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PubMedDate not supplied

Screening for cervical cancer, results from Thailand.

Pap smears are recommended asa general screening methods to early diagnose cervical cancer in order to decrease morbidity and or mortality. Women in Thailand have a relatively high risk. Here, the author summarizes reported results from cervical screening programs set in Thailand. A total of 101,107 subjects of screening were included. The overall prevalence of cervical cancer was 0.38% (383 cases). The overall prevalence of pre-cancerous cases and other lesions (infection and inflammation) were 2.4% (2,405) and 5.3% (5,358). There was no significant association between the prevalence rate and the region. These results document the importance of cervical cancer in Thailand and the high detection rate of pre-cancerous lesion supports the utility of screening programs for secondary prevention of cervical cancer. Health education seems to play an important role in success of the cervical cancer screening program for Thai females.

Female↗
PubMed2005

Trends in cervical cancer incidence--Indian scenario.

Cancer of the uterine cervix is the second most common cancer among women in the world after breast cancer. It is the most common cancer among Indian women. The present communication reports the trends in the incidence rate of cervical cancer for the Indian population. The data published in Cancer Incidence in Five Continents for various Indian registries for different periods and/or publication by the individual registry served as the source material. During the years 1990-1997, the age-adjusted incidence rates (AAR) for cervical cancer varied from 10.9 to 65.4 amongst various registries. The highest incidence was noted in the Ambillikai registry. The age-specific incidence rates (ASIR) for cervical cancer revealed that the disease increases from 35 years and reaches a peak between the ages 55 to 64 years. The trend analysis by period showed a decreasing trend in the incidence rate of cervical cancer in all the registries. However, the decrease was very small. The mean annual percentage decrease in the AAR ranged from 0.9 to 2.6% amongst various registries. Analysis of the data by ASIR revealed that the mean annual percentage decrease was higher for women in earlier age groups in most of the registries. For women beyond 64 years, the disease incidence showed an increasing trend or minimal decrease. It was also noted that most of the cervical cancer cases were detected with regional spread of the disease and a very small proportion were diagnosed at a localized stage. In India, an organized mass-screening programme with Pap smear for early detection of cervical cancer is not in practice. The data suggest an urgent need for initiation of community screening and educational programmes for the control and prevention of cervical cancer.

Adolescent↗
PubMedDate not supplied

Surgical management of advanced and recurrent cervical cancer.

Since the early 1940s, the incidence of cervical cancer has dramatically decreased due in large part to the work of Papanicolaou and Traut. Successful treatment can now be done using simple or radical surgical intervention for early invasive lesions and radiation therapy for more advanced lesions. However, despite current advances in screening and early treatment, local recurrences still happen and are difficult to treat. The natural history of cervical cancers is that of a slowly growing, locally invasive tumor. As such, it lends itself to radical surgical resection in selected patients prior to distant metastasis. Current advances in intraoperative and postoperative monitoring, as well as improved surgical techniques and devices, have decreased the morbidity and mortality of radical surgical procedures to acceptable levels. Current data associated with these procedures for advanced or recurrent cervical cancer are described.

Combined Modality Therapy↗
PubMed1996

Difficulty in elucidating the male role in cervical cancer in Colombia, a high-risk area for the disease.

