The Association of Molecular Biomarkers in the Diagnosis of Cervical Pre-Cancer and Cancer and Risk Factors in Senegalese

Background: Cervical intraepithelial neoplasia (CIN) grading is subjective and affected by substantial rates of discordance among pathologists. Although recent studies have suggested that p16INK4a may be a useful surrogate biomarker of cervical neoplasia, Ki-67 and human papillomavirus testing have also been shown to be useful in detecting neoplasia. The purpose of this study was to determine the expression of p16INK4a and Ki-67 in cervical neoplasia and its correlations with cofactors. Methods: The study involved 69 patients with and without cervical neoplasia who underwent colposcopic directed biopsy. On each patient, two samples were taken; the first was used for immunohistochemistry and the second for molecular testing, using HPV16and18 genotyping Real-Time PCR Kit. Results: The study revealed the expression level of p16INK4a and Ki-67 in a descending order, from invasive squamous cell carcinoma (SCC), CIN2/3, CIN1 and non-dysplastic lesions. Correlations showed an association between the staining of p16NK4a and Ki-67 with the increase of age (OR: 1.79 (95%IC: 0.49 – 6.55), p = 0.037) and marital status (OR: 0.17 (95%IC: 0.04 – 0.68), p = 0.003). We found that the expressions of p16INK4a and Ki-67 were significantly different between invasive SCC vs non-dysplasia (OR: 44.57 (95%IC: 4.91 – 403.91), p <0.0001). The study showed significant correlation between HPV 16and18 infection with p16 INK4a and Ki-67 expression (OR: 0.13 (95%IC: 0.03 – 0.52), p <0.0001). Strong expression of p16INK4a and Ki-67 were observed in invasive squamous cell carcinoma, moderate staining was found in CIN2/3, weak staining in CIN1 and normal histology. Conclusion: Our findings indicate that p16INK4a and Ki-67 expressions associated strongly with cervical pathology. Therefore, p16/Ki-67 could be considered as a suitable biomarker for cervical cancer screening, particularly in HPV-based screening programs.     

Effects of Reproductive Factors on Risk of Breast Cancer: A Literature Review

Breast cancer is the leading women’s cancer worldwide. However, there are geographical considerabledifferences with high rates of disease in North America and North Europe and relatively low rates in Africa andAsia. This article reviews the effects of reproductive factors on risk of breast cancer : early menarche, nulliparityor late age at first birth, late menopause, as well as hormonal factors. Knowing risk factors of breast cancercould significantly contribute to an improved prevention of this cancer. Furthermore, this review aimed tohighlight potentially controversial conditions in the Asian countries compared to other parts of the world whichcould in the future improve early prevention of breast cancer in Asian women.     

宫颈癌患者淋巴结转移的影响因素分析

目的探讨宫颈癌患者淋巴结转移的分布规律、高危因素。方法选取均经活检或手术病理证实的71例宫颈癌患者为研究对象,对影响淋巴结转移的因素采用Logistic多因素回归分析。结果71例宫颈癌患者中有14例患者发生淋巴结转移,转移率为19．7％;单因素分析结果显示肿瘤直径、SCCAg水平、FIGO分期、病理分型、肌层浸润深度、脉管侵犯、分化程度与淋巴结转移相关（P〈0．05）,而年龄、手术切缘与淋巴结转移不具相关性（P〉0．05）;Logistic多因素回归分析结果显示治疗前SCCAg水平、脉管侵犯、FIGO分期、肌层浸润深度以及分化程度5个因素是淋巴结转移的独立危险因素。结论治疗前SCCAg〉4ng／ml、宫颈浸润深度≥肌层1／2、脉管侵犯、FIGO分期较晚及细胞分化程度较高是宫颈癌盆腔淋巴结转移的主要危险因素。     

Physiological,Reproductive Factors and Breast Cancer Risk in Jiangsu Province of China

To evaluate the relationship between physiological, reproductive factors and risk of breast cancer, weconducted a case-control study with 669 cases and 682 population-based controls in Jiangsu Province of China.A structured questionnaire was used to elicit detailed information. All subjects completed an in-person interview.Unconditional logistic regression analysis was performed to calculate odds ratios (ORs) and 95% confidenceintervals (CIs) as measures of risk for breast cancer. The results have revealed that there was an increasing riskof breast cancer, include early age at menarche(≤13 year), late age at menopause(>50 year) and older age at firstpregnancy (≥30 year). Breastfeeding was associated significantly with a reduced risk of breast cancer. Womenwho had history of breastfeeding were at significantly decreased OR (0.44, 95%CI: 0.27-0.73). The protectiveeffects of breastfeeding for breast cancer seemed greater for women who had extended duration of breastfeedingduring their lifetime (p for linear trend: 0.0095). These results suggested that physiological and reproductivefactors may play important roles in the development of breast cancer among Jiangsu’ women of China.     

