Cervical Cancer Prevention and Early Detection; The Role of Nurse and Midwives

Worldwide 31% of cancers in women are in the breast or uterine cervix. Cancer of the uterine cervix is one of the ‍leading causes of cancer death among women. The estimated new cancer cervix cases per year is 500.000 of which ‍79% occur in the developing countries, where it is consistently the leading cancer and there are in excess of 233.000 ‍deaths from the disease. The major risk factors for cervical cancer include early age at first intercourse, multiple ‍sexual partners, low socioeconomic status, HSV, HPV infection, cigarette smoking and extended use of oral ‍contraceptives. Well organized and applied public education and mass screening programmes can substantially ‍reduce the mortality from cervical cancer and the incidence of invasive disease in the population. Women who are ‍health conscious are more likely to have used screening services (mammogram, pap-smear test) and performed ‍breast-self examination and genital hygiene. There are both opportunities and burdens for nurses and midwives ‍working in primary health care settings. This is a prime example of a role of public education in cancer prevention ‍with reference to population-based cancer screening programs. ‍     

Cancer Occurrence in Old Age: Results of a Population-Based Cancer Registry in Semnan,Iran

Introduction: The proportion of elderly persons has increased in most countries during the last few decades, and ‍will increase further in the coming years. A population-based study was here carried out to clarify the site-specific ‍cancer-incidence rates in old age in Iran. Aims and Methods: A comprehensive search was undertaken to survey and ‍register all new cancer cases during a 5-year (1998-2002) period among the indigenous population of Semnan Province ‍aged 65 years or over. Diagnosis of cancer was based on histopathology, clinical or radiological findings, and death ‍certificates. Results: A total of 791 patients were registered with cancers. Of these, 492 (62.1%) were males. Crude ‍rates were 1,310 and 962 per 100,000 persons per year for males and females respectively, and age-standardized ‍ratios (ASRs) were 1350 and 973. Gastric cancer was the most common tumor with incidence rates of 340 and 153 ‍per 100,000 persons per year for elderly males and females respectively. In women breast cancer was the second most ‍common cancer (ASR= 108). In men prostate cancer was the second most common cancer with ASR= 150. ‍Conclusions: Based on the present standardized rates, cancer is almost 9 times and 7 times more frequent among the ‍elderly compared with younger men and women (30-64). The highest incidence of cancers was in group 75-79 years ‍in both sex and then decrease was noted with increasing age.     

The Coverage of Cervical Cancer Screening in Khon Kaen,Northeast

Cervical cancer is a common cancer in Thai women and one of the only cancers that can be readily cured if early ‍detection is successful. The Pap smear is an accepted as an appropriate means for cervical cancer screening at ‍present. However, there are still some management problems with early detection programmes. Since data showing ‍how many women have been screened by Pap smear are limited in Thailand, the present study was conducted with ‍the aim of determining coverage in a defined population in the sample area, Thakaserm sub- district in Nampong ‍district, Khon Kaen province, Thailand. The investigation was carried out during June-August 2000 to collect ‍information on history of screening for cervical cancer using questionnaires. All women aged 20 and above were ‍asked to answer the set of questionnaires a total of 1,199 women responded. There were 66.9% that reported having ‍received a Pap smear test for screening for cervical cancer at least once. However, there were 33.1 % that had never ‍undergone a Pap smear in their life. It is important to find a strategy to increase the coverage of cervical cancer ‍screening programme for this population. ‍     

Évaluation du dépistage des cancers de la femme et du dépistage après 75 ans dans le département de la Loire

In France, there is an important interregional disparity concerning participation to cancer screening programs. The aim of this study was to assess oncologic screening practices in Loire, a French rural department, in women and in the elderly (over age 74 years). For this, two surveys were conducted. The first one was regarding screening for breast, cervical and colorectal cancer in women over age 18 years living in Loire. The second survey was regarding onco-geriatric screening through two questionnaires : one for the elderly and the other for general practitioner (GP) of the department, evaluating screening for breast, colorectal, prostate, cervical and lung cancer. One hundred sixty six women were included in the first investigation mean age of 47.6 years. Ninety three point six per cent were screening for breast cancer, 19% received Human Papilloma virus vaccine, 83.1% were screening by Papanicolau smear for cervical cancer and finally, 51.7% were screening for colorectal cancer, among the one entering screening program criteria. In the second survey, 44 patients and 28 GP were included. Thirty-eight point six per cent of patients over 74 years continue screening. Only 11.4% were reluctant to screening and in 80% because of anxiety du to the results. Among GP, 50 % continued screening on two major criteria : life expectancy and performans status. The present study shows heterogeneity of screening in this department both rural and working class and gives us a societo-medical photography.     