BACKGROUND: Epidemiologic evidence has been inconclusive in linking men's sexual behavior and genital human papillomaviruses (HPVs) with cervical cancer risk in their sexual partners in areas with a high incidence of cervical cancer. PURPOSE: This study assesses the role of men's sexual behavior and the presence of penile HPV DNA on the risk of their wives' developing cervical neoplasia in an area in Colombia with a high incidence of cervical cancer. METHODS: A total of 210 husbands of women with cervical intraepithelial neoplasia grade III (n = 118) or invasive squamous cell carcinoma of the cervix (n = 92) and a total of 262 husbands of women recruited as control subjects (173 and 89, respectively) were interviewed. Questionnaires included detailed information on sexual behavior. Exfoliated cells were obtained from the glans penis and from the distal urethra of the penis. The specimens were analyzed for HPV DNA by use of a polymerase chain reaction-based assay that included a generic probe and 25 type-specific probes. Serum specimens were collected and analyzed for antibodies to Chlamydia trachomatis, Treponema pallidum, herpes simplex virus type II, and Neisseria gonorrhoeae. RESULTS: Limited education (adjusted odds ratio [OR] = 4.4; 95% confidence interval [CI] = 1.9-9.8; for no schooling versus secondary or higher education) and presence of antibodies to C. trachomatis (adjusted OR = 2.5; 95% CI = 1.5-4.4) in husbands were the only identified risk factors for cervical neoplasia in their wives. The prevalence of HPV DNA in the penis was 25.7% among husbands of case women and 18.9% among husbands of control women (adjusted OR = 1.2; 95% CI = 0.6-2.3). Neither the lifetime number of female sexual partners (adjusted OR = 1.0; 95% CI = 0.4-2.6; for > 50 partners versus one to five) nor the lifetime number of female prostitutes as sexual partners (adjusted OR = 1.2; 95% CI = 0.7-2.0; for > or = 21 prostitutes versus one to five) was associated with the risk of cervical cancer. CONCLUSIONS: Our results are compatible with the hypothesis that in the population of Cali, whose women are at high risk of developing cervical cancer, exposure to HPV among young men is a common occurrence and is mediated by contacts with large numbers of female sexual partners and prostitutes. These widespread sexual practices limit the power of case-control studies to detect significant associations between men's sexual behavior and the cervical cancer risk in their sexual partners. HPV DNA detection in the penis of adult men is a poor reflection of lifetime exposure or of etiologically relevant exposure to HPV. The role of C. trachomatis in cervical carcinogenesis deserves further investigation. IMPLICATIONS: Further research is needed to elucidate the male's role in cervical carcinogenesis in populations at high risk for cervical cancer. HPV DNA prevalence surveys and studies of the natural history of HPV in young men will be of great value.

Carcinoma, Squamous Cell↗
PubMed2000

[Neoadjuvant chemotherapy with cisplatin and CPT-11 for advanced cervical cancer].

Neoadjuvant chemotherapy (NAC) is currently used for the treatment of advanced cervical cancer by many institutions. We investigated the value of NAC followed by radical surgery and/or radiotherapy for patients with locally advanced cervical cancer. Sixteen patients with stage Ib2-IIIb cervical cancer were enrolled in this study. CPT-11 (60 mg/m2) in 500 m/5% glucose was given intravenously on Days 1, 8, and 15, before cisplatin (60 mg/m2) in 500 ml normal saline. The treatment was repeated every 4 weeks for 2 or 3 cycles. All patients were evaluable for response and toxicity. Two achieved a clinical complete response (CR), 11 had a partial response (PR), 2 had no change (NC) and 1 had progressive disease (PD), for an overall response of 81.3%. Neutropenia was observed in 100% (> grade 3: 70.6%) and diarrhea was recorded in 55.9% (> grade 3: 5.9%). The combination of CPT-11 and cisplatin in locally advanced cervical cancer is thus an active regimen with a manageable toxicity as a neoadjuvant chemotherapy.

Adult↗
PubMed1977

Tumor antigen and human chorionic gonadotropin in CaSki cells: a new epidermoid cervical cancer cell line.

Epidermoid cervical carcinoma cells (CaSki line) have been established in continuous culture. When leukocytes from cervical cancer patients were incubated with CaSki culture fluid concentrates, inhibition of leukocyte migration was observed in more than 70 percent of the patients tested. By contrast, significantly less inhibition was observed with normal donor leukocytes or leukocytes from patients with other types of cancer. These results were consistent with the expression of tumor-associated antigen by CaSki cells. Analysis of the serum from the donor of the cell line at the time of tumor biopsy, and of CaSki culture fluids, demonstrated the presence of the beta subunit of human chorionic gonadotropin.

Adult↗
PubMed2000

Determination of p53-mediated transactivational ability in radiation-treated cervical cancer.

