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PubMed1995

Trichomonas vaginalis and cervical cancer. A prospective study in China.

The relationship between Trichomonas vaginalis infection and cervical cancer was investigated prospectively in a cohort of 16,797 women aged 25 years or more who were followed from 1974 to 1985 within the framework of a cervical screening program in Jingan, China. Personal interviews were conducted by trained interviewers when the women first entered the screening program. At initial screening, 421 (2.51%) women had a positive cytologic diagnosis of T. vaginalis infection. Ninety-nine incident cases of pathologically confirmed squamous cell carcinoma were identified from the cohort, with a total of 140,018 person-years of observation. T. vaginalis infection was found to contribute to the risk of cervical cancer, as determined by crude estimates and after adjustment for potential confounding effects. In a multiple proportional hazards model, the relative risk for cervical cancer was 3.3 (95% confidence interval: 1.5 to 7.4) among women with T. vaginalis infection. Furthermore, in the multivariate analysis, increased risk of cervical cancer was associated with the following factors: number of extramarital sexual partners of both the subjects and their spouses, cigarette smoking, and irregular menstruation. Having a large number of negative Pap smears was associated with lower risk. This study suggests that there might be an association between T. vaginalis infection and the risk of cervical cancer, but only 4 to 5% of cervical cancer in Chinese women may be attributable to T. vaginalis infection.

Adult↗
PubMed1998

Development and implementation of a breast and cervical cancer screening program in urban and rural Alaska.

Early detection of breast and cervical cancers represents the single best strategy to effect the reduction of associated morbidity and mortality. The State of Alaska identified a need to establish a service delivery system which would assure the availability of breast and cervical cancer screening services for women who are low income, under- and uninsured, and from racial/ethnic minorities. In March 1995 the Alaska Breast and Cervical Cancer Early Detection Program (AK-BCCEDP) began funding breast and cervical cancer screening services through the Centers for Disease Control and Prevention, National Breast and Cervical Cancer Early Detection Program. The purpose of AK-BCCEDP is to establish a comprehensive service delivery strategy which includes screening, tracking, referral, follow-up, public education, quality assurance, surveillance, coalition building/partnering, and evaluation. During the first year of services (March 1, 1995, to February 29, 1996) 651 women were screened for breast and cervical cancer. Higher than expected numbers of breast cancer were detected. Of the 651 women screened, four were diagnosed with invasive breast cancer and three were diagnosed with high-grade squamous intraepithelial lesions.

Adolescent↗
PubMed2003

Risk of invasive cervical cancer after three consecutive negative Pap smears.

OBJECTIVES: To determine the factors that influence risk of cervical cancer after three consecutive negative Pap smears. METHODS: A cohort study was conducted using data from the British Columbia Cervical Cancer Screening Program and British Columbia Cancer Registry. Analysis was based on a one percent sample of women aged 20-69 years with Pap smears enriched with all invasive cervical cancer cases diagnosed between 1994-99. Screening intervals, after three negative screens, were created with the following variables: age at beginning of interval, interval length, previous cytologic abnormality and previous cervical procedure. The risk of cervical cancer by histologic type was calculated using survival analysis methods. RESULTS: The sample consisted of 10,509 women, who contributed 28,309 intervals, and 371 cervical cancer cases. The incidence rate of invasive squamous cervical cancer increased with time since last screen up to six years. Women with a history of dysplasia remained at elevated risk for squamous cancer, hazard ratio=2.6 (95% confidence interval [CI]=1.9, 3.4) but age or previous procedure were not related to risk. No relationship between time since last screen and non-squamous cancer risk was found although history of a previous procedure was significant. The marginal effectiveness of Pap smears declined with increasing frequency of use. CONCLUSIONS: This study confirmed the preventive effect of Pap smear screening and its dependency on frequency of use. Women with a history of dysplasia, prior to three consecutive negatives, were at increased risk of developing invasive squamous cervical cancer compared with women with no such history.

Adult↗
PubMed1996

Screening for cervical cancer.

It is well accepted that conscientious and widespread use of cervical cytology will significantly decrease the incidence and mortality rates of cervical cancer. The Papanicolaou smear for cervical cytology fulfills all the criteria for an ideal screening test. Not only is it cost effective, acceptable to most patients, and adaptable to widespread screening, it is sensitive enough to detect preinvasive disease resulting in decreased morbidity and mortality. Nevertheless, in developing countries cervical cancer still occurs at epidemic proportions, where an estimated 460,000 new cases per annum will be diagnosed, a significant proportion of which will be in advanced stages. First world notions pertaining to screening have proved unrealistic for the developing health care system of third world nations. This article provides an overview of screening for cervical cancer and considers cytological smearing, cervicography and direct visualization of the cervix, be it without or with the application of 4 percent acetic acid.

