No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Worldwide burden of gynecological cancer: The size of the problem
Abstract
The estimation of cancer burden is valuable to set up priorities for disease control. The comprehensive global cancer statistics from the International Agency for Research on Cancer indicate that gynaecological cancers accounted for 19% of the 5.1 million estimated new cancer cases, 2.9 million cancer deaths and 13 million 5-year prevalent cancer cases among women in the world in 2002. Cervical cancer accounted for 493 000 new cases and 273 000 deaths; uterine body cancer for 199 000 new cases and 50 000 deaths; ovarian cancer for 204 000 new cases and 125 000 deaths; cancers of the vagina, vulva and choriocarcinoma together constituted 45 900 cases. More than 80% of the cervical cancer cases occurred in developing countries and two-thirds of corpus uteri cases occurred in the developed world. Political will and advocacy to invest in healthcare infrastructure and human resources to improve service delivery and accessibility are vital to reduce the current burden in low- and medium-resource countries.
... Diagnoses were based on histological findings. [105,106,1]. Risk factors for some of the reported cases of cancers include active sexual history, age, parity, family history, and vaginal bleeding, among others. ...
Introduction: Gynaecological malignancies cause most death in women. The estimation of gynaecological epidemiology is invaluable in setting priorities for its control. No study has elucidated the epidemiological burden on Nigerian women until this point.
Methods: Our work covered published articles on gynaecological malignancies in Nigeria. The terms of search are "Gynaecological malignancies" and "Nigeria". We searched databases (PubMed, AJOL, Research4Life, Science Direct, Scopus, and Google Scholar), journal homepages (BMC, Sahel Medical Journal), and free web searches of related papers. Downloaded papers were assessed for eligibility following PRISMA 2009.
Results: The charted data indicated that cervical, ovarian, and uterine were the commonest forms. The rarest was fallopian tube cancers. Developed cities in Nigeria, such as Lagos, Zaria, Anambra, and Enugu had the highest number of publications. In contrast, less developed states such as Imo, Lokoja, Oyo, Akwa Ibom, Bauchi, Benin, Delta, Kebbi and Ogun states had the least publications. The histological screening was the primary means of diagnosis. Risk factors for some reported cases include active sexual history, age, parity, and family history.
Conclusions: The distribution pattern of gynaecological cancers is consistent with what is obtainable worldwide, where cervical, ovarian, and uterine cancers were identified as the most prevalent.
National screening protocol, national health insurance schemes, and workforce education are key to early detection, mitigating diseases, and improving survival outcomes.
Keywords: Gynaecological malignancies, cancers, burden, epidemiology, systematic review, prevalence, incidence
... Women with a genetic predisposition to ovarian cancer are diagnosed roughly 10 years earlier than the median age of diagnosis [4].Women are frequently diagnosed with advanced stage disease because of the vague nature of the presenting symptoms [5].Nearly all benign and malignant ovarian tumors originate from one of three cell types: epithelial cells, stromal cells, and germ cells. In developed countries, more than 90% of malignant ovarian tumors are epithelial in origin, 5%-6% of tumors constitute sex cord-stromal tumors (e.g., granulosa cell tumors, the comas, etc.), and 2%-3% are germ cell tumors (e.g., teratomas, dysgerminomas, etc.) [6]. ...
... According to global mortality data from 2019, >75% of the 20.4 million premature deaths occurring between the ages of 30 and 70 are attributed to non-communicable diseases (WHO, 2020). Gynecological cancers, in particular, pose a significant threat to women worldwide, especially for women in low-and middleincome countries (Sankaranarayanan and Ferlay, 2006). Gynecological cancers, including ovarian, cervical, uterine, vaginal, and vulvar cancers, encompass a range of malignancies affecting the female reproductive tract (FRT) (CDC, 2024). ...
Cancer remains a significant global health concern, and understanding factors that regulate cancer development is important. The microbiome, with its potential role in cancer development, progression, and treatment, has garnered increasing attention in recent years. The cervicovaginal and gastrointestinal microbiomes in females constitute complex biological ecosystems. Although the gut microbiome has been extensively studied, little is known about the cervicovaginal microbiome. The microbiome plays a crucial role in maintaining local microenvironments and tissue homeostasis, but dysbiosis can disrupt this fine balance and contribute to pathological ramifications leading to cancer. This review explores the current understanding of the microbiome’s correlation with gynecological cancers and highlights the potential of microbiome-based interventions to improve outcomes in these cancers. In addition, this review underscores the gaps and limitations in the literature, such as findings in specific ethnicities compared with understudied ethnicities. In addition, discrepancies in molecular techniques and terminology (microbiome vs. microbiota) used in the literature are addressed. Emerging evidence linking gynecological cancers and dysbiosis underscores microbiota as a potential target for cancer prevention and therapy. Manipulating the microbiome, such as through the use of probiotics, prebiotics, antibiotics, or vaginal and fecal transplantation, has demonstrated benefits in the treatment of chronic and inflammatory conditions. Further translational research in this field is needed to integrate the benefits of beneficial microorganisms in the fight against gynecological cancers.
... Table 1. The association of PD-L-1 expressions and the clinicopathological characteristics.1 2 observations were missing.2 20 observations were missing.3 ...
Ovarian germ cell tumors (OVGCTs) account for 28% of all diagnosed ovarian cancers, and malignant germ cell tumors specifically account for approximately 13% of diagnosed ovarian cancers in Saudi Arabia. Although most germ cell tumor patients have a high survival rate, patients who experience tumor recurrence have a poor prognosis and present with more aggressive and chemoresistant tumors. The use of immunotherapeutic agents such as PD-L1/PD-1 inhibitors for OVGCTs remains very limited because few studies have described the immunological characteristics of these tumors. This study is the first to investigate PD-L1 expression in ovarian germ cell tumors and explore the role of PD-L1 expression in tumor microenvironment cells and genetic alterations. A total of 34 ovarian germ cell tumors were collected from pathology archives. The collected tumor tissues included ten dysgerminomas, five yolk sac tumors, five immature teratomas, and one mature teratoma, and the remaining samples were mixed germ cell tumors. The tumors were analyzed using immunohistochemical analysis to determine PD-L1 expression, immune cell infiltration and cancer stem cell populations and their correlation with clinical outcome. Furthermore, the genetic alterations in different subtypes of germ cell tumors were correlated with PD-L1 expression and clinical outcome. Datasets for testicular germ cells (TGCTs) were retrieved from The Cancer Genome Atlas (TCGA) and analyzed using cBioPortal (cbioportal.org) and Gene Expression Profiling Interactive Analysis (GEPIA). Compared with yolk sac tumors, dysgerminomas highly express PD-L1 and are associated with high levels of tumor infiltrating lymphocytes (TILs) and stem cell markers. In addition, compared with PD-L1-negative yolk sac tissue, dysgerminomas/seminomas with high PD-L1 expression are associated with more genetic alterations and a better prognosis. Our findings will contribute to the knowledge about the potential benefits of ovarian cancer immunotherapy in specific subsets of germ cell tumor patients and the risk factors for resistance mediated by tumor microenvironment cells.
... Cervical carcinoma is now recognized as the most preventable cancer, as there are various prevention methods, such as primary prevention with HPV vaccination and secondary prevention with effective screening tests [4][5][6]. The risk factors associated with HPV-related cervical cancer include early onset of sexual activity, multiple sex partners, history of sexually transmitted diseases, history of vulvar or vaginal squamous intraepithelial neoplasia or cancer, smoking status, and human immunodeficiency virus (HIV) status [7]. ...
Objective:
The primary objective of this study was to compare the detection rate of high-risk human papillomavirus (HPV) infection between self-sampling to collect vaginal specimens and clinician sampling to collect cervical specimens, as well as the correlation between the two techniques. The secondary objective was to assess satisfaction with self-sampling for HPV testing.
Methods:
From October 2021 to September 2022, women positive for HPV 16/18 and other 12 high-risk HPV genotypes and cytological ASCUS were enrolled. All participants were instructed on the method for self-collection of HPV samples. Self-collected vaginal samples and clinician-collected cervical samples were subjected to HPV DNA typing.
Results:
Paired self- and clinician-collected specimens were obtained from 104 women with positive HPV-positive results. The detection rate of high-risk HPV infection was comparable between the two techniques: 79/98 (80.6%) vs. 81/98 (82.7%) for the self-sampling and clinician-sampling techniques, respectively (McNemar's test; P=0.774). The agreement in detecting HPV infection was substantial, with a kappa coefficient of 0.75. More than 90% of the participants rated self-collection as satisfactory to very satisfactory because of its convenience and safety. Regarding methods of further follow-up, 51% of the participants chose self-sampling, whereas the remaining participants preferred collection by clinicians. No intervention-related complications were observed.
Conclusion:
The self-sampling technique for HPV testing was as effective as the clinician-sampling technique, and both techniques were substantially correlated in detecting high-risk HPV infection. The self-sampling method appears to be highly satisfactory and may provide better compliance for the detection of cervical HPV infection.
... Choriocarcinoma accounts for 0.6% of all gynaecological cancers with the highest incidence rates seen in South-East Asia [22]. In this study, it is the third most common cancer, accounting for 7.5% of the cases. ...
Background
Gynaecological cancers, which affect the female genital tract, constitute a significant public health problem, especially in developing countries. Some of these malignancies have known aetiology and premalignant stages making them preventable. Understanding the burden of gynaecological malignancies in our environment will provide baseline information and help form strategies for their control.
Aim
To describe the histological subtypes of gynaecological cancers, their frequency and age distribution trends in Katsina State over the 10-year study period.
Methods
This was a 10-year retrospective cross-sectional multicenter study of all histologically diagnosed gynaecological cancer cases seen from 1st January 2012 to 31st December 2021 at Federal Teaching Hospital Katsina, General Hospital Katsina and General Amadi Rimi Specialist Hospital Katsina. Data for this study were extracted from departmental record registers of the pathology laboratories of the corresponding hospitals whose laboratories provide pathology services to the State. Cancer distribution over the years was sorted based on the primary site of diagnosis, histological diagnosis and age. Data were analysed using Statistical Package for Social Science version 28 and results were presented in tables and charts.
Results
Two thousand three hundred and fifty-nine cancers were seen over the 10-year study period. Of these cases, 58.4% (n = 1,378) were females. Gynaecological malignancies accounted for 18.7% (441/2,359) of all cancers and 32.0% (441/1,378) of all female cancers. The highest frequency of gynaecological cancers was seen in women who were within the age groups of 40–49 and 50–59, and the lowest was seen in women who were ≥90 years old. The mean age was 48.9 ± 14.9 years. The most common site of gynaecological malignancies was the cervix uteri (n = 262, 59.4%) followed by the ovary (n = 106, 24.0%). Other sites in descending order were corpus uteri (n = 29, 6.6%), vulva (n = 9, 2.0%) and vagina (n = 2, 0.5%). The most common histo-morphologic subtypes were large-cell keratinizing squamous cell carcinoma in the cervix, large-cell non-keratinizing squamous cell carcinoma in the cervix and cystadenocarcinoma in the ovary. Choriocarcinoma was found in 33 cases (7.5%).
Conclusion
This study demonstrated the various histotypes of gynaecological malignancies and their trends in Katsina state. The leading cancer was found to be cervical cancer which is mainly preventable. It is hoped that data from this study will provide a basis for making and implementing policies and strategies to lessen the problems of gynaecological malignancies through regular screening programs, especially for cervical cancer and accepting human papilloma virus (HPV) vaccination take-up.
... Ovarian cancer (OC) is one of the deadliest gynaecological malignancies in women worldwide, with an estimated 19,710 new cases and 13,270 deaths in the United States by 2023 [1]. EOC is the major pathological subtype, accounting for more than 90% of OC cases and is most common in postmenopausal women [2]. The fiveyear survival rate for the EOC is less than 50% despite the application of advanced medical techniques and drugs [3,4]. ...
Background
Epithelial ovarian cancer (EOC) is one of the deadliest gynaecological malignancies worldwide. The aim of this retrospective study was to create a predictive scoring model based on simple immunological and inflammatory parameters to predict overall survival (OS) and progression-free survival (PFS) in patients with EOC.
