Familial association of pancreatic cancer with other malignancies in Swedish families

Background:

The aim of this study was to characterise the familial association of pancreatic cancer with other malignancies.

Methods:

Relative risks (RRs) of pancreatic cancer according to family history of cancer were calculated using the updated Swedish Family-Cancer Database, which includes over 11.5 million individuals. Estimates were based on Poisson regression. RRs of tumours for individuals with a parental history of pancreatic cancer were also estimated.

Results:

The risk of pancreatic cancer was elevated in individuals with a parental history of cancers of the liver (RR 1.41; 95% CI 1.10–1.81), kidney (RR 1.37; 95% CI 1.06–1.76), lung (RR 1.50; 95% CI 1.27–1.79) and larynx (RR 1.98; 95% CI 1.19–3.28). Associations were also found between parental history of pancreatic cancer and cancers of the small intestine, colon, breast, lung, testis and cervix in offspring. There was an increased risk of pancreatic cancer associated with early-onset breast cancer in siblings.

Conclusion:

Pancreatic cancer aggregates in families with several types of cancer. Smoking may contribute to the familial aggregation of pancreatic and lung tumours, and the familial clustering of pancreatic and breast cancer could be partially explained by inherited mutations in the BRCA2 gene.     

Review of the Cervical Cancer Burden and Population-Based Cervical Cancer Screening in China

Cervical cancer continues to be a serious public health problem in the developing world, including China. Because of its large population with geographical and socioeconomic inequities, China has a high burden of cervical cancer and important disparities among different regions. In this review, we first present an overview of the cervical cancer incidence and mortality over time, and focus on diversity and disparity in access to care for various subpopulations across geographical regions and socioeconomic strata in China. Then, we describe population-based cervical cancer screening in China, and in particular implementation of the National Cervical Cancer Screening Program in Rural Areas (NACCSPRA) and the challenges that this program faces. These include low screening coverage, shortage of qualified health care personnel and limited funds. To improve prevention of cervical cancer and obtain better cancer outcomes, the Chinese government needs to urgently consider the following key factors: reducing disparities in health care access, collecting accurate and broadly representative data in cancer registries, expanding target population size and increasing allocation of government funding for training of personnel, improving health education for women, enhancing quality control of screening services and improving a system to increase follow up for women with positive results.     

Cervical Cancer Risk Levels in Turkey and Compliance to the National Cervical Cancer Screening Standard

Cervical cancer screening with Pap smear test is a cost-effective method. The Ministry of Health in Turkeyrecommends that it be performed once every five years after age 35. The purpose of this study was to determinethe cervical cancer risk levels of women between 35 and 69, and the intervals they have the Pap smear test,and to investigate the relation between the two. This study was performed on 227 women aged between 35and 69 living in Balcova District of İzmir province. Using the cervical cancer risk index program of HarvardSchool of Public Health, the cervical cancer risk level of 70% of the women was found below average, 22.1%average, and 7.9% above average. Only 52% of the women have had Pap smear test at least once in their lives.The percentage screening regularly in conformity with the national screening standard was 39.2%. Women inthe 40-49 age group, were married, conformed significantly more (p<0.05) to the national screening standard.Compliance also increased with the level of education and decreased with the cervical cancer risk level (p<0.05).A logistic regression model was constructed including age, education level, menstruation state of the women andthe economic level of the family. Not having the Pap smear test in conformity with the national cervical cancerscreening standard in 35-39 age group was 2.52 times more than 40-49 age group, while it was 3.26 times morein 60-69 age group (p<0.05). Not having Pap smear test in 35-39 age group more than other groups might resultfrom lack of information on the cervical cancer national screening standard and the necessity of having Papsmear test. As for 60-69 age group, the low education level might cause not having Pap smear test. Under thesecircumstances, the cervical cancer risk levels should be determined and the individuals should be informed.Providing Pap smear test screening service to individuals in the target group of national screening standard, asa public service may resolve the inequalities due to age and educational differences.     

