence rate of HPV58 in Hungary is by far higher than that in any other country in this analysis except Japan where this virus is of similarly high frequency. In Hungary, the incidence of HPV59 is relatively high just like in Central and South America. HPV33 and HPV66 infections occur in a significantly higher number with Hungary than in any of the countries studied. In our study The European type variant of HPV16 (E-V-350G) occurred in 2/10 CIN II-III cases. The authors also compared the various clinico-pathological grouping of HPV types published, and identified several inconsistencies. Viruses considered to have high risk occurred in intact epithelium, CIN I-II-III and carcinoma alike. The general tendency was, however, that certain viruses correlated with specific clinico-pathological entities. At present there is no reason to include the PCR-based HPV typing in the mass screening of cervical cancers. HPV typing and physical state of the virus can reasonable be determined if the cervical cytology is suspect for HPV infection or even control examination after "loop" conisation. Negative cytology completed with negative HPV-DNA test means the lack of cancer risk even in the case of a previously removed CIN or carcinoma. However, a positive HPV test detected after conisation associated with negative cytology finding indicates a risk of 70% of the development of CIN within 2 years.
UI - 11843937
AU - McGahan CE; Blanks RG; Moss SM
TI - Reasons for variation in coverage in the NHS cervical screening programme.
SO - Cytopathology 2001 Dec;12(6):354-66
AD - Cancer Screening Evaluation Unit, Institute of Cancer Research, Section of Epidemiology, Sutton, UK.
In order to investigate reasons for variation in coverage of cervical screening, data from standard Department of Health returns were obtained for all Health Authorities for 1998/1999. Approximately 80% of the variation between health authorities is explained by differences in age distribution and area classification. Considerable differences between Health Authority and Office of National Statistics (ONS) population figures in City and Urban (London) areas for the age group 25-29 years and for City (London) for age group 30-34 years, suggest an effect of list inflation in these groups. Coverage as a performance indicator may be more accurately represented using the age range 35-64 years. Using this narrower age range, the percentage of health authorities meeting the 80% 5-year coverage target increases from 87% to 90%.
UI - 11843938
AU - Wordsworth S; Ryan M; Waugh N
TI - Costs and benefits of cervical screening IV: valuation by women of the cervical screening programme.
SO - Cytopathology 2001 Dec;12(6):367-76
AD - Health Economics Research Unit, University of Aberdeen, UK. email@example.com
OBJECTIVES: To assess the value of the cervical smear test to women, taking account of the positive and negative aspects of the cervical screening service. DESIGN: A postal survey. SETTING: Tayside Health Board region of Scotland. PARTICIPANTS: A sample of 2000 women aged 20-59. MAIN OUTCOME MEASURES: Maximum willingness to pay (WTP) for a cervical smear test. RESULTS: Women were prepared to pay 50.20 British pounds per smear on a 3-yearly basis. Willingness to pay was positively related to income, but unrelated to age and whether or not the respondent had previously had a smear. CONCLUSIONS: Previous studies have estimated the cost per screen or cost per life year saved by cervical screening. This study used the economic instrument of WTP to take account of other potential (dis)benefits to women. The value women place on having a smear was more than the cost to the National Health Service (NHS) of providing the service. The output of a WTP study is potentially useful at the policy level. Future work should explore both the value of alternative approaches to cervical screening, and the value of competing health care interventions.
UI - 11843939
AU - Migliore G; Rossi E; Aldovini A; Mudu P; Alderisio M; Giovagnoli MR;
TI - Fabiano A; Morosini PL; Branca M Variation in the assessment of adequacy in cervical smears.
SO - Cytopathology 2001 Dec;12(6):377-82
AD - Laboratory of Epidemiology and Biostatistics, Cytopathology Unit, National Institute of Health, Rome, Italy.
OBJECTIVE: To assess the interobserver reproducibility of the diagnosis of 'adequacy' of cervical smears according to the Bethesda System criteria in cervical smears. STUDY DESIGN: 358 cervical smears were obtained from three Italian cytopathological centres in 1998-99. All centres provided consecutively collected smears. The cervical smears were independently and blindly assessed by four cytologists.The screening was performed using a 10x objective and an additional evaluation of the percentage of cellularity was performed using a 4x objective. RESULTS: The proportion of smears assessed by the four cytologists as 'adequate' ranged from 60% to 70%, the proportion of 'satisfactory for evaluation but limited by' ranged from 27% to 38%, and the proportion of 'inadequate smears' ranged from 2% to 4%. Full agreement in the assessment of smear adequacy was observed in 311 slides and disagreement was observed only in 47. The category 'inadequate smear' was less reliable than the other two; however, the kappa value observed was acceptable. CONCLUSION: The present study shows that it is possible to achieve a high reproducibility in the assessment of smear adequacy, at least among expert cytologists who follow the Bethesda System criteria strictly.
