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ABSTRACT: OBJECTIVES: To compare the cost-effectiveness of three screening options for endometrial cancer in asymptomatic, postmenopausal women prior to undergoing morcellation in minimally-invasive supracervical hysterectomy and minimally-invasive sacral colpopexy for the treatment of pelvic organ prolapse (POP). METHODS: A decision tree model was constructed to compare no screening, endometrial biopsy, and transvaginal ultrasound for asymptomatic, postmenopausal women prior to surgery. Effectiveness was measured by life years. The incremental cost effectiveness ratio, defined as the difference in cost between two screening options divided by the difference in life years between the two options, was calculated in 2012 U.S. dollars for endometrial biopsy and transvaginal ultrasound, in comparison to no screening. RESULTS: Using an endometrial cancer prevalence of 0.6% and a 40% risk of upstaging after morcellation, the expected per patient cost was $8,800, $9,023 and $9,112 over five years for no screening, endometrial biopsy and transvaginal ultrasound, respectively. The expected life years saved compared to no screening, were 0.00108 for endometrial biopsy and 0.00105 for transvaginal ultrasound, i.e., 0.39 and 0.38 days, respectively. The estimated incremental cost-effectiveness ratio was $207,348 for endometrial biopsy and $298,038 for transvaginal ultrasound compared to no screening. Sensitivity analysis showed that the prevalence of endometrial cancer and the risk of endometrial cancer upstaging after morcellation had the greatest impact on the cost-effectiveness of screening. CONCLUSIONS: For asymptomatic, postmenopausal women, preoperative endometrial evaluation via endometrial biopsy or transvaginal ultrasound helps improve the preoperative detection of endometrial cancer, but universal screening is not cost-effective.
American journal of obstetrics and gynecology 03/2013; · 3.28 Impact Factor
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ABSTRACT: : To compare the sexual function of older women who had bilateral oophorectomy with that of older women who had retained their ovaries.
: This cross-sectional study involved analysis of 1,352 women aged 57 to 85 years from the National Social Life, Health, and Aging Project. Women with previous bilateral oophorectomy were compared with women who retained their ovaries. The primary outcome of interest was self-report of sexual ideation, chosen because having thoughts about sexual experiences is not prohibited by either a partner or a woman's own physical limitations.
: Three hundred fifty-six (25.8%) women reported previous bilateral oophorectomy. Our analysis achieved 90% power to detect a difference of 10% in sexual ideation. No significant difference in the report of sexual ideation was found between women with previous bilateral oophorectomy and women who retained their ovaries (54.5% and 95% confidence interval [CI] 48.1-61.0 compared with 49.9% and 95% CI 45.3-54.5, P=.230), even after adjusting for current hormone therapy, age, education, and race (adjusted odds ratio 1.32, 95% CI 0.96-1.80).
: Bilateral oophorectomy may not play a pivotal role in sexual ideation and function among older women.
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Obstetrics and Gynecology 10/2012; 120(4):833-42. · 4.73 Impact Factor
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ABSTRACT: To examine human papillomavirus (HPV) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students.
Females aged 18 to 26 attending a university health service gynecology clinic (n = 256).
Participants were randomized to receive either HPV-specific education with a mailed reminder or standard care. Predictors of HPV vaccine intent and uptake at 6 months following enrollment were identified.
At baseline, 41% intended to undergo HPV vaccination. Participants who were currently sexually active and lacked supplemental health insurance had decreased intent. Perceived parental approval regarding HPV vaccination, perceived vulnerability to HPV infection, and belief in health benefits of HPV vaccine were associated with increased intent. HPV vaccine uptake was low (5.5%) and did not differ by study group. However, baseline intent was significantly associated with HPV vaccine uptake.
Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination.
Journal of American College Health 02/2012; 60(2):151-61. · 1.45 Impact Factor
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ABSTRACT: Higher testosterone (T) is tied to risk-taking, especially in financial domains but also in health domains relevant to acquiring sexually transmitted infections (STIs). However, safer sex constructs could themselves carry the possibility of "social risk" due to sexual stigma or embarrassment, or could involve boldness or confidence because they could represent status displays of frequent sexual activity.
