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PubMed2006

[Vaccination against human papillomavirus for the prevention of cervical cancer].

Persistent infections with high-risk Human papillomavirus (HPV) can lead to cervical cancer. This fact could imply that vaccination against HPV could prevent this disease. Such vaccines could be aimed at the prevention of HPV infections or the treatment of infections, cervical intraepithelial neoplasia (CIN) and cervical cancer. There are two prophylactic candidate vaccines against the high risk HPV types 16 and 18, which appear to be safe and effective in preventing incidental and persistent HPV infections. Phase III studies should reveal whether these vaccines will also have long-term effects by preventing the development of CIN and eventually cervical cancer. The introduction of such an HPV vaccine in the Netherlands, its cost-effectiveness and introduction into the existing national vaccination programmes needs to be studied. The vaccination of girls before they become sexually active seems to be the most effective approach, although older women can also profit from prophylactic vaccination. The current community-based screening, possibly complemented by an HPV test, needs to be continued to identify and treat presently HPV-infected women. In a population with an existing community-based screening program for cervical cancer, a vaccine preventing persisting infection with high-risk HPV will further reduce the incidence of HPV-related cervical cancer.

Female↗
PubMed1990

Surgery or radiation for early cervical cancer.

In summary, neither radiation nor surgery is clearly superior. The benefits of surgery include: 1) emotional satisfaction that the tumor has been removed, 2) accuracy of surgical staging, 3) preservation of the ovaries, 4) no secondary uterine cancer (a very uncommon problem), and 5) complications that are more readily correctable. Radiation offers the major advantages of being useful in most patients regardless of age or medical condition and is the choice for large cancers. Because stage IB cervical cancer is a very diverse pathological entity with a number of potential prognostic factors (including cell type, depth of invasion, tumor volume, lymphatic space involvement, and occult lymph node metastases), and because patients present with a number of other conditions (including excess weight, advanced age, prior pelvic surgery or infection, and severe medical illness), we are fortunate to have two good methods for treating cervical cancer. Prospective randomized studies will be necessary in the future to better define specific advantages in the various clinical settings. But, in general, the following have proven most expedient: 1) class I hysterectomy, for microinvasive cancer of 3 mm invasion or less without lymphatic space involvement, 2) modified, extended hysterectomy (class II) and pelvic lymphadenectomy for lesions of 3 mm and lymph vascular space involvement or when the lesion seems to just exceed 3 mm and for very early adenocarcinoma, 3) an extended hysterectomy (class III) and pelvic lymphadenectomy for larger IA2, IB, and IIA lesions that are less than 4 cm, particularly for the pregnant or younger patient, and when ovarian conservation is desired, 4) radiation therapy is used for lesions over 4 cm and for women with severe medical illness making extended hysterectomy too hazardous, 5) combination therapy and chemotherapy are now reserved for study in poor prognosis patients with very large lesions (greater than 6 cm), occult metastases, and unfavorable histologic criteria (Table 2).

Combined Modality Therapy↗
PubMed2002

Recurrent cervical cancer: detection and prognosis.

BACKGROUND: Only a small proportion of cervical cancer recurrences is detected during routine follow-up. We investigated which percentage of recurrences is detected during follow-up, which diagnostic tools are helpful to detect recurrent disease and which factors are of prognostic significance once recurrent disease has been established in patients treated for cervical cancer stage IB-IVA. METHODS: Characteristics of the primary tumor, characteristics of recurrent disease and follow-up were collected retrospectively from clinical records of 277 patients who achieved a complete remission of at least 3 months after primary treatment for cervical cancer in 1992, 1993 and 1994 in three university hospitals in the Netherlands. RESULTS: Of 277 patients, 47 (17%) developed recurrent disease; this was most often detected after self-referral (45%), and in 32% during routine follow-up. Survival did not differ significantly between these two groups. The presence of symptoms (87%) was the most important first abnormal test result leading to diagnosis of recurrence. In univariate analysis, disease-free interval (DFI) and treatment modality were significant prognostic factors for crude survival of recurrence. However, treatment modality varied considerably and the subgroups were small. Therefore, multivariate analysis was not feasible and clinically valid conclusions could not be drawn. CONCLUSIONS: In only 32% of all cases, recurrence was detected during a scheduled follow-up visit. In the majority of patients, recurrent cervical cancer was detected by symptoms (87%). In recurrent disease, DFI was a prognostic factor for survival.