Methods
We obtained 576 EOC patients and randomly assigned them to the training set (n = 405) and the validation set (n = 171) in a ratio of 7:3. We retrospectively evaluated the association between PIV and OS and PFS using a novel immunoinflammatory marker, according to the optihmal treshold of PIV, we divided the patients into two different subgroups, high PIV (PIV > 254.9) and low PIV (PIV ≤ 254.9). Pan-immune Inflammatory Value (PIV) was computed as follows: neutrophil count (10⁹/L) × platelet count (10⁹/L) × monocyte count (10⁹/L)/lymphocyte count (10⁹/L). Then developed a simple score prediction model based on several independent prognostic parameters using Cox regression analysis. We used receiver operator characteristic (ROC) curves, calibration plots, and decision analysis (DCA) curves to evaluate the performance of the model. Finally, we used Kaplan-Meier curves to ensure that the model could distinguish well between low- and high-risk groups.
Results
There was a significant difference in survival outcomes between high PIV (PIV > 310.2) and low PIV (PIV ≤ PIV310.2) (3-year survival rates of 61.34% and 76.71%, respectively); 5-year OS, 25.21% and 51.14%, respectively; 3-year PFS, 40.90% and 65.30%; 5-year PFS, 19.33% and 39.73%, respectively). Column plots of OS and PFS were constructed using independent prognostic factors. In the training module, the 3-, 5-, and 10-year AUCs for OS and PFS column charts were 0.713, 0.796, 0.839, and 0.730, 0.799, 0.826, respectively.In the validation cohort, the 3-, 5-, and 10-year AUCs for OS and PFS column charts were 0.676, 0.803, 0.685, and 0.700, respectively, 0.754, 0.727. The calibration curves showed good agreement between predicted survival and actual observations. The decision analysis curves also showed that the current model has good accuracy and clinical applicability. 3-year OS was 61.34% and 76.71%, respectively; 5-year OS was 25.21% and 51.14%, respectively; 3-year PFS was 40.90% and 65.30%, respectively; 5-year PFS was 19.33% and 39.73%, respectively.
Conclusions
We constructed and validated a PIV-based nomogram to predict OS and PFS in EOC patients, with a view to helping gynaecologists converge on oncologists in their treatment and follow-up expertise in epithelial ovarian cancer.
... Ovarian malignancies account for 23% of all the gynaecological malignancies and 4% of malignancies, seen in women worldwide [1]. It is the sixth most common malignancy overall and the second most common amongst malignancies of the female genital tract [2]. In India, Delhi and Pune showed the highest incidence of ovarian cancers with incidence rates ranging from 0.9 to 8.4 per 100,000 person-years [3]. ...
Ovarian tumours constitute the second most common tumour of the female genital tract after cervical cancers. The study describes the histological subtypes of ovarian neoplasms along with other parameters like age, laterality and consistency of lesion in a tertiary care centre in Uttarakhand. The retrospective data of ovarian tumours sent to the Department of Pathology was collected over a period of 4.5 years. They were classified into benign, borderline and malignant categories in the respective histological subtypes (surface epithelial, germ cell, sex cord stromal and metastatic) based on the latest WHO classification. The consistency of tumour, laterality and age of the patient were also evaluated. Of the 130 cases studied, 73 (56%) were benign, 13 (10%) were borderline and 44 (34%) were malignant. The majority of cases (73.1%) were surface epithelial tumours, followed by germ cell tumours (20.8%), sex cord stromal tumours (4.6%) cases and metastatic tumours (1.6%). Most cases (80.8%) showed unilateral involvement while 19.2% cases had bilateral involvement. The majority of cases in the present study were benign. Serous cystadenoma was the most common benign tumour with its malignant counterpart being the most common tumour in the malignant category.
... Gynecological cancers are a major cause of morbidity and mortality among women worldwide. The International Agency for Research on Cancer estimates that gynecological cancers contribute approximately 19% of the 5.1 million cancerrelated deaths worldwide, with most of these deaths attributed to cervical cancer 5,6 . Cervical cancerrelated mortality varies between countries, ranging between 0.77/100 000 in Israel and 14.87/100 000 in Chile. ...
... The increased risk with obesity is consistent with numerous studies globally and in India showing 1.5 to 3 times higher 11,12 endometrial cancer odds in those with high BMI. However, the magnitude of this association in our sample was even greater than that reported in meta-analyses. ...
Background: Endometrial cancer rates are rising in India,but research on modifiable risk factors is limited.This study aimed to examine associations between lifestyle exposures and endometrial cancer among Indian women. Methodology: In this retrospective cohort study, medical records of 25 histopathology-confirmed endometrial cancer cases diagnosed from 2015-2020 were reviewed to collect data on obesity, physical activity, smoking, alcohol use, and other factors. Logistic regression analyzed associations with endometrial cancer risk. Results: Mean age at diagnosis was 55 years. Obesity (BMI ≥30 kg/m2) was prevalent in 24% of cases. In adjusted analyses, obesity significantly increased endometrial cancer odds (OR 2.5, 95% CI 1.4-3.9). Former and current smoking also raised risk,with ORs of 3.6 (95% CI 1.9-8.5). No significant associations were found for alcohol use,diabetes, or hypertension. Conclusion: In this study on lifestyle factors and endometrial cancer focused on Indian women, obesity and smoking emerged as important modifiable risk factors. This study provides initial evidence to guide targeted prevention strategies addressing India's escalating endometrial cancer burden.
... Diagnoses were based on histological findings. [105,106,1]. Risk factors for some of the reported cases of cancers include active sexual history, age, parity, family history, and vaginal bleeding, among others. ...
Introduction: Gynaecological malignancies cause most death in women. The estimation of gynaecological epidemiology is invaluable in setting priorities for its control. No study has elucidated the epidemiological burden on Nigerian women until this point. Methods: Our work covered published articles on gynaecological malignancies in Nigeria. The terms of search are "Gynaecological malignancies" and "Nigeria". We searched databases (PubMed, AJOL, Research4Life, Science Direct, Scopus, and Google Scholar), journal homepages (BMC, Sahel Medical Journal), and free web searches of related papers. Downloaded papers were assessed for eligibility following PRISMA 2009. Results: The charted data indicated that cervical, ovarian, and uterine were the commonest forms. The rarest was fallopian tube cancers. Developed cities in Nigeria, such as Lagos, Zaria, Anambra, and Enugu had the highest number of publications. In contrast, less developed states such as Imo, Lokoja, Oyo, Akwa Ibom, Bauchi, Benin, Delta, Kebbi and Ogun states had the least publications. The histological screening was the primary means of diagnosis. Risk factors for some reported cases include active sexual history, age, parity, and family history. Systematic Review Article Ani et al.; IRJO, 6(4): 55-73, 2022; Article no.IRJO.94101 56 Conclusions: The distribution pattern of gynaecological cancers is consistent with what is obtainable worldwide, where cervical, ovarian, and uterine cancers were identified as the most prevalent. National screening protocol, national health insurance schemes, and workforce education are key to early detection, mitigating diseases, and improving survival outcomes.
... On the other hand, psychologically, early detection alleviates the emotional distress associated with a cancer diagnosis, while raising awareness about the benefits and encourages individuals to participate in regular screening programs. Ultimately, emphasizing the importance of early detection contributes to better patient outcomes and improved overall public health [9][10][11] . ...
In today's digital era, the rapid growth of databases presents significant challenges in data management. In order to address this, we have developed and designed CHAMP (Cervical Health Assessment using machine learning for Prediction), which is a user interface tool that can effectively and efficiently handle cervical cancer databases to detect patterns for future prediction diagnosis. CHAMP employs various machine learning algorithms which include XGBoost, SVM, Naive Bayes, AdaBoost, Decision Tree, and K-Nearest Neighbors in order to predict cervical cancer accurately. Moreover, this tool also designates to evaluate and optimize processes, to retrieve the significantly augmented algorithm for predicting cervical cancer. Although, the developed user interface tool was implemented in Python 3.9.0 using Flask, which provides a personalized and intuitive platform for pattern detection. The current study approach contributes to the accurate prediction and early detection of cervical cancer by leveraging the power of machine learning algorithms and comprehensive validation tools, which aim to provide learned decision-making.•CHAMP is a user interface tool which is designed for the detection of patterns for future diagnosis and prognosis of cervical cancer.
•Various machine learning algorithms are employed for accurate prediction.
•This tool provides personalized and intuitive data analysis which enables informed decision-making in healthcare.
... [1] The International Agency for Research on Cancer reported that nearly one million gynecological cancers occurred in 2020. [2] In the Kingdom of Saudi Arabia, 13000 cancers occurred among women, according to the International Agency for Research on Cancer 2020 report; research focusing on gynecological malignancies is scarce in Saudi Arabia. The available studies were limited by the short duration and limited number of patients. ...
... Gynaecological illnesses are a concern to the health of women all over the world, with more than 100,000 women dying each year [2,3]. Gynaecological tumours are one of the most common causes of disease worldwide [4,5], particularly in developing and undeveloped areas [6]. Numerous studies have established a link between ambient air pollution and gynaecological cancers such as ovarian cancer [7], cervical cancer [8], and uterine fibroid [9]. ...
... The worldwide incidence of cervical cancer is approximately 5,10,000 cases annually, with approximately 2,88,000 deaths worldwide. [1] Cervical cancer is the second most common cancer in women in India, with an incidence of 2 per 10,00 population in 2014 and accounting for over 67,477 deaths annually. [2] More developed and less developing countries bear 16% and 84.3% of the global cervical cancer burden respectively (WHO, 2010). ...
... Cancer may appear anywhere in the human body, being the most common one Breast Cancer reporting 287,850 of annual cases, followed by lung cancer with 2,206,771 of annual cases and approximately 350 deaths per day (the deadliest cancer), and then, colorectal cancer with 1,931,590 of annual cases [3]. Regarding Gynecological Cancers (GCs) which are the target of this review, account for 19% of the 5.1 million new cancer cases, causes 2.9 million deaths worldwide per year [4], and has a survival rate for five years of 44%. ...
The International Federation of Gynecology and Obstetrics has recognized the benefits of using Positron Emission Tomography (PET) imaging in the detection, stage evaluation and followup of gynecological cancers (GCs). However, conventional state-of-the-art PET scanners offer low sensitivity and non-uniform spatial resolutions which are insufficient for the correct diagnosis of onco-gynecological lesions. Extending the use of PET in the gynecological practice requires the development of patientadaptable scanners able to provide photon depth of interaction (DOI) information for 3D positioning of the events, time-of-flight (TOF) capabilities and high sensitivity. In addition, the equipment must achieve homogeneous spatial resolutions < 2mm in the entire field-of-view (FOV), better image contrast and, be affordable. The inclusion of such a dedicated PET equipment in gynecological oncology will impact the socio-sanitary field since better image quality enables for better diagnoses, which is a key factor in the recovery and life expectancy of patients. In this review, each of these points are studied, delving into the impact of PET imaging for GCs assessment and how may contribute improving diagnostic and therefore patient recuperation. The present article begins introducing GCs and its incidence in our society. This is followed by a description of the basic concepts underlying PET imaging, the historical facts that contribute to its development and, the main components typically encountered in PET detectors. Then, a revision of the state-of-the-art PET technology is provided highlighting the main limitations encountered for accurate diagnoses of onco-gynecological lesions and, the requirements to overcome them. Finally, some hints regarding the most suitable scanner design for the detection, assessment and followup of gynecologic oncology patients is offered.
... The development of the HPV vaccine has been a huge benefit. Over the past years, numerous studies on the acceptance, knowledge, attitudes, and behaviors around the HPV vaccine have been conducted worldwide (Sankaranarayanan GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2023, VOL 5, ISSUE 2 gggggglo& Ferlay, 2006& Małgorzata, 2021. According to the studies(Aswathy et al., 2012& Ali et al., 2010& Nganwai et al., 2008& Alnafisah et al., 2019 & Tiro et al., 2007 high-income countries had a good understanding of cervical cancer, the PAP test, and the HPV vaccine, but low-income nations including ...
Introduction: Cervical cancer is a major killer among women in less developed countries. It is a preventable disease if screened regularly and women are vaccinated. But late detection leads to poor outcomes and morbidity. The objective was to assess knowledge about Cervical cancer and its practices of screening and vaccination among women health care professionals. Methods: It was a descriptive, cross-sectional survey carried out through an online questionnaire among women healthcare professionals of 21-65 years in various hospitals in Kolkata city, India. Results: 72% (203) Participants had good knowledge, 19%(54) have moderate and 9%(25) had poor knowledge about Cervical cancer, its screening tests, and high-risk factors. Only 34(12.4%) had been completely vaccinated against Human papillomavirus (HPV). Also, 189(67%) women in this group never had a Papanicolaou (PAP) test. Conclusion: Most of the women had good knowledge about Cervical cancer, practices of screening and vaccination, but had not undergone screening or vaccination. A positive uptake towards Cervical cancer screening and vaccination protocols for themselves shall help them in better health promotion towards their clientele. More emphasis needs to be paid to disseminating health information and the importance of screening and vaccination. We need to recognize the need to include the HPV vaccine in the National Immunization Schedule. HPV vaccination and HPV-based PAP screening have the potential to reduce Cervical cancer incidence in the coming decades if implemented on a global basis.