To determine how T and behaviorally relevant attitudes about sexual risk-taking are linked, to better understand biopsychosocial aspects of sexual health related to STIs.
In 78 first-year male college students, we examined correlations between salivary T and behaviorally relevant safer sex attitudes assessed via questionnaires.
T, via saliva; safer sex attitudes, via a composite and the University of California, Los Angeles Multidimensional Condom Attitudes Scale (MCAS).
Higher T was significantly correlated with higher scores on the following: safer sex likelihood composite, r(73)=0.33, P=0.003; the MCAS safer sex resilience, r(32)=0.36, P=0.037; and the MCAS condom purchase comfort, r(32)=0.37, P=0.031. Associations between T and safer sex likelihood and resilience were still robust after controlling for potential confounds, though the association between T and purchase comfort diminished to a trend.
Higher T was positively linked with safer sex attitudes, especially those most closely tied to STI risk avoidance. Thus, future research and interventions for STI prevention should address the possibility that safer sex may be paradoxically perceived as a "bold" or "risky" choice even as it decreases STI risk.
Journal of Sexual Medicine 11/2011; 9(3):727-34. · 3.55 Impact Factor
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ABSTRACT: Persistent infection with high-risk human papillomavirus (HPV) types is necessary for the development of high-grade cervical dysplasia and cervical carcinoma. The presence of HPV DNA in the blood of cervical cancer patients has been reported; however, whether HPV DNA is detectable in the blood of patients with pre-invasive cervical disease is unclear.
The objectives of this study were to determine if HPV 16 and HPV 18 DNA could be detected in the serum of colposcopy clinic patients, and if serum HPV detection was associated with grade of cervical disease and HPV cofactors.
Samples were selected from a biorepository collected from non-pregnant, HIV-negative women ages 18-69 attending colposcopy clinics at two urban public hospitals. Cervical disease status was based on review of colposcopy, biopsy and cytology findings. Serum HPV DNA detection was conducted using a novel PCR and mass spectroscopy-based assay.
Of the 116 adequate serum samples, all (100%) were negative for HPV 16 and HPV 18. Over half (51.7%) of participants had cervical HPV 16 and/or HPV 18 infection. Nearly one-third (31.1%) had high grade, 10.3% had low grade, and 50.9% had no cervical disease. Nearly one-third (28.5%) had ever regularly smoked cigarettes, 70.7% had early onset of sexual intercourse, and 75% had ever used oral contraceptives.
In this colposcopy clinic population with a range of clinical characteristics and established HPV cofactors, HPV DNA was undetectable in their serum. Our findings suggest that serum HPV DNA detection is not a cervical cancer screening tool.
Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 02/2011; 50(4):342-4. · 3.12 Impact Factor
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ABSTRACT: Adolescent human papillomavirus (HPV) vaccination uptake, as a means of cervical cancer prevention, remains suboptimal with significant racial disparity. A survey study of mothers already engaging in their own cancer screening, at a predominantly black urban site and a predominantly white suburban site, finds that a majority of mothers surveyed support hypothetical mandates for adolescent HPV vaccination three years after the introduction of these vaccines. Enactment of state laws may represent an efficient means to improve HPV vaccination in adolescent daughters of these mothers. Nevertheless, in a sizable minority, maternal perceptions of the HPV vaccine may hinder adherence to these vaccination laws. In these women, tailored interventions directed at these perceptions may be required.
Human vaccines 02/2011; 7(2):225-9. · 3.58 Impact Factor
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ABSTRACT: Breast or cervical cancer screening visits may present an opportunity to motivate mothers to have their daughters vaccinated against human papillomavirus (HPV). In preparation for a future intervention study, we sought to establish the feasibility of using these visits to identify women with at least one daughter in the appropriate age range for adolescent HPV vaccination.
We conducted a cross-sectional mailed survey of women who had received breast or cervical cancer screening within the 6-18 months before the survey. The study was conducted at two diverse institutions: one serving a mostly black (54.1%) urban inner-city population and another serving a mostly white (87.5%) suburban population.
Our overall response rate was 28% (n = 556) in the urban site and 38% (n = 381) in the suburban site. In the urban site, the proportions of mothers completing mammography or Pap smear visits with HPV vaccine-eligible daughters were 23% and 24%, respectively. In the suburban site, the proportions of mothers completing mammography or Pap smear with at least one vaccine-eligible daughter were 41% and 26%, respectively.