Evaluating Teaching Techniques in the Hmong Breast and Cervical Cancer Health Awareness Project

Cancer health disparities are a reality for Hmong women who are often diagnosed at a later stage and have low literacy and experienced care that are not culturally appropriate. Lack of attention to cultural appropriateness and literacy levels of cancer screening materials may contribute to disproportionately low levels of cancer screening among Hmong women. The purposes of this study were to evaluate the Hmong Health Awareness Project (HHAP), a program designed to create awareness and acceptance of breast and cervical cancer screening, and to examine participants’ perceptions of the utility of the content of the workshops. Hmong researchers partnered with three Midwestern Hmong community centers to implement six workshops. Three teaching techniques: pictographs, videos, and hands-on activities were utilized to teach Hmong participants about cancer screening. Participants included 150 Hmong (male participants?=?30 and female participants?=?120). Teach-back method was used to assess the participants’ understanding of cancer screening throughout the workshops. Qualitative data were collected in focus groups to assess the feasibility of teaching methods and participants’ perceptions of the utility of the content of the workshops. Directed content analysis was used to analyze participants’ responses. The three teaching techniques were helpful in increasing the Hmong people’s understanding about breast and cervical cancer screening. Nearly, all participants perceived an increased in their understanding, greater acceptance of cancer screening, and increased willingness to be screened. Men expressed support for screening after the workshops. Findings can guide future interventions to improve health communications and screening and reduce diagnostic disparities among Hmong and immigrant populations.     

Breast Cancer in Iran: Results of a Multi-center study

Introduction: Breast Cancer is the most common cancer in Iranian women. This study aims to demonstrate the ‍characteristics of breast diseases- and especially breast cancer- according to pathologic records in Tehran, Iran. ‍Methods: In this cross-sectional study, all records of pathologic specimens (biopsy or mastectomy) categorized as ‍“breast diseases” from 1996 to 2000 in five teaching hospitals in Tehran were studied. For each patient, sex, age, ‍breast pathology, pathological staging of malignant lesions, side and location of the tumor and the type of surgery ‍were reviewed by a trained general practitioner. SPSS version 10 was used for statistical analysis. Results: The mean ‍age of women with breast cancer was 48.8. The highest frequency of malignancies was observed in the 40-49 age ‍group (31.8%). Twenty-three percent of breast cancers were observed in women younger than 40 years. About 83 ‍percent of malignant lesions in women were in T2, T3 or T4 at diagnosis. Only about 4 percent of women with breast ‍cancers had tumors in stage I or in-situ carcinomas. Nearly 70 percent of the cancers were detected only after lymph ‍node involvement. Only 4.3 percent of our female cases had the chance of conservative mastectomy. Twenty-eight ‍percent of specimens from biopsies in women were malignant. Discussion and Conclusion: In Iran, breast cancer ‍affects women at least one decade younger than their counterparts in developed countries. A considerable proportion ‍of our cases (96%) were in stage II or III at diagnosis. These results show advanced cases at presentation in Iran ‍which further mandate a national cancer detection program involving more effective public education and ‍encouragement of women for breast self-examination and participation in screening campaigns. ‍     

