Diagnosis Of Invasive Cervical Cancer Research Articles

Impact of HIV infection on access to cancer care and survival among women with invasive cervical cancer in Côte d'Ivoire: A prospective cohort study.

To assess the impact of HIV on access to invasive cervical cancer (ICC) care and overall survival (OS) in a time of universal access to antiretroviral therapy (ART). A cohort of women prospectively diagnosed with ICC was consecutively recruited from 2018 to 2020 in public/private cancer centers in Côte d'Ivoire. Follow-up data were collected through facility- and phone-based approaches. Logistic and Cox regression models allowed analysis of factors associated with access to cancer care and OS, respectively. Overall, 294 women with ICC aged 50 years (interquartile range [IQR] 43-60) were enrolled, including 21.4% of women living with HIV (WLHIV), 87% being on ART. An advanced ICC clinical stage (III-IV) was less frequent in WLHIV (63.5% vs. 77.1% in HIV-uninfected women; P = 0.029). Cancer care was initiated in 124 (42.2%) women (54.0% in WLHIV; 39.0% in HIV-uninfected; P = 0.030). Factors independently associated with access to cancer care were International Federation of Gynecology and Obstetrics (FIGO) stage I-II (adjusted odds ratio [aOR] 3.58, 95% CI 2.01-6.38) and no treatment by traditional healers prior to ICC diagnosis (aOR 3.69, 95% CI 1.96-6.96). The 2-year OS was 37.9% (95% CI 30.0-47.9). HIV status was not predictive of mortality (adjusted hazard ratio [aHR] 0.98, 95% CI 0.60-1.69). An advanced clinical stage was the only measured predictor of death (aHR 1.59, 95% CI 1.02-2.47). In a time of universal access to ART, HIV infection was not associated with OS among women with ICC in Côte d'Ivoire. Higher access to cancer care in WLHIV might be mediated by enhanced access to ICC screening services, supporting the need to expand these services to other types of healthcare facilities.

Retrospective Analysis of Cervical Cancer Treatment Outcomes: Ten Years of Experience with the Vaginal Assisted Radical Laparoscopic Hysterectomy VARLH.

Background LACC trial demonstrated inferiority of laparoscopic approach for the treatment of early-stage cervical cancer. There are still limited data from retrospective trials regarding whether survival outcomes after laparoscopic radical hysterectomy are equivalent to those after open abdominal radical hysterectomy. In this study, we present results of combined vaginal radical laparoscopic hysterectomy in the treatment of early-stage cervical cancer. Methods This retrospective study was carried out at the Department of Gynecology in Mathilden Hospital (Herford, Germany). Between January 2008 and April 2018, all the patients with invasive cervical cancer who underwent combined vaginal assisted radical laparoscopic hysterectomy (VARLH) without the use of any uterine manipulator were enrolled to the study. Results A total number of 124 patients with diagnosis of invasive cervical cancer were enrolled in the study. All of the patients underwent minimally invasive surgery and were divided according to FIGO 2019: stage IA (25.9%), IB1 (25.0%), IB2-IIB (28.4%), and III/IV (20.7%). Overall, the mean age of the patients was 51.84 years. After a study collection, a median follow-up was 45.6 (range 23.7-76.5) months. The 3- and 5-year disease-free survival rates for early-stage cervical cancer were both 98%, and the 3- and 5-year overall survival rates were 100% and 97%, respectively. We have not observed any recurrence in our study group of patients with early-stage cervical cancer. Conclusions Combined VARLH can be considered a safe and effective procedure for the treatment of early-stage cervical cancer. Surgical strategy with oncological principles determines the quality and long-term success of the operation in early cervical cancer regardless of laparoscopic approach.

Sociodemographic and clinical characteristics of patients with advanced forms of invasive cervical cancer and morphological features of their tumors

Due to the availability of effective primary prevention methods and screening strategies, cervical cancer is one of the pre-ventable malignancies. Death rates from cervical cancer remain high. Moreover, in most cases, the tumor is detected at advanced stages. It creates the problem of finding the reasons for the late primary diagnosis of invasive cervical cancer. The article discusses issues related to the characteristics of the main histological types of cervical cancer from the standpoint of the clinical, morphological and socio-demographic characteristics of the profiles of patients with advanced disease. The current understanding of the factors associated with late primary diagnosis of cervical cancer at advanced stages is highlighted.