... The worldwide incidence of cervical cancer is approximately 5,10,000 cases annually, with approximately 2,88,000 deaths worldwide. [1] Cervical cancer is the second most common cancer in women in India, with an incidence of 2 per 10,00 population in 2014 and accounting for over 67,477 deaths annually. [2] More developed and less developing countries bear 16% and 84.3% of the global cervical cancer burden respectively (WHO, 2010). ...
Background: Cervical cancer is fifth most common cancer worldwide and second most common cancer in women in India, with an incidence of 1,22,844 cases and accounts for over 67,477 deaths annually (GLOBOCON 2012). Although vaccines are available to prevent the cervical cancer but there is lack of awareness regarding the same. Hence the present study has been proposed. Objectives: To study the awareness of human papilloma virus (HPV) vaccination among the medical students. Methods: A cross-sectional study was conducted between Jan-March 2017 among the medical students. All those who gave consent were included and a predesigned, pretested pro-forma consisting of variables about demographic characteristics, HPV, vaccination and the other necessary information required for the study was collected. Results: 72.4% of the participants were aware of the HPV infection, 70.5% about the HPV vaccination and 69.5% of the participants thought that only females should be vaccinated. 52.3 % of the participants expressed interest for vaccination. Interns had 100% awareness about the infection and vaccination. students who were not interested in vaccination, 18.9% of them said they are not sexually active, 8.5% thought there was no need of vaccine, 6.1% felt vaccine is too expensive and 1.3% worried about the safety of the vaccine. Sources of information was mainly through lectures/textbooks (64.8%) followed by doctors/healthcare facility (20.9%). Conclusion: study revealed appreciable level of awareness among the participants. With this study, the participants are encouraged to get vaccinated as the age group of participants is appropriate for the vaccination.
... Cervical cancer screening and free HPV vaccination have reduced cervical cancer mortality rates. However, the success of these programs relied heavily on public awareness of cervical cancer prevention [11]. ...
Background
Increasing women’s health literacy is the key to preventing cervical cancer, and various tools have been developed to assess women’s cancer health literacy. However, many of these tools come from other countries and have not been adapted to Chinese requirements. Furthermore, a system for evaluating cervical cancer health literacy among Chinese women has not been developed. Therefore, we sought to establish an evaluation index system for cervical cancer health literacy among Chinese women and to provide an effective evaluation tool for tertiary prevention of cervical cancer in China.
Methods
We invited 20 recognized experts to participate in two rounds of Delphi expert consultation, and the modified Delphi process with percentage weighting and multiplication was used. A literature review identified 67 potential indicators. Subsequent discussions within our research team led to the retention of 48 indicators following a rigorous screening process. On this basis, two rounds of Delphi expert consultation were conducted to rate and screen the indexes. Percentage weighting and multiplication were used to determine index weights.
Results
Twenty experts participated in the first-round Delphi consultations (95.23% recovery rate). In the second-round Delphi consultations, 20 questionnaires were returned (100%), and the expert authority coefficient was 0.93 ± 0.02. After both rounds of Delphi consultation, 4 first-level indicators, 9 second-level indicators, and 32 third-level indicators were identified for cervical cancer literacy among Chinese women. On a five-point scale, importance ratings ranged from 3.76 to 4.95 points, with variation coefficients ranging from 0.06 to 0.25, while sensitivity ratings ranged from 3.71 to 4.83 points, with variation coefficients ranging from 0.08 to 0.24. Across both rounds, Kendall’s W coefficients ranged from 0.168 to 0.248. The weights of first-level indicators of basic knowledge and attitudes about cervical cancer, primary prevention of cervical cancer literacy, secondary prevention of cervical cancer literacy, and tertiary prevention of cervical cancer literacy were 0.257, 0.249, 0.251, and 0.243, respectively.
Conclusions
We have developed the first tertiary prevention-based, comprehensive evaluation index system for cervical cancer literacy among Chinese women, which will provide theoretical support for cervical cancer prevention and health education programs.
... In developing countries, cervical cancer cases have significantly decreased due to screening tests. However, the mortality and morbidity rates for cervical cancer remain high, at approximately 85% and 83%, respectively [2][3][4][5]. Moreover, more than 80% of patients with cervical cancer in less developed countries are diagnosed at an advanced stage [6]. ...
Background:
Cervical cancer is the fourth most common cancer among females worldwide. Identifying peptide patterns discriminating healthy individuals from those with diseases has gained interest in the early detection of cancers. Our study aimed to determine signature peptide patterns for cervical cancer screening.
Methods:
Our study focused on the serum peptidome analysis of 83 healthy women and 139 patients with cervical cancer. All spectra derived from matrix-assisted laser desorption/ionization time-of-flight mass spectrometry were analyzed using FlexAnalysis 3.0 and ClinProTools 2.2 software.
Results:
In the mass range of 1000-10,000 Da, the total average spectra were represented as the signature pattern. Principal component analysis showed that all the groups were separately distributed. Furthermore, the peaks at m/z 1466.91, 1898.01, 3159.09, and 4299.40 significantly differed among the investigated groups (Wilcoxon/Kruskal-Wallis test and ANOVA, p < 0.001).
Conclusions:
Laboratory-based rapid mass spectrometry showed that serum peptidome patterns could serve as diagnostic tools for diagnosing cervical cancer; however, verification through larger cohorts and association with clinical data are required, and the use of externally validated samples, such as patients with other types of cancers, should be investigated to validate the specific peptide patterns.
... The posttest completed within 5 days, that is one day in each school. Lack of hygiene and more than one sexual contact had been the best chance elements stated with the aid of using 3.9 in step with cent (32) and 1.6 in step with cent (13) An experimental study was undertaken with the objectives to assess and evaluate the effectiveness of an informational booklet on prevention of cervical cancer in terms of knowledge and attitude among female college students before and after the administration of informational booklet Paired "t" test was used to find out the significance Of difference in mean pretest and posttest knowledge The finding recommend that the mean posttest knowledge score (25.9) was essentially higher than mean pre-test information score (20.2) at p < 0. 05 questionnaires. In the study the mean pretest knowledge score was 9.17, median knowledge score 10, and standard deviation was 2.18 in the ranged from 5-13, which indicated that the knowledge level of the patients having cervical cancer were assessed by the researcher. ...
... Around 288,000 people die from cervical cancer each year worldwide. 3 In Sub-Saharan Africa, the annual death rate for the disease is 22.5/100,000 women, while the rate of new cases is 34.8/100,000 women. On the other hand, these numbers are 2.5 and 6.6, respectively, 4 in North America. ...
Cancer of the cervix is the most common genital tract malignancy in the female and is a major public health problem in developing countries. Study of the sociodemographic data, clinical profile and compliance of patients is the first step in planning preventive measures and treatment facilities.
The aims of the study were to determine the sociodemographic data and clinical profile, prognostic factors, compliance to concurrent chemo radiation of cervical cancer patients and study their association with other tumor-related factors.
Our study is a record-based retrospective study from a single institution. The data of sociodemographic and clinical factors of 175 cervical cancer patients visited and their compliance to treatment were analyzed over a 2-year period. Data were analyzed using descriptive statistics.
The mean age at presentation in our study is 54.8 years. The patients presented with bleeding per vagina as the most common presenting complaint i.e. 42.28%.38.88% patients presented with both bleeding per vagina and white discharge per vagina and 18.85% patients presented with white discharge per vagina.21.14% presented with symptoms less than 1 month, 52 patients presented with symptoms 1to 3 months duration. 49.14% presented with symptoms >3months. In our study, 62.85% patients were married at age < 17> 17 years. squamous cell carcinoma is the most common histology in our study accounting for 85.71% followed by adenocarcinoma 11.42% other histoligies accounted for 2.85%.87.42% were grade 2 histologies. Stage IIB is the most common stage of presentation our study 47.4%. 86.28% patient are compliant with planned treatment (external beam radiotherapy +brachy therapy, 4.57% patients defaulted prior to the start of treatment, 3.42% patients defaulted during external beam radiotherapy, 15.71% defaulted for brachytherapy out of 151 patients who completed planned treatment, 80.79% patients received 5-6 cycles of concurrent ciplatin 40mg/m 2.11.92% were lost to follow up at the end of 1 year.
Cervical cancer is a debilitating illness seen to affect mainly elderly women. Late presentation is still the norm, as majority of the patients presented with advanced disease at the time of diagnosis and were treated with radical radiotherapy, with or without chemotherapy. Compliance during treatment was good comparable to the other studies. The response and complication rates were comparable with other datasets. Further, the scope of studying socio-demographic factors is not limited to hospital services, and this information can also be utilized while making public health policies and implementation of cervical cancer control programs.
... Ovarian cancer is a well-known lethal gynecological cancer that impacts females worldwide [1]. Most cases of ovarian cancer are typically due to epithelial cells and are divided into five subtypes: high-grade serous, low-grade serous, mucinous, endometrioid, and clear cell carcinoma [2]. Among ovarian epithelial cells, high-grade serous carcinoma is the most common subtype in ovarian cancer patients [3,4]. ...
In the current study, we identified a mechanism of resveratrol (RES) underlying its anti-cancer properties against human ovarian adenocarcinoma SKOV-3 cells. We investigated its anti-proliferative and apoptosis-inducing effects in combination with cisplatin, using cell viability assay, flow cytometry, immunofluorescence study and Western blot analysis. We discovered that RES suppressed cancer cell proliferation and stimulated apoptosis, especially when combined with cisplatin. This compound also inhibited SKOV-3 cell survival, which may partly be due to its potential to inhibit protein kinase B (AKT) phosphorylation and induce the S-phase cell cycle arrest. RES in combination with cisplatin strongly induced cancer cell apoptosis through activating the caspase-dependent cascade, which was associated with its ability to stimulate nuclear phosphorylation of p38 mitogen-activated protein kinase (MAPK), well recognized to be involved in transducing environmental stress signals. RES-induced p38 phosphorylation was very specific, and the activation status of extracellular signal-regulated kinase 1/2 (ERK1/2) and c-Jun N-terminal kinase (JNK) was not mainly affected. Taken together, our study provides accumulated evidence that RES represses proliferation and promotes apoptosis in SKOV-3 ovarian cancer cells through activating the p38 MAPK pathway. It is interesting that this active compound may be used as an effective agent to sensitize ovarian cancer to apoptosis induced by standard chemotherapies.
... Contaminated water sources become the sources of spread of human diseases, including diarrhea, hepatitis, encephalitis, cryptosporidiosis, leptospirosis, and typhoid fever; it has been linked Globally, the incidence of hepatitis A is predicted to 1.40 million patients, with a fatality rate between 12,800 and 16,100 per annum [9]. ...
In this research, hydrothermally synthesized tungsten trioxide (WO3) nanocomposites doped polyvinylpyrrolidone (PVP) and chitosan (CS) were studied. Various concentrations (3, 6, and 9 wt%) of PVP were doped into a fixed amount of binary system (CS-WO3) nanocomposites. PVP/CS polymers showed attractive attention because of their different structure, functionality, and architecture control as dopant to WO3. The PVP/CS encapsulates the WO3 (ternary composite), which controls crystallite size (band gap reduction), rapidly overcomes the recombination electron-hole pairs issues, and generates the active sites, resulting in improved catalytic and antimicrobial activity. The synthesized nanocomposites revealed significant catalytic efficiency and methylene blue (MB) dye depletion of 99.9 % in the presence of reducing agent (NaBH4) in neutral and acidic media. Antimicrobial effectiveness of produced nanostructures towards Escherichia coli (E. coli) pathogen at low and high concentrations were investigated by Vernier caliper in mm. Furthermore, to their microbicidal action, docking experiments of CS-doped WO3 and PVP/CS-doped WO3 nanostructures for DHFR and FabI of Escherichia coli suggested blockage of aforesaid enzymes as the plausible pathway.