Disease-Free Survival↗
PubMed2002

Recurrent cervical cancer: detection and prognosis.

BACKGROUND: Only a small proportion of cervical cancer recurrences is detected during routine follow-up. We investigated which percentage of recurrences is detected during follow-up, which diagnostic tools are helpful to detect recurrent disease and which factors are of prognostic significance once recurrent disease has been established in patients treated for cervical cancer stage IB-IVA. METHODS: Characteristics of the primary tumor, characteristics of recurrent disease and follow-up were collected retrospectively from clinical records of 277 patients who achieved a complete remission of at least 3 months after primary treatment for cervical cancer in 1992, 1993 and 1994 in three university hospitals in the Netherlands. RESULTS: Of 277 patients, 47 (17%) developed recurrent disease; this was most often detected after self-referral (45%), and in 32% during routine follow-up. Survival did not differ significantly between these two groups. The presence of symptoms (87%) was the most important first abnormal test result leading to diagnosis of recurrence. In univariate analysis, disease-free interval (DFI) and treatment modality were significant prognostic factors for crude survival of recurrence. However, treatment modality varied considerably and the subgroups were small. Therefore, multivariate analysis was not feasible and clinically valid conclusions could not be drawn. CONCLUSIONS: In only 32% of all cases, recurrence was detected during a scheduled follow-up visit. In the majority of patients, recurrent cervical cancer was detected by symptoms (87%). In recurrent disease, DFI was a prognostic factor for survival.

Disease-Free Survival↗
PubMed2005

A study of Pap test history and histologically determined cervical cancer in NSW women, 1997-2003.

OBJECTIVES: To determine the risk of a histological diagnosis of cervical cancer following a given Pap test result and for a given history of Pap test results in a screened population across the full spectrum of possible cytological results. METHODS: All the Pap screening results held on the New South Wales Pap Test Register for 1997-2003 (five million tests for 1.87 million women) were analysed using Cox proportional hazards regression to estimate the odds of having a histologically determined cervical cancer for a given Pap test result and test result history. The hazard ratios of having cervical cancer in relation to Pap test result histories were estimated: (i) in regard only to the last Pap test result adjusting for age, frequency of Pap testing and proportion of high grade (>or=cervical intraepithelial neoplasia 2 [CIN2]) abnormalities found in a woman's total recorded test result history; and (ii) with regard to the last Pap test result against the highest grade of cytological abnormality found prior to the last Pap test result. The hazard ratios are for a cancer diagnosis occurring before the next Pap test and were adjusted for age, quintile of socioeconomic status of residence, frequency of past Pap testing and proportion of high-grade abnormalities detected in each woman's prior Pap test history. The adjusted hazard ratios were then applied to the tabulated proportions of referent women with negative cytology in each broad age group, and for all women, to estimate the '1 in n' odds of being diagnosed histologically with cervical cancer for a given last Pap test result, and by a given last Pap test result for various prior Pap test result histories. RESULTS: After adjusting for age, socioeconomic status, frequency of previous Pap testing and proportion of past high-grade screen-detected abnormalities, the adjusted hazard ratio of having a subsequent cervical cancer diagnosis for women with a negative Pap test result was 1 in 5,546, compared with 1 in 833 for a low-grade epithelial abnormality (atypia, CIN1), 1 in 56 for a high-grade epithelial abnormality and 1 in seven for a cytological prediction of cervical cancer. These odds estimates were significantly modified by age and by the highest Pap test result prior to the most recent Pap test result: the higher the age and, less consistently, the higher the previous highest Pap test result for a given last Pap test result, the shorter the odds of having a subsequent histological diagnosis of cervical cancer. CONCLUSIONS: The results presented here will enable clinicians to inform their patients of their chances of being diagnosed with cervical cancer for a given Pap test result, and for some combinations of the last Pap test result and highest recorded prior Pap test result.

Adolescent↗
PubMed2006

Malignancies following in situ cervical cancer in Hispanic Americans and non-Hispanic Whites.