Women who undergo breast or cervical cancer screening in the two different demographic groups evaluated have at least one adolescent daughter at the appropriate age for HPV vaccination. An important implication of this finding in adolescent daughters of urban mothers is the potential use of maternal breast or cervical cancer screening encounters to target a potentially undervaccinated group.
Journal of Women s Health 11/2010; 19(12):2271-5. · 1.57 Impact Factor
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ABSTRACT: For some cancers, married individuals present with less advanced stage of disease, receive more aggressive treatment, and live longer after diagnosis compared with unmarried individuals. We examined survival differences by marital status among women with cervical cancer using a population-based sample of patients in the United States while considering patient, tumor, and treatment characteristics.
We identified 7,997 women (1,835 single, 3,849 married, 1,193 separated/divorced, and 1,120 widowed) diagnosed with primary invasive cervical cancer from 1992 to 1996 (with follow-up through December 31, 2004) from the Surveillance, Epidemiology, and End Results program. Associations of marital status, race, age at diagnosis, tumor grade, tumor stage, cancer-directed radiotherapy, and cancer-directed surgery with survival were examined using Cox proportional hazard regression models.
Five-year survival was highest for married women and lowest for widowed women (p <.0001). Compared with married women, risks of death for single, separated/divorced, and widowed women were 1.13 (95% confidence interval [CI] = 1.03-1.25), 1.41 (95% CI = 1.28-1.57), and 2.51 (95% CI = 2.29-2.76), respectively. After adjustment, marital status was not independently associated with risk of death (p =.21), although it interacted with tumor stage and cancer-directed radiation therapy. Married women with early stage disease who did not receive radiation therapy had improved survival compared with single, separated/divorced, or widowed women.
Marital status interacted with tumor stage and cancer-directed radiation therapy to influence survival among women with cervical cancer. Additional study of the pathways through which partner status influences survival after cancer diagnosis could inform the development of social support interventions.
Journal of Lower Genital Tract Disease 10/2010; 14(4):329-38. · 1.07 Impact Factor
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ABSTRACT: Human papillomavirus (HPV) vaccines represent a remarkable opportunity for the primary prevention of cervical cancer and other HPV-related diseases. With almost four years of vaccine availability now accrued in the United States (U.S.), data are beginning to accumulate about vaccine utilization patterns and how these may be affected by public opinions about the vaccines. This article describes the burden of HPV infection and related disease in the U.S., and reviews what is currently known about HPV vaccine utilization among adolescent and young adult females in this country. In addition, we report on emerging data on the personal and attitudinal factors that appear to influence HPV vaccine utilization and discuss how these data may be useful for designing future interventions to improve uptake of these vaccines. Finally, we re-examine cost-effectiveness studies of HPV vaccines, taking into account updated information on utilization of, and public attitudes about, these vaccines.
Human vaccines 09/2010; 6(9). · 3.58 Impact Factor
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ABSTRACT: We sought to compare continence system function of black and white women in a population-based sample.
As part of a cross-sectional population-based study, black and white women ages 35-64 years were invited to have pelvic floor testing to achieve prespecified groups of women with and without urinary incontinence. We analyzed data collected from 335 women classified as continent (n = 137) and stress (n = 102) and urge (n = 96) incontinent based on full bladder stress test and symptoms. Continence system functions were compared across racial and continence groups.
Comparing black to white women, maximal urethral closure pressure (MUCP) was 22% higher in blacks than whites (68.0 vs 55.8 cm H(2)O, P < .0001). White and black women with stress incontinence had MUCP 19% and 23% lower than continent women. MUCP in urge incontinent white women was as low as stress incontinent whites, but blacks with urge had normal urethral function.
Black women have higher urethral closure pressures than white women. White women with urge incontinence, but not black women, have reduced MUCP.
American journal of obstetrics and gynecology 06/2010; 202(6):584.e1-584.e12. · 3.28 Impact Factor
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ABSTRACT: We sought to compare pelvic floor structure and function between older women with and without fecal incontinence (FI) and young continent (YC) women.