胃癌的家族聚集性研究

本文采用遗传流行病学病例对照研究方法,探讨遗传因素在胃癌病因中所起的作用,并研究胃癌的家族聚集性.结果病例组有胃癌家族史的比例(22.53%)显著高于对照组(10.79%),病例组一级亲属患胃癌的比例(3.21%)高于对照组(1.44%,0R=2.27,95%CI1.38～3.73).用(p+q)n模型拟合结果家族中实际病例数的分布高于二项分布的概率范围,经频数分布拟合优度的检验,P＜0.01,说明胃癌在家族中并非按机会均等的概率分布,而是呈现明显的家族聚集现象,胃癌家族史是胃癌发生的危险因素.     

Cervical Cancer Screening: Patients Understanding in Major Hospitals in Malaysia

We studied women with cervical cancer to determine whether they had had a Pap smear within the 3 yearspreceding cancer development and their understanding of screening for this cancer. The study had 2 parts;Pathology Data and Survey Data. For pathology data, all cases of cervical cancer diagnosed in 2000-2006 wereretrieved from eight hospitals and Pap smear history was obtained from clinical records. For the Survey data;patients who were still undergoing treatment in some of these hospitals and three others were administeredstructured questionnaires to determine their awareness about screening. The results showed 1431 cases ofcervical cancer in women aged 25-85 were diagnosed in these hopsitals. Most had not had a Pap smear within 3years before cancer development. The percentage of patients who had had Pap smear ranged from 0-12%.Questionnaires were returned by 221 patients; 56.3% had none or only primary education and 61.1% had ahousehold income of RM1000 or less. Level of education and the household income were strongly associated(p<0.05) with knowledge and having had a Pap test. The main reasons cited for not having had a Pap smearwere “Never heard about it” (36.2%), “Shy” (10.4%), “Afraid to do it” (13.1%), “Think the test is not important”(8.1%) and “No encouragement from family” (4.5%). A large majority (95.9%) of the patients did not know theoptimal interval. In conclusion, a large number of cervical cancer patients had not had a Pap smear within 3years preceding cancer development and most had inadequate knowledge about this screening test.     

Familial risk of childhood cancer and tumors in the li‐fraumeni spectrum in the utah population database: Implications for genetic evaluation in pediatric practice

We used the Utah Population Database to examine risk of cancer in relatives of 4,482 pediatric cancer cases (≤18 years old) diagnosed from 1966 to 2009 compared to matched population controls. We quantified cancer risk in relatives of children with cancer to determine evidence of familial aggregation and to inform risk assessment and counseling for families. Odds ratios that reflect risk were obtained using conditional logistic regression models adjusting for number of biological relatives, their degree of genetic relatedness and their person‐years at risk. First‐degree relatives (primarily siblings) of pediatric cases faced a twofold increased risk of a cancer diagnosis before age 19, which extended to their second‐degree relatives (p < 10^?4, respectively). Furthermore, first‐degree relatives of children diagnosed before age 5 had a 3.6‐fold increased risk of developing pediatric cancer (p < 10^?7), second‐degree relatives of very young (under age 5) cases were at 2.5‐fold risk (p < 10^?4) and third‐degree relatives were at twofold risk (P < 10^?3) of childhood cancer. Although first‐degree relatives of pediatric cases have a slight increased risk of adult tumors, when they do develop cancer they have a 1.7‐fold risk of developing a tumor in the Li‐Fraumeni spectrum. Our findings support the hypothesis of familial aggregation in pediatric cancer and suggest that a higher percent of childhood cancers may be related to hereditary syndromes than are adult cancers. We encourage the collection of a family medical history that is routinely updated for all pediatric cancer patients, and that families with early‐onset adult cancers or clusters of several cancers are referred for genetic counseling.     