OBJECTIVES: Some risk factors for cervical cancer in situ convey risk for malignancies of the cervix and other sites. We estimate risk of several malignancies following in situ cancer of the cervix for Hispanic Americans and non-Hispanic Whites. METHODS: Using California Cancer Registry data (1988-1999) we identify 56,020 women with cervical cancer in situ and observe subsequent malignancies in that cohort, with over three million woman-months of follow-up. We focus on cancers of the reproductive system and cancers related to smoking. Risk estimates are standardized incidence ratios, accounting for age, time at risk, cancer type, and race/ethnicity. RESULTS: There is elevated risk for invasive cervical cancer (SIR=4.1, 95% CI: 3.5-4.7), which is significantly higher for Hispanics than for non-Hispanic Whites (SIRs=5.2 and 3.2, respectively, chi2(1)=7.66, P=0.006). Excluding cervix, non-Hispanic Whites show elevated risk for a pool of reproductive cancers (SIR=1.8, 95% CI: 1.4-2.4). While both groups show elevated risk for a pool of smoking-related cancers, only non-Hispanic Whites show significant risk specifically for lung cancer (SIR=1.7, 95% CI: 1.4-2.1). Non-Hispanic Whites show elevated risk for ovarian cancer (SIR=1.8, 95% CI: 1.3-2.4). Ovarian cancer following in situ cervical cancer is disproportionately of borderline histology (G2(1)=7.43, P=0.006). CONCLUSIONS: These results have implications for public health planning for women, as well as better understanding of disparities in care or biologic paths to malignancies in women with in situ cancer of the cervix.

Adult↗
PubMed1996

Male sexual behavior and human papillomavirus DNA: key risk factors for cervical cancer in Spain.

BACKGROUND: It is now established that certain types of human papillomaviruses (HPVs) are the sexually transmitted agents etiologically linked to cervical cancer. Studies assessing the contribution of the male's sexual behavior and genital HPV DNA status to the risk of development of cervical neoplasia in sexual partners have yielded inconsistent results. PURPOSE: This study evaluates the role of men's sexual behavior and the presence of HPV DNA in the penis on the development of cervical cancer in their sexual partners in Spain, a low-risk area for cervical neoplasia. METHODS: Husbands (n = 633) of women participating in two case-control studies of cervical neoplasia were interviewed to obtain information on lifestyle habits, including sexual practices. Cytologic samples were taken from the distal urethra and the surface of the glans penis of 183 husbands of case women and of 171 husbands of control women. These samples were analyzed by a polymerase chain reaction-based system using a generic probe and 25 type-specific probes for the detection and typing of HPV DNA. Serologic specimens were also obtained and analyzed for antibodies to Chlamydia trachomatis, Treponema pallidum, herpes simplex virus type II, and Neisseria gonorrhoeae. RESULTS: The presence of HPV DNA in the husbands' penis conveyed a fivefold risk of cervical cancer to their wives (adjusted odds ratio [OR] for HPV DNA positivity = 4.9; 95% confidence interval [CI] = 1.9-12.6). The risk of cervical cancer was strongly related to HPV type (adjusted OR for HPV type 16 = 9.0; 95% CI = 1.1-77.5), to the husbands' number of extramarital partners (adjusted OR = 11.0; 95% CI = 3.0-40.0; for > or = 21 women versus one), and to the number of prostitutes as extramarital sexual partners (adjusted OR = 8.0; 95% CI = 2.9-22.2; for > or = 10 women versus none). Presence of antibodies to C. trachomatis (adjusted OR = 2.6; 95% CI = 1.4-4.6) and an early age at first sexual intercourse of the husband (adjusted OR = 3.2; 95% CI = 1.7-5.9; for < or = 15 years versus > or = 21 years) were also associated with cervical neoplasia in the wife. After adjustment for these variables and for the wife's pack-years of smoking, the husband's smoking was moderately associated with cervical cancer in his wife (adjusted OR = 2.5; 95% CI = 1.4-4.4; for > or = 26.2 pack-years versus none). CONCLUSIONS: The study supports the role of men as vectors of the HPV types that are related to cervical cancer. Life-time number of female sexual partners, number of female prostitutes as sexual partners, and detection of HPV DNA in the penis of husbands are all surrogate markers of exposure to HPV during marriage. IMPLICATIONS: Men who report multiple sexual partners or who are carriers of HPV DNA may be vectors of high-risk HPV types and may place their wives at high risk of developing cervical cancer. Prostitutes are an important reservoir of high-risk HPVs.