Cancer in the Minnesota Hmong population

BACKGROUND: The Hmong are an isolated, agrarian people who settled in the mountainous regions of what today are Vietnam, Cambodia, and Laos. After the Vietnam War, many Hmong were relocated to the U.S. Minnesota has the second largest population (after California) of Hmong individuals. The objective of this study was to examine cancer incidence in this population, because it may indicate areas for targeted surveillance and intervention. METHODS: The Minnesota Cancer Surveillance System database was screened for Hmong surnames, and proportional incidence ratios (PIRs) were calculated for the period 1988-1999. RESULTS: Compared with all Minnesotans, the Hmong population had increased PIRs for nasopharyngeal cancer (PIR, 39.39; 95% confidence interval [95% CI], 21.01-66.86), gastric cancer (PIR, 8.70; 95% CI, 5.39-13.25), hepatic cancer (PIR, 8.08; 95% CI, 3.88-14.71), and cervical cancer (PIR, 3.72; 95% CI, 2.04-6.20) and had decreased PIRs for prostate cancer, breast cancer, Hodgkin disease, and melanoma. CONCLUSIONS: The current observations have implications for cancer control interventions. In particular, an increased incidence of cervical cancer might be addressed in part by targeting culturally sensitive screening programs in the Hmong population.     

Is it Reporting Bias Doubled the Risk of Prostate Cancer in Vasectomised Men in Mumbai,India?

Background: Vasectomy is a common method of family planning in India and worldwide. The objective of the ‍present study was to assess the association of vasectomy with prostate cancer in a low risk population of a developing ‍country. A population based case control study was conducted in Mumbai, India, for this purpose. Methods: Included ‍in this study were microscopically proved cases of prostate cancer diagnosed during 1998 to 2000 and registered by ‍Bombay Population Based Cancer Registry (n=594). The controls were healthy men belonging to the resident general ‍population of Mumbai, India. Two controls for each case matched by age and place of residence were selected as the ‍comparison group. Data on vasectomy and potential confounding factors were obtained by structured face to face ‍interviews. After exclusions, 390 cases and 780 controls were available for final analysis and confounding was controlled ‍by multiple logistic regression. Results: Overall 14.9% of cases and 10.0% of controls had undergone vasectomy. ‍Compared with no vasectomy the OR with ever having undergone vasectomy was 1.9 (95% CI: 1.3-2.9), after ‍controlling for age and other possible confounding factors. The risk for those who had had a vasectomy before the ‍age of 45 years was 2.1 fold (95% CI: 1.2-3.9) and for those who underwent the procedure at a later age was 1.8 fold ‍(95% CI: 1.1-2.9). The linear trend for an increase in risk with a decrease in age at vasectomy was statistically ‍significant (p for trend= 0.01). The risk for those who completed 25 years or more time since undergoing vasectomy ‍was 3.8 fold (95% CI: 1.9-7.6) and for those who completed less than 25 years it was 1.2 fold (95% CI: 0.7-2.1). The ‍linear trend for an increase in risk with an increase in time since vasectomy was highly significant (p for trend = ‍0.001). Conclusion: There are major public health and birth control implications on vasectomy increases the risk for ‍prostate cancer. It is likely, however, that biases identified in this study result in high estimates of risk and the true ‍risk due to vasectomy is substantially less than the estimated one. Due to the several limitations and possibilities for ‍reporting biases in this study, the evidence for the estimates of the higher odds ratio for prostate cancer in vasectomised ‍men may not be a strong one. In view of the importance of vasectomy for fertility control, further studies with good ‍design and conduct (the information on vasectomy need to be collected with better reliability) are required to clarify ‍the issue of vasectomy associations with prostate cancer.     

Cancer Screening in Korea, 2012: Results from the Korean National Cancer Screening Survey

We investigated the cancer screening rates for five types of cancer (stomach, liver, colorectal, breast, andcervix uteri) using data from the Korean National Cancer Screening Survey (KNCSS), which is a nationwide,annual cross-sectional survey. The eligible study population included cancer-free men 40 years of age and olderand women 30 years of age and older. The lifetime screening rate and screening rate with recommendation werecalculated. The lifetime screening rates for gastric, liver, colorectal, breast, and cervical cancers were 77.9%,69.9%, 65.8%, 82.9%, and 77.1%, respectively. The screening rates with recommendation were 70.9%, 21.5%,44.7%, 70.9%, and 67.9%, respectively. The most common reason for all types of cancer was “no symptoms,”followed by “lack of time” and “fear of the examination procedure.” Efforts to facilitate participation in liverand colorectal cancer screening among Korean men and women are needed.     