... Nearly all benign and malignant ovarian tumors originate from one of three cell types: epithelial cells, stromal cells, and germ cells. More than 90% of malignant ovarian tumors are epithelial in origin, 5%-6% of tumors constitute sex cord-stromal tumors, and 2%-3% are germ cell tumors [2]. Due to its unknown pathophysiology some of the proposed hypotheses for the development of ovarian cancer are such as "Incessant ovulation theory", Ovulation includes an inflammatory process with leukocyte infiltration and release of inflammatory mediators and reactive oxidants that can cause DNA damage. ...
Ovarian cancer is the most fatal gynecological disease and arises from epithelial cells, stromal cells, and germ cells. The incidence of ovarian cancer increases with age, with a peak incidence at the age of 50-60 years. Almost 60% of the women who develop ovarian cancer will lead to death. Some of the risk factors for ovarian cancer involve hysterectomy, pelvic inflammatory disease, and polycystic ovarian syndrome. In this review, we discussed various animal models which accurately represent the cellular and molecular changes associated with the initiation and progression of human ovarian cancer and have significant potential to facilitate the development of better methods for the early detection and treatment of ovarian cancer. Also, we reviewed the reliability and limitations of the existing tumor models.
... Vulvar cancer (VC) is the fourth most common genital tumor in women, accounting for 3% of all gynecological cancers worldwide (Sankaranarayanan and Ferlay 2006). Albeit VC is considered a rare tumor entity, its incidence has increased over the recent decade by 20%. ...
Purpose
Vulvar squamous cell carcinoma (VSCC) is a rare malignancy of the female genital tract with increasing incidence rates. Etiologically, HPV-dependent and HPV-independent VSCC are distinguished. Surgical treatment and/or radiotherapy represent the therapeutic mainstay for localized disease. For recurrent or metastatic VSCC, treatment options are limited. Research has identified trophoblast cell surface antigen 2 (TROP-2) to be broadly expressed across different tumor entities. The aim of the present study was to systematically investigate the expression of TROP-2 in VSCC.
Methods
TROP-2 protein expression was investigated by immunohistochemistry in a cohort comprising n = 103 patients with primary VSCC. A four-tier scoring system (0: no staining, 1 + : low staining, 2 + : moderate staining, 3 + : high staining) was applied for quantification of protein expression. For further analyses, two groups (low TROP-2 expression: 0/1 + ; high TROP-2 expression: 2 + /3 +) were generated. The entire study cohort, as well as HPV-dependent and HPV-independent VSCC were considered separately.
Results
In the entire VSCC study cohort, TROP-2 expression was present in 97.1% of all cases (n = 100) with 74.8% displaying high TROP-2 expression (2 + /3 +). Only 2.9% of tumors showed absent TROP-2 expression. Of note, all HPV-dependent VSCC (n = 18) demonstrated high TROP-2 expression (2 + /3 +). In the subgroup of HPV-independent VSCC (n = 70), high TROP-2 expression was associated with favorable clinical outcomes based on log rank test and univariate cox analysis.
Conclusion
TROP-2 protein expression is of prognostic value in HPV-independent VSCC. The broad expression of TROP-2 in VSCC indicates the TROP-2 directed ADC Sacituzumab govitecan as a potential new therapeutic strategy for VSCC patients.
... Ovarian cancer (OC) is one of the most lethal gynecological malignancies among women worldwide, with 81,584 new cases and 54,220 deaths in 2022 [1,2]. Epithelial Ovarian cancer (EOC) is the most predominant pathologic subtype, accounting for over 90% of OC cases, which is most commonly diagnosed among women of post-menopausal age [3]. Although advanced medical techniques and drugs had been applied, the five-year survival rate of EOC is still below 50% [4,5]. ...
Background
Epithelial ovarian cancer (EOC) is one of the most fatal gynecological malignancies among elderly patients. We aim to construct two nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) in elderly EOC patients.
Methods
Elderly patients with EOC between 2000 and 2019 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Enrolled patients were randomly divided into the training and validation set at a ratio of 2:1. The OS and CSS were recognized as endpoint times. The independent prognostic factors from the multivariate analysis were used to establish nomograms for predicting the 3-, 5- and 10-year OS and CSS of elderly EOC patients. The improvement of predictive ability and clinical benefits were evaluated by consistency index (C-index), receiver operating characteristic (ROC), calibration curve, decision curve (DCA), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Finally, the treatment efficacy of surgery and chemotherapy in low-, medium-, and high-risk groups were displayed by Kaplan–Meier curves.
Results
Five thousand five hundred eighty-eight elderly EOC patients were obtained and randomly assigned to the training set (n = 3724) and validation set (n = 1864). The independent prognostic factors were utilized to construct nomograms for OS and CSS. Dynamic nomograms were also developed. The C-index of the OS nomogram and CSS nomogram were 0.713 and 0.729 in the training cohort. In the validation cohort, the C-index of the OS nomogram and CSS nomogram were 0.751 and 0.702. The calibration curve demonstrated good concordance between the predicted survival rates and actual observations. Moreover, the NRI, IDI, and DCA curves determined the outperformance of the nomogram compared with the AJCC stage system. Besides, local tumor resection had a higher benefit on the prognosis in all patients. Chemotherapy had a better prognosis in the high-risk groups, but not for the medium- risk and low-risk groups.
Conclusions
We developed and validated nomograms for predicting OS and CSS in elderly EOC patients to help gynecologists to develop an appropriate individualized therapeutic schedule.
... The clinico-pathologic prognostic elements and existence of more young versus more elderly women with epithelial ovarian cancer ought to be analyzed [5]. From 1988 to 2001, information on patients with ovarian cancer from the Reconnaissance, The study of cancer transmission, and Outcome Program were gathered in a study conducted by Mohammed et al.,. ...
The paper is based on a two-step procedure known as "Systematic Literature Network Analysis (SLNA)" (Colicchia & Strozzi, 2012): a systematic literature review (SLR) and a subsequent analysis of the subset of pertinent articles obtained through a bibliographic network analysis (NA): specifically, the citation network analysis, the co-occurrence networks analysis, and the basic statistics. The first qualitative evaluation is primarily based on the researchers' opinions regarding the choice of keywordsand relies on an explanatory approach, whereas the bibliometric evaluation offers more objective insights through quantitative and statistical data (Aliyev et al., 2018). The most influential author names, journal titles, article titles, article keywords, and publication years are only a few examples of the bibliographic data examined by bibliometric approaches. The topic of the study is ovarian cancer among GenY, from reservoir of academic databases like Pubmed and Scopus, the authors have accumulated list of publications relating to keywords which are ovarian cancer, family risk, IVF and smoking which was limited to the area of medical, human, female, ovary, cancer and health .
Current treatments for gynecological cancers include surgery, radiotherapy, and chemotherapy. However, these treatments often have significant side effects. Phytochemicals, natural compounds derived from plants, offer promising anticancer properties. Coumarins, a class of benzopyrone compounds found in various plants like tonka beans, exhibit notable antitumor effects. These compounds induce cell apoptosis, target PI3K/Akt/mTOR signaling pathways, inhibit carbonic anhydrase, and disrupt microtubules. Additionally, they inhibit tumor multidrug resistance and angiogenesis and regulate reactive oxygen species. Specific coumarin derivatives, such as auraptene, praeruptorin, osthole, and scopoletin, show anti-invasive, anti-migratory, and antiproliferative activities by arresting the cell cycle and inducing apoptosis. They also inhibit metalloproteinases-2 and -9, reducing tumor cell migration, invasion, and metastasis. These compounds can sensitize tumor cells to radiotherapy and chemotherapy. Synthetic coumarin derivatives also demonstrate potent antitumor and anticancer activities with minimal side effects. Given their diverse mechanisms of action and minimal side effects, coumarin-class phytochemicals hold significant potential as therapeutic agents in gynecological cancers, potentially improving treatment outcomes and reducing side effects. This review will aid in the synthesis and development of novel coumarin-based drugs for these cancers.
Ovarian germ cell tumors (GCT) comprise 15-20% of ovarian neoplasms of which 3-5% are malignant. The incidence of ovarian germ cell tumor in pregnancy is low and malignant GCT account for 18-26%. Among the malignant GCTs, Dysgerminoma is the most common tumor followed by Yolk sac tumor. An interesting case of Malignant mixed germ cell tumor in 23-year old pregnant lady who had a full term normal delivery is reported. The patient remained asymptomatic till term pregnancy. Routine ultrasonography misdiagnosed as swelling as a fibroid in early 8 week of gestation, which progressed to a size 13x10cm at 32 week gestation. At 38 weeks, patient underwent LSCS along with resection of the tumor which mimicked as fibroid. On histopathological examination along with Immunohistochemistry, it was reported as malignant mixed GCT with Dysgerminoma (85%) and Yolk sac tumor (15%) components. Misdiagnosis is not uncommon in pregnancy; hence multidisciplinary approach can help in arriving at an earlier and correct diagnosis which further helps in early and appropriate treatment thereby increasing the survival rates. This case is reported for its rare presentation mimicking as a fibroid radiologically and histopathological examination reported as Malignant Mixed GCT and was associated with a successful term viable pregnancy.
Introduction: To evaluate the results of surgical treatment of ovarian cancers at the Donka Oncology Surgery Unit. Patients and methods: This was a retrospective cohort of patients operated for histologically confirmed ovarian cancer from April 11, 2007 to December 31, 2017. Results: We collected 69 cases of ovarian cancer, of which 20 (28.98%) were operated on. The age ranged from 13 to 66 years with an average of 41.5 years; 45% were menopausal and 35% multiparous. The abdominopelvic pain and ascites were revealing respectively in 14 and 11 patients. The preoperative diagnosis was based on abdomino-pelvic ultrasound performed in 19 patients, she objectified the ovarian mass in 57.9% of cases. During the initial surgery, minimal cytoreduction was obtained in 14 patients and maximum cytoreduction in 6 patients. Second-look surgery was performed in 6 of the operated patients. The postoperative complications observed were ventral hernia, suppuration and evisceration with 2 locoregional recurrences. Survival at 12 months was 38%. Conclusion: The diagnosis of ovarian cancer is late. Surgery remains the standard treatment supported by chemotherapy to improve the survival and prognosis of ovarian cancer in our context. Keywords: Ovarian cancer - results - surgical treatment
Enhancing nurse's knowledge and performance helps them in facing challenges in caring for women with gynecologic cancer undergoing chemotherapy. This study Aimed to investigate the effect of developing and implementing of evidence-based nursing guidelines for women with gynecological cancer undergoing chemotherapy. Subject & Method: a quasi-experimental study design was used in carrying out this study at gynecological oncology unit of Maternity Hospital, outpatient & inpatient gynecological department of Radiation Oncology & Nuclear Medicine center of Ain Shams University. A purposive sample of 40 nurses working in these units & 50 women was included in the study. Tools: Data were collected through Five types of tools, Opinionnaire sheet for expertise, a structured interviewing questionnaire and observation checklist for nurses, Dairy and opinionnaire sheet to evaluate women's response to the care they received, In addition to, supportive material (evidence based nursing guideline for women with gynecological cancer) Results: Statistically significant improvements of nurses' knowledge and performance were found after implementation of the guidelines as well as at the follow-up. The percentages of adequate performance have demonstrated a declining trend at 3-month follow-up, but never dropped down to pre-guidelines levels. also The study revealed that women's side effects of chemotherapy were reduced after implementation of evidence based guideline. Conclusion: implementation of evidence based nursing care guidelines led to improvement of nurses' knowledge & performance, and had a positive women's response regarding nursing care they received. Recommendations: developed nursing care guidelines should be more widely used, and similar ones need to be developed for other treatment modalities (radiotherapy& surgical treatment).
Background
Ovarian germ cell tumors (OVGCTs) account for 28% of all diagnosed ovarian cancers, and malignant germ cell tumors specifically account for approximately 13% of diagnosed ovarian cancers in Saudi Arabia. Although most germ cell tumor patients have a high survival rate, patients who experience tumor recurrence have a poor prognosis and present with more aggressive and chemoresistant tumors. The use of immunotherapeutic agents such as PD-L1/PD-1 inhibitors for OVGCTs remains very limited because few studies have described the immunological characteristics of these tumors. This study is the first to investigate PD-L1 expression in ovarian germ cell tumors and explore the role of PD-L1 expression in tumor microenvironment cells and genetic alterations.
