British Columbia Women Research Articles

An Observational Study of Umbilical Cord Clamping Practices of Maternity Care Providers in a Tertiary Care Center

Severing the umbilical cord at birth is likely the oldest intervention, the timing of which remains fraught with controversy. Emerging evidence suggests benefit in delaying cord clamping for both term and preterm infants. The objective of this study was to investigate actual cord clamping time and circumstances at a large tertiary care center in Canada. We used a stopwatch to time the interval from the time the infant was born as far as the umbilicus until the time that the umbilical cord was clamped before cutting. We reported on timing of the umbilical cord clamping overall and by practitioner group (obstetrician, midwife, and family practitioner). A total of 98 women and their practitioners consented to be observed at the British Columbia Women's Hospital and Health Center, Vancouver, Canada. More than one-half (56.2%) of all infants had their umbilical cord clamped within 15 seconds. The median (5th, 95th percentile) clamping time in seconds for the full sample was 12 (4, 402) with practitioner subgroups as follows: obstetricians (12 [3, 107]), family physicians (19 [6, 325]), and midwives (81 [6, undefined]). The median clamping time was likely to be longer when the birth occurred spontaneously, no umbilical cord blood was collected, and no birth or neonatal complications occurred. In our sample taken in 2006 to 2007, most infants had umbilical cords clamped immediately after the birth, with more than one-half clamped within 15 seconds of birth. Since the time of our study, delayed umbilical cord clamping for the healthy term newborn has become a part of recommended management of third stage of labor and resuscitation guidelines. It would be informative to repeat a study like this one to determine compliance with the current standards of care.

Population-based evaluation of type-specific HPV prevalence among women in British Columbia, Canada

BackgroundBritish Columbia (BC) introduced a school-based HPV vaccine program in September 2008. As part of the HPV vaccine program evaluation, we determined the type-specific HPV prevalence in a population-based sample of women presenting for routine cervical cancer screening in the province. MethodsFrom June 2010 to February 2011, a total of 1100 physicians from all health regions in BC were invited to return ten sequential cytobrushes used during routine office-based Pap screening to the Provincial Health Services Authority Laboratories for HPV type-specific testing. Client age was the only identifier provided. Specimens were screened by the Digene Hybrid Capture® 2 High-Risk (hr) HPV DNA Test (HC2). HC2 positive specimens were then genotyped using the Roche cobas® 4800 HPV Test, the Roche Linear Array (LA) HPV Genotyping Test and the Digene® HPV Genotyping LQ Test. ResultsOverall, 12.2% of the 4330 specimens with valid HC2 results were hrHPV positive. Age range was 15–69 (median 39.0). By age group, the proportion HC2 hrHPV positive was: 15–19, 25.7%; 20–24, 33.2%; 25–29, 21.9%; 30–34, 12.6%; 35–39, 9.5%; 40–44, 8.4%; ≥45, 3.4%. Overall hrHPV prevalence was 10.1% by Roche cobas® 4800, 10.5% by Roche LA and 10.3% by Digene LQ. For HPV 16/18, rates by age group by Roche LA were: 15–19, 5.1%/2.8%; 20–24, 9.5%/3.9%; 25–29, 6.2%/1.0%; 30–34, 2.4%/1.7%; 35–39, 1.2%/1.0%; 40–44, 1.6%/0.2%; ≥45, 0.3%/0.2%. Similar HPV 16/18 rates were obtained with the Digene LQ and Roche cobas® 4800 methods. Agreement between the three genotyping methods for HPV 16 and 18 was high. ConclusionsComparable to other evaluations, hrHPV positivity was highest among younger women and HPV 16 was the most frequent genotype detected. These baseline estimates will be useful for monitoring the effectiveness of the HPV vaccine in BC. Type-specific analyses repeated at regular intervals over time may determine whether the use of HPV vaccine results in hrHPV genotype replacement in the province.

Women Politicians and Adult Education and Learning in British Columbia

The lack of participation of women in electoral politics is a problem of justice, equity and democracy. Although feminist scholars have explored this phenomenon from a variety of angles, few have focussed on the education and learning dimensions. Using a feminist approach that included individual interviews, focus groups and observations at two training programmes, our two-year study uncovered how women in British Columbia were educated or learned to be or become politicians. Findings show a complex web of practical, transformational or feminist learning, media relations and communications, knowledge and power, passion and subservience, neutrality and normativity. We argue that this complex web of powerful, problematic and often, contradictory practices contributes to but also impedes women’s political empowerment and thereby, substantive political change.