YC (n=9) and older continent (OC) (n=9) women were compared to older women with FI (older incontinent [OI]) (n=8). Patients underwent a pelvic organ prolapse quantification, measurement of levator ani (LA) force at rest and with maximum contraction, and magnetic resonance imaging. Displacement of structures and LA defects were determined on dynamic magnetic resonance imaging.
LA defects were more common in the OI vs the YC (75% vs 11%, P=.01) and OC (22%, P=.14) groups; women with FI were more likely to have LA defects than women without (odds ratio, 14.0, 95% confidence interval, 1.8-106.5). OI women generated 27.0% and 30.1% less force during maximum contraction vs the OC (P=.13) and YC (P=.04) groups. During Kegel, OI absolute structural displacements were smaller than in the OC group (P=.01).
OI women commonly have LA defects, and cannot augment pelvic floor strength.
American journal of obstetrics and gynecology 05/2010; 202(5):491.e1-6. · 3.28 Impact Factor
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ABSTRACT: Cervical cancer represents a global women's health issue. The emergence of vaccines against the most common types of human papillomaviruses causing cervical cancer represents a significant advance in cervical cancer prevention. Adolescent girls are the primary target population for vaccination-a population that traditionally has been difficult to reach. Obstetricians and gynecologists may hold the key to improving adolescent human papillomavirus vaccinations through the novel use of their existing relationships with adolescents' mothers during the routine cervical cancer screening visit. We propose using maternal cancer screenings, specifically breast and cervical cancer screening episodes, as "teachable moments," naturally occurring life or health events thought to motivate a person to adopt risk-reducing health behaviors spontaneously, to improve human papillomavirus vaccination rates among adolescents.
Obstetrics and Gynecology 04/2010; 115(4):834-8. · 4.73 Impact Factor
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ABSTRACT: The potential benefit in preventing pelvic floor disorders (PFDs) is a frequently cited reason for requesting or performing cesarean delivery on maternal request (CDMR). However, for primigravid women without medical/obstetric indications, the lifetime cost-effectiveness of CDMR remains unknown, particularly with regard to lifelong pelvic floor consequences. Our objective was to assess the cost-effectiveness of CDMR in comparison to trial of labor (TOL) for primigravid women without medical/obstetric indications with a single childbirth over their lifetime, while explicitly accounting for the management of PFD throughout the lifetime.
We used Monte Carlo simulation of a decision model containing 249 chance events and 101 parameters depicting lifelong maternal and neonatal outcomes in the following domains: actual mode of delivery, emergency hysterectomy, transient maternal morbidity and mortality, perinatal morbidity and mortality, and the lifelong management of PFDs. Parameter estimates were obtained from published literature. The analysis was conducted from a societal perspective. All costs and quality-adjusted life-years (QALYs) were discounted to the present value at childbirth.
The estimated mean cost and QALYs were $14,259 (95% confidence interval [CI] $8,964-$24,002) and 58.21 (95% CI 57.43-58.67) for CDMR and $13,283 (95% CI $7,861-$23,829) and 57.87 (95% CI 56.97-58.46) for TOL over the combined lifetime of the mother and the child. Parameters related to PFDs play an important role in determining cost and quality of life.
When a woman without medical/obstetric indications has only one childbirth in her lifetime, cost-effectiveness analysis does not reveal a clearly preferable mode of delivery.
Journal of Women s Health 01/2010; 19(1):147-60. · 1.57 Impact Factor
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ABSTRACT: The purpose of this study was to compare differences in degree of bother in black and white women with urinary incontinence (UI).
A population-based study was conducted in black and white women in Michigan. Participants completed an interview and the Incontinence Impact Questionnaire short form (IIQ-7). Statistical analysis included 2-way analysis of variance for post hoc comparisons of IIQ-7 scores between races at different frequencies, amounts, and types of UI.
Black women with moderate UI had significantly higher IIQ-7 scores than white women (31.4 +/- 3.5 vs 23.7 +/- 1.9; P = .03). Overall, black women with urge incontinence had higher scores than white women (30.5 +/- 4.0 vs 21.0 +/- 3.0; P = .05). After adjustment for severity, black women with urge and mixed incontinence tended to be more bothered (P = .06).