Personal and Socio-Cultural Barriers to Cervical Cancer Screening in Iran,Patient and Provider Perceptions: a Qualitative Study

Background: Although cervical cancer is preventable and early screening might decrease the associatedmortality, challenges faced by the women and health care providers can postpone early detection. This qualitativestudy aimed to establish patient and provider perceptions about personal and socio-cultural barriers for cervicalcancer screening in Mashhad, Iran. Materials and Methods: In the present study, which was conducted in 2012,eighteen participants, who were selected purposefully, participated in individual in-depth, semi-structuredinterviews, which were recorded, transcribed verbatim, and analyzed using conventional content analysis andAtlas-Ti software. Results: One theme and two categories were derived from data including: cognitive/behavioralfactors (lack of a community-based approach to cervical cancer, lack of awareness, wrong attitude and lackof health seeking behaviors) and socio/cultural issues (socio-cultural invasion, mismatch between tradition,modernity and religious, extra marital relationships and cultural taboos). Conclusions: Providing communitybased approach education programs and employing social policy are needed for preventing of cervical cancerin Iran.     

Knowledge about Human Papillomavirus Infection and Cervical Cancer Prevention among Nurses in Chiang Mai University Hospital,Thailand

This study was undertaken to evaluate knowledge about HPV infection and cervical cancer among nursesin Chiang Mai University Hospital, Thailand. The 16 questions evaluating knowledge were “true/false/do notknow” type. Two hundred and twenty nurses agreed to participate in this survey. Most knew that cervicalcancer is the most common female cancer in Thailand (92.7%), HPV infection is a causal factor of cervicalcancer (81.8%), early stage cervical cancer is curable (94.1%), and an adequate scale of cervical screening couldprevent morbidity and mortality from cervical cancer (86.8%). The majority of participants (more than 70%)correctly acknowledged risk factors for cervical cancer as smoking, having multiple sexual partners, and sex atan early age. However, the majority of participants did not know that HPV infection and early stage cervicalcancer are commonly asymptomatic. In conclusion, knowledge regarding cervical cancer among nursing staffin the author’s institute is considerably favorable. However, their understanding about the natural history ofHPV infection and cervical cancer is suboptimal, and requires further attention if an effective cervical cancerscreening program is to be implemented.     

Adaptive Radiotherapy in the Management of Cervical Cancer: Review of Strategies and Clinical Implementation

The complex and varied motion of the cervix–uterus target during external beam radiotherapy (EBRT) underscores the clinical benefits afforded by adaptive radiotherapy (ART) techniques. These gains have already been realised in the implementation of image-guided adaptive brachytherapy, where adapting to anatomy at each fraction has seen improvements in clinical outcomes and a reduction in treatment toxicity. With regards to EBRT, multiple adaptive strategies have been implemented, including a personalised internal target volume, offline replanning and a plan of the day approach. With technological advances, there is now the ability for real-time online ART using both magnetic resonance imaging and computed tomography-guided imaging. However, multiple challenges remain in the widespread dissemination of ART. This review investigates the ART strategies and their clinical implementation in EBRT delivery for cervical cancer.     

Opportunistic Screening for Cervical Cancer in a Tertiary Hospital in Karnataka,India

The incidence and mortality of cervical cancer remains high in India even after sixty years of introductionof the Pap smear (cervical cytology) which is an effective means of identifying preinvasive lesions of carcinomacervix. The morbidity and mortality due to cervical cancer has come down drastically in countries with wellestablished screening programmes at national level. This study aims at screening women for cervical canceropportunistically during their visit to hospital and to study various types of neoplastic and non-neoplastic lesionsof the cervix by cervical smear study (Pap smear study). In the present study, a total of 350 cervical smearswere studied. The age of patients ranged from 19 years to 80 years with mean age being 37.5 years. Out of 350cases, the diagnosis of neoplasia was given in 43 cases and 258 cases were diagnosed as inflammatory smears.Forty-cases were normal and 9 cases were inadequate to evaluate. Forty-three patients who were found to haveneoplastic lesions on cytology were referred for further investigations like colposcopy and biopsy to confirm thediagnosis and avail proper treatment. Limitation of the present study was small sample size as all female patientsaged between 20 and 60 years visiting hospital were not included in the screening, other screening tests like VIA(visual inspection with acetic acid test) and HPV DNA (human papilloma virus) tests were not done. Until thetime centrally organised screening programmes for cervical cancer are established in India, arrangements shouldbe made for hospital based opportunistic screening for all women attending hospital. The cost effectiveness ofdifferent screening tests for cervical cancer should be evaluated.     