Developing Countries↗
PubMed1991

Maternal and fetal outcome after invasive cervical cancer in pregnancy.

Invasive carcinoma of the cervix is the most common gynecologic malignancy to occur during the reproductive years. To analyze the effects of pregnancy on the course and survival of invasive cervical cancer, we compared 40 women with invasive cervical cancer to 89 nonpregnant controls matched for age, calendric year of diagnosis, stage, and tumor type. Additionally, we compared the distribution of invasive cervical cancer stages among the 40 pregnant women with that among the 1,963 cases of invasive cervical cancer treated during the same 30 years in women less than 45 years of age registered in the same hospital. To evaluate pregnancy outcome, we compared babies born to women with invasive cervical cancer to babies born of women matched for maternal age and not exposed to known teratogens or reproductive risks during pregnancy. Thirty-year survival of pregnant women with invasive cervical cancer was identical to that of their matched controls. Women having invasive cervical cancer were 3.1 times more likely to be diagnosed with stage I disease (95% confidence interval, 1.6 to 6.2). Additionally, they had a significantly lower chance of being diagnosed with stages III and IV (P = .02). Babies born to women with invasive cervical cancer were similar in gestational age and rates of prematurity but had a lower birth weight than the matched controls. There were two stillbirths among the 24 pregnancies that continued to term (8%), not statistically different from the 1.1% rate for Ontario. Our data suggest that pregnancy per se does not adversely affect the survival of women with invasive cervical cancer. However, this study provides evidence that pregnant women are more likely to present with early disease because of regular, pregnancy-related obstetric exams. Moreover, there is an increased risk for stillbirth, which should lead to follow-up of these patients by a high-risk perinatal unit.

Adult↗
PubMed1977

Long-term follow-up studies on herpes simplex antibodies in the course of cervical cancer: patterns of neutralizing antibodies.

The kinetics of neutralization was used to study antibodies to herpes simplex virus type 2 in 90 patients with invasive carcinoma of the cervix uteri. The first sera were drawn before treatment and consective sera were drawn at intervals thereafter. Control groups consisted of 90 age-matched healthy women and 70 cancer patients suffering from malignancies other than cervix carcinoma. Patients surviving during the observation period of 12-60 months had a significantly higher frequency of neutralizing antibodies than control groups. Twenty-six of the women with cervix carcinoma died during the observation period and 13 others had a recurrence of the cancer. Survivors with advanced cervical cancer had higher antibody titers than survivors with less severe cervical cancer while patients whose cancer caused death had low titer or to a great extent lacked neutralizing antibodies. Women with recurrences and progressing cervical lesions had no detectable antibodies while women with recurrences and regressing lesions all had antibodies. There was a rise in K2-values 6-18 months after treatment. In serum samples collected later than 18 months, there was a return to original levels.

Adult↗
PubMed1999

Organised vs. spontaneous Pap-smear screening for cervical cancer: A case-control study.

To compare the effect of organised pap-smear screening for cervical cancer with that of the spontaneous one on the incidence of invasive cervical cancer, we performed a case-control study within the catchment area of the Helsinki University Hospital (Helsinki, Finland). The study material consisted of 179 incident cases of invasive cervical cancer and 1,507 population controls. Data on lifetime pap smears before the year of the cancer diagnosis were collected using a self-administered questionnaire. The questionnaire information was obtained for 82% of the cases and 73% of the controls. The main outcome measure was relative risk of invasive cervical cancer among those with history of organised or spontaneous screening compared with risk among those with no history of screening for cervical cancer, measured as odds ratios (OR) with 95% confidence intervals (CI) and computed with logistic regression. Odds ratio of invasive cervical cancer among those who participated in the organised screening programme was 0.38 (CI 0.26-0.56) whereas any lifetime spontaneous pap smear had an OR value of 0.82 (CI 0. 53-1.26), in terms of unit risk for those not subjected to any screening and adjusted for age and the other type of the screening activity. Our results indicate that the substantial decrease in the incidence of and mortality due to cervical cancer in Finland is mainly due to the organised mass-screening.

Adult↗
PubMedDate not supplied

Assessment of cervical cancer screening and follow-up programs.