Evaluation of oxidative markers in women with invasive cervical cancer in Lagos, Nigeria.

Epidemiological studies have showed that low levels of antioxidants induce the generation of free radicals leading to DNA damage and further mutations seen in cancer. This study evaluated the effects of oxidative markers on the occurrence and severity of cervical cancer at the Lagos University Teaching Hospital. This was an analytical cross-sectional study carried out among women with histological diagnosis of invasive cervical cancer and their healthy cancer-free comparison group. Venous blood samples were collected from each participant for measurements of antioxidants (erythrocyte glutathione and vitamin C) and malondialdehyde (a marker of lipid peroxidation). Descriptive statistics were carried out for relevant demographic and clinical data. Associations between continuous variables were tested using the independent sample t-test or the analysis of variance for normally distributed data or the Mann–Whitney U test for skewed data, whereas categorical variables were compared using the χ2 test. p < 0.05 was considered statistically significant. The mean level of malondialdehyde (MDA) was statistically higher in women with cervical cancer than in their cancer-free counterparts (p = 0.032). However, the mean glutathione (32.6 ± 6.2 versus 14.2 ± 6.1 mg/dL; p = 0.019) and vitamin C (12.4 ± 2.3 versus 14.6 ± 2.4 µmol/L; p = 0.001) levels were significantly lower in the case group compared to the cancer-free group. There are statistically increasing mean levels of MDA (p = 0.017) and decreasing mean levels of vitamin C (p = 0.004) with increasing stages of the disease. This study showed that women with cervical cancer have low levels of antioxidants and an increased level of the oxidative marker. The levels of these markers become more pronounced as the disease progresses. This will, therefore, form the basis for the conduct of future randomised controlled trials of antioxidant supplementations among cervical cancer patients in sub-Saharan Africa.

Changes in HIV-Related Cervical Cancer Over a Decade in Côte d'Ivoire.

PURPOSEMajor improvements have occurred in access to invasive cervical cancer (ICC) screening in HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associated with HIV infection in women with ICC in Côte d'Ivoire.METHODSA repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d'Ivoire, through the 2009-2011 and 2018-2020 periods. Women diagnosed with ICC were systematically tested for HIV. Demographics, ICC risk factors, cancer stage (International Federation of Gynecology and Obstetrics), and HIV characteristics were collected through questionnaires. Characteristics of HIV-related ICC were compared between the periods, and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariable logistic model.RESULTSDuring the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed with estimated HIV prevalence of 24.5% and 21.9% (P = .53), respectively. In HIV-infected women, access to antiretroviral treatment increased from 2.8% to 73.8% (P < 10−4) and median CD4 cell count from 285 (IQR, 250-441) to 492 (IQR, 377-833) cells/mm3 (P = .03). In women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (International Federation of Gynecology and Obstetrics I or II stage) (adjusted OR, 2.2 [95% CI, 1.1 to 4.4]) and with ICC diagnosis through a systematic screening (adjusted OR, 10.5 [95% CI, 2.5 to 45.5]).CONCLUSIONDespite a persistently high proportion of HIV-related ICC over time in Côte d'Ivoire, HIV was associated with less advanced clinical stage at ICC diagnosis. Recent improvements in ICC screening services across HIV clinics might explain this association and support their implementation across non-HIV health facilities.

