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PubMed2000

The risk of cervical cancer in relation to serum concentrations of folate, vitamin B12, and homocysteine.

Due to its role in the synthesis and repair of DNA, folate may protect against the development of cervical cancer. Prospective data on the possible association between folate and cervical cancer have been lacking. There is also a paucity of prospective evidence concerning the possible associations between cervical cancer and vitamin B12, which shares pathways with folate, and homocysteine, a marker of low B vitamin concentrations. A nested case-control study was conducted to prospectively evaluate the associations between cervical cancer and serum concentrations of folate, vitamin B12, and homocysteine. Among a community-based cohort of women who donated blood in 1974 for a serum bank in Washington County, Maryland, 39 cases of cervical cancer diagnosed between 1975 and mid-1990 were included in the study (13 cases of invasive cervical cancer and 26 cases of carcinoma in situ). Two controls were matched to each case by age, race, and sex. Stored serum from the cases and controls was assayed for folate, B12, and homocysteine concentrations. For folate, adjusted odds ratios were 1.0, 0.62, and 0.60 for the low to high thirds of the serum concentrations, respectively, a trend in the protective direction that was not statistically significant (P for trend = 0.42). Overall, the results for vitamin B12 tended to mimic those for folate, whereas the associations for homocysteine tended to be in the opposite direction. None of the results of this study were statistically significant, but patterns of the associations are in accord with hypothesized mechanistic pathways concerning B vitamins and cervical cancer.

Adult↗
PubMed1978

Cervical cancer in younger women.

Cervical cancer does not begin in women at some vague mid-procreative term, but is a concomitant of early sexual activity. In Brighton the mean age of patients with histologically proven carcinoma of the cervix has been falling, from 50 in 1967 to 35 by 1977. In one year abnormal cells were found in cervical smears from 24 teenage girls (5 aged 16, 2 aged 17, 8 aged 18 and 9 aged 19), and in 4 of these teenage cases malignancy was subsequently proved histologically. Until the aetiology of the disease is established no lower age limit should be set for cervical screening; all young women should be entitled and encouraged to have cervical cytology tests.

Adenocarcinoma↗
PubMed2006

[Killing activity of cytotoxic T lymphocytes stimulated by dendritic cell vaccine loaded with autologous cervical cancer antigen].

BACKGROUND & OBJECTIVE: Dendritic cells (DCs), the strongest antigen-presenting cells (APCs), can present antigens to T lymphocytes in vivo and in vitro, and induce cytotoxic T lymphocyte (CTL) reaction. This study was designed to investigate the killing activity of CTLs stimulated by Dcs loaded with autologous cervical cancer antigen in vitro. METHODS: Tumor antigens were made from frozen-thawed cervical cancer cells from patients after operation. DCs were isolated from peripheral blood mononuclear cells of patients with cervical cancer, cultured with granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4), loaded with tumor antigen to prepare DC vaccine, and used to stimulate autologous T lymphocytes to prepare antigen-specific CTLs. The killing activities of CTLs on autologous cervical cancer cells and HeLa, HepG2, MCF7, A549, and MGC803 cells were observed. RESULTS: CTLs stimulated by the DC vaccine had high killing activity on autologous cervical cancer cells, with killing rates of 79.32%-89.27% which were obviously higher than that of lymphokine-activated killing cells (t> or =2.89, P<0.05). The killing activity of CTLs was significantly weaker on HeLa cells (40.35%-58.09%) than on autologous cervical cancer cells (t> or =2.97, P<0.05). The specific CTLs had no obvious killing activity on HepG2, MCF7, A549, and MGC803 cells. CONCLUSIONS: CTLs stimulated by autologous cervical cancer antigen-loaded DCs have highly efficient and specific immune activity on autologous cervical cancer cells. It may be used in biotherapy for cervical cancer.

Antigens, Neoplasm↗
PubMed2004

Human papillomavirus genotypes in cervical cancers in Mozambique.

The distribution of human papillomavirus (HPV) types in cervical cancers is essential for design and evaluation of HPV type-specific vaccines. To follow up on a previous report that HPV types 35 and 58 were the dominant HPV types in cervical neoplasia in Mozambique, the HPV types in a consecutive case series of 74 invasive cervical cancers in Mozambique were determined. The most common worldwide major oncogenic HPV types 16 and 18 were present in 69 % of cervical cancers, suggesting that a vaccine targeting HPV-16 and -18 would have a substantial impact on cervical cancer also in Mozambique.