Carcinoma, Squamous Cell↗
PubMed2002

Antibodies to human papillomavirus 16 L1 virus-like particles as an independent prognostic marker in cervical cancer.

OBJECTIVE: Infection with high-risk human papillomavirus (HPV) types such as HPV-16 is a major risk factor for the development of cervical cancer. HPV-16 capsid antibodies are detectable in approximately 50% of patients with HPV-16 DNA-positive cervical cancer. We investigated the prognostic significance of HPV capsid antibodies for survival in patients with cervical cancer in comparison with conventional clinicopathologic features such as staging, histologic grading, histology, age, and treatment modality. STUDY DESIGN: Serum samples from 68 patients with cervical cancer and 65 healthy female control subjects were analyzed by enzyme-linked immunosorbent assay for HPV-specific immunoglobulin G (IgG) antibodies to baculovirus expressed HPV-6, HPV-11, HPV-16, and HPV-18 L1 virus-like particles (VLPs). RESULTS: HPV-16 L1 IgG antibodies were detectable in 6 of 65 (9%) of the control subjects and in 19 of 68 (28%) of the patients with cervical cancer (P =.007). In the subgroup of patients with HPV-16 DNA-positive cervical cancer (comprising 50% of the investigated samples), HPV-16 L1 antibodies were detected in 40%. HPV-16 L1 seropositivity was in univariate and multivariate analysis in addition to International Federation of Gynecology and Obstetrics stage, the only independent positive prognostic factor for overall survival (P =.01). CONCLUSION: Antibodies to HPV-16 L1 were found to be an independent prognostic factor for overall survival in patients with cervical cancer. Thus, HPV-16 infection may be involved not only in oncogenesis but also in tumor development and behavior.

Adult↗
PubMed2005

[Correlation between methylation of 5'-CpG islands and inactivation of FHIT gene in cervical cancer].

BACKGROUND & OBJECTIVE: Fragile histidine triad (FHIT) gene, a tumor suppressor gene, correlates with tumorigenesis of many solid tumors, and may be inactivated via methylation. This study was designed to explore relationship of methylation of 5'-CpG islands with inactivation of FHIT gene in cervical cancer. METHODS: Methylation of 5'-CpG islands in 10 normal cervical squamous epithelial tissues, and 40 cervical cancer tissues was detected with methylation specific polymerase chain reaction (MSP), protein expression of FHIT was detected with immunohistochemistry, and their correlations with clinicopathologic features of cervical cancer were statistically analyzed. RESULTS: (1) The 5'-CpG islands methylation rate of FHIT gene in cervical cancer tissues was 40.0% (16/40), while no methylation of FHIT gene was found in normal cervical tissues. (2) The methylation rates of FHIT gene in cervical cancer of stage I was 14.3% (2/14), significantly lower than that in cervical cancer of stage II (56.5%, 13/23) (P<0.05). (3) Expression of FHIT protein in cervical cancer was 33.0% (12/40), significantly lower than that in normal cervical tissue (100%, 10/10) (P<0.05). CONCLUSION: The 5'-CpG islands methylation may play an important role in inactivation of FHIT gene, and may be related with tumorigenesis of cervical cancer.

Acid Anhydride Hydrolases↗
PubMed2005

Cervical cancer in the Netherlands 1989-1998: Decrease of squamous cell carcinoma in older women, increase of adenocarcinoma in younger women.