A Systematic Review of Economic Aspects of Cervical Cancer creening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking

Background: Organized cervical screening has decreased the incidence of cervical cancer. However, screeningstrategies vary in different countries. Objectives: We performed a systematic review to evaluate the economicaspects of different screening methods. Materials and Methods: We searched databases and then data wereabstracted from each study. We evaluated articles based on different types of screening tests as well as screeningage and intervals, and using incremental cost effectiveness ratio via calculating quality adjusted life years(QALY), or life years gained (LYG) per cost. We compared the incremental cost-effectiveness ratio (ICER) ofeach study using GDP per capita. Furthermore, we compared national guidelines with recommendations of costeffectivenessstudies in different countries. Results: A total of 21 articles met our criteria, of which 19 studiesshowed that HPV DNA testing, 13 suggested an age of 30 years or more, and 10 papers concluded that at leasta 5-year or longer interval were the most cost-effective strategies. In some countries, the national guidelines didnot match the recommendations of the cost-effectiveness studies. Conclusions: HPV testing, starting at age 30years or older and repeated at 5-year or longer intervals, is the most cost-effective strategy in any setting. Closercollaboration with health economists is required during guideline development.     

重庆市宫颈癌机会性筛查方法研究

[目的]分析重庆市宫颈癌机会性筛查的基本现状,探索适合重庆市宫颈癌机会性筛查方法。[方法]收集分析2009年重庆市8家医院机会性筛查资料,筛查方法包括液基细胞学、巴氏涂片、HPVDNA检测,以及专家推荐的三种筛查方案,Ⅰ方案：HPV检测和液基细胞学组合;Ⅱ方案：传统巴氏涂片和HPV检测;Ⅲ方案：仅用肉眼观察（醋酸或碘染色法,VIA/VILI）。病理确诊宫颈病变及宫颈癌,并对受检妇女进行流行病学调查。[结果]筛查过程中医生实际使用液基细胞学2390例（64.26%）,Ⅲ方案2300例（61.84%）,巴氏涂片194例（5.22%）,Ⅰ方案103例（2.77%）,Ⅱ方案52例（1.40%）,HPVDNA检测17例（0.46%）,最普遍采用的方法是液基细胞学、肉眼观察。检出CIN217例,检出率为9.68%;宫颈癌22例,检出率为0.98%。对受检妇女进行流行病学调查显示,愿意选择液基细胞学所占比例（69.69%）最高,其次分别为阴道镜（47.26%）、VIA/VILI（40.04%）、巴氏涂片（4.35%）,所占比例最低为HPVDNA（3.54%）,而经济欠发达、文化程度低、年长者、家人未患有肿瘤者更愿意选择传统筛查方法。[结论]不管是筛查过程中医生实际使用,还是受检妇女的选择,均是以细胞学为重庆市宫颈癌的主要检测手段,液基细胞学正逐步被广泛使用;而肉眼观察仍为重庆市经济欠发达地区宫颈癌筛查的另一主要检测手段。     

Combined Screening of Cervical Cancer,Breast Cancer and Reproductive Tract Infections in Rural China