UI - 11843940
AU - Herbert A; Johnson J
TI - Personal view. Is it reality or an illusion that liquid-based cytology is better than conventional cervical smears?
SO - Cytopathology 2001 Dec;12(6):383-9
AD - Histopathology Department, Guy's and St Thomas' Hospitals NHS Trust, London, UK.
Liquid-based cytology (LBC) has been heralded as the way forward for cervical screening, and as the answer to many of its problems. It is already used as a sole method of cell preparation in many private clinics in the UK. It is being used for colposcopy smears in many NHS clinics and is now being piloted for primary screening in three screening centres in England, as well as one in Scotland and one in Wales. LBC has been welcomed as a new technology because it deals with the problem of specimen adequacy at source, removing responsibility for slide preparation and fixation from the clinician or nurse. It provides uniformly well-fixed preparations that are free of inflammatory exudate and blood, and seem easier to screen than conventional smears. There are many articles in the world literature suggesting that LBC is more accurate than conventional screening, and it is thought likely to reduce the number of false negative tests. The main reasons for piloting LBC in the NHS Cervical Screening Programme (NHSCSP) lie in its potential for reducing screening times and for reducing the numbers of repeats for inadequate tests. LBC is expensive in terms of equipment, capital costs, maintenance, consumables, training, technical preparation time, transportation and disposal of liquid media. Its costs could be justified if they were offset by the money saved from reduced screening time and repeat tests, but only if its accuracy in terms of sensitivity and specificity were proven to be equal to or better than conventional cytology. Although that is generally held to be true by the public and medical profession alike, there is very little hard evidence to support it.
UI - 11169969
AU - Bergstrom A; Pisani P; Tenet V; Wolk A; Adami HO
TI - Overweight as an avoidable cause of cancer in Europe.
SO - Int J Cancer 2001 Feb 1;91(3):421-30
AD - Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden.
There is growing evidence that excess body weight increases the risk of cancer at several sites, including kidney, endometrium, colon, prostate, gallbladder and breast in post-menopausal women. The proportion of all cancers attributable to overweight has, however, never been systematically estimated. We reviewed the epidemiological literature and quantitatively summarised, by meta-analysis, the relationship between excess weight and the risk of developing cancer at the 6 sites listed above. Estimates were then combined with sex-specific estimates of the prevalence of overweight [body mass index (BMI) 25-29 kg/m(2)] and obesity (BMI > or = 30 kg/m(2)) in each country in the European Union to obtain the proportion of cancers attributable to excess weight. Overall, excess body mass accounts for 5% of all cancers in the European Union, 3% in men and 6% in women, corresponding to 27,000 male and 45,000 female cancer cases yearly. The attributable proportion varied, in men, between 2.1% for Greece and 4.9% for Germany and, in women, between 3.9% for Denmark and 8.8% for Spain. The highest attributable proportions were obtained for cancers of the endometrium (39%), kidney (25% in both sexes) and gallbladder (25% in men and 24% in women). The largest number of attributable cases was for colon cancer (21,500 annual cases), followed by endometrium (14,000 cases) and breast (12,800 cases). Some 36,000 cases could be avoided by halving the prevalence of overweight and obese people in Europe.
UI - 11783689
AU - Updegrove KK
TI - An evidence-based approach to male circumcision: what do we know?
SO - J Midwifery Womens Health 2001 Nov-Dec;46(6):415-22
AD - University of Pennsylvania Midwifery Program, USA.
Midwives care for women throughout their childbearing years, guiding them through decisions made about themselves and their newborn children. The decision to circumcise a male infant depends on a number of factors, including medical, social, cultural, and religious considerations. Data surrounding medical benefits and risks of this surgery are inconsistent and, therefore, confusing. However, substantial data exist to support the conclusions that uncircumcised males have greater incidences of urinary tract infections, especially in the first 6 months of life when complications are greatest, greater incidences of ulcerative sexually transmitted infections, and increased transmission of human immunodeficiency virus. This article reviews available research on the medical benefits and risks of infant circumcision. Informed consent is essential for all parents who must make this decision.