Methods
A total of 34 ovarian germ cell tumors were collected from pathology archives. The collected tumor tissues included ten dysgerminomas, five yolk sac tumors, five immature teratomas, and one mature teratoma, and the remaining samples were mixed germ cell tumors. The tumors were analyzed using immunohistochemical analysis to determine PD-L1 expression, immune cell infiltration and cancer stem cell populations and their correlation with clinical outcome. Furthermore, the genetic alterations in different subtypes of germ cell tumors were correlated with PD-L1 expression and clinical outcome. Datasets for testicular germ cells (TGCTs) were retrieved from The Cancer Genome Atlas (TCGA) and analyzed using cBioPortal (cbioportal.org) and Gene Expression Profiling Interactive Analysis (GEPIA).
Results
Compared with yolk sac tumors, dysgerminomas highly express PD-L1 and are associated with high levels of infiltrating lymphocytes and stem cell markers. In addition, compared with PD-L1-negative yolk sac tissue, dysgerminomas/seminomas with high PD-L1 expression are associated with more genetic alterations and a better prognosis.
Conclusion
Our findings will contribute to the knowledge about the potential benefits of ovarian cancer immunotherapy in specific subsets of germ cell tumor patients and the risk factors for resistance mediated by tumor microenvironment cells.
Gynaecological cancer is a prevalent type of cancer affecting women worldwide, and early detection is critical for successful treatment and prevention of cancer recurrence. In our study, we introduce an innovative method to predict cervical cancer risk using a combination of deep learning models. Our approach employs a nested ensemble technique, where multiple deep learning base models are individually trained and then integrated to create a more precise ensemble model. In the initial phase of our nested ensemble method, we leverage sophisticated stacking deep learning techniques, including Convolutional Neural Networks (CNNs), Recurrent Neural Networks (RNNs), and Support Vector Machines (SVMs). The subsequent MetaClassifier section introduces a voting mechanism, seamlessly integrating methods such as j48 and SGD. Our experimental findings reveal that our method surpasses expectations, demonstrating superior performance compared to existing state-of-the-art approaches in analyzing cervical cancer data.
Background
Ovarian cancer (OC) is commonly diagnosed among older women who have comorbidities. This hypothesis‐free phenome‐wide association study (PheWAS) aimed to identify comorbidities associated with OC, as well as traits that share a genetic architecture with OC.
Methods
We used data from 181,203 white British female UK Biobank participants and analysed OC and OC subtype‐specific genetic risk scores (OC‐GRS) for an association with 889 diseases and 43 other traits. We conducted PheWAS and colocalization analyses for individual variants to identify evidence for shared genetic architecture.
Results
The OC‐GRS was associated with 10 diseases, and the clear cell OC‐GRS was associated with five diseases at the FDR threshold ( p = 5.6 × 10 ⁻⁴ ). Mendelian randomizaiton analysis (MR) provided robust evidence for the association of OC with higher risk of “secondary malignant neoplasm of digestive systems” (OR 1.64, 95% CI 1.33, 2.02), “ascites” (1.48, 95% CI 1.17, 1.86), “chronic airway obstruction” (1.17, 95% CI 1.07, 1.29), and “abnormal findings on examination of the lung” (1.51, 95% CI 1.22, 1.87). Analyses of lung spirometry measures provided further support for compromised respiratory function. PheWAS on individual OC variants identified five genetic variants associated with other diseases, and seven variants associated with biomarkers (all, p ≤ 4.5 × 10 ⁻⁸ ). Colocalization analysis identified rs4449583 (from TERT locus) as the shared causal variant for OC and seborrheic keratosis.
Conclusions
OC is associated with digestive and respiratory comorbidities. Several variants affecting OC risk were associated with other diseases and biomarkers, with this study identifying a novel genetic locus shared between OC and skin conditions.
Progesterone (P4), commonly administered in high doses for endometrial cancer palliative management, has limitations in current delivery systems. This preliminary in vitro drug release study introduces electrospun patches to offer a new perspective on P4 delivery. The study aimed to assess the influence of the surfactant polysorbate 80 (PS80) on the release of P4 from polycaprolactone (PCL) fibers. The PS80 effects are examined to inform the fine‐tuning of the fibre generation process. Patches developed, PCL wet (with PS80) and PCL dry (without PS80), showed encapsulation efficiencies of 76% and 42%, respectively. The dose levels studied are 6.1 mg for PCL wet and 4.4 mg for PCL dry samples. Molecular studies show that higher surfactant levels improved P4‐polymer mixing, enhancing dissolution and release rates. Patches with PS80 released 66% of the drug in 17 h, while those without released only 51%. Release data best fit the Weibull model, showcasing promise for these patches in transdermal P4 delivery. This study offers a non‐invasive option compared to traditional methods and underscores the need for further research to confirm the patches' clinical effectiveness for potential use in gynecological oncology.
Objective: The objective of the study was to determine the knowledge of cervical cancer, patients' life style in relation to risk factors for cervical cancer and utilization of Pap smear as a screening method for cervical cancer.Materials and Method: A structured questionnaire incorporating demographic, life style and knowledge of cervical cancer and its prevention was distributed to 500 consecutive women attending the gynaecological out- patient clinic of the Obafemi Awolowo University Teaching Hospital.Results: 437 (87.4%) respondents completed the questionnaire. The mean age of respondents was 37.1 years (17-70). Knowledge of cervical cancer was low, as 62.7% of the respondents had never heard of cervical cancer. Also very few had actually done Pap smear.Conclusion: Knowledge of cervical cancer is poor among Nigerian women and there is poor utilization of screening services
Ovarian cancer (OC) is the second most common gynaecological malignancy. It typically affects females over the age of 50, and since 75% of cases are only discovered at stage III or IV, this is a sign of a poor diagnosis. Despite intraperitoneal chemotherapy's chemosensitivity, most patients relapse and face death. Early detection is difficult, but treatment is also difficult due to the route of administration, resistance to therapy with recurrence, and the need for precise cancer targeting to minimize cytotoxicity and adverse effects.
On the other hand, undergoing debulking surgery becomes challenging, and therapy with many chemotherapeutic medications has manifested resistance, a condition known as multidrug resistance (MDR). Although there are other therapeutic options for ovarian cancer, this article solely focuses on co-delivery techniques, which work via diverse pathways to overcome cancer cell resistance. Different pathways contribute to MDR development in ovarian cancer; however, usually, pump and non-pump mechanisms are involved. Striking cancerous cells from several angles is important to defeat MDR. Nanocarriers are known to bypass the drug efflux pump found on cellular membranes to hit the pump mechanism.
Nanocarriers aid in the treatment of ovarian cancer by enhancing the delivery of chemotherapeutic drugs to the tumour sites through passive or active targeting, thereby reducing unfavorable side effects on the healthy tissues. Additionally, the enhanced permeability and retention (EPR) mechanism boosts the bioavailability of the tumour site. To address the shortcomings of conventional delivery, the current review attempts to explain the current conventional treatment with special reference to passively and actively targeted drug delivery systems (DDSs) towards specific receptors developed to treat ovarian cancer. In conclusion, tailored nanocarriers would optimize medication delivery into the intracellular compartment before optimizing intra-tumour distribution. Other novel treatment possibilities for ovarian cancer include tumour vaccines, gene therapy, targeting epigenetic alteration, and biologically targeted compounds. These characteristics might enhance the therapeutic efficacy.
Objective
We compared the performance of high-risk human papillomavirus (HPV) messenger RNA testing of physician- and self-collected specimens for detecting histological grade 2 or higher cervical intraepithelial neoplasia (CIN) among women who visited a colposcopy clinic in Thailand.
Methods
From January 2022 to April 2022, 500 women participated in this cross-sectional multicenter study; 494 had complete data and valid specimen results. The participants were women who attended any one of the 10 participating institutes’ colposcopy clinics due to abnormal cytology, positive high-risk HPV testing, or for follow-up. Participants used a self-sampling Aptima Multitest Swab specimen collection kit to self-collect vaginal samples before physicians biopsied the cervix during the colposcopic examination. The self- and physician-collected specimens were tested for high-risk HPV messenger RNA using Aptima nucleic acid amplification assays. Cervical tissues were collected during colposcopic-directed biopsy from the most severe lesion or a random biopsy and endocervical curettage specimen if no lesion was detected.
Results
We detected high-risk HPV messenger RNA in 75.4% of self-collected specimens and 70.6% of physician-collected specimens. The prevalence of histological grade 2 or higher CIN from cervical histology was 25.1% (n=124). For self-collected specimens, the sensitivity and specificity of high-risk HPV messenger RNA for grade 2 or higher CIN were 87.0% (95% CI 79.7% to 92.4%; n=108) and 28.5% (95% CI 24.0% to 33.4%). For physician-collected specimens, the sensitivity and specificity of high-risk HPV messenger RNA for grade 2 or higher CIN were 90.2% (95% CI 83.6% to 94.9%; n=112) and 36.1% (95% CI 31.2% to 41.3%).
Conclusions
Self-collected specimens for high-risk HPV messenger RNA testing demonstrated good sensitivity and negative predictive value for detecting grade 2 or higher CIN in Thai women attending the participating institutes’ colposcopy clinics. Self-collected samples performed similarly to physician-collected ones.
Context
There has been an increase in the incidence of gastrointestinal and gynaecological cancers and advancement in surgeries has made surgical treatment more for these participants more feasible.
Aim
To evaluate the effect of structured early mobilization programs in postoperative gastrointestinal and gynaecological cancer patients on 30second chair stand test, functional assessment of cancer therapy-general (FACT-G) and length of hospital stay.
Settings and Design
This was a clinical trial conducted at tertiary care hospital on gastrointestinal and gynecological cancer patients.
Materials and Methods
Participants diagnosed with gastro-intestinal (n = 23) and gynaecological (n = 17) cancers who underwent surgery were included in the study. Lower extremity strength was assessed using 30 s chair stand test and the quality of life (QOL) was assessed using the FACT-G Scale. Length of hospital stay was noted from the postoperative day 1 till the day of discharge.
Statistical Analysis Used
Wilcoxon Test and Spearman's rank correlation coefficient test were used for analysis.
Results
Early mobilization program in postoperative gastro-intestinal and gynecological surgery participants showed improvement in the lower extremity strength in terms of 30 s chair stand test ( P = 0.001). Moreover, improvements were also observed in the components of QOL viz., physical ( P = 0.004), social ( P = 0.041) and functional ( P = 0.004) components.
Conclusion
The study findings demonstrate improvement in lower extremity strength in terms of 30 s chair stand test and QOL according to FACT-G.
Introduction:
there is a great diversity in the profile of cancers in the world. This study set out to analyze the profile of gynecological cancer in Federal University Teaching Hospital, Owerri, [FUTHO] (former Federal Medical Centre, Owerri, Imo state, Nigeria). Methods: this was a retrospective cross sectional descriptive study of the records of women admitted in the gynecological ward in FUTHO from January 2020 to November 2022. It was analyzed using SPSS version 23.0 and reported in simple percentages for categorical variables and measures of central tendency for quantitative variables.
Results:
a total of 1,378 gynecological patients were admitted into the Gynaecological ward of the hospital, out of which 242 (17.6%) were cancer cases. The most common cancer over the three years in review, was ovarian, 81 (33.5%), followed by cervical, 66 (27.3%), endometrial, 65 (26.8%), choriocarcinoma, 22 (9.1%), vulvar, 6 (2.5%) and vagina, 2 (0.8%). The most common gynecological cancers in this study is very different from previous reports from Nigeria and other African countries. The pattern looks like that seen in developed countries where endometrial and ovarian cancers top the list.
Conclusion:
this report shows a possible change in lifestyle and improved access to cervical cancer prevention strategies. It is also assumed that all the facilities who have recorded cervical cancer as the most common cancer can actually have a similar result as ours if a more current review is done.