False-positive Screening Mammograms and Biopsies Among Women Participating in a Canadian Provincial Breast Screening Program

Mammography screening results in false positives that cause anxiety and utilize scarce medical resources for their resolution. Determination of screening recommendations requires knowledge of the population risk of false positives.Data were extracted from the Screening Mammography Program of British Columbia and analyzed to determine the influence of personal factors including age, ethnic group and screening history, and the centre where screening was performed, on the likelihood a new screen would result in a false positive and whether a biopsy was required. The resulting probabilities were combined to provide values for lifetime screening algorithms.Age, screen sequence number, history of previous abnormal screens and centre where screening was performed were significantly related to the likelihood a new screen would be a false positive. British Columbia women screened biennially between the ages of 50 and 69 have a projected 41% chance of a false-positive screen and a 5.6% risk of a related biopsy, with the best performing centres having rates of 26% and 3%, respectively.Model projections for BC overall are comparable to other North American estimates. Estimates varied depending upon screening centre attended.

Estimation of additional MRI resources needed in British Columbia for screening high-risk women for breast cancer.

51 Background: Screening women at high risk with MRI has been shown to detect breast cancer at an early stage. Therefore, MRI screening has been recommended in the UK and USA for women who are at a high risk of developing breast cancer. However, there is no information available in the province of British Columbia (BC) about the number of women who have a high risk of developing breast cancer. Therefore, we carried out a study to estimate the breast cancer risk distribution in three sample populations in BC using Tyrer-Cuzick (TC) risk prediction model so that additional resource requirement for MRI breast screening can be calculated. Methods: A survey questionnaire was designed based on the TC model, which includes family history, hormonal factors, and benign breast disease. Additional questions also include factors that are used in other models (Gail, Claus, and BCRAPRO) as well as factors that may be included in the future. Women were recruited by staff and volunteers at three screening mammography clinics: Kelowna, Victoria General Hospital, and BC Women’s Health Centre in Vancouver. The survey was available to women to complete on the web, by phone, or on paper. An online database was constructed to store and query the data. The 10-year risk of developing breast cancer for each woman was calculated using the Tyrer-Cuzick IBIS Risk Evaluator software and the risk distribution of the survey population was analyzed. Results: Data from 3,200 women recruited from three sites, gives a risk distribution showing 2.6% are at high risk of developing breast cancer, 31.2% are at moderate risk, and 66.2% are at low risk. Based on NICE guidelines (UK), high risk is defined as having a 10-year risk of greater than 8%, moderate risk as 3-8%, and low risk as less than 3%. Extrapolating this to the approximately 500,000 women who are eligible to attend for screening mammography in BC, 13,000 women are considered at high risk. Conclusions: Our results indicate that 2.6% of women ages 40-79 attending screening mammography in BC may have a very high risk of developing breast cancer based on personal and family history. Based on a 14-hour work day, three additional MRI scanners would be required to implement MRI screening for these high-risk women in BC.

Ethnicity-Specific Growth Distributions for Prediction of Newborn Morbidity

ObjectivesBirth weight distributions differ according to the ethnic origin of the mother. We aimed to determine whether using ethnicity-specific growth distributions would identify newborns at risk for adverse infant outcomes associated with small for gestational age (SGA) birth better than population-based distributions. MethodsWe examined 2647 singletons born to healthy non-smoking mothers at British Columbia Women’s Hospital at 37 to 41 completed weeks’ gestation. We compared the ability of ethnicityspecific growth distributions and population-based distributions to predict which infants were at increased risk of adverse outcomes associated with SGA, as well as extended length of stay in hospital,using crude and adjusted odds ratios. ResultsThe ethnicity-specific growth distributions were associated with an increased risk of adverse infant outcomes while the population-based distributions were not (adjusted odds ratio [aOR] 1.49 [95% CI 0.82 to 2.70] vs. aOR 0.88 [95% CI 0.48 to 1.64]). While both distributions predicted extended length of stay in hospital, this likely reflects clinicians’ use of the population-based distribution to identify SGA infants ConclusionThe use of ethnicity-specific growth distributions will likely improve our ability to differentiate between babies who are pathologically small and those who are constitutionally small, and prevent misclassification of constitutionally small but healthy newborns born to mothers of Chinese or South Asian descent as SGA.