Evaluating multiple diagnostic tests: An application to cervical cancer

Systematic Reviews of diagnostic test accuracy (DTA) studies are increasingly comparing the accuracy of multiple tests to facilitate selection of the best performing test(s). Common approaches to compare multiple tests include multiple meta-analyses or meta-regression with the test type as a covariate. Within-study correlation between tests are typically not considered in these approaches. Several DTA network meta-analysis (DTA-NMA) models have been suggested to compare the accuracy of multiple index tests in a single model. Our aim was to identify all DTA-NMA methods for comparing the accuracy of multiple diagnostic tests. We conducted a methodological review of the DTA-NMA models. We searched PubMed, Web of Science, and Scopus from inception until the end of July 2019. Studies of any design published in English were eligible for inclusion. We also reviewed relevant unpublished material. The methods were applied in a network of 37 studies comparing human papillomavirus (HPV) DNA, mRNA, and cytology (ASCUS+/ LSIL+ threshold) for the diagnosis of invasive cervical cancer (CIN2+). We included 10 relevant studies, and identified four Bayesian hierarchical DTA-NMA methods including the 2×2 data table for each index test. Using CIN2+ as a case study, we applied the DTA-NMA methods to determine the most promising test, in terms of sensitivity and specificity. All models showed the mRNA test as the most accurate test followed by HPV DNA: relative sensitivity compared to the cytology test 1.36-1.39 and 1.33-1.35, respectively. However, both tests had similar or worse specificity than cytology (relative specificity range in mRNA 0.96-0.98 and in HPV-DNA 0.94-0.95). Both sensitivity and specificity of mRNA were associated with the highest uncertainty across all models (widest 95% credible intervals 0.68-0.97 and 0.74-0.94, respectively). Precision and estimation of between-study and within-study variability vary across models, which might be due to the differences in the key properties of the models. Different DTA-NMA methods may lead to different results. The choice of a DTA-NMA method for the comparison of multiple diagnostic tests may depend on the available data, e.g., threshold data, as well as on clinically-related factors.

Laboratory parameters as predictors of prognosis in uterine cervical neoplasia

ObjectivesThe aims of study were to assess platelet counts, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), RWD (red cells distribution width) and fasting glucose in patients with cervical intraepithelial neoplasia (CIN) and invasive cervical cancer; and to relate these parameters to prognostic factors and survival in cervical cancer. Study DesignWe evaluated the patients with confirmed diagnosis of invasive cervical cancer (n = 102), and CIN (n = 102). Histological type, NLR, PLR, RDW, platelets count, fasting glucose, staging, overall survival (OS), and disease-free survival (DFS) were evaluated. The results of laboratory parameters were assessed by Mann-Whitney test. A receiver operating characteristic (ROC) curve was used to determine the best cut-off values. Survival was verified by the Kaplan-Meyer method followed by the Gehan-Breslow test. Multivariate analysis was performed using Cox regression. The level of significance was less than 0.05. ResultsComparing CIN and invasive malignancies, higher values of NLR, PLR, RDW and fasting glucose were found in cancer patients (p < 0.0001, p = 0.011, p = 0.0153 and p = 0.0096, respectively). In cervical cancer, higher NLR and PLR values were found at stage II to IV when compared to stage I (p = 0.0066 and p = 0.005, respectively). ROC curves were performed. In invasive neoplasms, the cut-off values for NLR and PLR in the comparison between stage I and greater than I were 4 and 165.45, respectively. For survival curves, there was lower OS and DFS in patients with NLR greater than 4 (p = 0.0004 and p = 0.0153, respectively) and PLR greater than 165.45 (p = 0.0319 and p = 0.0362, respectively). After multivariate analysis, only NLR remained as an independent factor in DFS (HR = 6.095, 95 % CI = 1.120–33.177, p = 0.037) and OS (HR = 4.522, 95 % CI = 1.241–16.479, p = 0.022) ConclusionHigher NLR is associated to lower OS and DFS in invasive uterine cervical neoplasia, and can be considered an independent factor of worse prognosis.

Wait-time for hysterectomy and survival of women with early-stage cervical cancer: A clinical implication during the coronavirus pandemic