Antitumor immune response requires the presence, activation, and stimulation of all lymphoid components of the immune system. An increasing number of studies on this topic have led to the recognizing that the accumulation of tumor-infiltrating lymphocytes (TILs) in gynecological cancer is prognostic for increased survival through activation of an advanced immune response.Cancer immunoediting, the interaction process between the immune system and tumor, represents a dynamic process, with TILs playing an important role in antitumor response. Cancer development may be constrained or promoted by the immune system in three specific steps: elimination, equilibrium, and escape.Recently, therapies that modulate the immune system have emerged as a new, effective, life-changing approach in several cancers. Combination of immunotherapy and traditional treatments has proved effective in preventing tumor development, thus improving both the prognosis and overall survival of cancer patients. Immunomodulatory therapies have already become standard of care for some cancers. Such an approach can possibly be extended also to gynecological cancers. Despite extensive knowledge in tumor diagnosis and treatment, new strategies are strongly required that while effective at attacking the disease, can also be more tolerable.This chapter is devoted to authors’ analysis of tumor response mechanisms and TILs action in gynecological malignancies, both from a molecular and a clinical perspective.KeywordsCervical cancerEndometrial cancerEpithelial ovarian cancerImmune systemProgrammed cell death-1 (PD-1)Tumor-infiltrating lymphocytes (TILs)
Purpose: To provide perspective on patient-reported outcome measurement (PROM) instruments to adopt in patients diagnosed with gynecological cancers. Methods: A systematic search was conducted to identify PROMs developed for or applied in gynecological cancer populations. PROMs identified in more than one study subsequently underwent assessment according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. Results: Overall, 55 PROMs were identified within the gynecological cancer setting, and 20 were assessed according to COSMIN guidelines. Most PROMs had limited information reported, but a best fit approach was adopted to recommend a number of instruments for use in patients with gynecological cancer. Conclusion: Further study to assess the methodological quality of each PROM utilized in gynecological cancers is warranted to endorse the recommendations of this review.
Background:
The distribution of ovarian tumour characteristics differs between germline BRCA1 and BRCA2 pathogenic variant carriers and non-carriers. In this study, we assessed the utility of ovarian tumour characteristics as predictors of BRCA1 and BRCA2 variant pathogenicity, for application using the American College of Medical Genetics and the Association for Molecular Pathology (ACMG/AMP) variant classification system.
Methods:
Data for 10,373 ovarian cancer cases, including carriers and non-carriers of BRCA1 or BRCA2 pathogenic variants, were collected from unpublished international cohorts and consortia and published studies. Likelihood ratios (LR) were calculated for the association of ovarian cancer histology and other characteristics, with BRCA1 and BRCA2 variant pathogenicity. Estimates were aligned to ACMG/AMP code strengths (supporting, moderate, strong).
Results:
No histological subtype provided informative ACMG/AMP evidence in favour of BRCA1 and BRCA2 variant pathogenicity. Evidence against variant pathogenicity was estimated for the mucinous and clear cell histologies (supporting) and borderline cases (moderate). Refined associations are provided according to tumour grade, invasion and age at diagnosis.
Conclusions:
We provide detailed estimates for predicting BRCA1 and BRCA2 variant pathogenicity based on ovarian tumour characteristics. This evidence can be combined with other variant information under the ACMG/AMP classification system, to improve classification and carrier clinical management.
Background: Neutrophil-to-lymphocyte ratio (NLR) has been described as a predictor of progression-free and overall survival, and in the field of peri-operative care it seems to be a factor that can help discriminate patients at risk of developing post-operative complications. In the present study we sought to determine whether NLR is useful as a biomarker in predictive models that aim to identify patients with gynecologic cancer undergoing surgery at risk of developing post-operative infectious morbidity. Patients and Methods: We designed a prospective cohort study that enrolled 208 patients with gynecologic cancer. Post-operative infectious morbidity was evaluated based on a 30-day follow-up interval from the procedure. Results: Forty-three patients (20.5%) developed post-operative infectious morbidity. Using an optimal cutoff value of 1.7 for the pre-operative NLR we observed that the sensitivity of the biomarker was 76.7% and the specificity 73.3% with a produced area under the curve of 0.760 (95% confidence interval [CI], 0.680-0.839). Univariable logistic regression indicated that NLR is a predictor of post-operative morbidity. Cox regression analysis revealed that NLR was the only factor that was associated with the timing of infectious morbidity (hazard ratio [HR], 1.339; 95% CI, 1.180-1.519; p < 0.001). Using random forest analysis and decision trees we achieved a diagnostic accuracy of the predictive model that exceeded 90%. Conclusions: Neutrophil-to-lymphocyte ratio may be a factor that could potentially help evaluate the risk of post-operative morbidity in patients with gynecologic cancer.
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.
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).
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.
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.
Vaccination against the most common oncogenic human papillomavirus (HPV) types, HPV-16 and HPV-18, could prevent development of up to 70% of cervical cancers worldwide. We did a randomised, double-blind, controlled trial to assess the efficacy, safety, and immunogenicity of a bivalent HPV-16/18 L1 virus-like particle vaccine for the prevention of incident and persistent infection with these two virus types, associated cervical cytological abnormalities, and precancerous lesions.
We randomised 1113 women between 15-25 years of age to receive three doses of either the vaccine formulated with AS04 adjuvant or placebo on a 0 month, 1 month, and 6 month schedule in North America and Brazil. Women were assessed for HPV infection by cervical cytology and self-obtained cervicovaginal samples for up to 27 months, and for vaccine safety and immunogenicity.
In the according-to-protocol analyses, vaccine efficacy was 91.6% (95% CI 64.5-98.0) against incident infection and 100% against persistent infection (47.0-100) with HPV-16/18. In the intention-to-treat analyses, vaccine efficacy was 95.1% (63.5-99.3) against persistent cervical infection with HPV-16/18 and 92.9% (70.0-98.3) against cytological abnormalities associated with HPV-16/18 infection. The vaccine was generally safe, well tolerated, and highly immunogenic.
The bivalent HPV vaccine was efficacious in prevention of incident and persistent cervical infections with HPV-16 and HPV-18, and associated cytological abnormalities and lesions. Vaccination against such infections could substantially reduce incidence of cervical cancer.
Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms for screening, investigating, treating, and following up the targeted women. The findings from the large body of research on various screening approaches carried out in developing countries and from the available managerial guidelines should be taken into account when reorganizing existing programmes and when considering new screening initiatives.
In health services planning, in addition to the basic measures of disease occurrence incidence and mortality, other indexes expressing the demand of care are also required to develop strategies for service provision. One of these is prevalence of the disease, which measures the absolute number, and relative proportion in the population, of individuals affected by the disease and that require some form of medical attention. For most cancer sites, cases surviving 5 years from diagnosis experience thereafter the same survival as the general population, so most of the workload is therefore due to medical acts within these first 5 years. This article reports world-wide estimates of 1-, 2-3- and 4-5-year point prevalence in 1990 in the population aged 15 years or over, and hence describes the number of cancer cases diagnosed between 1986 and 1990 who were still alive at the end of 1990. These estimates of prevalence at 1, 2-3 and 4-5 years are applicable to the evaluation of initial treatment, clinical follow-up and point of cure, respectively, for the majority of cancers. We describe the computational procedure and data sources utilised to obtain these figures and compare them with data published by 2 cancer registries. The highest prevalence of cancer is in North America with 1.5% of the population affected and diagnosed in the previous 5 years (about 0.5% of the population in years 4-5 and 2-3 of follow-up and 0.4% within the first year of diagnosis). This corresponds to over 3.2 million individuals. Western Europe and Australia and New Zealand show very similar percentages with 1.2% and 1.1% of the population affected (about 3.9 and 0.2 million cases respectively). Japan and Eastern Europe form the next batch with 1.0% and 0.7%, followed by Latin America and the Caribbean (overall prevalence of 0.4%), and all remaining regions are around 0.2%. Cancer prevalence in developed countries is very similar in men and women, 1.1% of the sex-specific population, while in developing countries the prevalence is some 25% greater in women than men, reflecting a preponderance of cancer sites with poor survival such as liver, oesophagus and stomach in males. The magnitude of disease incidence is the primary determinant of crude prevalence of cases diagnosed within 1 year so that differences by region mainly reflect variation in risk. In the long-term period however different demographic patterns with long-life expectancy in high-income countries determine a higher prevalence in these areas even for relatively uncommon cancer sites such as the cervix.
It is uncertain whether male circumcision reduces the risks of penile human papillomavirus (HPV) infection in the man and of cervical cancer in his female partner.
We pooled data on 1913 couples enrolled in one of seven case-control studies of cervical carcinoma in situ and cervical cancer in five countries. Circumcision status was self-reported, and the accuracy of the data was confirmed by physical examination at three study sites. The presence or absence of penile HPV DNA was assessed by a polymerase-chain-reaction assay in 1520 men and yielded a valid result in the case of 1139 men (74.9 percent).
Penile HPV was detected in 166 of the 847 uncircumcised men (19.6 percent) and in 16 of the 292 circumcised men (5.5 percent). After adjustment for age at first intercourse, lifetime number of sexual partners, and other potential confounders, circumcised men were less likely than uncircumcised men to have HPV infection (odds ratio, 0.37; 95 percent confidence interval, 0.16 to 0.85). Monogamous women whose male partners had six or more sexual partners and were circumcised had a lower risk of cervical cancer than women whose partners were uncircumcised (adjusted odds ratio, 0.42; 95 percent confidence interval, 0.23 to 0.79). Results were similar in the subgroup of men in whom circumcision was confirmed by medical examination.
Male circumcision is associated with a reduced risk of penile HPV infection and, in the case of men with a history of multiple sexual partners, a reduced risk of cervical cancer in their current female partners.
Cervical cancer remains the second most common cancer in women worldwide and the most frequent in developing countries. Pre-neoplasic cervical lesions represent an additional burden in countries where screening is widespread. The human papillomavirus (HPV) prevalence and type distribution in normal smears and in cancer specimens are being described and show relatively small international variation. State-of-the-art detection techniques have unequivocally shown that HPV-DNA can be detected in 95% to 100% of adequate specimens of cervical cancer, supporting the claim that HPV is the necessary cause. The odds ratios for cervical cancer related to a cross sectional detection of HPV-DNA range from 50 to several hundred in all studies. The risk for any of 15 high-risk types is not statistically different from the risk reported for HPV16. The estimates of the attributable fraction range from 90% to 98%. Additional work should be done in providing information on incidence of cervical cancer and on HPV infection in areas where the disease is common. Theoretical work including modeling of the incidence could be of potential use in the evaluation of the existing and novel preventive strategies. Research is currently being conducted on the mechanisms of HPV carcinogenesis. These include the determinants of the systemic and cellular immune response to the viral infection, the interaction between the host and the virus and the relevance of the different strains and variants of the HPV viral types. Technology developments in this area suitable for epidemiological studies are needed.
The impact of a single round of screening of visual inspection with acetic acid (VIA) on cervical cancer incidence and mortality was investigated in a cluster randomized trial in south India. Women 30-59 years of age in 113 clusters in Dindigul District were randomized to VIA screening (57 clusters, 48,225 women) by nurses and to a control group (56 clusters, 30,167 women). 30,577 eligible women were screened between May 2000 and April 2003; 2,939 (9.6%) screen-positive women were investigated with colposcopy by nurses and 2,777 (9.1%) women had biopsy. CIN 1 was diagnosed in 1,778 women, CIN 2-3 lesions were found in 222, and there were 69 screen detected invasive cervical cancers. The detection rates of lesions per 1,000 screened women were 58.2 for CIN 1, 7.3 for CIN 2-3, and 2.3 for invasive cancer. The detection rate of high-grade lesions in our study was 2-3-fold higher than those observed in repeatedly screened populations in developed countries. 71% of women with CIN 1 and 80% of those with CIN 2-3 lesions accepted cryotherapy provided by nurses and surgical treatment by mid-level clinicians. Overall, 97 and 34 incident cervical cancer cases were observed in the intervention and control arms, respectively. The intervention arm accrued 124,144 person years and the control arm accrued 90,172 during the study period. The age standardized cervical cancer incidence rates were 92.4/100,000 person-years in the intervention and 43.1/100,000 in the control arms. In the screened arm, 35.0% of cases were in Stage I as opposed to none in the control arm. The preliminary findings from our study indicate that not only is a VIA-based screening programme feasible, safe and acceptable to a population in rural settings, it also results in early detection of cervical neoplasia.
Human papillomavirus (HPV) vaccines for the prevention of cervical cancer have produced encouraging results in recent clinical trials, and expectations are high that one or more vaccines will be licensed for commercial distribution within the next five years. The availability of an HPV vaccine would raise several implementation issues that must be addressed if the vaccine is to achieve the coverage necessary to significantly reduce the incidence of cervical cancer. The main implementation issues will differ between developing countries, where cervical cancer is often a leading cause of cancer deaths in women, and developed countries, where cervical cancer screening programmes have already substantially reduced the number of deaths from cervical cancer.