Role of Print and Audiovisual Media in Cervical Cancer Prevention in Bangladesh

Background: Visual inspection of cervix with acetic acid (VIA) is offered at 252 centers in 64 districts ofBangladesh. VIA+ve women are managed at colposcopy clinics of Bangabandhu Sheikh Mujib Medical University(BSMMU) and 14 Medical College Hospitals (MCHs). This research work has been supported by ‘UICC CancerPrevention Campaign’ programme. Objectives: This study explored the role of print materials and electronicmedia to improve cervical cancer screening in the present socio-cultural context of Bangladesh. Methods: Thisstudy was performed from January to August 2011 at two upazilas of Bangladesh (Singair with screening facilityand Sonargaon without screening facility). Data were collected by focus group discussion (FGD) with women,husbands and community people before and after intervention. Information on cervical cancer screening and VIAcamps was disseminated using advertisement through local cable line of the television, microphone announcement,service providers and leaflet throughout the week prior to a VIA camp. Three-day VIA camps were organized atthe upazila health complex (UHC) of both upazilas. Quantitative data was gathered from women at the campson source of information on VIA and the best method of awareness creation. Results: The population was awareof “cancer” and a notable number knew about cervical cancer. Baseline awareness on prevention and VIA waslow and it was negligible where screening services were unavailable. Awareness was increased fourfold in bothupazilas after interventions and half of the women and the majority of the community people became aware ofscreening and available facilities. Cable line advertisement (25.5%), microphone announcement (21.4%), anddiscussion sessions (20.4%) were effective for awareness creation on VIA. Television was mentioned as the bestmethod (37.4%) of awareness creation. Conclusion: Television should be used for nation-wide awareness creation.For local awareness creation, cable line advertisement, microphone announcements and health education atUthan Baithaks/ EPI sessions can easily be adopted by the government.     

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.     

Reproductive Risk Factors for Thyroid Cancer: A Prospective Cohort Study in Khon Kaen,Thailand

Background: Because of the gender disparity in the incidence of thyroid cancer, this study aimed to determinethe association between reproductive factors and thyroid cancer. Methods: A total of 10,767 eligible women fromthe Khon Kaen Cohort, recruited and interviewed between 1990 and 2001, were followed up until 2011. Thedata were linked to the Khon Kaen Population-Based Cancer Registry to detect thyroid cancer cases. Results:There was 17 thyroid cancer cases detected, an incidence of 11.2 per 100,000 person-years, of which 70.6 % werepapillary tumors. The incidence was apparently greater among those with an early age of menarche, nulligravidawomen, and oral contraceptive users. Conlusions: There was a trend for thyroid cancer to develop in relationto longer estrogen exposure. This evidence is inconclusive but warrants further investigation.     

Risk of Breast Cancer in Relation to Reproductive Factors in North-west of Iran, 2013-2014

More than one million new patients suffer from breast cancer annually in the world. In developed countries,breast cancer is the most common malignancy diagnosed among women, and in developing regions, it oftenranks second to cervical cancer. This study aimed to investigate the relationship between incidence of breastcancer and reproductive factors in North-West of Iran. This retrospective analytical control-case study wasconducted with 235 breast cancer patients and 235 women in the control group. Data collection tools includeda set of questions with interviews and patient medical records. Data were analyzed using statistical tests: t-test,Chi-square, Fisher, and Pearson correlation coefficient. Significantly increased risks were associated betweenbreast cancer and older age at first pregnancy, age at menopause and history of contraceptive use. A trend fordecreasing risk were observed with increasing parity. Findings of this study showed no association between breastcancer and age at menarche. The study results suggested that physiological and reproductive factors may playimportant roles in the development breast cancer among Iranian women.     

宫颈癌腹腔镜手术治疗的有效性及术后患者手术部位感染的影响因素

目的 分析宫颈癌腹腔镜手术治疗的有效性及术后患者手术部位感染的影响因素.方法 选取宫颈癌患者81例,均行腹腔镜手术治疗,统计临床效果、手术部位感染发生率,收集患者年龄、体质量指数(BMI)、是否绝经、宫颈癌分期、是否多发肿瘤、手术时间等资料信息,分析术后手术部位感染的影响因素.结果 腹腔镜手术治疗总有效率为90.12％...     