ObjectiveA global pandemic caused by a novel coronavirus (Covid-19) has created unique challenges to providing timely care for cancer patients. In early-stage cervical cancer, postponing hysterectomy for 6–8 weeks is suggested as a possible option in the Covid-19 burdened hospitals. Yet, literature examining the impact of surgery wait-time on survival in early-stage cervical cancer remains scarce. This study examined the association between surgery wait-time of 8 weeks and oncologic outcome in women with early-stage cervical cancer. MethodsThis is a single institution retrospective observational study at a tertiary referral medical center examining women who underwent primary hysterectomy or trachelectomy for clinical stage IA-IIA invasive cervical cancer between 2000 and 2017 (N = 217). Wait-time from the diagnosis of invasive cervical cancer via biopsy to definitive surgery was categorized as: short wait-time (<8 weeks; n = 110) versus long wait-time (≥8 weeks; n = 107). Propensity score inverse probability of treatment weighting was used to balance the measured demographics between the two groups, and disease-free survival (DFS) and overall survival (OS) were assessed. A systematic literature review with meta-analysis was additionally performed. ResultsIn a weighted model (median follow-up, 4.6 years), women in the long wait-time group had DFS (4.5-year rates, 91.2% versus 90.7%, hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.47–2.59, P = 0.818) and OS (95.0% versus 97.4%, HR 1.47, 95%CI 0.50–4.31, P = 0.487) similar to those in the short wait-time group. Three studies were examined for meta-analysis, and a pooled HR for surgery wait-time of ≥8 weeks on DFS was 0.96 (95%CI 0.59–1.55). ConclusionOur study suggests that wait-time of 8 weeks for hysterectomy may not be associated with short-term disease recurrence in women with early-stage cervical cancer.

Prevalence and predictors of HIV screening in invasive cervical cancer: a 10 year cohort study

BackgroundInvasive cervical carcinoma is associated with a human immunodeficiency virus (HIV) prevalence of >0.1%, and screening is recommended and cost-effective for cancer populations exceeding this threshold. HIV status is also...

Psychologic Distress Is Associated with Cancer-Specific Mortality among Patients with Cervical Cancer.

Emerging evidence suggests a role of psychologic factors in the progression of different cancer types. However, it is unclear whether psychologic distress around the time of diagnosis of invasive cervical cancer places patients at a higher risk of cancer-specific mortality, independently of tumor characteristics and treatment modalities. We conducted a nationwide cohort study, including 4,245 patients with newly diagnosed cervical cancer during 2002-2011 in Sweden. Psychologic distress was indicated by a clinical diagnosis of depression, anxiety, or stress reaction and adjustment disorders, or the experience of a stressful life event, including death or severe illness of a family member, divorce, or between jobs, from one year before cancer diagnosis and onwards. We calculated the HRs of cancer-specific mortality among the patients exposed to psychologic distress, compared with unexposed patients, controlling for socioeconomic characteristics and other known prognostic indicators such as tumor and treatment characteristics. We found that patients exposed to psychologic distress had an increased risk of cancer-specific mortality (HR 1.33; 95% CI, 1.14-1.54). The association was primarily driven by distress experienced within one year before or after diagnosis (HR 1.30; 95% CI, 1.11-1.52), but not thereafter (HR 1.12; 95% CI, 0.84-1.49). In summary, our study shows that psychiatric disorders and stressful life events around cancer diagnosis are associated with increased cancer-specific mortality among patients with cervical cancer, independent of tumor characteristics and treatment modality. SIGNIFICANCE: These findings support the integration of psychologic screening and intervention in the clinical management of patients with cervical cancer, particularly around the time of cancer diagnosis.

Determinants of Abnormal Cervical Cancer Screening Follow-Up And Invasive Cervical Cancer Among Uninsured and Underinsured Women in New Jersey.

To identify determinants of follow-up care and diagnosis of invasive cervical cancer among uninsured/underinsured women screened for cervical cancer. We examined the associations between health care facility, area-level, and individual-level factors on the outcomes of interest in retrospective cohort of women from the New Jersey Cancer Education and Early Detection Program (2000-2015). Women screened at department of health clinics (aOR:3.11, 95% CI: 2.30-4.20) and health care system-affiliated clinics (aOR:1.71, 95% CI: 1.11-2.64) had higher odds of lacking follow-up care compared with women in private physician practices. Similarly, women residing in areas with the highest unemployment had higher odds of lacking follow-up (aOR:1.48, 95% CI: 1.07-2.06). Delays in follow-up care were higher for women born in Central/South American countries compared with U.S.-born women (aOR: 1.46, 95% CI: 1.12-1.92). Improved outreach efforts and multilevel strategies are needed to address the persistent barriers to appropriate follow-up care for underserved women.