There is essentially no debate about the benefits of cervical cancer screening. The current debate centers around periodicity, the appropriate interval for repeated testing, and the age at which screening should be discontinued. As the frequency of screening is increased within a defined population, there is a gain in survival (life-years) depending upon the risk status of the population segment screened. However, each increment in survival comes at an increasingly high cost. Significant gains have been made in improving screening and detection services through widespread availability of the Papanicolaou test. However, there has been concern raised that the cost-effectiveness of cervical cancer screening has not been clearly demonstrated. This report analyzes the current status of the literature on screening for cervical cancer with a focus on cost-effectiveness and cost-benefit analyses of screening using the Pap test. A relatively small group of studies was located which directly addressed the cost-effectiveness question. All of the studies cited attempted in some manner to describe the relationship between benefits of cervical cancer screening and costs. Two studies reported a program design with net positive monetary benefits, while one estimated that the direct cost of medical care avoided through screening was approximately equal to the cost of the screening program. In general, however, screening for cervical cancer is viewed as an investment in extending life (a net cost per year of life gained). Most analysts ascribe a net monetary cost to cervical cancer screening programs. Then the question becomes one of cost-effectiveness--designing a program so as to optimize the result obtained. With respect to optimizing screening, the literature leaves no doubt of the value of cervical cancer screening in general. From a cost-effectiveness perspective, screening no more frequently than every 3-5 years appears reasonable. It is important to think in terms of a total program and how effectively the population at risk is being reached. The literature reviewed spans a period of more than twenty years and reflects studies across the globe. While the quality is uneven, from this body of work a consensus emerges: screening is effective, but the frequency of screening in the United States is probably too high. In addition, those who are most intensively screened are probably at the lowest risk. Outreach and targeting of at-risk population groups needs to be addressed in order to improve cost-effectiveness of cervical cancer screening. The effectiveness of the screening technology (the Pap test) is taken for granted, but this may be a mistake.(ABSTRACT TRUNCATED AT 400 WORDS)

Cost-Benefit Analysis↗
PubMed2001

Effective screening programmes for cervical cancer in low- and middle-income developing countries.

Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms for screening, investigating, treating, and following up the targeted women. The findings from the large body of research on various screening approaches carried out in developing countries and from the available managerial guidelines should be taken into account when reorganizing existing programmes and when considering new screening initiatives.

Adult↗
PubMed1995

Cervical cancer survival in a high risk urban population.

BACKGROUND: Cervical cancer remains an important public health problem, particularly for the urban minority population. To the authors' knowledge, determinants of cervical cancer survival have not been studied in this high risk population. METHODS: This study included all 158 women diagnosed and treated for invasive cervical cancer from January 1, 1986, through December 31, 1992, at the Grady Memorial Hospital and Clinics (Atlanta, GA). Medical records were abstracted to determine age at diagnosis, race, International Federation of Gynecology and Obstetrics (FIGO) clinical stage, treatment, and survival. Pathologic material was reviewed to confirm the diagnosis. RESULTS: Most patients (80%) were African American, and the stage distribution was similar for African American and white patients. Sixty-six (42%) had FIGO Stage I disease; 50%, Stage II or III; and 8%, Stage IV. Four-year actuarial survival differed significantly according to clinical stage (Ia = 94%, Ib = 79%, II = 39%, III = 26%, IV = 0%). Overall survival was lower for patients with glandular carcinomas than for those with squamous cell carcinomas (26% vs. 55%, P = 0.09). This difference was almost entirely due to increased mortality in patients with Stage Ib adenocarcinomas (53% vs. 88% for squamous cell carcinoma, Stage Ib, P = 0.03). CONCLUSIONS: The major prognostic markers for cervical cancer survival in this high risk patient population were clinical stage and histology, factors identical to those identified for other populations.

Black or African American↗
PubMed2003

Transduction of adenovirus-mediated wild-type p53 after radiotherapy in human cervical cancer cells.

OBJECTIVE: Radiotherapy is the mainstay of treatment for advanced cervical cancer and most cervical cancers have evidence of HPV (human papilloma virus) infection, which inactivates the p53 gene. The goal of this study was to determine the effect of combining radiotherapy and Adp53 infection on the growth of cervical carcinoma cells. METHODS: The silta cervical carcinoma cell line contains wild-type p53 and HPV 16 infection. The C33A cell line has a p53 mutation. The Adp53 recombinant adenovirus contains the cytomegalovirus promoter, wild-type p53 cDNA, and a polyadenylation signal in a minigene cassette inserted into the El-deleted region of a modified adenovirus 5. Transduction efficiency was assessed by using an adenovirus containing the Escherichia coli beta-galactosidase gene and expression of wild-type p53 in infected cells was evaluated by Western blot analysis. One group of cells was irradiated prior to infection, the other group received no irradiation, but were either infected with virus or mock-infected. Cells were analyzed for viability 1 to 7 days after infection by using the sulforhodamine B assay. The percentage of cells undergoing apoptosis was determined by using a TUNEL assay. RESULTS: Fifty percent of C33A cells were transduced with 5 muthplicities of infection of virus whereas SiHa cells required 25 multiplicities of infection. Adp53 expression was found 48 h after infection. In the cells treated with both radiation and Adp53 infection growth inhibition was increased compared with inhibition resulting with either treatment alone. The combination treatment also increased the percentage of cells undergoing apoptosis. CONCLUSION: Combining radiotherapy with Adp53 infection increases the inhibition of growth of cervical cancer cells in vitro. This combination treatment has the potential of increasing efficacy and of therapy.