Patient‐Initiated Elective Cesarean Section of Nulliparous Women in British Columbia, Canada

The proportion of cesarean sections is increasing in Canada overall and in British Columbia in particular. It has been suggested that this increase is partially the result of women requesting the procedure, although the prevalence of patient-initiated elective cesarean section is unclear. The objective of this study was to examine the prevalence of probable elective cesarean and physician-suggested elective cesarean section among nulliparous women who had a cesarean section in British Columbia, Canada. An electronic search of patient charts from seven British Columbia hospitals between June 1, 2002, and May 31, 2004, was completed and potential nulliparous women seeking elective cesarean were identified. Any women with medical factors predisposing them to a cesarean section were excluded. Identified charts were then subjected to individual chart review by two independent researchers to ensure accuracy of classification into a cohort of women with probable patient-initiated elective cesarean section. For the study period, 10,546 nulliparous women gave birth at the seven study hospitals and 3,301 delivered by means of cesarean section. Of these 3,301 women, 36 were judged to have had a patient-initiated elective cesarean. These 36 women represented 0.34 percent of all nulliparous births and 1.09 percent of all nulliparous cesarean births. Those judged to have selected an elective cesarean were significantly older and had babies with a lower gestational age than women with a nonelective cesarean section. No significant differences between the two groups were found with respect to maternal weight, length of stay for the mother or baby, newborn birthweight, or special care nursery days. Overall, the prevalence of nulliparous women judged to have had a patient-initiated elective cesarean was found to be low and is not likely to be substantially contributing to the rising proportion of cesarean births.

Shifting Sands: Changing Regional and Gender-specific Patterns of HIV/AIDS Mortality in Canada, 1987 to 2008

To assess patterns of HIV-related mortality by period, gender and age group in Canada from 1987 to 2008. We applied standard demographic techniques to assess changes in HIV/AIDS mortality over five time periods: 1987-1991, 1992-1996, 1997-2001, 2002-2006, and 2007-2008. HIV/AIDS-related mortality was based on deaths in which HIV infection or AIDS was reported as the underlying cause of death. Population figures were obtained from annual estimates. Age-, sex- and province-specific crude and standardized HIV/AIDS mortality rates and ratios were used to examine changes in mortality. In the period from 1987 to 2008, there were 17,287 HIV/AIDS-related deaths; of these, 15,587 (90.2%) occurred among men and 1,700 (9.8%) among women. Standardized and age-specific death rates were generally higher in men than women. Among men, rates of mortality were highest in Quebec and British Columbia; and among women, rates increased over time in British Columbia and the Prairies and decreased in Quebec. In general, rates of death were highest in 1992-1996 and lowest in the latest period. We observed a sharp decline in mortality rates with the introduction of HAART; however, the rates were higher among men in Quebec and British Columbia and among women in British Columbia, Quebec and the Prairies.

Women’s Health Care Utilization among Harder-to-Reach HIV-Infected Women ever on Antiretroviral Therapy in British Columbia

Background. HIV-infected women are disproportionately burdened by gynaecological complications, psychological disorders, and certain sexually transmitted infections that may not be adequately addressed by HIV-specific care. We estimate the prevalence and covariates of women's health care (WHC) utilization among harder-to-reach, treatment-experienced HIV-infected women in British Columbia (BC), Canada. Methods. We used survey data from 231 HIV-infected, treatment-experienced women enrolled in the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) study, which recruited harder-to-reach populations, including aboriginal people and individuals using injection drugs. Independent covariates of interest included sociodemographic, psychosocial, behavioural, individual health status, structural factors, and HIV clinical variables. Logistic regression was used to generate adjusted estimates of associations between use of WHC and covariates of interest. Results. Overall, 77% of women reported regularly utilizing WHC. WHC utilization varied significantly by region of residence (P value <0.01). In addition, women with lower annual income (AOR (95% CI) = 0.14 (0.04–0.54)), who used illicit drugs (AOR (95% CI) = 0.42 (0.19–0.92)) and who had lower provider trust (AOR (95% CI) = 0.97 (0.95–0.99)), were significantly less likely to report using WHC. Conclusion. A health service gap exists along geographical and social axes for harder-to-reach HIV-infected women in BC. Women-centered WHC and HIV-specific care should be streamlined and integrated to better address women's holistic health.