Epidemiological data on the occurrence of cancer in sub-Saharan Africa are sparse, and population-based cancer survival data are even more difficult to obtain due to various logistic difficulties. The population-based Cancer Registry of Kampala, Uganda, has followed up the vital status of all registered cancer patients with one of the 14 most common forms of cancer, who were diagnosed and registered between 1993 and 1997 in the study area. We report 5-year absolute and relative survival estimates of the Ugandan patients and compare them with those of black American patients diagnosed in the same years and included in the SEER Program of the United States. In general, the prognosis of cancer patients in Uganda was very poor. Differences in survival between the two patient populations were particularly dramatic for those cancer types for which early diagnosis and effective treatment is possible. For example, 5-year relative survival was as low as 8.3% for colorectal cancer and 17.7% for cervical cancer in Uganda, compared with 54.2 and 63.9%, respectively, for black American patients. The collection of good-quality follow-up data was possible in the African environment. The very poor prognosis of Ugandan patients is most likely explained by the lack of access to early diagnosis and treatment options in the country. On the policy level, the results underscore the importance of the consistent application of the national cancer control programme guidelines as outlined by the World Health Organization.
More than one in 20 female cancers in Europe are of the endometrium. Surveillance of incidence rates is imperative given the rapidly changing profile in the prevalence and distribution of the underlying determinants. This study presents an analysis of observed and age-period-cohort-modeled trends in 13 European countries. There were increasing trends among postmenopausal women in many Northern and Western countries. Denmark and possibly France and Switzerland were exceptions, with decreasing trends in postmenopausal women. In premenopausal and perimenopausal women, declines were observed in Northern and Western Europe, most evidently in Denmark, Sweden, and the United Kingdom, affecting consecutive generations born after 1925. These contrast with the increasing trends regardless of menopausal age in some Southern and Eastern European countries, particularly Slovakia and Slovenia. These observations provide evidence of changes in several established risk factors over time and have implications for possible primary prevention strategies. In postmenopausal women, changes in reproductive behavior and prevalence of overweight and obesity may partially account for the observed increases, as well as hormone replacement therapy use in certain countries. Combined oral contraceptive use may be responsible for the declines observed among women aged <55 years. Whereas there are some prospects for chemoprevention in premenopausal women as oral contraceptive use becomes more widespread in Europe, increases in obesity and decreases in fertility imply that endometrial cancer in postmenopausal women will become a more substantial public health problem in the future.
Population-based cancer registries from Algeria, China, Costa Rica, Cuba, India, the Philippines, and Thailand are collaborating with the International Agency for Research on Cancer in a study of cancer survival in developing countries. Comparisons with the SEER program results of the National Cancer Institute in the United States, and the EUROCARE study of survival in European countries revealed considerable differences in the survival of patients with certain tumors associated with intensive chemotherapeutic treatment regimes (Hodgkin's disease and testicular tumors), more modest differences in the survival of patients with tumors for which early diagnosis and treatment confer an improved prognosis (carcinomas of the large bowel, breast, and cervix), and only slight differences for tumors associated with poor prognosis (carcinomas of the stomach, pancreas, and lung). With limited resources to meet the challenge of the increasing incidence of cancer expected in the next few decades, health authorities in developing countries should be aware of the importance of investing in a range of cancer control activities, including primary prevention and early detection programs as well as treatment. Cancer 1996; 78:2461-4.
Time trends in the incidence of cervical adenocarcinoma and adenosquamous cell carcinomas during the period 1973–1991 were examined using data provided by 60 population-based cancer registries from 32 defined populations in 25 countries. Three components of the incidence trend were studied: age, calendar period of diagnosis and birth cohort. Cumulative incidence rates per 1,000 for 2 groups with age ranges 25–49 and 50–74 years were calculated from the model that best described the incidence data. There was a significant increase in the cumulative incidence of cervical adenocarcinomas in women born in the mid-1930s and in successive cohorts thereafter in some populations in the United States (whites and Hispanic women), Australia, New Zealand (non-Maori), England, Scotland, Denmark, Slovenia, Slovakia and Japan (Osaka) and among Chinese women in Singapore, with a general decline in the incidence in women born in earlier periods. In Sweden and Slovenia there is a suggestion of an increasing trend in both age groups. A decrease in incidence in both age groups was apparent in Finland, France and Italy. There were no changes in incidence in 24 registries covering other European, Asian and black populations in the United States. Part of the increase may be attributable to an increasing prevalence of human papillomavirus infection, and part to improvements in screening. Int. J. Cancer 75:536–545, 1998.© 1998 Wiley-Liss, Inc.
Objective:
The aim of this study was to compare the age-adjusted incidence and survival for invasive adenocarcinoma and squamous cell carcinoma of the uterine cervix using population-based data.
Methods:
The SEER database was used to identify all cases of cervical cancer registered between 1973 and 1996. Stage was defined as localized, regional, or distant. Age-adjusted incidence rates were analyzed statistically using the Jonchkeere-Terpstra exact test for trends. Relative and observed survival rates, respectively, were compared using z tests and log-rank tests.
Results:
The age-adjusted incidence rates per 100,000 for all invasive cervical cancers decreased by 36.9% over 24 years [12.35 (1973-1977) vs 7.79 (1993-1996)]. Similarly, the age-adjusted incidence rates for squamous cell carcinoma declined by 41.9% [9.45 (1973-1977) vs 5.49 (1993-1996)]. In contrast, the age-adjusted incidence rates for adenocarcinoma increased by 29.1% [1.34 (1973-1977) vs 1.73 (1993-1996)]. The proportion of adenocarcinoma increased 107.4% relative to all cervical cancer, 95.2% relative to squamous cell carcinoma, and 49.3% relative to the population of women at risk [10. 8% vs 22.4% (P < 0.001), 12.4% vs 24.0% (P < 0.001), and 1.40 vs 2. 09 per 100,000 women (P < 0.001), respectively]. Observed survival rates for adenocarcinoma vs squamous cell carcinoma were poorer for regional (P = 0.04), but not localized or distant disease.
Conclusions:
Over the past 24 years, the incidence of all cervical cancer and squamous cell carcinoma has continued to decline. However, the proportion of adenocarcinoma relative to squamous cell carcinoma and to all cervical cancers has doubled, and the rate of adenocarcinoma per population at risk has also increased. These results suggest that current screening practices in the United States are insufficient to detect a significant proportion of adenocarcinoma precursor lesions.
It has been accepted generally that the cancer registry has more of a 'back room' than a 'front line' role in cancer control, its particular responsibilities lying in description of cancer patterns, care, and outcome, in monitoring these variables in relation to control activities, and in providing a research database--often, for others to utilize. While readily justifiable, this prevailing concept of the cancer registry's role may not be sustainable in times of economic restraint. A survey of members of the International Association of Cancer Registries showed that most registries fit the accepted mold. Some, however, extend beyond it, particularly in the direct conduct of epidemiologic research and in the implementation of control programs, particularly screening. Sixteen percent appeared only to be collecting incidence statistics and may be at risk of economic rationalization. It would be consonant with their basic role and skills, and promote more rational cancer control, if cancer registries were to take on an expanded role, including direct participation in epidemiologic research, evaluation of interventions against cancer at the population level, situation analysis and cancer control planning, and implementation of aspects of cancer control--particularly coordination of screening--and monitoring the performance of cancer control programs. This expanded role could become the responsibility of specialized cancer control units of which cancer registration would be the central function.
The American Cancer Society's Department of Epidemiology and Statistics reports its 29th annual compilation of cancer incidence, survival and mortality data for the United States and around the world.
BACKGROUND. Ovarian cancer is the fifth most common cause of cancer-related death in American women. The median age at diagnosis is about 62 years; incidence rises rapidly after age 60. Pelvic examination has been the primary method for detection of ovarian carcinoma. It is insensitive for the detection of early disease, however: most women present with disease beyond the pelvis (Stages III and IV) and are not curable with existing techniques. Two new technologies may be useful as screening tools for earlier detection of ovarian cancer. CA 125 is an antigenic determinant expressed on an ovarian cancer cell line. Transvaginal ultrasound (TVUS) images the ovaries from within the vagina and can be performed by a technician in about 10 minutes. In small preoperative studies of women with ovarian masses, serum CA 125 levels have been elevated (typically above 35 U/ml) in over two-thirds of cases and in up to 50% of Stage I cases. The test is not absolutely specific: elevations have been reported with pregnancy, endometriosis, menstruation, benign ovarian tumors, and with cancers of the breast, colon, pancreas, lung, stomach, and liver. Nevertheless, the specificity of CA 125 in postmenopausal women has been reported at about 95% or more. TVUS provides higher resolving power for ovarian abnormalities than transabdominal ultrasound or physical examination; however, experience with it is limited. CA 125 and TVUS may be complementary. CONCLUSIONS. For these reasons, the National Cancer Institute is planning a randomized trial of all three tests versus routine medical care in women of ages 60-74 years. This is part of a larger trial to determine the efficacy of screening for lung, colorectal, and ovarian cancers in women, and for lung, colorectal, and prostatic cancers in men. Seventy-four thousand women will be randomized in the study.
Huge differences in incidence rates of invasive cervical cancer occur among populations. These differences reflect the influences of both etiological environmental factors and removal of precursor lesions detected upon screening. The purposes of this article are (i) to describe similarities and differences in the shapes and magnitudes of age-specific incidence rates of invasive cervical cancer before screening had an effect, (ii) to provide baseline data for further global study of screening effects, and (iii) to provide baseline incidence data for the design of optimal screening programs. To eliminate the impact of screening effects, we have selected age-specific incidence rates from times when and from populations in which screening was insignificant. The selected rates were suitably scaled and compared regarding age at onset of increase in incidence, age at peak incidence, and rate of subsequent decline. Despite a 16-fold difference in incidence rates, all curves had the same basic structure, with an increase to a peak followed by a decline or a plateau. Although all populations but one had an onset around age 25, 7 European countries showed an earlier peak age (mean = 46 vs. 59) and a more rapid decline after the peak than most other populations. The common basic shape of the age-specific incidence curve, overall, suggests a relatively similar development of invasive cervical cancer in different populations. These results illustrate the underlying similarities in the markedly different age-specific incidence rates of invasive cervical cancer. They also provide a basis for studying screening effects and for optimizing screening programs in specific geographic areas.
The value of screening for ovarian cancer is uncertain. We did a pilot randomised trial to assess multimodal screening with sequential CA 125 antigen and ultrasonography.
Postmenopausal women aged 45 years or older were randomised to a control group (n=10,977) or screened group (n=10,958). Women randomised to screening were offered three annual screens that involved measurement of serum CA 125, pelvic ultrasonography if CA 125 was 30 U/mL or more, and referral for gynaecological opinion if ovarian volume was 8.8 mL or more on ultrasonography. All women were followed up to see whether they developed invasive epithelial cancers of the ovary or fallopian tube (index cancers).
Of 468 women in the screened group with a raised CA 125, 29 were referred for a gynaecological opinion; screening detected an index cancer in six and 23 had false-positive screening results. The positive predictive value was 20.7%. During 7-year follow-up, ten further women with index cancers were identified in the screened group and 20 in the control group. Median survival of women with index cancers in the screened group was 72.9 months and in the control group was 41.8 months (p=0.0112). The number of deaths from an index cancer did not differ significantly between the control and screened groups (18 of 10,977 vs nine of 10,958, relative risk 2.0 [95% CI 0.78-5.13]).
These results show that a multimodal approach to ovarian cancer screening in a randomised trial is feasible and justify a larger randomised trial to see whether screening affects mortality.
Africa is the least developed continent as regards radiation oncology resources. The documented ASR of cancer is of the order of 1 to 2 per 1000. With improving health care this is becoming more significant. This review was undertaken to help develop priorities for the region.
Radiation Oncology departments in Africa were identified and a survey of their equipment performed. These were compared to the reported situation in 1991. Population tables for the year 2000 were compared to available megavoltage machines.
Of 56 countries in Africa, only 22 are confidently known to have megavoltage therapy concentrated in the southern and northern extremes of the continent. The 155 megavoltage machines operating represents over 100% increase over the past 8 years. The population served by each megavoltage machine ranges from 0.6 million to 70 million per machine. Overall, only 50% of the population have some access to Radiation Oncology services.
Progress has been made in initiating radiation oncology in Ghana, Ethiopia and Namibia. There has been some increase in machines in Algeria, Egypt, Libya, Morocco and Tunisia. However, a large backlog exists for basic radiation services.