Factors Contributing to the Low Survival Among Women With a Diagnosis of Invasive Cervical Cancer in Ghana

Information on women with a diagnosis of cervical cancer from 2010 to 2013 was collected from the Komfo Anokye and Korle-Bu Teaching Hospitals through review of paper-based and electronic medical records (including pathology records) at the oncology units and the departments of obstetrics and gynecology. Telephone interviews were conducted with patients and relatives to gather further information. Data were recorded using a standardized questionnaire and analyzed using summary statistics. Information for 821 women was available for the survival analysis. Of these, 497 (60.5%) died during follow-up. At 3 years after diagnosis, survival was 39%. Survival was lowest in women with stage IV disease. Women with squamous cell carcinoma had a survival advantage over those with adenocarcinoma. Furthermore, women who received surgery, radiotherapy, and chemotherapy had better survival than did women with other forms of treatment. In conclusion, cervical cancer survival is low in Ghana and is likely to be improved if a greater proportion of the disease is detected early. Improving knowledge of the disease for early diagnosis, reducing financial barriers, and greater organization of health care delivery are likely to improve survival from cervical cancer in Ghana.

Previous cervical cytology and high-risk human papillomavirus testing in a cohort of patients with invasive cervical carcinoma in Shandong Province, China.

BackgroundCurrently, available data regarding previous cervical cytology and high-risk human papillomavirus (hrHPV) test results to detect invasive cervical cancer are limited and controversial in China. Therefore, this retrospective study in a population of Chinese women with invasive cervical carcinoma aimed to gain further insight into the roles of cytology and hrHPV testing in cervical cancer screening.MethodsA total of 1214 cases with a histological diagnosis of invasive cervical cancer were retrieved from the Pathology Database of Jinan KingMed Diagnostics (JKD) over a 5-year period. Previous cytology and hrHPV test results of 469 patients carried out within the year before cancer diagnosis were documented.ResultsA higher percentage of patients who had undergone prior screening had micro-invasive cervical carcinoma than patients who had no prior screening (25.4% vs. 12.1%, P < 0.001). Of the 469 patients with available prior screening results, 170 had cytology alone, 161 had hrHPV testing alone, and 138 had both cytology and hrHPV testing. There was a significantly lower percentage of hrHPV-positive cases with adenocarcinoma than with squamous cell carcinoma (77.8% vs. 96.4%, P = 0.001). The hrHPV test showed a significantly higher sensitivity than cytology alone (94.4% vs. 85.3%, P = 0.006). The overall sensitivity of the combination of cytology and hrHPV testing (98.6%) was much higher than that of cytology alone (P < 0.001) but only marginally higher than that of hrHPV testing alone (P = 0.058).ConclusionsThe results revealed that prior cervical screening can detect a significantly larger number of micro-invasive cervical cancers. The hrHPV test can provide a more sensitive and efficient strategy than cytology alone. As the addition of cytology to hrHPV testing can only marginally increase the efficiency of the hrHPV test, hrHPV testing should be used as the primary screening approach, especially in the low-resource settings of China.

Caracterización de la supervivencia de mujeres con cáncer invasivo de cuello uterino usando minería de datos

En este artículo se presenta uno de los resultados del proyecto de investigación denominado: Detección de patrones de supervivencia en mujeres con cáncer invasivo de cuello uterino con técnicas de minería de datos , utilizando como fuente principal la información almacenada en la base de datos del Registro Poblacional de Cáncer del Municipio de Pasto (Colombia). Aplicando la metodología para proyectos de minería de datos CRISP-DM, se construyó, limpió y transformó un repositorio de datos con la información de las mujeres que fueron diagnosticadas con cáncer invasivo de cuello uterino entre los años 1998 y 2002, con una ventana de observación hasta el 2007. Se detectaron los principales factores socioeconómicos y clínicos asociados con la supervivencia de este grupo poblacional, utilizando las tareas de minería de datos: clasificación, asociación y agrupación. El patrón principal descubierto es aquel que caracteriza a una mujer con cáncer invasivo de cuello uterino como sobreviviente, si sobrepasa los 52 meses después del momento del diagnóstico del cáncer.