To establish a new predictor of human cervical cancer radioresponse, we investigated the transactivational ability of p53 gene in tumor tissue for use as a marker of both pretreatment and postirradiation levels of mRNA of its downstream gene, WAF1. A total of 38 wild-type p53-bearing patients with histologically proved uterine cervical cancer were treated with definitive radiotherapy. Their p53 status was investigated using a single-strand conformation polymorphism analysis, and human papilloma virus 16, 18, 33, and 58 E6 was determined by polymerase chain reaction in pretreatment biopsy specimens. WAF1 mRNA was estimated by reverse transcriptase-polymerase chain reaction in both pretreatment specimens and those obtained after the administration of 10.8 Gy. Undetectable or low pretreatment levels of WAF1 mRNA were associated with complete response in the majority of cases, whereas only a few patients with a high pretreatment WAF1 level responded to treatment (P = .03). The increase in the postirradiation level of WAF1 mRNA positively correlated with better treatment response and long survival (P = .02). Although the human papilloma virus infection did not change the radiation response directly, it decreased the inducibility of WAF1. Consequently, the lower inducibility of WAF1 resulted in a poor treatment response. This is the first clinical report showing that the transactivational ability of p53 may be a determinant of the efficacy of cervical cancer radiotherapy.

Biopsy↗
PubMedDate not supplied

Coincidental detection of T-cell rich B-cell lymphoma in the paraaortic lymph nodes of a woman undergoing lymph node dissection for cervical cancer.

The diagnosis of cervical squamous cell carcinoma with concurrent T-cell rich B-cell lymphoma in dissected lymph nodes has not been reported to our knowledge. We report such a case. The biopsy of an exophytic lesion at the uterine cervix showed squamous cell carcinoma in a 50-year-old woman presenting with postcoital bleeding. Type III hysterectomy, bilateral salpingo-oophorectemy, bilateral pelvic, paraaortic lymph node dissections were performed. Pathologic examination revealed a T-cell rich B-cell lymphoma in some lymph nodes beside squamous cell carcinoma in several of others. ELISA for human immuno-deficiency virus (HIV) was negative. The cervical carcinoma was staged as FIGO clinical stage IB1 and the lymphoma as Ann Arbor IIA. Six cycles of CHOP (cyclophosphamide, adriamycin, vincristine, and prednisone) chemotherapy for the lymphoma and concomitant pelvic chemo-radiotherapy with cisplatin for cervical cancer were given. In this rare coincidence; the best available therapy for each of the diseases should be considered individually. We also suggest that HIV screening test be carried out, because both diseases may be related to human immuno-deficiency virus, although our patient was HIV-negative.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Interactions between human papillomavirus and other sexually transmitted agents in the etiology of cervical cancer.

The interplay between human papillomavirus, notably type 16, and HIV in cervical carcinogenesis leads to persistent infection and cervical neoplasia by destruction of the afferent arm (Langerhans cells) of the host immune system. The joint effect takes place at the early stages of squamous intraepithelial lesions and has severe consequences if left untreated. The recent increase of cervical cancer mortality in young women in developed countries may well be a result of the HIV epidemic. Infection with Chlamydia trachomatis is associated with cervical squamous cell carcinoma but not with cervical adenocarcinoma, and the association remains after adjusting for human papillomavirus 16. Joint effects of C. trachomatis and the human papillomaviruses have not been studied at the population level but indirect evidence from epidemiological studies suggests that the interaction might be different (synergistic versus antagonistic) at different stages (cervical intraepithelial neoplasia versus invasive cervical cancer) of cervical carcino-genesis. Concomitant exposure to human papillomaviruses 6 or 11 and human papillomavirus type 16 has not been shown to result in excess risk of cervical squamous cell carcinoma. This antagonistic joint effect was also discovered between human papillomavirus types 18 and 16, as well as 33 and 16. Herpes simplex virus type 2 antibodies are associated with a modest risk of cervical cancer, which is not surprising since the presence of herpes simplex virus antibodies reflects risk-taking sexual behaviour. However, no excess risk remains after adjustment for human papillomavirus type 16, and no interaction between these two viruses has been found in epidemiological studies. Evidence of interaction between human papillomavirus type 16 and the other members of the herpesvirus family is still at an experimental level and difficult to judge. Little progress has been made in the most promising experimental association between the oncogenic human papillomaviruses and adeno-associated viruses. In addition to the well established interaction between human papillomaviruses and HIV, intriguing interactions are emerging between the human papillomaviruses and C. trachomatis, as well as between the different human papillomavirus types.