Adenoviridae↗
PubMed2005

[Expression of RASSF1A mRNA and its relationship with HPV-16 in cervical cancer].

OBJECTIVES: To study the expression of RASSF1A mRNA and its relationship with HPV-16 in cervical cancer. METHODS: Reverse transcription polymerase chain reaction (RT-PCR) was used to detect the expression of RASSF1A mRNA in 56 patients with cervical cancer, 36 patients with CIN and 20 patients with normal cervix. HPV-16 DNA was also examined by PCR in 56 patients with cervical cancer. RESULTS: The rates of loss of RASSF1A mRNA expression were 0% (0/20), 22.2% (8/36) and 50.0% (28/56) in patients with normal cervix, CIN and cervical cancer respectively. The loss rate of RASSF1A mRNA in the cervical tissues at the advanced stages (stages III-IV, 82.4%) was higher than that at the early stages (stages I-II, 35.9%, P < 0.05). RASSF1A mRNA deletion occurred more often in the tissues of squamous cervical cancers (63.3%) than in those of adenocarcinoma (34.6%) (P < 0.05). The loss rate of the poor differentiation group was 70.8%, significantly higher than that of the middle and high differentiation group (37.5%, P < 0.05). The loss of RASSF1A was negatively related with HPV-16 infection in cervical cancers, especially in adenocarcinoma (P < 0.905). CONCLUSION: Loss of RASSF1A may play an important role in tumorgenesis and development of cervical cancer.

Adenocarcinoma↗
PubMed2001

Effects of screening on cervical cancer incidence and mortality in New South Wales implied by influences of period of diagnosis and birth cohort.

STUDY OBJECTIVES: Cervical cancer incidence and mortality in NSW during 1972-1996 is examined under counterfactual assumptions to estimate the number of new cervical cancer cases averted and deaths avoided, with projections to 2006. SETTING: Cervical cancer incident cases and deaths in NSW for 1972-96 were obtained from the NSW Central Cancer Registry, Sydney, Australia. DESIGN: Data were analysed by age-period-cohort (APC) modelling, using Poisson regression. Projection of incidence to 2006 was based on a linear trend for period effects. A counterfactual scenario was constructed assuming stable period effects (1972-74), but modelled cohort effects. Modelled rates were converted to cases and deaths (using mortality:incidence ratios for cervical cancer), and compared with actual data to estimate cancers prevented and deaths averted due to screening. RESULTS: Rising cohort effects with recency of birth were found after controlling for age and period of diagnosis, and declining period effects were identified after controlling for age and birth cohort. The estimated cumulated number of new cases of cervical cancer prevented during 1972-1996 was 3440. The cumulated number of averted deaths over 1972-1996, derived from incident cases, was estimated to be 1610 (including actual declines in the M/I ratio). With no change in the M/I ratio from 1972, estimated cumulated mortality averted due to cervical cancer for 1972-1996 was 1210 deaths. CONCLUSIONS: Cervical screening has prevented a substantial number of new cases of cervical cancer and deaths. In addition, secondary prevention and improved treatment has contributed further to cervical cancer deaths averted.

Adult↗
PubMed1990

Cytological screening history of patients with early invasive cervical cancer.

The value of population screening for cervical cancer has recently been questioned. The purpose of this study was to examine the cytological screening history in 100 consecutive patients undergoing Wertheim's hysterectomy for early invasive cervical cancer. Twenty three per cent of the patients were never screened; the screening history was unavailable in 11%; the patient was referred appropriately in 21%; there was a delay in referral for gynaecological assessment in 21%; the patient's previous cervical smear before referral was normal in 24%. If population screening in Ireland is to have an impact on mortality from cervical cancer, the results of this study indicate that greater attention needs to be given not only to extending the number of women screened, but also to increasing the frequency of screening and to improving the clinical response to an abnormal smear.

Adenocarcinoma↗