Female↗
PubMed1989

Mass screening for cervical cancer in Taiwan from 1974 to 1984.

The cervical cancer screening program in Taiwan was carried out in two phases. This study focused on the first 10-year screening program. Univariate descriptive analysis with chi-square test and multivariate analysis with logistic regression were applied to find the significant risk factors related to cervical cancer in Taiwan. Comparison of Phase I and II screening revealed a cohort effect. The high examination rate in women aged 30 to 39 years in Phase I resulted in a drop in the suspicious rate in the 35 to 44 year age group in Phase II, and a decreasing trend of age-specific death rates from both cervical and uterine cancer in the 40 to 49 year age group based on all of the female population in Taiwan. In Phase II, an increasing trend in ratio of carcinoma in situ to invasive carcinoma was also found. These findings suggest that the 10-year screening program in Taiwan conducted by the Cancer Society of the Republic of China has been effective. How to increase the examination rate is the key issue in the control of cervical cancer in Taiwan.

Adult↗
PubMed2005

Cost-effectiveness of cervical-cancer screening in five developing countries.

BACKGROUND: Cervical-cancer screening strategies that involve the use of conventional cytology and require multiple visits have been impractical in developing countries. METHODS: We used computer-based models to assess the cost-effectiveness of a variety of cervical-cancer screening strategies in India, Kenya, Peru, South Africa, and Thailand. Primary data were combined with data from the literature to estimate age-specific incidence and mortality rates for cancer and the effectiveness of screening for and treatment of precancerous lesions. We assessed the direct medical, time, and program-related costs of strategies that differed according to screening test, targeted age and frequency, and number of clinic visits required. Single-visit strategies involved the assumption that screening and treatment could be provided in the same day. Outcomes included the lifetime risk of cancer, years of life saved, lifetime costs, and cost-effectiveness ratios (cost per year of life saved). RESULTS: The most cost-effective strategies were those that required the fewest visits, resulting in improved follow-up testing and treatment. Screening women once in their lifetime, at the age of 35 years, with a one-visit or two-visit screening strategy involving visual inspection of the cervix with acetic acid or DNA testing for human papillomavirus (HPV) in cervical cell samples, reduced the lifetime risk of cancer by approximately 25 to 36 percent, and cost less than 500 dollars per year of life saved. Relative cancer risk declined by an additional 40 percent with two screenings (at 35 and 40 years of age), resulting in a cost per year of life saved that was less than each country's per capita gross domestic product--a very cost-effective result, according to the Commission on Macroeconomics and Health. CONCLUSIONS: Cervical-cancer screening strategies incorporating visual inspection of the cervix with acetic acid or DNA testing for HPV in one or two clinical visits are cost-effective alternatives to conventional three-visit cytology-based screening programs in resource-poor settings.

Adult↗
PubMed2001

[Screening and diagnosis of cervical cancer].

The screening of cervical cancer is ideal. Performing its screening allows discovering early stage of invasive cancer but above all to diagnose numerous precursor lesions: their treatment carry out the prevention of invasive cancer. Without an organised screening in France, there is a spontaneous screening. Nevertheless the incidence of invasive cancer decreased twofold since twenty years. It remains unfortunately frequent. With a well organised mass screening its rate will probably decrease significantly.

Colposcopy↗
PubMedDate not supplied

Invasive cervical cancer among American Indian women in the Northern Plains, 1994-1998: incidence, mortality, and missed opportunities.

OBJECTIVES: Cervical cancer mortality rates among the American Indian and Alaska Native (AI/AN) population in North and South Dakota were five times the national average (15.6 per 100,000 vs. 3.1 per 100,000, age adjusted) when last evaluated (from 1989 through 1993). Our goals were to update the AI/AN population cervical cancer mortality rates and to present incidence rates for AI/AN women in the region. METHODS: We reviewed charts for women diagnosed with invasive cervical cancer at Indian Health Service (IHS) facilities in North and South Dakota from 1994 through 1998 and collected information about cervical cancer screening and treatment history. Incidence and mortality rates were standardized to the 1970 U.S. population. RESULTS: Twenty-one cases of invasive cervical cancer and eight deaths were identified. Annualized incidence and mortality rates were 11.5 per 100,000 and 4.5 per 100,000. These compare with national all-race/ethnicity rates of 8.5 per 100,000 and 2.7 per 100,000 for incidence and mortality. Fifteen (71%) of 21 cases were diagnosed due to symptoms. CONCLUSIONS: While cervical cancer mortality rates have declined, incidence and mortality rates among AI/AN women remain higher than in the general U.S. population. Increased use of pap tests and careful follow-up of abnormal results should be aggressively promoted among AI/AN women in North and South Dakota.

