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PubMed2001

Situational analysis for diagnosis and treatment of cervical cancer in mainland Tanzania.

OBJECTIVE: To determine factors influencing early diagnosis and treatment of cervical cancer in Tanzania women. DESIGN: A cross-sectional study. SETTING: Forty primary health care facilities, twenty district/regional and four referral (tertiary) hospitals in mainland Tanzania. RESULTS: The most basic equipment for cytology-based cervical cancer were available at all health care facilities. However, screening against cervical cancer was appallingly inadequate at all levels of health care delivery system. Apart from medical doctors at tertiary level, other medical personnel including nurses were poorly or hardly utilised for cervical cancer screening. Treatment facilities for pre-cancerous lesions in most district, regional and even tertiary hospitals were inadequate or non-existent despite being very simple, cheap and yet very effective. There was total lack of organised institutional or national policy guidelines on cervical cancer screening in Tanzania. CONCLUSION: There is an urgent need to introduce systematic screening against cervical cancer and treatment of precursor lesions at all levels of health care delivery system in Tanzania. A national policy guideline should be urgently drawn addressing specifically frequency of screening and at what age to start screening.

Cross-Sectional Studies↗
PubMed2004

[Correlation between P53 codon 72 polymorphism and tumorigenesis of cervical cancer].

BACKGROUND & OBJECTIVE: The p53 codon 72 polymorphism affects human papillomavirus (HPV) E6-mediated degradation of p53. This study was to investigate distribution of p53 polymorphism in Guangdong women, and relationship between p53 polymorphism and tumorigenesis of cervical cancer. METHODS: Cervical smears of 46 patients with cervical cancer (case group), and 84 patients with benign gynecologic tumor (control group) treated in our hospital from Sept. 2002 to May 2003 were collected. DNA, extracted from cervical smears,were examined by polymerase chain reaction (PCR) for detection of HPV DNA and p53 codon 72 polymorphism. RESULTS: Positive rate of HPV DNA in case group was 47.8%, in control group was 20.2%. Proportions of genotypes Arg/Arg, Pro/Pro, and Arg/Pro in case group were 56.5%, 21.7%,and 21.7%, respectively; in control group were 71.4%,20.2%, and 8.3%,respectively. There were no significant differences in proportions of Arg/Arg (OR,0.520; 95% CI,0.245-1.102), and Arg/Pro (OR, 1.095; 95% CI,0.454-2.639) between 2 groups; proportion of Pro/Pro in case group was significantly higher than control group (OR, 3.056; 95% CI,1.076-8.678), but no significant difference was found in women with HPV infection. CONCLUSION: Arg/Arg genotype is not a high-risk factor for cervical cancer in Chinese population, and individuals with Pro/Pro genotype are likely to develop cervical cancer.

Codon↗
PubMedDate not supplied

12-county program: screening of 34,318 women for cervical cancer in California, 1975-78.

The California Department of Health Services conducted a cervical cancer screening program in 12 counties where local health agencies provided the screening services. A major purpose of the study was to screen women at high risk of cervical cancer and to assure that women with abnormal results on cervical cytology testing obtained appropriate diagnostic workup and treatment. A total of 34,318 women were screened, and 7,811 returned for up to 3 annual rescreening examinations. Final cytologic results were 33,658 normal, 100 unsatisfactory, and 560 abnormal smears. Of the abnormal smears, 484 were indicative of cervical dysplasia, 41 of in situ cervical cancer and 22 of invasive cervical cancer. In 13 women, endometrial cancer was suspected. Complete followup information on diagnostic evaluation and treatment was obtained for 80 percent of the women with abnormal Pap test results. Histological confirmation of neoplasia was reported for 173 women. The diagnoses were cervical dysplasia in 108, cervical cancer in 58 (49 in situ, 9 invasive) and endometrial cancer in 7. The program reached greater proportions of older women, the less affluent, women of Spanish origin and oriental women and a smaller proportion of blacks than were present in the general female population of California.

Adult↗
PubMed2006

Early clinical outcomes of 3D-conformal radiotherapy using accelerated hyperfractionation without intracavitary brachytherapy for cervical cancer.