Feasibility, acceptability, and effectiveness of visual inspection of the cervix with acetic acid and cryotherapy for dysplasia in Nigeria

ObjectiveTo demonstrate the feasibility, acceptability, and effectiveness of visual inspection of the cervix with acetic acid (VIA) and treatment of dysplasia with cryotherapy in Nigeria. MethodsA prospective study was conducted at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, between August 1, 2006, and July 31, 2009. Women aged 20–65 years who had had their sexual debut at least 3years previously were screened for cervical dysplasia using VIA. Women with positive test results were offered cryotherapy immediately after screening. ResultsOverall, 5529 women (mean age 40.24±10.33years) underwent screening with VIA. Dysplasia was detected among 317 (5.7%) women. Lesions suspicious for cancer were recorded among 52 (1.0%) women; histological diagnosis of invasive cervical cancer was confirmed in 38 (0.7%) women. VIA was as expected or better for 5330 (96.4%) women screened. Cryotherapy was as expected or better for 219 (99.5%) women who received treatment. Among 127 women who underwent cryotherapy and had repeat screening, 121 (95.3%) had negative test results after 1year. ConclusionCervical cancer screening using VIA and cryotherapy was feasible and effective despite scarce resources in the Nigerian health system. Furthermore, this approach was socially and culturally acceptable.

Abstract B51: Ethnic differences in cervical cancer survival in women living along the Texas-Mexico border

Abstract Background and objective: Ethnicity-specific estimates of survival after the diagnosis of invasive cervical cancer in women residing on the Texas-Mexico border are lacking. The objective of this analysis was to examine ethnic differences (Hispanic vs. non-Hispanic) in survival after diagnosis with invasive cervical cancer in women residing in 32 Texas counties located within 100 km of the Texas-Mexico border. Methods: Data from the Texas Cancer Registry's Limited-Use SAS File covering the years 1995-2009 were analyzed. Cases of invasive cervical cancer were identified using the primary site, histology, and tumor behavior variables, which had been coded using the ICD-O-3. The sample was restricted to 1634 women who were residents of Texas border counties at the time they were diagnosed with invasive cervical cancer. Univariate associations were explored initially and followed by survival analyses. Ethnicity hazard ratios (HR) for mortality adjusted for age at diagnosis (65+ years vs. &amp;lt;65 years) were calculated using Cox regression after stratifying by stage at diagnosis (localized vs. other stage) and surgery status (whether or not surgery was performed as a first course of treatment). The other stage category was composed of women who were at a regional stage or had distant metastasis at the time of diagnosis. The censoring variable took on three values: alive (censored), died of causes other than cervical cancer (censored), and died of cervical cancer. HRs are reported along with 95% confidence intervals (CI) and P values. Correlation coefficients of scaled Schoenfeld residuals vs. time indicated that the assumption of proportional hazards was met for both covariates in each of the four stage-surgery strata. Results: A total of 1459 Hispanics and 175 non-Hispanics were identified. Approximately 93% of the non-Hispanics and 99.9% of the Hispanics were of white race. Hispanics were more likely to be under 65 years of age at the time of diagnosis than non-Hispanics: 77.6% vs. 70.9% (P=0.046). Ethnicity was not associated with tumor grade in a univariate analysis (P=0.96). Slightly less than half of the Hispanic cases (48.5%) and 53.1% of the non-Hispanics were at a localized stage at the time of diagnosis (P=0.25). The remaining results are stratified by stage and surgery status: cases who were at a localized stage and had surgery as a first course of treatment (group 1), localized stage and did not have surgery as a first course of treatment (group 2), other stage and had surgery as a first course of treatment (group 3), and other stage and did not have surgery as a first course of treatment (group 4). The total number of cervical cancer deaths in groups 1, 2, 3, and 4 were 38, 46, 53, and 225, respectively. HRs comparing Hispanics with non-Hispanics for groups 1 through 4, respectively, were HR=1.13 (95% CI: 0.40-3.17, P=0.82); HR=0.55 (95% CI: 0.24-1.24, P=0.15); HR=0.70 (95% CI: 0.33-1.45, P=0.35); and HR=0.59 (95% CI: 0.39-0.87, P=0.01). Conclusions: Among women who were not at a localized stage at the time of diagnosis and had not undergone surgery as a first course of treatment, Hispanics experienced a 41% reduction in their hazard of mortality compared to non-Hispanics. Social support may partially explain this protective association. In addition, there could be strong social ties to Mexico that lead women with more advanced disease to return to Mexico thereby limiting the reporting of vital status back to the Texas Cancer Registry. We are exploring how this lack of definitive follow-up data could have also produced the results we see. Citation Format: Thelma Carrillo, Leonid Fradkin, Loretta L. Hernandez, Christina M. Gutierrez, Maria Haynes, Irma Hernandez, Michael Scheurer, Christina Melendez, Michele Follen, Zuber D. Mulla. Ethnic differences in cervical cancer survival in women living along the Texas-Mexico border. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B51. doi:10.1158/1538-7755.DISP13-B51