UI - 11818345
AU - Marteau TM; Hankins M; Collins B
TI - Perceptions of risk of cervical cancer and attitudes towards cervical screening: a comparison of smokers and non-smokers.
SO - Fam Pract 2002 Feb;19(1):18-22
AD - Psychology and Genetics Research Group, Guy's King's and St Thomas's School of Medicine, Thomas Guy House, Guy's Campus, London SE1 9RT, UK.
OBJECTIVES: The aim of this study was to compare smokers' and non-smokers' perceptions of risks of cervical cancer and attitudes towards cervical screening. METHODS: A cross-sectional descriptive study was carried out in 722 women aged between 20 and 64 years. RESULTS: While smokers perceived their relative risk of heart disease to be greater than that of non-smokers, they did not perceive their risks of cervical cancer to be greater. Smokers held less positive attitudes towards cervical screening than did non-smokers. Smokers and non-smokers did not differ in their intentions to attend for cervical screening: for both groups, intentions were very high. Using logistic regression analysis, both attitudes towards cervical screening [odds ratio (OR) 1.9; 95% confidence interval (CI) 1.7-2.2] and perceived relative risk of developing cervical cancer (OR 1.5; 95% CI 1.0-2.1) were predictive of intentions to attend for screening, as well as educational level (OR 3.8; 95% CI 1.2-11.3) and marital status (OR 0.6; 95% CI 0.3-0.9). CONCLUSIONS: Smokers seem unaware of their increased risks of cervical cancer and hence the increased value for them of regular smears. Evaluations are needed to determine the effectiveness of interventions delivered in the context of cervical screening aimed at (i) raising smokers' awareness of their increased risk of cervical cancer and (ii) stopping smoking.
UI - 11889288
AU - Pasick RJ; Stewart SL; Bird JA; D'Onofrio CN
TI - Quality of data in multiethnic health surveys.
SO - Public Health Rep 2001;116 Suppl 1():223-43
AD - Northern California Cancer Center, Union City 94587-3106, USA. Rpasick@nccc.org
OBJECTIVE: There has been insufficient research on the influence of ethno-cultural and language differences in public health surveys. Using data from three independent studies, the authors examine methods to assess data quality and to identify causes of problematic survey questions. METHODS: Qualitative and quantitative methods were used in this exploratory study, including secondary analyses of data from three baseline surveys (conducted in English, Spanish, Cantonese, Mandarin, and Vietnamese). Collection of additional data included interviews with investigators and interviewers; observations of item development; focus groups; think-aloud interviews; a test-retest assessment survey; and a pilot test of alternatively worded questions. RESULTS: The authors identify underlying causes for the 12 most problematic variables in three multiethnic surveys and describe them in terms of ethnic differences in reliability, validity, and cognitive processes (interpretation, memory retrieval, judgment formation, and response editing), and differences with regard to cultural appropriateness and translation problems. CONCLUSIONS: Multiple complex elements affect measurement in a multiethnic survey, many of which are neither readily observed nor understood through standard tests of data quality. Multiethnic survey questions are best evaluated using a variety of quantitative and qualitative methods that reveal different types and causes of problems.
UI - 11727171
AU - Dayal M; Barnhart KT
TI - Noncontraceptive benefits and therapeutic uses of the oral contraceptive pill.
SO - Semin Reprod Med 2001 Dec;19(4):295-303
AD - Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
The oral contraceptive pill is one of the most extensively studied medications ever prescribed. The health benefits are numerous and outweigh the risks of their use. Definitive evidence exists for protection against ovarian and endometrial cancers, benign breast disease, pelvic inflammatory disease requiring hospitalization, ectopic pregnancy, and iron-deficiency anemia. It has also been suggested that oral contraceptives may provide a benefit on bone mineral density, uterine fibroids, toxic shock syndrome, and colorectal cancer. Minimal supportive evidence exists for oral contraceptives protecting against the development of functional ovarian cysts and rheumatoid arthritis. Treatment of medical disorders with oral contraceptives is an "off-label" practice. Dysmenorrhea, irregular or excessive bleeding, acne, hirsutism, and endometriosis-associated pain are common targets for oral contraceptive therapy. Most patients are unaware of these health benefits and therapeutic uses of oral contraceptives, and they tend to overestimate their risk. Counseling and education are necessary to help women make well-informed health-care decisions and improve compliance.