Factors Influencing Knowledge and Practice Regarding Cervical Cancer and Pap smear Testing among Omani Women

Background: Knowledge of cervical cancer and performance of Pap smear testing are influenced by severalsociodemographic factors. This study aimed to describe the effect of relevant variables on knowledge and compliancewith guidelines in Oman. Methods: In this cross-sectional survey, participants were divided into three groups: patientswho attended Outpatient Gynecology Department, female medical staff and university graduate students. Results: Therewere 204 outpatients, 133 staff, and 157 students. Adequate knowledge among was seen in 38.7%, 35.3%, and 7.6%,respectively. Knowledge of cervical cancer and Pap smear was significantly lower among outpatients with secondaryeducation, while those with high level of income were more likely to have adequate cancer knowledge. Uptake of Papsmear was significantly greater among outpatients aged ≥ 30 years, with high income and a positive history of cancer.Conclusion: Culturally tailored interventions that focus on improving cancer risk knowledge are needed to maximizescreening uptake for cervical cancer.     

Breast and Cervical Cancer Screening Prevalence and Associated Factors among Women in the South African General Population

Purpose: The aims of the study were to estimate the prevalence of breast and cervical cancer screening amongwomen in the South African general population and assess associated factors. Methods: Data from a national populationbasedcross-sectional household survey in South Africa in 2012 for 10,831 women aged 30+ years were analysed usingbivariate and multivariable logistic regression. The outcome variables were cervical cancer screening (Papanicolaousmear test) and breast cancer screening (mammography). Exposure variables were sociodemographic factors, lifestylevariables, and chronic conditions. Results: The prevalences of Papanicolaou (PAP) smear test and mammographyparticipation were 52.0% and 13.4%, respectively. On multivariable logistic regression analysis, women with highereducation, those who were non-black African, having medical aid and having chronic conditions were more likely toundergo a Pap smear test and mammography. Living in rural areas was related to a lower likelihood of receiving bothtypes of screening. In addition, undertaking moderate or vigorous physical activity was associated with breast cancerscreening. Conclusion: Screening for cervical cancer was relatively high but for breast cancer it was low, despite thelatter being a major public health problem in South Africa. This may be attributed to the limited availability, affordability,and accessibility of breast cancer screening services among socio-economically disadvantaged individuals There aresome socio-economic disparities in adopting both breast and cervical cancer screening guidelines that could be targetedby interventions.     

Association of RAD51 and XRCC2 Gene Polymorphisms with Cervical Cancer Risk in the Bangladeshi Women

Objective: Alterations in common DNA repair genes (RAD51 and XRCC2) may lead to cervical cancer (CC) development. In the present study, we analyzed the association between RAD51 rs1801320 and XRCC2 rs3218536 polymorphisms and CC. Methods: Variants were selected based on their associations with some cancers in several ethnicities and the risk allele frequency (>0.05) in different populations. The variants were detected using the PCR-RFLP method. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were determined by logistic regression models. Result: Significantly increased risk (p <0.05) were detected for both SNPs with CC (rs1801320- GC vs. GG: aOR=2.21, 95% CI=1.43-3.42; CC vs. GG: aOR=4.48, 95% CI=1.76-11.42; dominant model: aOR=2.49, 95% CI=1.65-3.76; recessive model: aOR=3.52, 95% CI=1.40-8.88; allele model: OR=2.30, 95% CI=1.63-3.26, and rs3218536- GA vs. GG: aOR=2.77, 95% CI=1.85-4.17; AA vs. GG: aOR=5.86, 95% CI=2.08-16.50; dominant model: aOR=2.97, 95% CI=1.99-4.42; recessive model: aOR=3.56, 95% CI=1.30-9.73; and allele model: aOR=2.21, 95% CI=1.62-3.00). Besides, older patients (>60 years) with rs1801320 showed significantly reduced risk (OR=0.53, 95% CI=0.29-0.96, p=0.04) but with rs3218536 depicted significantly increased risk (aOR=2.44, 95% CI=1.20-4.96, p=0.01) for CC. Conclusion: This study indicates an association of rs1801320 and rs3218536 polymorphisms with CC and confirms that patients older than 60 years are more likely to develop CC for rs3218536 polymorphism.     

宫颈癌患者PICC导管多重耐药菌感染的危险因素及病原学特征

目的 探讨宫颈癌患者经外周静脉穿刺中心静脉置管(PICC)导管多重耐药菌感染的危险因素及病原学特征.方法 选取宫颈癌PICC导管患者589例,回顾性观察纳入者相关资料,对PICC导管多重感染者加强监测,着重分析、归纳感染危险因素;同时监测和记录感染者病原学特征.结果 宫颈癌PICC导管相关性感染94例、感染率15.96...     