Cervical cancer is a preventable disease, occurring in relatively young women. In the Netherlands, population-based cervical screening aims at women aged 30-60 years. We performed a population-based study of the incidence of invasive cervical cancer in the Netherlands to evaluate trends, with emphasis on age at time of diagnosis. Histologic diagnosis was retrieved from the Netherlands Cancer Registry for all women residing in the Netherlands with invasive cervical cancer between January 1, 1989, and December 31, 1998. In this 10-year period, the incidence rate of squamous cell carcinoma decreased significantly from 7.1/100,000 to 6.1/100,000 (p < 0.001), with the greatest decrease in women aged 60-74 (-5.5%). While the overall incidence rate of adenocarcinoma remained stable, it increased in women aged 15-29 (+15.8%) and in women aged 30-44 (+2.5%), though the number of cases was small. For squamous cell carcinoma, the incidence of stage II at diagnosis decreased most (-2.7%). There was no change in stage at diagnosis for adenocarcinoma. Most cases of cervical cancer, 60.5%, were detected between ages 30 and 60 years, i.e., the Dutch screening age interval. Cervical cancer in women below age 30 contributed 5.0% to the total incidence, with 3.0% occurring between ages 27 and 29. Thus, screening for cervical cancer in the Netherlands is associated with a decrease in the incidence of squamous cell carcinoma and adenocarcinoma incidence appears to be increasing in younger women.

Adenocarcinoma↗
PubMed2002

Serum vascular endothelial growth factor and serum leptin in patients with cervical cancer.

OBJECTIVE: Serum levels of vascular endothelial growth factor (VEGF) can be seen as surrogate markers of angiogenesis. Recently, leptin, which is involved in the control of satiety and energy expenditure, was also shown to modulate angiogenesis. As angiogenesis plays an abundant role in cervical carcinogenesis, we evaluated serum VEGF and leptin in patients with cervical intraepithelial neoplasia (CIN) and cervical cancer. METHODS: Serum VEGF and leptin were measured in 84 patients with cervical cancer, in 28 patients with CIN I-III, and in 35 healthy women, using a commercially available enzyme-linked immunosorbent assay and radioimmunoassay, respectively. RESULTS: Serum VEGF was significantly elevated in patients with cervical cancer and in patients with CIN I-III compared to healthy women. In patients with cervical cancer serum VEGF was significantly correlated with tumor stage, but not with lymph node involvement and histological grade. Univariate and multivariate analyses showed that elevated pretreatment serum VEGF was not associated with the duration of disease-free and overall survival. Serum leptin did not differ among patients with cervical cancer, patients with CIN I-III, and healthy women. Serum leptin was significantly correlated with body mass index (BMI). All further analyses were performed with absolute and serum leptin corrected by BMI. No differences in serum leptin could be ascertained between patients with cervical cancer and patients with CIN I-III. Serum leptin was not associated with any clinicopathological parameter and patients' survival. No correlation between serum VEGF and leptin was found. CONCLUSIONS: It can be speculated that serum VEGF might be used as a surrogate marker of angiogenesis in patients with cervical cancer. Our data support the concept that VEGF plays a role in malignant transformation and tumor growth, but not in the lymphatic spread of cervical cancer. This is the first report on leptin in a gynecological malignancy. Our results show that serum leptin falls short of being a useful marker in patients with cervical cancer.

Adult↗
PubMed2005

Changes in epidemiology and clinical characteristics of cervical cancer over the past 50 years.

OBJECTIVE: To evaluate the changes in the epidemiology and clinical characteristics of cervical cancer over the past 50 years, and explore appropriate treatment corresponding to these changes. METHODS: The clinical and pathological data of 1557 patients with invasive cervical cancer treated between January, 1955 and December, 2004 were retrospectively analyzed. RESULTS AND CONCLUSIONS: The average age of cervical cancer onset gradually decreased over the past 50 years, from 56.27+/-8.45 in 1955-1964 to 43.81+/-8.9 years in 1995-2004, whereas the ratio of young (< or =35 years old) patients rose from 3.42% to 24.91%. The ratio of early clinical stage (stages I-II) and non-squamous cancer also steadily increased (P<0.05, respectively). The tumor stage, pathological type and rate of lymph node metastasis were all significantly different among different age groups (P<0.05). In particular, the young (< or =35 years old) group had evidently higher ratios of non-squamous and advanced stage (III-IV) cancers with a higher rate of lymphatic metastasis in comparison with other age groups (P<0.01, respectively). Because of the changes in epidemiology and clinical characteristics of cervical cancer, it is necessary to modify the conventional treatment regimens and explore reasonable therapy corresponding to these changes. Preservation of reproductive endocrine function ought to be fully considered in cervical cancer treatment in women at childbearing age. Neoadjuvant intraarterial chemotherapy is an useful method for cervical cancer treatment at present.