2018年广西恶性肿瘤流行情况及疾病负担分析

目的 分析2018年广西恶性肿瘤流行情况与疾病负担特征,为广西恶性肿瘤防治提供参考。方法 根据广西36个肿瘤登记处上报的2018年肿瘤登记数据,计算2018年广西恶性肿瘤发病率、中国人口年龄标准化发病率（简称中标发病率）、死亡率、中国人口年龄标准化死亡率（简称中标死亡率）,分析2018年广西恶性肿瘤发病和死亡情况;计算伤残调整生命年（disability adjusted life years,DALYs）、早死所致的寿命损失年（years of life lost with premature death,YLLs）等指标,评价2018年广西恶性肿瘤的疾病负担。结果 2018年广西36个肿瘤登记处共报告新发病例数为55 552例,粗发病率为222.83/10万,中标发病率为182.50/10万;共报告死亡例数为35 001例,粗死亡率为140.40/10万,中标死亡率为110.13/10万。2018年广西恶性肿瘤合计损失的DALYs为519 489.94人年,DALYs率为 2 083.79/10万。肝癌和乳腺癌分别是男性和女性最常见的恶性肿瘤,肝癌和肺癌所导致的DALYs负担分别位居男性和女性恶性肿瘤DALYs顺位的首位。白血病、女性乳腺癌、肝癌和肺癌分别是儿童（0~14岁）、中青年（15~44岁）、中老年（45~64岁）和老年（65岁及以上）人群中最常见的恶性肿瘤。城市地区肺癌、女性乳腺癌、结直肠癌和前列腺癌的发病率和死亡率均高于农村地区,而农村地区肝癌、子宫颈癌、鼻咽癌和食管癌的发病率和死亡率均高于城市地区。结论 广西当前的恶性肿瘤主要包括肝癌、肺癌、女性乳腺癌、结直肠癌和子宫颈癌等。广西居民恶性肿瘤负担仍严重,恶性肿瘤负担地区差异、性别差异及年龄差异明显,恶性肿瘤防控形势严峻。     

Reproductive Characteristics and the Risk of Breast Cancer - A Case-control Study in Iran

Breast cancer is a common malignancy for women in most parts of the world and the incidence in Iranian women ‍is growing. The patients are relatively younger than their western counterparts. The present hospital based casecontrol ‍study was designed to determine roles of reproductive factors for breast cancer among women in Iran. ‍Conducted at a teaching hospital in Tehran, Iranin 2004, the study covered a total of 303 cases of breast cancer and ‍303 healthy controls. Cases were identified through the Oncology Department of a university hospital and controls ‍were collected from other wards or out-patient clinics at the same hospital. Control subjects were matched to ‍patients for age. Informed consent was obtained from all cases and controls then demographic and reproductive ‍factors were ascertained by in-person interview using a constructed questionnaire. Odds ratios and their 95% ‍confidence intervals for breast cancer were derived using logistic regression analysis. The mean +SD ages of cases ‍and controls were 48.8 + 9.8 and 50.2 + 11.1 years, respectively, (range 24-84). The final model for multiple analysis ‍indicated that never married, post menopause, age at first live birth, number of live births, use of oral contraceptive ‍pills, and history of chest X-rays between adolescence and 30 yrs of age, were significantly associated with breast ‍cancer. Variables such as higher education, early age at menarche, abortion, breast feeding and its duration were ‍not significant risk factors .     

Ethical Issues for Cancer Screening

In recent years medical ethics has become an undisputed part of medical studies. Many people believe that ‍modern advances in medical technology - such as the development of dialysis machines, respirators, magnetic ‍resonance imaging and genetic testing and types of cancer screenings - have created bioethical dilemmas that confront ‍physicians in the 21st century. Debates over research and screening ethics have until recently revolved around two ‍related questions: the voluntary, informed consent of subjects, and the appropriate relationship between risk and ‍benefit to subjects. ‍Every patient has a right to full and accurate information about his or her medical condition. This legal principle ‍arose primarily through court decisions concerning informed consent, but over time physicians recognized that ‍most patients prefer to learn the truth about their condition and use the information well. To screen is to search for ‍disease in the absence of symptoms or, in other words, to attempt to find disease in someone not thought to have a ‍disease. Examples of screening include routine mammography to detect breast cancer, routine pap smears to detect ‍cervical cancer, and routine Prostate Specific Antigen (PSA) testing to detect prostate cancer. Ethical principles to be ‍followed in cancer screening programmes are intended mainly to minimize unnecessary harm for the participating ‍individuals. Numerous ethical questions can be raised about the practice of screening for disease. ‍Here, we examine four leading cancer killers worldwide and we review the screening of protocols of these cancer ‍types and their possible ethics. ‍     