Adult↗
PubMed1983

Accuracy of registration of invasive cervical cancer.

The quality of the data recorded by the British Columbia Cancer Registry for 521 new cases of invasive cervical cancer was evaluated. The registry's pathological diagnosis in all new registrations of invasive cervical cancer diagnosed in British Columbia between 1977 and 1979 was compared with a best estimate of the true diagnosis, which was determined from the results of the provincial cervical cytology screening program and the clinical charts at the Cancer Control Agency of British Columbia. The registry's data overestimated the true incidence of invasive cervical cancer by approximately 55%, since 184 (35%) of the cases were incorrectly registered. Of the 184, 141 (77%) were cases of preinvasive cervical cancer, 26 (14%) did not meet the criteria for a true case (i.e., they were not newly diagnosed in British Columbia between 1977 and 1979) and 17 (9%) were cases of invasive cancer of another primary site. In addition, 28 cases of invasive cervical cancer diagnosed in the province during the study period had not been reported to the registry. Thus, both over-reporting and under-reporting occurred. There is a need for constant evaluation of registry data if cancer registries are to fulfil their potential contribution to cancer control programs and research.

Adult↗
PubMed2004

Identification of micrometastases in histologically negative lymph nodes of early-stage cervical cancer patients.

OBJECTIVE: Despite histologically negative lymph nodes, approximately 15% of patients with early-stage cervical cancer will develop recurrence. Micrometastases have been shown to be important in staging and treatment of breast cancers and melanoma and have been identified by polymerase chain reaction analysis in cervical cancers. This study sought to estimate the frequency of micrometastases identified by immunohistochemistry in histologically negative lymph nodes and compare this to other known risk factors for recurrence of cervical cancer. METHODS: Early-stage (stages IA2, IB1, and IB2) cervical cancer patients of all histologic subtypes were identified from the surgical logs of the Los Angeles County-University of Southern California Medical Center for the period 1994-2000. One hundred thirty-two patients had histologically negative lymph nodes. Immunohistochemical assay was performed on 3,106 lymph nodes by using antibodies against cytokeratins AE-1 and CAM 5.2 in combination according to standard protocols. The stained nodes were then evaluated for the presence of micrometastases and compared against the respective clinicopathologic information in each case. RESULTS: Micrometastases were detected in 19 of 132 (15%, 95% confidence interval [CI] 9%, 22%) patients, found in 29 of the 3,106 (0.9%) lymph nodes evaluated. Vascular space invasion was seen in 50 of 132 cases (38%, 95% CI 30%, 47%) and in 8 of 19 (42%, 95% CI 21%, 66%) cases with micrometastases. Surgical margins of the resected specimen were negative in 120 of 132 cases (91%, 95% CI 84%, 95%) and in 16 of 19 (84%, 95%CI 60%, 96%) of those cases with micrometastases. Micrometastases were seen most frequently in pelvic lymph nodes (25 of 29, 86%). Patients with more than 20 lymph nodes removed were more likely to demonstrate metastasis (P <.001). There was no statistically significant association between micrometastasis and vascular space invasion or tumor volume. CONCLUSION: Micrometastases are identifiable in histologically negative lymph nodes in 15% (95% CI 9%, 22%) of early-stage cancer patients, a frequency which approximates the recurrence rate for patients with negative nodes. In this series, patients with greater numbers of lymph nodes analyzed were more likely to have lymph node micrometastasis identified. There appears to be no relationship between tumor volume and the identification of micrometastases. Although micrometastases can be identified in histologically negative lymph nodes, their presence is not strongly associated with other known factors of cervical cancer recurrence. Further research is needed to determine whether the presence of lymph node micrometastases is associated with an unfavorable prognosis. LEVEL OF EVIDENCE: II-3

Adult↗
PubMed2001

Importance of urodynamic study before radical hysterectomy for cervical cancer.