Adenocarcinoma↗
PubMed1991

High dose rate intracavitary brachytherapy for recurrent cervical cancer of the vaginal stump following hysterectomy.

Forty-eight patients with recurrent cervical cancer of the vaginal stump following hysterectomy for cervical cancer, were treated with high dose rate intracavitary brachytherapy with or without external irradiation. The intervals between primary surgery and vaginal recurrences varied widely from 3 months to 36 years. Patients were classified into two groups, either with or without palpable tumor of the vaginal stump. Tumor size was determined by bimanual rectovaginal examination at the time of recurrence. Survival rates were 8% for the group with palpable tumors and 80% for those without, respectively. The survival rate of patients who did not have palpable masses and were treated with brachytherapy alone was not improved by combination with external irradiation. The time interval from the primary hysterectomy to the recurrence did not influence survival. These results suggest that the only significant prognostic factor for recurrent cervical cancer after hysterectomy is tumor size. The relationship between recurrent cervical cancer of the vaginal stump and second primary vaginal cancer is also discussed.

Adult↗
PubMed2006

Enhancement of the radiosensitivity of cervical cancer cells by overexpressing p73alpha.

Radiation therapy is the most effective therapy for cervical cancer in advanced stages. p53 plays a critical role in the cellular response to radiation-induced DNA damage. However, p53 function is often impaired in the presence of the oncoprotein E6 from human papillomavirus, which is often associated with the development of cervical cancer. p73, a p53 family member, is highly similar to p53, but is resistant to the degradation by human papillomavirus E6. In this study, we investigated the role of p73alpha in relation to cellular radiosensitivity in the p53-impaired cervical cancer cells. Radiosensitivity and irradiation-induced apoptotic cell death were examined in the exogenous overexpressed p73alpha- and p53-impaired cells. Our results showed that the endogenous p73alpha expressed only in the radiosensitive cervical cancer C4-1 cells, but not in the radioresistant SiHa, Caski, and HeLa cells. Overexpression of exogenous p73alpha by transfection in the radioresistant cells resulted in a significant increase of cellular sensitivity to radiation. Enhanced radiosensitivity in p73alpha-transfected cells was attributed by increase of cellular apoptosis. Coactivation of p21 was also observed in the p73alpha-transfected cells upon radiation treatment. In summary, our findings suggested that p73alpha is an important determinant of cellular radiosensitivity in the p53-impaired cervical cancer cells.

Apoptosis↗
PubMed2003

Expression genomics of cervical cancer: molecular classification and prediction of radiotherapy response by DNA microarray.

PURPOSE: The incidence and mortality rates of cervical cancer are declining in the United States; however, worldwide, cervical cancer is still one of the leading causes of death in women, second only to breast cancer. This disparity is at least partially explained by the absence of or comparatively ineffective screening programs in the developing world. Recent advances in expression genomics have enabled the use of DNA microarray to profile gene expression of various cancers. These expression profiles may be suitable for molecular classification and prediction of disease outcome and treatment response. We envision that expression genomics applied in cervical cancer may provide a more rational approach to the classification and treatment of the disease. EXPERIMENTAL DESIGN: In this report, we examined the expression profiles of cervical cancer compared with normal cervical tissues in DNA microarrays that contained approximately 11,000 features that correspond to either human transcripts with known function or anonymous expressed sequence tags. RESULTS: Our results showed that normal cervical tissues were completely segregated from the cancer samples using about 40 genes whose expressions were significantly different between these specimens. In addition, clinical stage IB and stage IIB tumors could also be classified based on their signature expression patterns. Most importantly, some of the tumor samples were further stratified into two major groups based on their response to radiotherapy, and we were able to predict the response of these patients to radiotherapy from their expression profiles. CONCLUSIONS: Gene expression profiling by DNA microarray may be used for further molecular classification of disease stages and prediction of treatment response in cervical cancer.

Cervix Uteri↗
PubMed2005

Awareness and Practice of Cervical Cancer Screening among Female Health Professionals in Murtala Mohammed Specialist Hospital, Kano.