Objectives: To investigate the current prevalence and knowledge of cervical cancer, breast cancer andreproductive tract infections (RTIs) in rural Chinese women, and to explore the acceptance and feasibility ofimplementing a combined screening program in rural China. Methods: A population-based, cross-sectionalstudy was conducted among women aged 30 to 59 years old in Xiangyuan County, Shanxi Province from 2009 to2010. Socio-demographic characteristics, knowledge of cervical cancer, breast cancer and RTIs, and the attitudetoward single or combined screening were collected by an interview questionnaire. Each participant receiveda clinical examination of the cervix, breast and reproductive tract. Examinations included visual inspection,mammography, laboratory tests and pathological diagnosis. Results: A total of 1,530 women were enrolled inthis study. The prevalence of cervical precancerous lesions, suspicious breast cancer, suspicious benign breastdisease and RTIs was 1.4%, 0.2%, 14.0% and 54.3%, respectively. Cervicitis, trichomonas vaginitis, and bacterialvaginitis were the three most common RTIs among our participants. Television, radio broadcast, and publiceducation during screening were the major source of healthcare knowledge in rural China. Moreover 99.7%of women expressed great interest in participating in a combined screening project. The affordable limit forcombined screening project was only 50 RMB for more than half of the rural women. Conclusion: A combinedscreening program would be more effective and popular than single disease screening projects, while appropriateaccompanied education and a co-pay model for its successful implementation need to be explored, especially inlow-resource settings.     

欧洲宫颈癌的普查

欧洲在开展宫颈癌普查工作至少已有30至40年。整体上看，宫颈癌死亡率明显下降。值得注意的是，欧洲一些国家年轻妇女宫颈癌发病率有上升趋势。在进一步开展宫颈癌普查工作中，亟需提高普查的效率，改善普查的价效比。     

Mapping HPV Vaccination and Cervical Cancer Screening Practice in the Pacific Region-Strengthening National and Regional Cervical Cancer Prevention

Objective : To provide background information for strengthening cervical cancer prevention in the Pacificby mapping current human papillomavirus (HPV) vaccination and cervical cancer screening practices, as wellas intent and barriers to the introduction and maintenance of national HPV vaccination programmes in theregion. Materials and Methods: A cross-sectional questionnaire-based survey among ministry of health officialsfrom 21 Pacific Island countries and territories (n=21). Results: Cervical cancer prevention was rated as highlyimportant, but implementation of prevention programs were insufficient, with only two of 21 countries andterritories having achieved coverage of cervical cancer screening above 40%. Ten of 21 countries and territorieshad included HPV vaccination in their immunization schedule, but only two countries reported coverage of HPVvaccination above 60% among the targeted population. Key barriers to the introduction and continuation ofHPV vaccination were reported to be: (i) Lack of sustainable financing for HPV vaccine programs; (ii) Lackof visible government endorsement; (iii) Critical public perception of the value and safety of the HPV vaccine;and (iv) Lack of clear guidelines and policies for HPV vaccination. Conclusion: Current practices to preventcervical cancer in the Pacific Region do not match the high burden of disease from cervical cancer. A regionalapproach, including reducing vaccine prices by bulk purchase of vaccine, technical support for implementationof prevention programs, operational research and advocacy could strengthen political momentum for cervicalcancer prevention and avoid risking the lives of many women in the Pacific.     

Self-Collection Tools for Routine Cervical Cancer Screening: A Review

Sub-optimal participation is a major problem with cervical cancer screening in developing countries whichhave no organized national screening program. There are various notable factors such as ‘embarrassment’,‘discomfort’ and ‘no time’ cited by women as they are often also the bread winners for the family. Implementationof self-sampling methods may increase their participation. The aim of this article was to provide a survey ofvarious types of self-sampling tools which are commonly used in collection of cervical cells. We reviewed currentlyavailable self-sampling devices and collated the advantages and disadvantages of each in terms of its acceptanceand its accuracy in giving desired results. In general, regardless of which device is used, self-sampling for cervicalscrapings is highly acceptable to women in most of the studies cited.