With moderate UI (not mild or severe), black women are more bothered than white women. At this discriminatory level of UI severity, racial differences are important, because they may dictate care-seeking behavior.
American journal of obstetrics and gynecology 11/2009; 201(5):510.e1-6. · 3.28 Impact Factor
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ABSTRACT: Knowledge of the central role of high-risk human papillomavirus (HPV) in cervical carcinogenesis, coupled with an emerging need to monitor the efficacy of newly introduced HPV vaccines, warrant development and evaluation of type-specific, quantitative HPV detection methods. In the present study, a prototype PCR and mass spectroscopy (PCR-MS)-based method to detect and quantitate 13 high-risk HPV types is compared to the Hybrid Capture 2 High-Risk HPV DNA test (HC2; Digene Corp., Gaithersburg, MD) in 199 cervical scraping samples and to DNA sequencing in 77 cervical tumor samples. High-risk HPV types were detected in 76/77 (98.7%) cervical tumor samples by PCR-MS. Degenerate and type-specific sequencing confirmed the types detected by PCR-MS. In 199 cervical scraping samples, all 13 HPV types were detected by PCR-MS. Eighteen (14.5%) of 124 cervical scraping samples that were positive for high-risk HPV by HC2 were negative by PCR-MS. In all these cases, degenerate DNA sequencing failed to detect any of the 13 high-risk HPV types. Nearly half (46.7%) of the 75 cervical scraping samples that were negative for high-risk HPV by the HC2 assay were positive by PCR-MS. Type-specific sequencing in a subset of these samples confirmed the HPV type detected by PCR-MS. Quantitative PCR-MS results demonstrated that 11/75 (14.7%) samples contained as much HPV copies/cell as HC2-positive samples. These findings suggest that this prototype PCR-MS assay performs at least as well as HC2 for HPV detection, while offering the additional, unique advantages of type-specific identification and quantitation. Further validation work is underway to define clinically meaningful HPV detection thresholds and to evaluate the potential clinical application of future generations of the PCR-MS assay.
Journal of virological methods 06/2009; 160(1-2):78-84. · 2.13 Impact Factor
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ABSTRACT: Primary prevention of human immunodeficiency virus (HIV) continues to pose an important challenge in the United States. Recent clinical trials conducted in Kenya, South Africa, and Uganda have demonstrated considerable benefit of male circumcision in reducing HIV seroincidence in males. These results have ignited debate over the appropriateness of implementing routine provision of neonatal circumcision in the United States for HIV prevention. This article discusses major contextual differences between the United States and the three African countries where the clinical trials were conducted, and cautions that the applicability of the scientific data from Africa to this country must be carefully considered before rational policy recommendations regarding routine neonatal circumcision can be made as a strategy to prevent the spread of HIV in the United States.
American journal of men's health 02/2009; 3(1):79-84. · 1.15 Impact Factor
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ABSTRACT: There is growing interest in causal factors for pelvic floor disorders. These conditions include pelvic organ prolapse and urinary and fecal incontinence and are affected by a myriad of factors that increase occurrence of symptomatic disease. Unraveling the complex causal network of genetic factors, birth-induced injury, connective tissue aging, lifestyle and comorbid factors is challenging. We describe a graphical tool to integrate the factors affecting pelvic floor disorders. It plots pelvic floor function in 3 major life phases: (1) development of functional reserve during an individual's growth, (2) variations in the amount of injury and potential recovery that occur during and after vaginal birth, and (3) deterioration that occurs with advancing age. This graphical tool accounts for changes in different phases to be integrated to form a disease model to help assess the overlap of different causal factors.
American journal of obstetrics and gynecology 07/2008; 199(6):610.e1-5. · 3.28 Impact Factor
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ABSTRACT: The purpose of this study was to report the distribution of pelvic support among a population-based sample of middle-aged community-dwelling women, as defined by pelvic organ prolapse quantification (POP-Q) and study factors that might influence POP-Q measurements.
We conducted a secondary analysis of a population-based study of community-dwelling, African American and white women aged 35-64 years from southeastern Michigan. Three hundred ninety-four women consented to physical examination using the POP-Q. Statistical analysis included descriptive statistics and multivariable regression. Estimates were weighted to reflect probability and nonresponse characteristics of the sample to increase generalizability of the findings.