Long-Term Trends in the Survival of Women with Endometrial Cancer in Canada: A Population-Based Study

Introduction: Annually in Canada, endometrial cancer affects approximately 4500 women and 790 are expected to die of their disease. To better understand survival trends across the country we undertook this population based study of Canadian women diagnosed with endometrial cancer. Long term trends in relative survival were evaluated by age and geographic region of residence. Methods: Women with an ICD-10 code of C54 and endometrial cancer were identified from the Canadian Cancer Registry. They were included if the incident diagnosis occurred between 1992 and 2005, and they were 16 years and older at diagnosis. A flexible parametric model was used to determine relative survival ratio (i.e., the observed survival rate among cancer patients divided by the expected survival rate in the general population). Results: 18,486 women were diagnosed with endometrial cancer. Mean age was 63.4 (SD=11.8) year. Relative survival decreased with each successive age group cohort of patient (16-49 yr compared to over 60 years, p<0.001). When relative survival was adjusted for age, women in British Columbia had the best outcomes (eastern Canada compared to other jurisdictions p<0.001). Five-year survival outcomes improved for each age group cohort during the 1992 to 2005 time frame. Conclusions: Regional variations in relative survival were identified across Canada for women with endometrial cancer. This suggests that other factors related to the patient or processes of care are involved. Examining these factors in further detail may provide opportunities to improve the care of women with endometrial cancer in Canada.

Prescription Drug Use in Pregnancy: A Retrospective, Population-Based Study in British Columbia, Canada (2001–2006)

BackgroundOwing to the paucity of evidence available on the risks and benefits of drug use in pregnancy, the use of prescription medicines is a concern for both pregnant women and their health care providers. ObjectiveThe aim of this study was to measure the frequency, timing, and type of medicines used before, during, and after pregnancy in a Canadian population. MethodsThis retrospective cohort analysis used population-based health care data from all pregnancies ending in live births in hospitals in British Columbia from April 2001 to June 2006 (n = 163,082). Data from hospital records were linked to those in outpatient prescription-drug claims. Data from prescriptions filled from 6 months before pregnancy to 6 months postpartum were analyzed. Drugs were classified by therapeutic category and US Food and Drug Administration (FDA) pregnancy risk categories. ResultsPrescriptions were filled in 63.5% of pregnancies. Evidence on safety is limited for many of the medicines most frequently filled in pregnancy, including codeine, salbutamol, and betamethasone. At least 1 prescription for a category D or X medicine was filled in 7.8% of pregnancies (5.5% category D; 2.5% category X). The most frequently filled prescriptions for category D drugs were benzodiazepines and antidepressants. The most frequently filled prescriptions for category X drugs were oral contraceptives and ovulation stimulants filled in the first trimester. ConclusionsThe majority of pregnant women in British Columbia filled at least 1 prescription, and ∼1 in 13 filled a prescription for a drug categorized as D or X by the FDA. The prevalence of maternal prescription drug use emphasizes the need for postmarketing evaluation of the risk–benefit profiles of pharmaceuticals in pregnancy. Future research on prenatal drug use based on administrative databases should examine maternal treatment adherence and the determinants of maternal drug use, considering maternal health status, sociodemographics, and the characteristics and providers of prenatal care.

Hepatitis C Infection Among Pregnant Women in British Columbia: Reported Prevalence and Critical Appraisal of Current Prenatal Screening Methods

Background: Despite the fact that hepatitis C virus (HCV) is a relatively common infection in Canada, particularly in British Columbia (BC), there is a paucity of information on actual HCV prevalence in pregnant women. At present, pregnant women are only screened if they fit risk criteria, which may result in under-identification of HCV in this population. The purpose of this study was to determine the overall prevalence rate, age and geographic distribution of reported HCV infection among pregnant women in BC, and compare results to a previously conducted anonymous seroprevalence survey. Methods: Reported HCV prevalence was determined through a confidential database linkage of all prenatal screening results at the Canadian Blood Services (CBS) with all HCV test results at the Provincial Laboratory, from May 2000 to Oct 2002. Data were stratified by age group and geographic location, and subsequently compared to an anonymous prenatal seroprevalence survey conducted in 1994. Results: The overall HCV prevalence rate was 50.3/10,000 (95% CI 46.3-54.6), or 0.5% of the cohort. Prevalence was highest in the northern BC region (66.2/10,000, 95% CI 51.4-85.3) and lowest in the populous suburban region southwest of Vancouver (38.0/10,000, 95% CI 32.3-44.8). Of note, the rate of reported HCV among pregnant women was significantly lower than the anonymous seroprevalence rate: 50.3/10,000 vs. 91.3/10,000 (p<0.0001). Conclusion: Rates of reported HCV among pregnant women were approximately 50% lower than the rates determined by the anonymous seroprevalence survey. Further research is needed to determine the relative merits of the current selective screening policy versus universal prenatal HCV screening in pregnancy. Key words: Hepatitis C virus; pregnancy; mother to child transmission; prenatal testing