Journal Article↗
PubMed1989

Complications of combined radical hysterectomy-postoperative radiation therapy in women with early stage cervical cancer.

Fifty patients with cervical cancer were treated with radical hysterectomy and lymphadenectomy followed by postoperative radiation therapy for high risk factors (nodal metastases, lymphvascular space invasion, close or involved margins) at the University of Alabama at Birmingham Medical Center from 1969 to 1984. Fifteen (30%) of the patients treated had serious complications, 8 (16%) requiring an operation, and 1 (2%) dying as a result of treatment-related problems. This combined modality approach is associated with significant complications.

Adenocarcinoma↗
PubMed2005

Strategies for the prevention of cervical cancer by human papillomavirus vaccination.

As cervical cancer is causally associated with 14 high-risk types of human papillomavirus (HPV), a successful HPV vaccine will have a major impact on this disease. Although some persistent HPV infections progress to cervical cancer, host immunity is generally able to clear most HPV infections. Both cell-mediated and antibody responses have been implicated in influencing the susceptibility, persistence or clearance of genital HPV infection. There have been two clinical trials that show that vaccines based on virus-like particles (VLPs) made from the major capsid protein, L1, are able to type specifically protect against cervical intra-epithelial neoplasia and infection. However, there is no evidence that even a mixed VLP vaccine will protect against types not included in the vaccine, and a major challenge that remains is how to engineer protection across a broader spectrum of viruses. Strategies for production of HPV vaccines using different vaccine vectors and different production systems are also reviewed.

Antibodies, Viral↗
PubMed1977

Negative smears in women developing invasive cervical cancer.

Fifty-six cervical smears originally classified as Pap. I, from women in whom cervical cancer of stage I to IV was detected within 4 to 5 years after the cytological check, were re-examined in order to estimate the screening error and sampling failure. At the review, 35 smears were classified as Pap. II to V. The incidence of changed classification of the smears obtained from population screening was 70% and that of the smears taken at private specialists or at hospitals was about 50%. The influence of sampling failure on the evaluation of the smears classified as Pap. II should be considered. On 14 slides, correctly interpreted as negative, there were no columnar cells present, a fact that may indicate inefficient sampling of cells from the squamo-columnar junction.

Adenocarcinoma↗
PubMed1994

[Mass screening for cervical cancer. A one-year registration of cervical cytological tests].

In 1990 the Norwegian Ministry of Health and Social Affairs decided to start an organised screening programme for cervical cancer. All women aged 25-70 years will be offered screening every three years. During the first three years of the programme, all spontaneous screening in Norway is to be reported to a central unit located at the Cancer Registry of Norway. A pilot project has been implemented in the counties of Sør-Trøndelag and Vestfold to evaluate the organisational aspects of the screening programme. A total of 509,641 smears were recorded during the first year of recording. The majority of smears were taken from women below 50 years. Most smears (88.6%) had normal tissue morphology, while 2.9% displayed various cellular changes. Smears from younger women showed the highest rate of Human papillomavirus (HPV) changes and mild (CIN 1) and moderate (CIN 2) dysplasias, whereas the rated malignant cellular changes was highest in the older age groups. The findings support the wide age range of the target group.

Adolescent↗
PubMed1993

High rate of concurrent genital infections with human cytomegalovirus and human papillomaviruses in cervical cancer patients.

A case-control study evaluated a possible association between infection with human papillomavirus (HPV) or cytomegalovirus (CMV) and cervical cancer. Seventy-eight patients with cervical cancer (cases) were compared with 55 age-compatible patients with uterine leiomyoma (controls). Genital CMV and HPV infections were diagnosed by polymerase chain reaction amplification of viral DNA in cervical tissues. Smoking, first coitus or pregnancy before age 20, multiple sex partners, history of multiple pregnancies, and frequent sexual intercourse were important factors associated with cervical cancer. Only 9% of the cases versus 29.1% of the controls did not have genital infection with either virus. Concurrent genital CMV and HPV infection was noted in 51.3% of the cases but in none of the controls. HPV infection alone occurred in 15.4% of the cases but in only 5.5% of the controls. CMV infection alone was associated with no increased risk for cervical cancer. These data suggest that a synergistic interaction may occur between these two viral infections in the oncogenesis of cervical cancer.