The following values were the mean values for POP-Q points: Aa and Ba = -1.2 cm, C = -6.5 cm (intact uterus), C = -6.9 cm (hysterectomy), and Ap and Bp = -1.8 cm. The POP-Q stages were organized in the following manner: stage 0, 8.8%; stage I, 21.4%; stage II, 67.7%; stage III, 2.1%. Increasing vaginal parity was associated with increasing descent of the anterior, apical, and posterior vaginal wall (P < .001).
In this population-based study of women from southeastern Michigan, 90% of the women had anterior and posterior vaginal wall support that was above or extended to the hymen. Increasing vaginal parity was associated with increasing descent of the anterior, posterior, and vaginal apex.
American journal of obstetrics and gynecology 05/2008; 198(5):548.e1-6. · 3.28 Impact Factor
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ABSTRACT: We examine racial differences in urinary incontinence prevalence, frequency, quantity, type, and risk factors in a population based sample of community dwelling black and white women.
Women 35 to 64 years old were sampled from telephone records from 3 southeast Michigan counties. Women self-identifying as black or white race completed a telephone interview that assessed demographics, health history, lifestyle factors and urinary incontinence experience. Statistical analysis included descriptive statistics, factor analysis and multivariable logistic regression to determine adjusted odds of urinary incontinence. Estimates were weighted to reflect probability and nonresponse characteristics of the sample, and to increase generalizability of the findings.
Interviews were completed by 1,922 black and 892 white women (response rate = 69%). The overall prevalence of urinary incontinence was 26.5%. By race, urinary incontinence prevalence was 14.6% for black women and 33.1% for white women (p <0.001). Among incontinent women there was no difference by race in the frequency of urinary incontinence. However, black women reported more urine loss per episode (p <0.05). A larger proportion of white women with incontinence (39.2%) reported symptoms of pure stress incontinence compared to black women (25.0%), whereas a larger proportion of black women (23.8%) reported symptoms of pure urge incontinence compared to white women (11.0%). Risk factors for urinary incontinence were generally similar for white and black women.
In this population based study we observed racial differences in prevalence, quantity and type of urinary incontinence. Frequency of and risk factors for urinary incontinence were generally similar for white and black women.
The Journal of urology 04/2008; 179(4):1455-60. · 4.02 Impact Factor
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Sujana Movva MD,
Anne-Michelle Noone MS,
Mousumi Banerjee PhD,
Divya A. Patel PhD,
MSPH Kendra Schwartz MD,
Cecilia L. Yee MS,
MPH Michael S. Simon MD,
Sujana Movva,
Anne‐Michelle Noone,
Mousumi Banerjee, Divya A. Patel,
Kendra Schwartz,
Cecilia L. Yee,
Michael S. Simon
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ABSTRACT: BACKGROUND
African-American (AA) women have lower survival rates from cervical cancer compared with white women. The objective of this study was to examine the influence of socioeconomic status (SES) and other variables on racial disparities in overall survival among women with invasive cervical cancer.METHODS
One thousand thirty-six women (705 white women and 331 AA women) who were diagnosed with primary invasive cancer of the cervix between 1988 and 1992 were identified through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a registry in the Surveillance, Epidemiology, and End Results (SEER) database. Pathology, treatment, and survival data were obtained through SEER. SES was categorized by using occupation, poverty, and educational status at the census tract level. Cox proportional hazards models were used to compare overall survival between AA women and white women adjusting for sociodemographics, clinical presentation, and treatment.RESULTSAA women were more likely to present at an older age (P < .001), with later stage disease (P < .001), and with squamous histology (P = .01), and they were more likely to reside in a census tract categorized as Working Poor (WP) (P < .001). After multivariate adjustment, race no longer had a significant impact on survival. Women who resided in a WP census tract had a higher risk of death than women from a Professional census tract (P = .05). There was a significant interaction between disease stage and time with the effect of stage on survival attenuated after 6 years.CONCLUSIONS
In this study, factors that affected access to medical care appeared to have a more important influence than race on the long-term survival of women with invasive cervical cancer. Cancer 2008. © 2008 American Cancer Society.
Cancer 03/2008; 112(6):1264 - 1271. · 4.77 Impact Factor