Hepatitis C infection among pregnant women in British Columbia: reported prevalence and critical appraisal of current prenatal screening methods.

Despite the fact that hepatitis C virus (HCV) is a relatively common infection in Canada, particularly in British Columbia (BC), there is a paucity of information on actual HCV prevalence in pregnant women. At present, pregnant women are only screened if they fit risk criteria, which may result in under-identification of HCV in this population. The purpose of this study was to determine the overall prevalence rate, age and geographic distribution of reported HCV infection among pregnant women in BC, and compare results to a previously conducted anonymous seroprevalence survey. Reported HCV prevalence was determined through a confidential database linkage of all prenatal screening results at the Canadian Blood Services (CBS) with all HCV test results at the Provincial Laboratory, from May 2000 to Oct 2002. Data were stratified by age group and geographic location, and subsequently compared to an anonymous prenatal seroprevalence survey conducted in 1994. The overall HCV prevalence rate was 50.3/10,000 (95% CI 46.3-54.6), or 0.5% of the cohort. Prevalence was highest in the northern BC region (66.2/10,000, 95% CI 51.4-85.3) and lowest in the populous suburban region southwest of Vancouver (38.0/10,000, 95% CI 32.3-44.8). Of note, the rate of reported HCV among pregnant women was significantly lower than the anonymous seroprevalence rate: 50.3/10,000 vs. 91.3/10,000 (p < 0.0001). Rates of reported HCV among pregnant women were approximately 50% lower than the rates determined by the anonymous seroprevalence survey. Further research is needed to determine the relative merits of the current selective screening policy versus universal prenatal HCV screening in pregnancy.

Birth Outcomes Among Older Mothers in Rural Versus Urban Areas: A Residence-Based Approach

We examined the association between rural residence and birth outcomes in older mothers, the effect of parity on this association, and the trend in adverse birth outcomes in relation to the distance to the nearest hospital with cesarean-section capacity. A population-based retrospective cohort study, including all singleton births to 35+ year-old women in British Columbia (Canada), 1999-2003. We compared birth outcomes in rural versus urban areas, and between 3 distance categories to a hospital (<50, 50-150, >150 km). Outcomes included labor induction, cesarean section, stillbirth, perinatal death, preterm birth (<37 weeks), small-for-gestational-age, large-for-gestational-age, and neonatal intensive care unit admission. We used multivariate regression to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Among the 29,698 subjects, 11.5% lived in rural areas; 5% lived within 50-150 km; and 1.1% lived >150 km from a hospital. Rural women were at lower risk of primary and repeat cesarean section (OR = 0.9, CI: 0.9-1.0; OR = 0.7, CI: 0.6-0.9) and small-for-gestational-age (OR = 0.8, CI: 0.7-0.9) births; they were at increased risk for perinatal death (OR = 1.5, CI: 1.1-2.1) and large-for-gestational-age (OR = 1.1, CI: 1.1-1.2) births. The association was stronger among multiparous versus primiparous women. No differences in emergency cesarean section, preterm birth, or neonatal intensive care admission were found, regardless of parity. Perinatal mortality increased with distance from hospital; OR = 1.5 (CI: 1.1-2.1) per distance category. Older women in rural versus urban areas had a lower rate of cesarean section and increased risk of perinatal death. The risk of perinatal death increased with the distance to hospital. Further studies need to evaluate the contribution of underlying perinatal risks, access to care, and decision making regarding referral and transport.