Recent trends in breast,cervical, and colorectal cancer screening test utilization in Canada,using self-reported data from 2008 and 2012

In Canada, self-reported data from the Canadian Community Health Survey 2008 and 2012 provide an opportunity to examine overall utilization of breast, cervical, and colorectal cancer screening tests for both programmatic and opportunistic screening.Among women 50–74 years of age, utilization of screening mammography was stable (62.0% in 2008 and 63.0% in 2012). Pap test utilization for women 25–69 years of age remained high and stable across Canada in 2008 and 2012 (78.9% in 2012). The percentage of individuals 50–74 years of age who reporting having at least 1 fecal test within the preceding 2 years increased in 2012 (to 23.0% from 16.9% in 2008), but remains low.Stable rates of screening mammography utilization (about 30%) were reported in 2008 and 2012 among women 40–49 years of age, a group for which population-based screening is not recommended. Although declining over time, cervical cancer screening rates were high for women less than 25 years of age (for whom screening is not recommended). Interestingly, an increased percentage of women 70–74 years of age reported having a Pap test.In 2012, a smaller percentage of women 50–69 years of age reported having no screening test (5.9% vs. 8.5% in 2008), and more women reported having the three types of cancer screening tests (19.0% vs. 13.2%).Efforts to encourage use of screening within the recommended average-risk age groups are needed, and education for stakeholders about the possible harms of screening outside those age groups has to continue.     

Influence of health insurance coverage on breast,cervical, and colorectal cancer screening in rural primary care settings

BACKGROUND:

The current study was performed to determine, in rural settings, the relation between the type and status of insurance coverage and being up‐to‐date for breast, cervical, and colorectal cancer screening.

METHODS:

Four primary care practices in 2 rural Oregon communities participated. Medical chart reviews that were conducted between October 2008 and August 2009 assessed insurance coverage and up‐to‐date status for breast, cervical, and colorectal cancer screening. Inclusion criteria involved having at least 1 health care visit within the past 5 years and being aged ≥ 55 years.

RESULTS:

The majority of patients were women aged 55 years to 70 years, employed or retired, and who had private health insurance and an average of 2.5 comorbid conditions. The overall percentage of eligible women who were up‐to‐date for cervical cancer screening was 30%; approximately 27% of women were up‐to‐date for clinical breast examination, 37% were up‐to‐date for mammography, and 19% were up‐to‐date for both mammography and clinical breast examination. Approximately 38% of men and 35% of women were up‐to‐date for colorectal cancer screening using any test at appropriate screening intervals. In general, having any insurance versus being uninsured was associated with undergoing cancer screening. For each type of screening, patients who had at least 1 health maintenance visit were significantly more likely to be up‐to‐date compared with those with no health maintenance visits. A significant interaction was found between having health maintenance visits, having any health insurance, and being up‐to‐date for cancer screening tests.

CONCLUSIONS:

Overall, the percentage of patients who were up‐to‐date for any cancer screening, especially cervical cancer screening, was found to be very low in rural Oregon. Patients with some form of health insurance were more likely to have had a health maintenance visit within the previous 2 years and to be up‐to‐date for breast, cervical, and/or colorectal cancer screening. Cancer 2012. © 2012 American Cancer Society.     