Adult↗
PubMed1991

Dialectic classification of syndrome diagnosis in traditional Chinese medicine used as new criterion for evaluating prognosis of patients with cervical cancer.

254 patients with cervical cancer were treated by radiotherapy from Jan 1979 to Dec 1984. All the patients were followed up at least for more than 3 years, of them 180 for over 5 years. According to various symptoms, picture of the tongue and pulse condition, the disease was classified into 4 types, namely: 1) deficiency of liver-yin and kidney-yin, 2) deficiency of splenic qi, 3) internal retention of damp-heat, and 4) stagnation of qi and blood or stagnation of liver qi. The survival rate of the various types was quite different. The patients of type 4 had the worst prognosis. The prognosis of patients with type 1 was significantly better than that of patients with type 4. The difference was of statistical significance (P less than 0.01).

Carcinoma, Squamous Cell↗
PubMed1988

In situ/invasive cervical cancer ratios: impact of cancer education and screening.

A study of cancer incidence rates in Newark, NJ showed an increase in invasive cervical cancer among black women between 1970 and 1976. The incidence was substantially higher than that found in the Third National Cancer Survey and the Surveillance Epidemiology End Results Program. The ratio of in situ/invasive cervical cancer incidence among black women was 1:1, far below the national ratio of about 3:1. It seemed that the high-risk population in Newark might not be having regular Papanicolaou smears. From 1976 through 1981, intensive educational and cervical cancer screening programs were carried out in the city of Newark. A review was made of cervical cancer cases (1976-1981) reported to the tumor registries or recorded on discharge diagnoses in hospitals where Newark residents are known to have sought care. The findings showed that the ratio of in situ to invasive cervical cancer had increased dramatically: the overwhelming majority of cancers were found to be in situ carcinomas. The improvement was far more impressive among black women than among white women. Since the intervention campaign had been directed primarily toward the black female population, a group at extremely high risk, this suggested that efficacy of the intervention program.

Adolescent↗
PubMed2004

Screening for cervical cancer in developing countries.

Cervical cancer is the most common malignancy amongst females in developing countries, mainly due to a lack of precursor screening. This absence of screening is the result of inherent disadvantages of the Pap smear: high cost, low sensitivity, the need for a laboratory with high human expertise and a complex screening program logistic system. The prerequisites for screening in a developing country include a screening method that is affordable, which can be effectively applied once in a lifetime at the age of 30-35 years, provide an immediate result and thereby allowing for on-site treatment of positive cases. None of the current screening methods comply with these prerequisites. More research is necessary into different combinations of tests, which improve sensitivity. On-site human papillomavirus (HPV) identification, alone or in combination with other tests, is promising. Another promising development is immunization against HPV infection, either as a preventative measure or for stimulating immunity in infected women.

Developing Countries↗
PubMed2004

Life style, environmental and genetic susceptibility to cervical cancer.

We have studied cervical cancer (CC) patients from Venezuela and the US to elucidate the contribution of certain acquired and genetic susceptibility factors to the development of the disease. For acquired susceptibility factors, infection with high risk human papilloma virus (HPV), having multiple sex partners and having early sexual activities are significant risk factors for CC in Venezuela. The latter two are not significant risk factors for the US population. Infection with high risk HPV is a more significant risk factor for the US than the Venezuela populations. On the other hand, cigarette smoking is significantly associated with CC in the US but not the Venezuela populations. From genetic susceptibility factors, polymorphisms in the CYP2E1 and mEH genes are not associated with CC but the GSTM1 null genotype is for the US population. Our study indicates that the same susceptibility factors can have very different roles in the development of the same disease such as CC in different countries. The information is useful for the development of effective but different disease prevention programs for different countries in the control of CC.

Environment↗