The Singapore Cancer Registry has provided comprehensive population-based incidence data since 1968. This paper describes the population-based survival analysis of the registry data. All invasive primary cancers diagnosed from January 1, 1968 to December 31, 1992 were passively followed up until December 31, 1997. Only 5.8% were lost to follow-up. Cumulative and observed survival rates were calculated using Hakulinen's method. Overall 5-year relative survival rates have increased dramatically over the 25-year period in both genders. Significant increases are seen with nasopharynx, stomach and colo-rectum cancers, non-Hodgkin's lymphoma, leukemias and cancers of the testis, cervix, ovaries and breast. When compared with the Surveillance, Epidemiology and End Results (SEER) rates in the United States, the 5-year relative survival rates in Singapore are generally lower. However, the rate of change between the two countries is fairly similar. On the average, the rates are 10 to 15 years behind the SEER rates and 5 to 10 years behind Finland, Switzerland and Japan, but they are close to the UK rates. The age-standardized 5-year survival rate for Singapore is higher for most sites compared with other developing countries like Qidong (China), Madras (India), Bombay (India) and Chiang Mai (Thailand). The 25-year trend in cancer survival in Singapore showed two extreme groups: those showing no change and those showing significant improvements. Reducing the incidence of cancers belonging to the first group remains the only viable mode of cancer control. For cancers in the second group, improvement in survival is due to a combination of successful early detection measures and effective treatment services in Singapore.
Resources for radiation therapy in Asian and Pacific countries were analyzed to obtain a better understanding of the status of radiation oncological practice in the region.
The data were obtained mainly through surveys on the availability of major equipment and personnel which were conducted through an International Atomic Energy Agency regional project. The study included 17 countries in South Asia, South East Asia, East Asia and Australasia. Data were related to national populations and economic and a general health care indices.
Large differences in equipment and personnel among countries were demonstrated. The availability of both teletherapy and brachytherapy was related to the economic status of the countries. The shortage of teletherapy machines was evident in more countries than that of brachytherapy. Many departments were found to treat patients without simulators or treatment planning systems. The number of radiation oncologists standardized by cancer incidence of a country did not correlate well with economic status.
There were significant deficiencies in the availability of all components of radiation therapy in the analyzed countries. The deficiencies were linked predominantly to the economic status of the country. Cognisance should be taken of the specific shortfalls in each country to ensure that expansion or any assistance offered appropriately match its needs and can be fully utilized. The information on the resources currently available for radiation oncological practice in the region presented in this paper provides a valuable basis for planning of development aid programs on radiation therapy.
Approximately 20 percent of adults become infected with human papillomavirus type 16 (HPV-16). Although most infections are benign, some progress to anogenital cancer. A vaccine that reduces the incidence of HPV-16 infection may provide important public health benefits.
In this double-blind study, we randomly assigned 2392 young women (defined as females 16 to 23 years of age) to receive three doses of placebo or HPV-16 virus-like-particle vaccine (40 microg per dose), given at day 0, month 2, and month 6. Genital samples to test for HPV-16 DNA were obtained at enrollment, one month after the third vaccination, and every six months thereafter. Women were referred for colposcopy according to a protocol. Biopsy tissue was evaluated for cervical intraepithelial neoplasia and analyzed for HPV-16 DNA with use of the polymerase chain reaction. The primary end point was persistent HPV-16 infection, defined as the detection of HPV-16 DNA in samples obtained at two or more visits. The primary analysis was limited to women who were negative for HPV-16 DNA and HPV-16 antibodies at enrollment and HPV-16 DNA at month 7.
The women were followed for a median of 17.4 months after completing the vaccination regimen. The incidence of persistent HPV-16 infection was 3.8 per 100 woman-years at risk in the placebo group and 0 per 100 woman-years at risk in the vaccine group (100 percent efficacy; 95 percent confidence interval, 90 to 100; P<0.001). All nine cases of HPV-16-related cervical intraepithelial neoplasia occurred among the placebo recipients.
Administration of this HPV-16 vaccine reduced the incidence of both HPV-16 infection and HPV-16-related cervical intraepithelial neoplasia. Immunizing HPV-16-negative women may eventually reduce the incidence of cervical cancer.
Each year, the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year, and compiles the most recent data on cancer incidence, mortality, and survival by using incidence data from the National Cancer Institute (NCI) and mortality data from the National Center for Health Statistics (NCHS). Incidence and death rates are age adjusted to the 2000 US standard population. In the year 2003, we estimate that 1,334,100 new cases of cancer will be diagnosed, and 556,500 people will die from cancer in the United States. Age-adjusted cancer death rates declined in both males and females in the 1990s, though the magnitude of decline is substantially higher in males than in females. In contrast, incidence rates continued to increase in females while stabilizing in males. African-American males showed the largest decline for mortality. However, African Americans still carry the highest burden of cancer with diagnosis of cancer at a later stage and poorer survival within each stage compared with Whites. In spite of the continued decline in cancer death rates in the most recent time period, the total number of recorded cancer deaths in the United States continues to increase slightly due to the aging and expanding population.
Despite its history of success in cancer screening, Pap cytology has important limitations, particularly its high false-negative rate, which carries important public health implications. Since the mid-1990s, there has been substantial interest in the use of human papillomavirus (HPV) DNA testing in cervical cancer screening under the premise that the testing of cervical cells for the causative agent of cervical cancer could have acceptable screening performance, while being more reproducible in clinical practice than Pap cytology. There have been several studies assessing the utility of HPV testing compared with the Pap test as a screening tool. These studies varied widely in lesion-outcome definition and in methodology. No studies were based on cervical cancer incidence or mortality. No randomized controlled trials have yet been published; all of the studies were based on concomitant testing for HPV and cytology or additional tests. HPV testing has greater sensitivity (average, 27%) but somewhat lower specificity (average, 8%) than Pap cytology for detecting high-grade lesions. Screening of women aged 30 years or older tends to improve test specificity, but it also does so for cytology. The combination of cytology and HPV attained high-negative predictive values, which suggests that their joint use could allow screening intervals to be safely increased, thus lowering costs. Although evidence is yet to come from long-term studies and from randomized controlled trials with high-grade lesions and invasive cancer as outcomes, HPV testing is clearly one of the most promising new technologies and has the potential to improve cervical cancer-screening effectiveness in many settings.
Gestational trophoblastic diseases (GTD) consist of a group of neoplastic disorders arising from placental trophoblastic tissue after normal or abnormal fertilisation. The WHO classification of GTD includes hydatidiform mole, invasive mole, choriocarcinoma, placental site trophoblastic tumour, and miscellaneous and unclassified trophoblastic lesions. GTD have a varying potential for local invasion and metastases and they generally respond to chemotherapy. Broad variations in the distribution of GTD exist worldwide, with higher frequencies in some parts of Asia, the Middle East and Africa, but the extent to which they can be attributed to methodological difficulties in obtaining accurate rates is unclear. Maternal age and a history of GTD have been established as strong risk factors for hydatidiform mole and choriocarcinoma. We review published data on the worldwide distribution of GTD, original data from cancer- registry-based statistics on choriocarcinoma, and major aetiological hypotheses, including parental age, AB0 blood groups, history of GTD, reproductive factors, oral contraceptive use, and other environmental factors.
This paper provides the first comprehensive population based cancer survival estimates from the African continent. Five-year absolute and relative survival estimates are presented for black and white Zimbabwean patients diagnosed with cancer in Harare, Zimbabwe between the years 1993 and 1997. The survival of black Zimbabwean cancer patients are among the lowest ever reported from population based cancer registries. For most cancer sites, white Zimbabwean patients have much higher survival than black Zimbabweans, except for lung and colorectal cancer, for which the estimates are similarly poor. Race specific comparisons to cancer patients in the United States show that Zimbabwean patients have much lower survival than American cancer patients and that the gap between black Zimbabwean patients and black American patients is broader than between white Zimbabwean and white American patients. Access to and the ability to pay for medical care may be a very important barrier to better survival for the majority of black Zimbabwean patients and the most important cause for the very low cancer survival in this population.
Estimates of the worldwide incidence, mortality and prevalence of 26 cancers in the year 2002 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. The results are presented here in summary form, including the geographic variation between 20 large "areas" of the world. Overall, there were 10.9 million new cases, 6.7 million deaths, and 24.6 million persons alive with cancer (within three years of diagnosis). The most commonly diagnosed cancers are lung (1.35 million), breast (1.15 million), and colorectal (1 million); the most common causes of cancer death are lung cancer (1.18 million deaths), stomach cancer (700,000 deaths), and liver cancer (598,000 deaths). The most prevalent cancer in the world is breast cancer (4.4 million survivors up to 5 years following diagnosis). There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors related to lifestyle or environment, and provides a clear challenge to prevention.
The impact of screening by visual inspection with acetic acid (VIA), cytology or HPV testing on cervical cancer incidence and mortality is investigated in a cluster randomized controlled trial in India. We report findings after the screening phase, when 52 clusters, with a total of 142,701 women aged 30-59 years in Osmanabad District, India, were randomized into 4 arms for a single round of screening by trained midwives with either VIA, cytology or HPV testing as well as a control group. All laboratory tests were done locally. Test-positive women underwent investigations (colposcopy/biopsy) and treatment in the base hospital. Data on participation, test positivity, positive predictive value and detection rates of cervical neoplasia were analyzed using cluster design methodology. Of the eligible women, 72-74% were screened. Test positivity rates were 14.0% for VIA, 7.0% for cytology and 10.3% for HPV. The detection rate of high-grade lesions was similar in all intervention arms (0.7% for VIA, 1.0% for cytology and 0.9% for HPV testing) (p = 0.06, Mann-Whitney test). While the detection rate for VIA dropped to 0.5% with declining test positivity during the course of the study, it remained constant for cytology and HPV testing. Over 85% of women with high-grade lesions received treatment. Our results show that a high level of participation and good-quality cytology can be achieved in low-resource settings. VIA is a useful alternative but requires careful monitoring. Detection rates obtained by HPV testing were similar to cytology, despite higher investments.
The objective of cervical cancer screening is to reduce cervical cancer incidence and mortality by detecting and treating precancerous lesions. Conventional cytology is the most widely used cervical cancer screening test. Although cytology has been effective in reducing the incidence of and mortality from cervical cancer in developed countries in both opportunistic and--more dramatically--organized national programs, it has been less successful and largely ineffective in reducing disease burden in low-resource settings where it has been implemented. Liquid-based cytology, testing for infection with oncogenic types of human papillomaviruses, visual inspection with 3-5% acetic acid, magnified visual inspection with acetic acid, and visual inspection with Lugol's iodine have been evaluated as alternative tests. Their test characteristics, and the applications and limitations in screening, are discussed with an emphasis on the work of the Alliance for Cervical Cancer Prevention over the past 5 years.
A randomised double-blind placebo-controlled phase II study was done to assess the efficacy of a prophylactic quadrivalent vaccine targeting the human papillomavirus (HPV) types associated with 70% of cervical cancers (types 16 and 18) and with 90% of genital warts (types 6 and 11).
277 young women (mean age 20.2 years [SD 1.7]) were randomly assigned to quadrivalent HPV (20 microg type 6, 40 microg type 11, 40 microg type 16, and 20 microg type 18) L1 virus-like-particle (VLP) vaccine and 275 (mean age 20.0 years [1.7]) to one of two placebo preparations at day 1, month 2, and month 6. For 36 months, participants underwent regular gynaecological examinations, cervicovaginal sampling for HPV DNA, testing for serum antibodies to HPV, and Pap testing. The primary endpoint was the combined incidence of infection with HPV 6, 11, 16, or 18, or cervical or external genital disease (ie, persistent HPV infection, HPV detection at the last recorded visit, cervical intraepithelial neoplasia, cervical cancer, or external genital lesions caused by the HPV types in the vaccine). Main analyses were done per protocol.
Combined incidence of persistent infection or disease with HPV 6, 11, 16, or 18 fell by 90% (95% CI 71-97, p<0.0001) in those assigned vaccine compared with those assigned placebo.
A vaccine targeting HPV types 6, 11, 16, 18 could substantially reduce the acquisition of infection and clinical disease caused by common HPV types.
National Cancer Institute
- Lag Ries
- M P Eisner
- C L Kosary
Five-Year consolidated report of the hospital cancer registries 1994–1998
- National Cancer Registry Programme