Rates of Congenital Anomalies and Other Adverse Birth Outcomes in an Offspring Cohort of Registered Nurses from British Columbia, Canada

Although there is concern that occupational exposures in some nursing professions may confer reproductive risks, there are few relevant studies. Our objective is to determine if a cohort of female registered nurses (RN) from British Columbia (BC), in comparison to BC women in general, have elevated rates of congenital anomalies, stillbirths, low birth weight, or prematurity in their offspring. A cohort of RNs from BC was linked to Vital Statistics birth records and the BC Health Status Registry (HSR) between the years 1986 and 2000. The RN offspring cohort included 23,222 births. For each outcome, odds ratios (OR) with 95% confidence intervals (CI) were determined by comparing rates in the nurses' cohort with the rates in the general population standardized for the year of birth. Apart from chromosomal anomalies, for each of the ICD-9 congenital anomaly categories there were fewer congenital anomalies than expected, resulting in an overall prevalence of congenital anomaly cases (with at least one anomaly) that was significantly lower in the RN cohort (1,567 observed vs. 1,846 expected; OR 0.84, 95% CI 0.78-0.90) in comparison to the general population. Low birth weight (1,138 observed vs. 1,260 expected; OR 0.90, 95% CI 0.83-0.98) was also significantly lower, while prevalence of prematurity and stillbirths were not significantly different than among the general population. Offspring of RNs in BC had a lower prevalence of congenital anomalies and low birth weight compared to the rates found among the general population. Further studies are underway to determine if subpopulations within the RN cohort are at risk.

Population-Based Comparison of CEF and AC/T, Two Adjuvant Chemotherapy 'Standards' for Early Stage Breast Cancer.

Abstract Introduction: Anthracyclines and taxanes in adjuvant therapy have improved the outcomes of women with early stage breast cancer. The first analysis of the phase III NCIC-MA21 trial comparing the three 6 month adjuvant regimens CEF, AC followed by q3weekly paclitaxel(AC/T) and dose dense EC followed by paclitaxel (EC/T) revealed inferior Relapse Free Survival for AC/Tversus CEF (HR 1.49[1.12,1.99]) and EC/T (HR1.68 [1.25-2.27]). The purpose of this population based analysis is to evaluate the characteristics and outcome of women with high-risk breast cancer treated with CEF vs q3weekly AC/T.Methods: The British Columbia Breast Cancer Outcomes Unit (BCOU) and Pharmacy databases were used to identify patients with node positive or high-risk node negative breast cancer between years 2000-2004 treated with adjuvant chemotherapy with either CEF or AC/T. Both regimens were available and recommended for high risk breast cancer during the time of the study. Patients with cTx, pTx tumours, previous or synchronous breast cancer and those with with locally advanced/inflammatory breast cancer were excluded. Patient and tumour characteristics were compared across study cohorts.Univariate comparisons of overall survival (OS) and breast cancer specific survival (BCSS) were performed using the Kaplan-Meier method. Propensity score models were used to compare outcomes in the two cohorts, adjusting for differences in prognostic and other treatment variables.Results: Between 2000-2004, 774 (CEF=557, AC/T=217)women with breast cancer met the inclusion criteria. Median follow-up for CEF was 4.7 years and for AC-T was 3.0 years. CEF-treated patients had more LVI (p=0.0001) and node +ve disease (p&amp;lt;0.0001), were younger (p&amp;lt;0.0001), more likely ER+ (p&amp;lt;0.0001), less likely to have grade 3 tumours (p&amp;lt;0.0001) and received higher rates of both hormones (p&amp;lt;0.0001) and radiation therapy to regional nodes (p&amp;lt;0.0001). Univariate analyses showed better outcomes for the CEF-treated cohort for both OS (p=0.0056) and BCSS (p=0.0012). Propensity score models also favoured the CEF cohort with adjusted HR's of 0.47 (95% CI: 0.27, 0.83; p=0.0086) and 0.40 (95% CI: 0.22, 0.71; p=0.0020) for OS and BCSS respectively.Conclusion: Between 2000 and 2004, women in British Columbia treated with adjuvant CEF had higher risk breast cancer than patients who received AC/T. However, CEF-treated patients have better outcomes than those receiving AC/T. Both univariate and adjusted analyses favour the CEF cohort. These population-based outcomes are consistent with the finding of the NCIC-MA21 randomized trial. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2084.

Prevalence of Human Papillomavirus 16 and 18 Neutralizing Antibodies in Prenatal Women in British Columbia

Human papillomavirus (HPV) type 16 and 18 neutralizing antibody (NAb) titers were measured in 1,020 prenatal women in British Columbia aged 15 to 39. HPV 16 and 18 NAbs were detected in 183/1,020 (17.9%) and 97/1,020 (9.5%), respectively, and 39 (3.8%) had NAbs to both types. Titers were similar across age strata.