Risk Factors for the Diagnosis of Lung Cancer in Poland: A Large-Scale,Population-Based Case-Control Study

Objective: Lung cancer is one of the most common and deadly malignant neoplasms. Currently, it is one of the main causes of cancer deaths worldwide. The study aimed to identify and evaluate patient characteristics, demographic and lifestyle factors that are associated with lung cancer at diagnosis. Methods: The study included 400 patients diagnosed with lung cancer and 400 within the control group. The research was based on a clinical, direct, individual, structured, in-depth and focused interview. Assessment of activity and BMI was used according to WHO recommendations, as well as the expert system. Results: The mean age of the patients was 74.53 ± 7.86 years, while in the control group 59.5 (7.93). There was a strong positive relationship between the incidence of tuberculosis and chronic obstructive pulmonary disease and the risk of lung cancer (p <0.001). The risk of lung cancer was significant in the case of smoking 20 or more than 20 cigarettes a day and smoking for more than 20 years (p = 0.01). Conclusions: Active and passive smoking, are a leading risk factor for lung cancer, which shows that understanding of the long-term and fatal effects of smoking is still very low in society.  No significant correlation has been found between lifestyle and risk of lung cancer. However, there was a strong positive correlation between tuberculosis and chronic obstructive pulmonary disease and the risk of lung cancer. Occupation is a predisposing factor for lung cancer occurrence.     

Effect of Demographic and Clinicopathologic Factors on Prognosis of Early Gastric Cancer in Iran

Background: The aim of this study was to estimate some prognostic factors that affect on overall survival ofpatients with early gastric cancer. Methods: A retrospective study had been done on patients diagnosed withearly gastric cancer who registered in cancer registry center, Tehran-Iran, between December 21, 2001 andDecember 21, 2006 and all patients were followed by telephone contacts. The Kaplan-Meier method was performedto describe survival curves and log-rank test to compare the survival rate in subgroups. Cox regression wasused to determine the prognosis factors. Results: The mean age was 57.9 ± 11.9 years and 72.6% of patientswere male. Tumor size (>35mm) and lymph node metastasis were established as significant factors for survivalof patients with EGC in both univariate and multivariate analysis. Conclusion: The findings of this studyindicate that lymph node metastasis and tumor size are the most independent prognostic factors in these patients.     

Parity,Other Reproductive Factors,and Risk of Pancreatic Cancer Mortality in a Large Cohort of U.S. Women (United States)

Several studies have found an inverse relationship between parity and risk of pancreatic cancer. However, most of the studies of pancreatic cancer in relation to parity and other reproductive factors have been small and the results inconsistent. Most recently, a well-conducted, prospective cohort study found a linear inverse association between parity and pancreatic cancer. To clarify the relationship between parity and other reproductive factors and risk of pancreatic mortality, we examined these associations among 387,981 postmenopausal U.S. women in the Cancer Prevention Study (CPS)-II cohort. CPS-II participants completed a self-administered questionnaire in 1982 and were followed for mortality through 2000. During follow-up, 1959 pancreatic cancer deaths occurred. Using Cox proportional hazards modeling, we calculated rate ratios (RR) adjusted for age, race, education, personal history of diabetes, body mass index, height, exercise, family history of pancreatic cancer, and cigarette smoking status, frequency, and duration. Overall, we did not observe a significant association between parity and pancreatic cancer mortality (trend p = 0.07). However, women who had five or more births had lower death rates from pancreatic cancer than nulliparous women (RR = 0.80, 95% CI = 0.66–0.96). We observed no association between any other reproductive factors examined (age at first birth, menarche, or menopause; type of menopause; diethylstilbestrol (DES) use; or duration of oral contraceptive or estrogen replacement therapy use) and pancreatic cancer mortality. In summary, our results support the observation that high parity is associated with lower risk of pancreatic cancer but do not show a linear trend with increasing parity. Furthermore, we find no evidence that other reproductive factors are associated with pancreatic cancer mortality.     

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.     

Reproductive variables and risk of uterine cervical cancer in Norwegian registry data

The influence of reproductive variables on cervical cancer incidence, controlling for other sociodemographic factors, was estimated in Norwegian register and census data, using Poisson regression models. Among the 1.3 million women under observation, a total of 2,870 cases of cervical cancer were diagnosed. According to models restricted to parous women, parity level had no independent impact on cervical cancer incidence, but a clear effect of age at first birth was noted. It was most pronounced in the squamous cell carcinomas, where the incidence was reduced by 48 percent from age at first birth <21 years to age at first birth 27+years. Women without children had the same cervical cancer incidence as parous women with a first birth after age 24. The sociodemographic variables controlled for exerted a strong net effect on the cervical cancer incidence. Educational level was related inversely to the cancer risk. Moreover, an increased risk was seen for women who had given birth when they were still single (never married) and for those who were divorced/separated at the time of the last previous census. A fairly small excess risk was found to be associated with living in non-rural compared with rural areas.Dr Bjørge is with the Cancer Registry of Norway, Oslo, Norway. Dr Kravdal is with the Section for Demography, Department of Economics, University of Oslo, Oslo, Norway. Address correspondence to Dr Bjørge, the Cancer Registry of Norway, Institute for Epidemiological Cancer Research, Montebello, N-0310 Oslo, Norway. This work was supported by grant no. 95034/001 from the Norwegian Cancer Society.