UI - 11694344
AU - Legro RS
TI - Polycystic ovary syndrome: the new millenium.
SO - Mol Cell Endocrinol 2001 Nov 26;184(1-2):87-93
AD - Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, M.S. Hershey Medical Center, PO Box 850, Hershey, PA 17033, USA. firstname.lastname@example.org
Our understanding of Polycystic Ovary Syndrome (PCOS) has been hampered by varying diagnostic criteria, and ignorance of the etiology of the syndrome. PCOS women are uniquely insulin resistant and obesity aggravates this underlying predisposition to insulin resistance. Diagnostic criteria which focus on hyperandrogenism and/or menstrual irregularity are more likely to identify insulin resistant women, than such criteria as abnormal gonadotropin secretion or ovarian morphology. The lack of a clear etiologic mechanism to the syndrome has led to a multitude of symptom-oriented treatments with few therapies improving all aspects of the endocrine syndrome of PCOS. Improving insulin sensitivity has become established as a baseline treatment strategy in PCOS. There are, however, few randomized controlled trials of adequate power to provide an evidence based guide to treatment in PCOS.
UI - 11841530
AU - O'Malley AS; Forrest CB; Mandelblatt J
TI - Adherence of low-income women to cancer screening recommendations.
SO - J Gen Intern Med 2002 Feb;17(2):144-54
AD - Department of Oncology, Georgetown University Medical Center, 2233 Wisconsin Ave. NW, Suite 440, Washington, D.C. 20007, USA. email@example.com
BACKGROUND: African-American and low-income women have lower rates of cancer screening and higher rates of late-stage disease than do their counterparts. OBJECTIVE: To examine the effects of primary care, health insurance, and HMO participation on adherence to regular breast, cervical, and colorectal cancer screening. DESIGN: Random-digit-dial and targeted household telephone survey of a population-based sample. SETTING: Washington, D.C. census tracts with > or =30% of households below 200% of federal poverty threshold. PARTICIPANTS: Included in the survey were 1,205 women over age 40, 82% of whom were African American. MAIN OUTCOME MEASURES: Adherence was defined as reported receipt of the last 2 screening tests within recommended intervals for age. RESULTS: The survey completion rate was 85%. Overall, 75% of respondents were adherent to regular Pap smears, 66% to clinical breast exams, 65% to mammography, and 29% to fecal occult blood test recommendations. Continuity with a single primary care practitioner, comprehensive service delivery, and higher patient satisfaction with the relationships with primary care practitioners were associated with higher adherence across the 4 screening tests, after considering other factors. Coordination of care also was associated with screening adherence for women age 65 and over, but not for the younger women. Compared with counterparts in non-HMO plans, women enrolled in health maintenance organizations were also more likely to be adherent to regular screening (e.g., Pap, odds ratio [OR] 1.89, 95% confidence interval [CI] 1.11 to 3.17; clinical breast exam, OR 2.04, 95% CI 1.21 to 3.44; mammogram, OR 1.95, 95% CI 1.15 to 3.31; fecal occult blood test, OR 1.70, 95% CI 1.01 to 2.83.) CONCLUSIONS: Organizing healthcare services to promote continuity with a specific primary care clinician, a comprehensive array of services available at the primary care delivery site, coordination among providers, and better patient-practitioner relationships are likely to improve inner-city, low-income women's adherence to cancer screening recommendations.
UI - 11867503
AU - McIntosh MW; Urban N; Karlan B
TI - Generating longitudinal screening algorithms using novel biomarkers for disease.