OBJECTIVES: The aim of this study was to characterize the urodynamic findings in patients with cervical cancer before radical hysterectomy and to correlate the results with age, parity, menopausal status, and cancer stage. METHODS: All patients with cervical cancer before radical hysterectomy who underwent urodynamic study (UDS) from January 1996 through December 1998 were enrolled. Detailed history, physical examination, and multichannel UDS data including uroflowmetry, filling and voiding cystometry, stress urethral pressure profile, and 20-min pad test were obtained for each patient. The urodynamic findings of each patient were analyzed and correlated with age, parity, menopausal status, and cancer stage. RESULTS: A total of 210 patients with cervical cancer were included in the study. The mean age was 48.9 +/- 10.5 years with a mean parity of 3.3 +/- 1.7. Forty-two percent (n = 88) of patients were menopausal, and 88% (n = 184) belonged to stage IB while 10% (n = 20) were stage IIA and 2% (n = 6) stage IIB. Urodynamic study showed that only 17% (n = 37) of the 210 patients were normal, 10% (n = 21) had voiding dysfunction, 45% (n = 94) had storing dysfunction, and 28% (n = 58) had both voiding and storing dysfunctions. In addition, 51% (n = 106) had urinary incontinence and 37% (n = 78) had genuine stress incontinence (GSI), 8% (n = 16) detrusor instability (DI), and 6% (n = 12) GSI/DI. Age, parity, and cancer stage did not show any significant differences among these four groups. CONCLUSIONS: In this series, only 17% of patients with cervical cancer had normal urodynamic findings before radical hysterectomy.

Female↗
PubMed1998

Prospects for a prophylactic HPV vaccine: rationale and future implications for cervical cancer screening.

Cytologic screening in combination with ablative therapy has helped reduce cervical cancer mortality in the developed world. Despite the success of this approach, cervical cancer remains a major cause of death, especially among women with limited access to health care. Recognition that human papillomaviruses (HPVs) are the main etiologic agent in cervical cancer suggests that a prophylactic vaccine could reduce the incidence of HPV infection and, therefore, achieve cancer control with reduced reliance on costly screening programs. In this review, the rationale for developing a prophylactic HPV vaccine and the potential impact that vaccination would have on cervical cancer screening are discussed.

Female↗
PubMed2003

Epidemiologic classification of human papillomavirus types associated with cervical cancer.

BACKGROUND: Infection with human papilloma virus (HPV) is the main cause of cervical cancer, but the risk associated with the various HPV types has not been adequately assessed. METHODS: We pooled data from 11 case-control studies from nine countries involving 1918 women with histologically confirmed squamous-cell cervical cancer and 1928 control women. A common protocol and questionnaire were used. Information on risk factors was obtained by personal interviews, and cervical cells were collected for detection of HPV DNA and typing in a central laboratory by polymerase-chain-reaction-based assays (with MY09/MY11 and GP5+/6+ primers). RESULTS: HPV DNA was detected in 1739 of the 1918 patients with cervical cancer (90.7 percent) and in 259 of the 1928 control women (13.4 percent). With the GP5+/6+ primer, HPV DNA was detected in 96.6 percent of the patients and 15.6 percent of the controls. The most common HPV types in patients, in descending order of frequency, were types 16, 18, 45, 31, 33, 52, 58, and 35. Among control women, types 16, 18, 45, 31, 6, 58, 35, and 33 were the most common. For studies using the GP5+/6+ primer, the pooled odds ratio for cervical cancer associated with the presence of any HPV was 158.2 (95 percent confidence interval, 113.4 to 220.6). The odds ratios were over 45 for the most common and least common HPV types. Fifteen HPV types were classified as high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82); 3 were classified as probable high-risk types (26, 53, and 66); and 12 were classified as low-risk types (6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP6108). There was good agreement between our epidemiologic classification and the classification based on phylogenetic grouping. CONCLUSIONS: In addition to HPV types 16 and 18, types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 should be considered carcinogenic, or high-risk, types, and types 26, 53, and 66 should be considered probably carcinogenic.

Adenocarcinoma↗
PubMed2005

The influence of smoking and other cofactors on the time to onset to cervical cancer in a southern European population.