PURPOSE/OBJECTIVE: To evaluate the outcome of cervical cancer patients unable to undergo conventional intracavitary brachytherapy (ICBT) treated with 3D-conformal radiotherapy (3DCRT) alone using accelerated hyperfractionation (AHF). METHODS AND MATERIALS: We reviewed the records of 7 patients who had received definitive radiotherapy with 3DCRT alone using AHF for cervical cancer between 2002 and 2005. FIGO stage was IB (1), IIB (2), IIIA (1), IIIB (2), and IVA (1). The reason we did not perform ICBT was due to patient refusal. In 1 patient with stage IB, a total dose of 65.4 Gy was delivered by local irradiation (LI) only. In 1 patient with stage IIIA, a total dose of 60 Gy was delivered by LI only. In 5 patients with Stage IIB-IV, a median total dose of 70.8 Gy was delivered by combination of whole pelvic irradiation (median dose of 45 Gy) with LI. Median overall treatment time was 42 days. RESULTS: Median follow-up for survival patients was 17 months. Out of 7 patients, 6 patients had CR and 1 patient had PR. The response rate was 100%. The 2-year local control rate was 85.7%. Of these patients, 5 are alive without disease and 1 is alive with lung metastasis. CONCLUSIONS: Our outcomes suggest that 3DCRT using AHF may be a promising as a definitive treatment for cervical cancer when ICBT is not able to be performed.

Aged↗
PubMed1986

Incidence of cervical cancer following negative smear. A cohort study from Maribo County, Denmark.

In order to estimate the risk of developing cervical cancer among women who originally had cytologically normal Papanicolaou (Pap) smears, information has been collected on all Pap smears taken in Maribo County, Denmark in 1966-1982 among women born 1918-1952. A total of 27,811 women are included in the study, and cases of invasive cervical cancer developed in the study population have been identified from the local department of pathology and from the Danish Cancer Registry. The incidence of cervical cancer has been tabulated by number of previous negative smears and by time elapsed since last negative smear. Women with one previous negative smear have a zero risk of developing cervical cancer during the first year following the negative smear. The incidence among these women increases with length of time since the negative smear and reaches the level of unscreened women during the fifth year of follow-up. Women with 2-4 previous negative smears also have a negligible risk of developing cervical cancer during the first two years following the last negative smear. The incidence among these women increases less over time than the incidence for women with one previous negative smear. No cases of cervical cancer were observed among 7,716 women with 5+ previous negative smears. The study indicates that the 5-year risk of developing cervical cancer is 48% lower in women with one previous negative smear than in an unselected population of unscreened women. The 5-year risk for women with 2-4 previous negative smears is 69% lower than that for unscreened women.

Adult↗
PubMedDate not supplied

Human papillomavirus type 18 and other risk factors for cervical cancer in Jakarta, Indonesia.

Infection with human papillomavirus (HPV) has now been established as a necessary cause of cervical cancer. Indonesia is a country with a high cervical cancer incidence and with the world's highest prevalence of HPV 18 in cervical cancer. No information exists about the prevalence of HPV 18 or other HPV types in the Indonesian population. We conducted a hospital-based case-control study in Jakarta, Indonesia. A total of 74 cervical carcinoma cases and 209 control women, recruited from the gynecological outpatient clinic of the same hospital, were included. All women were HPV typed by the line probe assay, and interviews were obtained regarding possible risk factors for cervical cancer. HPV was detected in 95.9% of the cases and in 25.4% of the controls. In the control group, 13.4% was infected with a high-risk HPV type. HPV 16 was detected in 35% of the case group and in 1.9% of the control group and HPV 18 was identified in 28% of the case group and in 2.4% of the control group, suggesting that the oncogenic potentials of HPV 16 and HPV 18 in Indonesia are similar. In addition to HPV infection, young age at first intercourse, having a history of more than one sexual partner, and high parity were significant risk factors for cervical cancer. Within the control group, we did not identify determinants of HPV infection. We hypothesize that the high prevalence of HPV 18 in cervical cancer in Indonesia is caused by the high prevalence of HPV 18 in the Indonesian population.

Adult↗
PubMed2003

Cervical cancer and use of hormonal contraceptives: a systematic review.