Italian cancer burden by broad geographical area

AIMS AND BACKGROUND: Cancer burden estimates in Italian regions are available for the period 1970-2010 as a result of the project "I TUMORI IN ITALIA" connected with EUROCHIP, the European project on cancer control. The Italian health-care system is organized at a regional level, so regional estimates of cancer indicators are useful to identify priorities for cancer plans. We compared cancer site-specific epidemiological estimates by 3 macro-areas (obtained by grouping regions) to suggest priorities for Italian cancer control plans, both at national and regional levels. METHODS: Mortality and incidence estimates for all cancers combined and for stomach, colorectal, lung, breast and prostate cancers were downloaded from the website www.tumori.net and aggregated in broad age classes (0-54, 55-74 and 75-84 years) and macro-areas (northern, central and southern Italy). RESULTS: Historically, Southern Italy had a lower cancer risk than the Center and North. After 2000 this epidemiological picture disappeared and the incidence and mortality rates in the Center are reaching those of the North. Also the weight of various cancer sites on all cancers has changed in Italy in the last decades. Lung cancer is still the most frequent cancer in the male population in the South, while in the Center-North it has been surpassed by prostate cancer and colorectal cancer. The lung cancer weight on all cancer deaths is increasing in women. Prostate cancer has become the most frequent male cancer in the Center-North in the age class 55-84. Breast cancer is the most frequent cancer in the female population and its incidence rates in the North are higher than those in the Center-South for all age classes. Colorectal cancer incidence rates have dramatically increased in men and colorectal cancer is nowadays the second cancer diagnosed in women in all age classes and macro-areas. DISCUSSION: From the epidemiological data here presented we derived the following suggestions and observations for cancer control plans: (a) tobacco prevention should focus on the male population in the South, and on female populations in the country as a whole; (b) prevention concerning diet and physical activity (risk factors for colorectal cancer) should be considered mainly for men at a national level; (c) the coverage of breast cancer screening programs should be increased in the Center-South; (d) colorectal cancer screening should be promoted at a national level; (e) PSA testing (that is not actually included among the screening programs recommended) for prostate cancer is probably more widespread in the Center-North, resulting in an increased incidence without any evident decline in mortality as yet.     

Cancer Screening Literature in the Period 2000-2002 : Pointers to Future Research Avenues

In order to determine which areas of cancer screening are currently receiving greatest emphasis in different ‍parts of the world a Medline search of the literature for the period 2000-2002 was performed, concentrating ‍attention on research into all aspects of efforts for early detection of tumours, with especial attention to ‍methodology, motivation (including awareness of utility in the general populace and in minority groups), and ‍intervention (professional training and general education). Focus on the skin, lung, cervix, breast, ovary + ‍endometrium, oral cavity-oesophagus, gastric, colorectal, kidney + urinary tract and prostate, demonstrated ‍large numbers of journals to be publishing papers in the field, with 10, 33, 130, 53, 24, 21, 6, 81, 12 and 58, ‍respectively, in the period investigated, the grand total being 259. The average numbers of papers/journal ‍ranged from 1.0-2.4 with only 15-35% appearing in journals with wide coverage. With the exception of oral, ‍oesophageal and gastric cancer screening, an approximately 50% contribution in all areas was made by scientists ‍in the US, followed by Europe (31% overall,) Asia (11%) then Australasia, Central and South America and ‍Africa (3%, 2% and 1%, respectively). Clear differences were evident with the organ regarding specific topics ‍receiving attention, most publications concerning the lung, ovary and urological tract dealing with detection ‍methods. With the cervix and colorectum this topic accounted for half of the papers with especial attention to ‍the relative advantages of the PAP smear, HPV testing and direct visual acetic acid (DVA) in the one, and FOBT ‍and endoscopy in the other. Another major focus was found to be minority attitudes to breast, prostate and ‍cervical screening in the US, whereas only few papers were found dealing with practical intervention, targeting ‍professionals or screenees to increase participation in screening programs. The present approach suggested a ‍number of areas requiring more attention, not least being the need for more comprehensive reviews across ‍organs to allow the general reader a better undertanding of the overall picture, and which avenues might best ‍reward exploration in the future. ‍     