BACKGROUND: Cervical cancer, although largely preventable, remains the most common cause of cancer mortality among women in the developing world. Other members of the community see health care workers as models, therefore their attitudes and actions are predictors of societal health behaviour. OBJECTIVES: We assessed the knowledge, attitude and practice regarding prevention of cervical cancer among female health professionals in a secondary health facility in Kano, Nigeria. METHODS: A structured questionnaire was administered on 230 female respondents in the various health professions including doctors, pharmacists, nurses and laboratory technologists in Murtala Mohammed Specialist hospital, Kano. RESULTS: Over 60% of the respondents were able to correctly identify all the important aetiological factors associated with cervical cancer, while a similar figure knew the important signs and symptoms of the disease. Up to 94.7% of the respondents had a positive attitude towards Pap smear while 8.2% disapproved of it. Only 20.8% of the respondents have had a Pap smear done previously. Married respondents were more than four times likely to have had a previous Pap smear compared to their single counterparts. (X(2) = 13.3 df=1 P = 0.0003)[O.R=4.8, 95% confidence interval= 1.9 -14.4]. In contrast, religion appeared to have no significant influence on the practice (X(2)= 0.87 df=1 P=0.35). CONCLUSIONS: Despite a moderately high level of knowledge of cervical cancer screening and positive attitude towards it, the uptake of Pap smear was low. There is a need for continuing education to improve uptake of these services by health professionals so as to serve as a motivating factor for the public. Key words: cervical cancer screening, pap smear, female health workers, knowledge, practices.

Early Detection of Cancer↗
PubMed2000

p53 codon 72 polymorphism does not affect the risk of cervical cancer in patients from northern Italy.

A case-control study was performed to investigate the risk of cervical cancer associated with p53 polymorphism at codon 72, encoding either arginine or proline. It has been recently suggested that the arginine isoform increases the susceptibility to invasive cervical cancer; however, data remain controversial. The polymorphism was examined by both allele-specific PCR and RFLP analysis in 101 patients with primary cervical cancer and in 140 healthy women of the same age and from the same geographical area. The distribution of p53 genotypes in cervical cancer patients and in controls was not significantly different (P = 0.445), and homozygosity for arginine at residue 72 was not associated with an increased risk for cervical cancer (odds ratio, 0.81; 95% confidence interval, 0.47-1.42; P = 0.52). Similarly, different genotype distribution and increased risk were not observed when patients versus controls were analyzed according to human papillomavirus status and cancer histotype. Therefore, no evidence of association between homozygosity for p53 arginine and cervical cancer was found in our population sample.

Adult↗
PubMed2002

The evaluation of cervical cancer screening by combining speculoscopy with Papanicolaou smear examination in Taiwan.

BACKGROUND: Cervical cancer is the most common malignancy in women in Taiwan. In order to improve the detection of cervical lesions using the Papanicolaou (Pap) smear in screening, a number of adjunctive tests have been developed. The purpose of this study is to evaluate the utility of a magnified chemiluminescent screening examination (speculoscopy) combined with the Pap smear (PapSure) in detecting cervical cancer. METHODS: A total number of 572 women underwent routine cervical cancer screening by receiving a Pap smear and speculoscopy examination. When either the Pap smear or speculoscopy result was positive, colposcopy was performed. Targeted biopsies were taken from any suspicious lesions that were found by positive colposcopies and the data analyzed using McNemar's test. RESULTS: Eighty-two women had a positive on either screening test. Of the 62 biopsy specimens obtained, 3 women showed high-grade squamous intraepithelial lesions (HGSIL), and 13 women showed low-grade squamous intraepithelial lesions (LGSIL). The histopathological findings were correlated at different levels with the results of the Pap smear alone and speculoscopy alone and both combined. The Pap smear alone detected 1.0% (6 of 572) of significant pathology, while speculoscopy alone detected 2.3% (13 of 572) of significant pathology. The use of the PapSure showed enhanced detection (16 of 572) compared with either the Pap smear alone or speculoscopy alone. CONCLUSIONS: Speculoscopy can be combined with the Pap smear (PapSure) as a cervical cancer screening test to yield a higher detection rate of biopsy-confirmed cervical pathology in women than the use of the Pap smear or speculoscopy alone.

Colposcopy↗