BACKGROUND: Human papillomavirus (HPV) is believed to be the most important cause of cervical cancer. Recent studies suggest that long duration use of oral contraceptives increases the risk of cervical cancer in HPV positive women. METHODS: Results from published studies were combined to examine the relationship between invasive and in situ cervical cancer and duration and recency of use of hormonal contraceptives, with particular attention to HPV infection. FINDINGS: 28 eligible studies were identified, together including 12531 women with cervical cancer. Compared with never users of oral contraceptives, the relative risks of cervical cancer increased with increasing duration of use: for durations of approximately less than 5 years, 5-9 years, and 10 or more years, respectively, the summary relative risks were 1.1 (95% CI 1.1-1.2), 1.6 (1.4-1.7), and 2.2 (1.9-2.4) for all women; and 0.9 (0.7-1.2), 1.3 (1.0-1.9), and 2.5 (1.6-3.9) for HPV positive women. The results were broadly similar for invasive and in situ cervical cancers, for squamous cell and adenocarcinoma, and in studies that adjusted for HPV status, number of sexual partners, cervical screening, smoking, or use of barrier contraceptives. The limited available data suggest that the relative risk of cervical cancer may decrease after use of oral contraceptives ceases. However, study designs varied and there was some heterogeneity between study results. INTERPRETATION: Although long duration use of hormonal contraceptives is associated with an increased risk of cervical cancer, the public health implications of these findings depend largely on the extent to which the observed associations remain long after use of hormonal contraceptives has ceased, and this cannot be evaluated properly from published data.

Case-Control Studies↗
PubMed1999

[Cancer of the endometrium following radiotherapy of cervical cancer].

We describe three cases of women who have been treated with radiotherapy for cervical cancer and then many years later develop cancer of the uterine endometrium. Apparently there may be active endometrium left in the uterus after radiotherapy, for which reason we recommend combined hormone therapy with oestrogen and progesterone.

Adenocarcinoma↗
PubMed2005

Proteomic analysis of progressive factors in uterine cervical cancer.

Human papillomavirus (HPV) infections play a crucial role in the progress of cervical cancer. The high-risk HPV types are frequently associated with the development of malignant lesions. Some of the latest studies have demonstrated that the high-risk HPV 16 and 18 are predominantly detected in the more aggressive cancers. In the present study, we aimed to establish the proteomic profiles and characterization of the tumor related proteins by using two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS). For proteomic analysis, patients infected by HPV 16 or 18 were included in this study. We compared nuclear protein and cytoplasmic protein, separately by using the subcellular fraction. Differential protein spots between cervical cancer with high-risk HPV, HPV 16 or HPV 18, and HaCaT cell lines were characterized by 2-DE. Those proteins analyzed by peptide mass fingerprinting based on MALDI-TOF MS and database searching were the products of oncogenes or proto-oncogenes, and the others were involved in the regulation of cell cycle, for general genomic stability, telomerase activation, and cell immortalization. However, there was no difference in protein characterization for cervical cancer between HPV 16 and HPV 18 infection. Nonetheless, these data are valuable for the mass identification of differentially expressed proteins involved in human uterine cervical cancer. Moreover, the data has enormous value for establishing the human uterine cervical cancer proteome database that can be used in screening a molecular marker for the further study of human uterine cervical cancer, and also for studying any correlation among the cancers induced by HPV.

Adult↗
PubMed1982

[Studies on the causes and prophylaxis of urinary tract infection following radical hysterectomy for cervical cancer].

In patients undergoing radical hysterectomy for cervical cancer, suprapubic bladder drainage by INGRAM's trocar catheter, which was removed when the postvoiding residual urine was under 30 ml, was attempted to reduce urinary tract infection. The incidence of urinary tract infection was 63.6% during 4 weeks after radical hysterectomy. Most appeared on the 7-14 th postoperative days. In the 6 months after radical hysterectomy, the incidence of significant bacteriuria in the suprapubic group was 9.4% compared to 21.1% in the urethral catheterized group. The difference between the two groups is significant. In view of these results the following is suggested: 1) The antibacterial mechanisms of both the urethra and urinary bladder are greatly weakened immediately following radical surgery for cervical cancer due to organic changes occurring as a result of the surgery. Urethrovesical reflux can regurgitate bacteria from the urethra into the bladder and cause infection despite the absence of urethral catheterization. 2) Indwelling and frequent urethral catheterization for residual urine may cause a chronic urethritis which may prove to be the greatest factor predisposing to urinary tract infection following radical surgery for cervical cancer.