Insulin,Insulin-like Growth Factor-I and Breast Cancer Risk in Japanese Women

To evaluate the effects of glucose metabolism related factors, such as insulin and insulin-like growth-factors ‍(IGFs), on breast cancer development among Japanese women, we conducted a case-referent study comparing 187 ‍women presenting with operable breast cancer and 190 women of the same age having no breast cancer. Odds ratios ‍(OR) and 95% confidence intervals (95%CI) were determined by multiple logistic regression analysis. ‍ In the present study, no association in risk was observed with increasing levels of IGF-I or IGF binding protein- ‍3 (IGFBP-3), before or after adjustment these factors. However, a suggestion of a positive association of an increased ‍breast cancer risk was evident in postmenopausal women with elevated plasma insulin levels, particularly those with ‍BMI>23.07. The OR for plasma insulin in the top tertile was 4.48 (95%CI:1.07-18.7) compared to the bottom tertile. ‍For C-peptide, there was a similar positive association, with a corresponding OR of 2.28. In addition, we observed ‍strong links between plasma insulin, C-peptide levels and estrogen receptor (ER) negative breast cancer, with ORs ‍of 2.79(95%CI:1.09-7.16), and 2.52 (95%CI:0.91-6.97) respectively, for the top versus bottom tertiles. In conclusion, ‍the present study suggested that plasma insulin level is a predictor of postmenopausal breast cancer in obese women ‍and ER negative breast cancer. Additional studies are needed to clarify the role of glucose metabolism pathways in ‍breast cancer development and interaction of IGF systems.     

Patterns of changing cancer risks with time since diagnosis of a sibling

Family history is a well‐known risk factor for many cancers. However, it is important to know if/how the familial risk of cancer changes over time. For each of four major cancers (colorectal, breast, prostate and melanoma), we identified siblings of cancer patients (case siblings) and siblings of matched cancer‐free controls sampled from Swedish population‐based registers. Effects of age and time since diagnosis on sibling risks were examined using Poisson regression and presented graphically as smoothed hazard ratios (HRs). Screening effects were investigated by comparing hazards before/after the introduction of mammography for breast cancer and prostate‐specific antigen (PSA) testing for prostate cancer. Case siblings had higher cancer incidence than control siblings for all cancers at all ages, with overall incidence rate ratios (IRRs) of 2.41 (95% confidence interval 2.14–2.71) for colorectal cancer, 2.37 (2.24–2.52) for breast cancer, 3.69 (3.46–3.93) for prostate cancer and 3.20 (2.72–3.76) for melanoma. Risks were highest in siblings who were young when the first cancer was diagnosed in the family, with siblings aged 30–40 having IRR 9.05 (3.03–27.00) for colorectal cancer and 4.30 (2.87–6.45) for breast cancer. Smoothed HRs remained fairly constant for up to 20 years except for prostate cancer, where the HR decreased steeply during the first few years. After introduction of PSA testing, men had higher incidence of prostate cancer shortly after diagnosis in a brother, but no such screening effect was found for breast cancer. Our findings can help inform the screening and counseling of family members of cancer patients.     

Accuracy of Visual Inspection with Acetic Acid (VIA) for Early Detection of Cervical Dysplasia in Tehran,Iran

Objective: To evaluate the accuracy of visual inspection with 5% acetic acid (VIA) when used to detect cervical ‍cancer and its precursors. ‍Methods: The study population included women attended Family Planning and Gynecological Clinic in Bagher ‍Abad Health Center and Mirza Koochak Khan Hospital for regular cervical screening tests. After obtaining informed ‍consent from each woman, VIA was performed. One hundred with a positive VIA test and 100 women with a ‍negative VIA test were randomly selected for this study. Cytology and colposcopy examination were performed for ‍all 200 cases and cervical biopsies were conducted for those individuals showing abnormal colposcopic findings. ‍Results: Nine cases in VIA-positive group and two cases in VIA-negative group had an abnormal cytology. Ninety ‍five women in the VIA-positive group and 25 in the VIA-negative group had abnormal colposcopic findings. From ‍biopsy examination, 67 (71%) of cases in the VIA-positive group and 3 (12%) cases in the VIA-negative group had ‍a final diagnosis of dysplasia. Among biopsied samples, only 7 cases of VIA-positive group showed abnormal result ‍and the remaining were normal. Based on these results, VIA test sensitivity and specificity were 95.7% and 44.0% ‍respectively, while they were 10% and 92% for cytology tests. ‍Conclusions: The results of this study indicate that although VIA is a sensitive screening test for detection of ‍cervical dysplasia, it can not be used by itself. Applying VIA along with Pap smears helps to detect a higher number ‍of cases with cancer precursor lesions.