Cervical cancer is a complex and multifactorial disease. Although there are substantial data supporting the causative role of persistent human papillomavirus (HPV) infection in the development of cervical cancer, the complete course of the disease has never been completely understood. Several risk cofactors have been suggested with controversial results. Portugal has the highest incidence of squamous cell carcinoma (SCC) within western Europe and there are no known studies regarding the role of cofactors in SCC. The aim of our study was to evaluate the role of smoking, sexual behaviour, reproductive and contraceptive history, in the time-to-onset (TTO) of severe cervical lesions (HGSIL/SCC) in the Portuguese population. We verified that age of first sexual intercourse under 18 years (odds ratio (OR) 2.8), pregnancy (OR 2.9), first pregnancy under 21 years (2.6), number of pregnancies (OR 2.3-5.4) and parity (OR 1.9-5.7) are risk factors in the development of cervical neoplasia. Smoke exposure index (SEI) was significantly different (P=0.002) between cases and controls. Our results regarding time-to-onset demonstrate that smoking (P<0.001, log rank test), number of sexual partners (P<0.001, log rank test) and use of oral contraceptives (P<0.001, log rank test) are important determinants in the earlier onset of severe cervical lesions. Using this approach, our findings may help to clarify the role of smoking and other cofactors in the persistence and progression of cervical lesions.

Adolescent↗
PubMedDate not supplied

Primary surgical management of cervical cancer.

Early-stage cervical cancer can be readily cured by surgery, with acceptably low morbidity. Successful treatment depends on appropriate surgical training, tight organisation, thorough selection of patients, selection of the right operation and close liaison with the pathologist and radiotherapist.

Female↗
PubMed1989

[Solitary ureteral metastasis from cervical cancer: a case report].

A case of solitary ureteral metastasis from cervical cancer in a 36-year-old female is reported. On April 4, 1988, the patient visited the gynecological department of our hospital with abnormal genital bleeding. Colposcopy and cervical biopsy revealed invasive cervical cancer, and computerized tomography (CT) indicated right hydronephrosis. She was referred to the urological department for further examinations. Right retrograde pyelography (RP) however could not be performed. On April 13, 1988, the patient underwent laparotomy due to acute abdomen, which was proved to be caused by subileus. On exploration, a tumor was found in the lower one third section of the right ureter, whereupon a right nephroureterectomy was performed because primary ureteral tumor was suspected. The histology of the ureteral tumor revealed it to be a metastatic squamous cell carcinoma identical to that obtained from punch biopsy of the cervix. At that time, a hysterectomy could not be done because of invasive cervical cancer. Following the operation, radiation therapy was conducted for primary cervical cancer. At present, 7 months after the operation, the patient is alive with good performance status.

Adult↗
PubMed1998

Promoting smoking cessation among women who seek cervical cancer screening.

OBJECTIVE: To determine whether 1) women smokers are aware that smoking increases their risk for cervical cancer; 2) awareness of risk factors and its impact on motivation to quit smoking vary by age; and 3) providers are advising smokers to quit smoking during routine gynecologic visits. METHODS: Women aged 18 years and older who had a Papanicolaou test in the prior month were identified from a managed care cytology database. Four weeks after receiving their test result, women were called to complete a health behavior survey in which their smoking status, sexual history, knowledge of risk factors for cervical cancer, and motivation to quit smoking were assessed. RESULTS: Only 49% of the 613 smokers surveyed were aware that smoking increased their risk of cervical cancer. Women aged 34 years and younger were significantly more likely to agree that smoking increased their risk for cervical cancer than women aged 45 years or older (54% versus 40%). Concern that smoking might cause cervical cancer or other cancers was endorsed highly by women as a motivator for cessation, particularly for women smokers aged 18-26 (mean 8.1 and 7.6 on 10-point scales, respectively). About 50% of the women reported that their provider had asked about smoking and had encouraged cessation. Only about 30% of smokers were aware of well-established risk factors for cervical cancer such as the number of lifetime sexual partners and not using a condom. CONCLUSION: Routine gynecologic screening visits represent an important and underutilized clinical opportunity to intervene with young women smokers.

Adolescent↗
PubMed1995

[Chemotherapy and systemic treatments of cervical cancer].

The prognosis of cervical cancer depends on nodal status and tumoral volume. Among patients with risk factors, chemotherapy seems promising, particularly with concomitant chemoradiation or neo adjuvant chemotherapy before surgery. The advent of treatments with combination of alpha interferon and 13 cis retinoid acid probably leads to a new therapeutic generation.

Chemotherapy, Adjuvant↗