Female↗
PubMed2002

Serum selenium and the risk of cervical cancer among women in the United States.

OBJECTIVE: To explore the relationship between serum selenium and cervical cancer. METHODS: We conducted a case-control study of cervical cancer in five areas around Birmingham, AL; Chicago, IL; Denver, CO; Miami, FL; and Philadelphia, PA. Community controls were selected by random-digit dialing and were matched to invasive cervical cancer cases by age, race/ethnicity, and telephone exchange. Serum selenium was determined by neutron activation analysis. Logistic regression analysis controlling for known risk factors of cervical cancer, including human papillomavirus (HPV) type-16 measured serologically, was performed on 227 invasive cases, 127 in-situ cases, and 526 controls. RESULTS: Values of serum selenium ranged from 67.5 to 185.0 ng/ml. Adjusted odds ratios for invasive cervical cancer by quintile were: 1.0 (highest selenium), 1.1, 1.0, 0.8, and 1.0 (lowest selenium), p for trend = 0.82. Similar patterns were observed for Stage I invasive, and Stages II-IV invasive cases, suggesting severity of disease did not influence the null results. Although no associations were seen among current or never smokers, a protective effect of selenium was suggested among former smokers. Effect modification was not evident for other variables examined. CONCLUSIONS: This study does not support a relationship between serum selenium and invasive cervical cancer at typical serum selenium levels in the US.

Adult↗
PubMed2003

E-cadherin expression is silenced by DNA methylation in cervical cancer cell lines and tumours.

A previous study showed E-cadherin expression was lost in some cervical cancer cell lines and tumours. This study was designed to clarify the significance of DNA methylation in silencing E-cadherin expression. We examined promoter methylation of E-cadherin in five cervical cancer cell lines and 20 cervical cancer tissues using methylation-specific PCR (MSP) and bisulphite DNA sequencing. The correlation of E-cadherin methylation and expression together with methyltransferase (DNMT1) were further studied. We found that hypermethylation of E-cadherin was involved in five cervical cancer cell lines and 40% (8/20) of cervical cancer tissues. E-cadherin protein was lost in 6/8 (75%) samples and 3/5 (60%) cell lines with promoter methylation. E-cadherin methylation was significantly correlated with increased DNMT1. Using an antisense DNMT1 oligo to transfect into SiHa HeLa C33A cell line, E-cadherin protein was re-expressed. We concluded that loss of E-cadherin expression was in part correlated with DNA methylation and DNMT1 expression in cervical cancer.

Antimetabolites, Antineoplastic↗
PubMed2003

[Human papillomavirus infection and other risk factors for cervical cancer in Chinese and Australian patients].

OBJECTIVE: To investigate the infection rate and genotypes of HPV in cervical cancer and analyse the clinicopathological characteristics and risk factors for cervical cancer with HPV infection in Chinese and Australian patients. METHODS: The human papillomavirus (HPV) DNA in cervical cancer specimens from 115 Chinese women and 79 Australian women was detected by polymerase chain reaction.HPV types were determined by sequencing and reverse hybridization. The relationship a between the HPV types and the clinicopathological characteristics of cervical cancer in Chinese and Australian women were analyzed. RESULTS: HPV DNA positive rate was 76. 5% in the Chinese women (88/115) and 89.9% in the Australian women (71/79, P = 0. 017). There were no significant differences of HPV 16 and HPV 18 prevalence between the two groups (P = 0. 806). HPV 58 and 59 were more prevalent in Chinese women (both 6. 8%) than in Australian women (1. 4% and 0). In China, HPV 58 prevalence rate was significantly higher in the Hunan region than in the Guangdong region (P = 0. 007). The mean ages at diagnosis was 44. 24 +/- 11. 31 years for Chinese and 53.08 +/- 16. 54 years for Australian women (P <0. 001). Combining the two groups, no relationship was found between HPV positivity/negativity and the FIGO stage, macroscopic features, histological type and grade of tumour, as well as pelvic lymphatic metastasis. However, HPV type wa significantly correlated with the histological type (P < 0. 001 ) and grade of cervical tumour (P = 0. 028). In comparison with the Chinese group, the Australian group presented more advanced cancers, a greater proportion of endocervical patterns, and more non-squamous cell carcinoma. There were no significant differences in grade of tumour and lymphatic node status between the two groups. CONCLUSION: The HPV infection rate in cervical cancer patients is significantly higher among Australians than among Chinese, which may be caused by more sexual transmitted diseases and more sex partners among the former group. HPV 58 and HPV 59 tie for third common genotypes in cervical cancers in China, however, these types are uncommon in Australia. There was a significant variation in types of HPV infection among different histological type and grade of cervical tumors. Both HPV 18 and 59 appear to be associated with the malignancy of cervical cancer.