Type distribution of human papillomavirus among adult women diagnosed with invasive cervical cancer (stage 1b or higher) in New Zealand.

BackgroundHuman papillomavirus (HPV) is the necessary cause of cervical cancer. Published data on the epidemiology of HPV in women with invasive cervical cancer (ICC) in New Zealand (NZ) are limited. This cross-sectional study investigated the distribution of high-risk and low-risk HPV types in cervical specimens collected from women throughout NZ who had been diagnosed with ICC between 2004 and 2010.MethodsWomen aged ≥18 years, with ICC International Federation of Gynecology and Obstetrics stage Ib or greater were identified from the five tertiary public hospitals in NZ regularly treating women with ICC. Women were enrolled in the study only after obtaining informed consent. Stored, formalin fixed, paraffin-embedded cervical specimens were retrieved and histopathologically reviewed to confirm the diagnosis of ICC. Cervical specimens were tested for HPV using polymerase chain reaction-short fragment10; HPV DNA was detected using DNA enzyme immunoassay and typed by reverse hybridization line probe assay.Results242 women were enrolled and ICC was histologically confirmed in 227 samples. HPV infection was detected in 88.5% (n = 201; 95% CI: 83.7–92.4) of women with ICC; high-risk HPV types were detected in 87.2% of women. The most commonly detected HPV types were HPV-16 (51.1%) and HPV-18 (20.7%), followed by HPV-31 (4.0%), HPV-45 and HPV-52 (3.1% each). Overall, HPV distribution was highest (94.3%) in women aged 30–39 years at diagnosis and a higher distribution of HPV-16 (68.8%) was observed in women younger than 30 years. The overall distribution of HPV types between Maori and non-Maori women were similar. HPV-positive women with ICC stage II or greater were less likely to be infected with HPV-16/18 (P = 0.002) or HPV-18 (P = 0.029) compared with the other high-risk types. Single type infection and multiple infections were detected in 93.5% and 5.5% of women, respectively.ConclusionsHPV-16, HPV-18, HPV-31, HPV-45 and HPV-52 were the most commonly detected high-risk HPV types. Findings from the study fill an important data gap on HPV type distribution from NZ which will help facilitate better understanding of the epidemiology of HPV in NZ women.Clinical trial registrationNCT01328028.

Younger age distribution of cervical cancer incidence among survivors of pediatric and young adult cancers

BackgroundPediatric and young adult (PAYA) cancer survivors may have an earlier onset of chronic diseases compared with the general population. We compared the age at cervical cancer diagnosis between PAYA cancer survivors and females in the general US population. MethodsWe used longitudinal data from 9 population-based registries of the Surveillance, Epidemiology, and End Results program collected between 1973 and 2010. PAYA cancer survivors were females diagnosed with any cancer before age 30years, survived at least 5years post-diagnosis, and were subsequently diagnosed with invasive cervical cancer (n=46). The general US population comprised females who were diagnosed with invasive cervical cancer as the primary malignancy (n=26,956). We estimated the difference in median age at diagnosis (ß50) and bootstrap 95% confidence limits (CL) of invasive cervical cancer after adjustment for year of diagnosis and race. ResultsThe median age at diagnosis of invasive cervical cancer was 33years for female PAYA cancer survivors and 40years for females in the general US population (ß50=−7.0, 95% CL: −11, −3.2). Similar differences were observed across subgroups of stage and histologic subtype of invasive cervical cancer. ConclusionOur results suggest that PAYA cancer survivors are diagnosed with invasive cervical cancer at a substantially younger age compared with females without a prior cancer diagnosis in the general US population. This issue warrants further study, and could have implications for determining age at initiation or frequency of cervical cancer screening if younger age at diagnosis is attributable to an underlying biological phenomenon.