Decision Making in Patient-Initiated Elective Cesarean Delivery: The Influence of Birth Stories

Patient-initiated elective cesarean delivery is emerging as an urgent issue for practitioners, hospitals, and policy makers and for pregnant women. This exploratory qualitative study looks at the birth stories and cultural knowledge that women use to inform the decision about an elective cesarean without medical indication. Data collection consisted of exploratory qualitative in-depth interviews with 17 primiparous women in British Columbia, Canada. Interviews revealed the influence of socially circulated birth stories and cultural narratives on their attitudes towards mode of delivery. Participants included in their decision making process both medical information and informal birth stories that were technologically inclined and confirmed their preference for cesarean delivery. Results indicate that women who participated in this study drew heavily from social and cultural knowledge in forming their decision to give birth by patient-initiated elective cesarean delivery. Although the numbers of women who request a cesarean delivery for social reasons is still small, the persuasive influence on parturient women of positive cesarean stories and negative vaginal stories must be considered. Care providers and childbirth educators need to become familiar with the social influences impacting women's decisions for mode of delivery so that truly informed choice discussions can be undertaken.

Prevalence and type distribution of human papillomavirus in 5,000 British Columbia women—implications for vaccination

BackgroundHuman papilloma virus (HPV) prevalence studies performed in different regions and population groups across Canada would inform public health decisions regarding implementation of anti-HPV vaccines.MethodsA total of 8,700 liquid-based specimens from 8,660 women aged 13–86 from throughout British Columbia were collected. DNA was isolated from 4,980 of these samples and assessed for HPV prevalence and type distribution. HPV was detected by PCR analysis using tagged GP5+/6+ consensus primers to amplify the L1 region of HPV; typing was done by bi-directional sequencing of PCR products.ResultsOverall HPV prevalence was 16.8% (age adjusted 15.5%). Prevalence of high-risk HPV was 13.9, and 10.7% of samples contained HPV16. HPV prevalence was highest in the youngest group of women (<20 years). One-third of HPV positive samples contained more than one HPV type. Percentages of low-grade (LGIL) and high-grade intraepithelial lesions (HGIL) containing high-risk HPV are 52.3 and 79.4%, respectively.ConclusionsOverall HPV prevalence in this study is within the range of estimates from other studies. The prevalence of HPV16 is higher than what is found in other Canadian and international studies. HPV16 and HPV18 compose a majority of the high-risk virus in this study. Use of current HPV vaccines could considerably reduce HPV-related conditions including cervical cancer and procedures such as colposcopy.Electronic supplementary materialThe online version of this article (doi:10.1007/s10552-009-9365-4) contains supplementary material, which is available to authorized users.

Effectiveness of a Letter Notification Program for Women With Early-Stage Breast Cancer Eligible for Extended Adjuvant Letrozole

After National Cancer Institute of Canada trial MA.17 demonstrated benefits with letrozole after 5 years of tamoxifen, oncologists needed to identify and offer therapy to patients in community follow-up who were eligible for extended adjuvant hormone therapy. In British Columbia (BC), letters about extended letrozole therapy were sent to eligible BC women, their primary care physicians (PCPs), and their oncologists. We evaluated the effectiveness of this communication strategy. Eight hundred eighty-five women with stage I-III breast cancer who completed 4 to 6 years of tamoxifen in 2004 with no documented recurrence were sent letters describing extended adjuvant letrozole in February 2005. Treatment uptake and characteristics for women who did or did not receive a subsequent letrozole prescription were described. Among 838 eligible women, 305 (36%) received a letrozole prescription before April 2006. More women in the letrozole cohort had tumors larger than 2.0 cm (44.2% v 30.8%); node-positive disease (52.5% v 22.5%); prior radiotherapy (71.1% v 58.5%); and prior chemotherapy (51.5% v 20.8%; all P <or= .001). Among women younger than 70 years with node-positive disease, 65% received letrozole (122 of 188). Most prescribing physicians were oncologists (57.0%) or PCPs (30.8%). A significant increase in letrozole prescriptions was observed after the letter mail-out. In this population-based setting, extended adjuvant letrozole was more common among younger women with higher risk disease and more prior therapy but underutilized overall. The reasons for extended therapy underutilization and the role of the letter mail-out strategy in informing breast cancer survivors of new available treatments in other health systems warrant further study.