Australia↗
PubMed2004

Vaccination to prevent and treat cervical cancer.

Human papillomaviruses (HPVs) are the primary etiologic agents of cervical cancer. Thus, cervical cancer and other HPV-associated malignancies might be prevented or treated by HPV vaccines. Transmission of papillomavirus may be prevented by the generation of antibodies to capsid proteins L1 and L2 that neutralize viral infection. However, because the capsid proteins are not expressed at detectable levels by infected basal keratinocytes or in HPV-transformed cells, therapeutic vaccines generally target nonstructural early viral antigens. Two HPV oncogenic proteins, E6 and E7, are critical to the induction and maintenance of cellular transformation and are coexpressed in the majority of HPV-containing carcinomas. Thus, therapeutic vaccines targeting E6 and E7 may provide the best option for controlling HPV-associated malignancies. Various candidate therapeutic HPV vaccines are currently being tested whereby E6 and/or E7 are administered in live vectors, as peptides or protein, in nucleic acid form, as components of chimeric virus-like particles, or in cell-based vaccines. Encouraging results from experimental vaccination systems in animal models have led to several prophylactic and therapeutic vaccine clinical trials. If these preventive and therapeutic HPV vaccines prove successful in patients, as they have in animal models, then oncogenic HPV infection and its associated malignancies may be controllable by vaccination.

Cancer Vaccines↗
PubMed2000

Cervical cancer screening in Ireland.

Screening for cervical cancer commenced in Ireland on an opportunistic basis in the late 1960s. The Data Protection Act was recently amended to allow access to specific databases for the purpose of setting up an age sex register for breast and cervical cancer screening. A pilot cervical screening programme is planned for women aged 25-60 years living in the Mid Western Area Health Board region.

Adult↗
PubMed2000

Racial, age, and rural/urban disparity in cervical cancer incidence.

PURPOSE: High mortality rates of cervical cancer among black women have been observed for several decades in the Southeast. The purpose of this study is to assess the factors associated with this geographic and racial enigma, and to see if incidence is consistent with mortality.METHODS: Using the Savannah River Regional Health Information System (SRRHIS), a 5-year cancer registry from 1991-1995, incidence rates were calculated and compared to rates from Surveillance, Epidemiology, and End Results (SEER). The rates per 100,000/year were analyzed by race, rural/nonrural, and age (<45 and >/=45).Rates are similar between SRRHIS and SEER except in the case of black women over the age of 45. These women in rural SRRHIS have 1.66 times the incidence rate compared to those in nonrural SRRHIS and 1.97 times the rate of rural SEER.RESULTS:Table 1CONCLUSIONS: The results of the study suggest that the incidence of cervical cancer in the region is consistent with the mortality rates. The age-group with the highest rates are black women over 45 in rural areas, suggesting the need to target this group to reduce the racial disparity in cervical cancer.

Journal Article↗
PubMed1990

Barrier and spermicidal contraceptive methods and risk of invasive cervical cancer.

The effects of barrier and spermicidal methods of contraception on cervical cancer risk were examined by studying 479 cases of histologically confirmed invasive cervical cancer cases and 788 random digit dialing controls. In addition to a detailed history of contraceptive practices, information was available on numerous potential confounders, including demographic characteristics, sexual behavior, reproductive factors, Pap smear screening history, and smoking. After adjustment for relevant confounders, diaphragm and condom use were found not to be significantly associated with risk of cervical cancer. Although there was a small reduction in risk (OR = 0.8) associated with long-term use (5+ years) of the diaphragm, the effect appeared to relate to concomitant spermicide use, since there was evidence of further decreases in risk for women using spermicides alone for extended periods (OR = 0.7 for 5+ years). Effects were only seen among subjects of higher income and education levels, suggesting that patterns of usage may be important. The potential ability of spermicides to reduce cervical cancer risk by neutralizing viral agents warrants further attention.

Adult↗