SO - Cancer Epidemiol Biomarkers Prev 2002 Feb;11(2):159-66
AD - Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA. firstname.lastname@example.org
Recent advances in molecular technology are leading to the discovery of new tumor biomarkers that may be useful for cancer screening and early diagnosis. Translating a potential screening biomarker from the laboratory to its use in patient care may require an algorithm or screening rule for its application. An algorithm that can detect the smallest deviation from a defined norm is likely to achieve the highest sensitivity, but any practical screening algorithm must do so with strict controls on test specificity to avoid false-positive results, and unnecessary patient alarm and risk. Longitudinal algorithms that make use of previous tumor marker values and trends are likely to obtain improvements over single threshold rules. Thus far, a few longitudinal screening algorithms have been proposed (e.g., using serial prostate-specific antigen values for the detection of prostate cancer and serial CA125 values for the detection of ovarian cancer), but these algorithms are not appropriate for novel tumor marker discoveries, because they rely on unverifiable assumptions that may not translate to the behavior of the new marker. The algorithm presented here is motivated by: (a) the need to develop an algorithm for early detection using novel markers; (b) the practical demands on data and specimen availability; and (c) the need to be robust enough to accommodate a wide range of tumor growth behavior. We use Parametric Empirical Bayes statistical theory to model the trajectory of markers over time in a cohort of asymptomatic healthy subjects, and use the estimated trajectory to produce person-specific thresholds that depend on the screening history of each person. The thresholds are chosen to give the person (or population) a specified false-positive rate. The resulting algorithm is simple and can be represented in a simple graph or a chart. The statistical analysis needed to generate the algorithm can be found in nearly every basic statistical package. The algorithm is highly robust and can detect a wide range of tumor behaviors. The Parametric Empirical Bayes screening algorithm should take a central role when evaluating marker discoveries for use in screening. The algorithm is particularly useful when screening with a new marker of which the behavior in the preclinical period is not well known.
UI - 11715007
AU - Kauff ND; Scheuer L; Robson ME; Glogowski E; Kelly B; Barakat R; Heerdt
TI - A; Borgen PI; Davis JG; Offit K Insurance reimbursement for risk-reducing mastectomy and oophorectomy in women with BRCA1 or BRCA2 mutations.
SO - Genet Med 2001 Nov-Dec;3(6):422-5
AD - Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
PURPOSE: Risk-reducing surgery is an important option for women with BRCA1 and BRCA2 mutations. There are reports in the literature that insurance reimbursement for these procedures varies greatly. Because health insurance coverage significantly affects medical decision-making, current information regarding reimbursement practices of third-party payers is needed. METHODS: Retrospective study of hospital billing records of 38 women with documented BRCA1 or BRCA2 mutations who underwent either a risk-reducing mastectomy or a risk-reducing oophorectomy between March 1, 1997, and July 30, 2000. RESULTS: Complete billing and reimbursement information was available for 35 women undergoing a total of 39 risk-reducing surgeries. A total of 38 of 39 (97%) risk-reducing surgeries were covered in full, less applicable coinsurance and deductibles. The rate of insurance reimbursement did not vary with type of insurance, personal history of cancer, or type of procedure. CONCLUSION: Insurance carriers reimbursed the vast majority of BRCA mutation carriers undergoing risk-reducing surgery.
UI - 11876611
AU - Gavarasana S; Kalasapudi R S; Rao T D; Thirumala S
TI - Prevention of carcinoma of cervix with human papillomavirus vaccine.
SO - Indian J Cancer 2000 Jun-Sep;37(2-3):57-66
AD - Department of Surgery, Brockton Hospital, MA 02402, USA.
BACKGROUND: Carcinoma of cervix is the most common cancer found among the women of India. Though cervical cytology screening was effective in preventing carcinoma of cervix in developed nations, it is considered unsuitable in developing countries. Recent research has established an etiological link between human papillomavirus infection and carcinoma of cervix. In this review, an attempt is made to answer the question, 'whether carcinoma of cervix can be prevented with human papillomavirus vaccine?' METHODS: Literature search using Pubmed and Medline was carried out and relevant articles were reviewed. RESULTS: There is ample experimental evidence to show that DNA of human papillomavirus integrates with cervical cell genome. Viral genes E6 and E7 of HPV type 16 and 18 inactivate p53 function and Rb gene, thus immortalize the cervical epithelial cells. Recombinant vaccines blocked the function of E6 and E7 genes preventing development of papillomas in animals. Vaccination with HPV-VLPs encoding for genes of E6 and E7 neutralizes HPV integrated genome of malignant cells of uterine cervix. CONCLUSIONS: Based on experimental evidence, it is possible to prevent carcinoma of cervix with human papillomavirus vaccine, IMPLICATIONS: Further research is necessary to identify a effective and safe HPV vaccine, routes of administration and characteristics of potential beneficiaries.
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