Human papillomavirus prevalence and type-distribution in women with cervical lesions: a cross-sectional study in Sri Lanka.

BackgroundCervical cancer ranks second among all cancers reported in Sri Lankan women. This study assessed the prevalence and type-distribution of human papillomavirus (HPV) among Sri Lankan women with invasive cervical cancer (ICC) and pre-cancerous lesions.Methods114 women aged 21 years and above, hospitalized in the National Cancer Institute, Sri Lanka with a diagnosis of ICC or cervical intraepithelial neoplasia (CIN) 2/3 were prospectively enrolled between October 2009 and September 2010 (110430/NCT01221987). The cervical biopsy or excision specimens collected during routine clinical procedures were subjected to histopathological review. DNA was extracted from samples with a confirmed histological diagnosis and was amplified using polymerase chain reaction and HPV DNA was detected using Enzyme Immuno Assay. HPV positive samples were typed using reverse hybridization Line Probe Assay.ResultsOf the cervical samples collected, 93.0% (106/114) had a histologically confirmed diagnosis of either ICC (98/106) or CIN 2/3 (8/106). Among all ICC cases, squamous cell carcinoma was diagnosed in the majority of women (81.6% [80/98]). HPV prevalence among ICC cases was 84.7% (83/98). The HPV types most commonly detected in ICC cases with single HPV infection (98.8% [82/83]) were HPV-16 (67.3%) and HPV-18 (9.2%). Infection with multiple HPV types was recorded in a single case (co-infection of HPV-16 and HPV-59).ConclusionsHPV was prevalent in most women with ICC in Sri Lanka; HPV-16 and HPV-18 were the predominantly detected HPV types. An effective prophylactic vaccine against the most prevalent HPV types may help to reduce the burden of ICC disease.

Human papillomavirus prevalence and type distribution in invasive cervical cancer in sub‐Saharan Africa

In sub-Saharan Africa, invasive cervical cancer (ICC) incidence and mortality are among the highest in the world. This cross-sectional epidemiological study assessed human papillomavirus (HPV) prevalence and type distribution in women with ICC in Ghana, Nigeria, and South Africa. Cervical biopsy specimens were obtained from women aged ≥ 21 years with lesions clinically suggestive of ICC. Histopathological diagnosis of ICC was determined by light microscopy examination of hematoxylin and eosin stained sections of paraffin-embedded cervical specimens; samples with a confirmed histopathological diagnosis underwent HPV DNA testing by polymerase chain reaction. HPV-positive specimens were typed by reverse hybridization line probe assay. Between October 2007 and March 2010, cervical specimens from 659 women were collected (167 in Ghana, 192 in Nigeria and 300 in South Africa); 570 cases were histologically confirmed as ICC. The tumor type was identified in 551/570 women with ICC; squamous cell carcinoma was observed in 476/570 (83.5%) cases. The HPV-positivity rate in ICC cases was 90.4% (515/570). In ICC cases with single HPV infection (447/515 [86.8%]), the most commonly detected HPV types were HPV16 (51.2%), HPV18 (17.2%), HPV35 (8.7%), HPV45 (7.4%), HPV33 (4.0%) and HPV52 (2.2%). The prevalence of single and multiple HPV infections seemed higher among HIV-positive women and HPV type distribution appeared to differ according to tumor type and HIV status. In conclusion, HPV16, 18, 45 and 35 were the most common HPV types in sub-Saharan African women with ICC and HPV infections were more common in HIV-positive women.