Endometrial Cancer: Trends in Incidence and Survival: A Preventable Disease?

Summary: Endometrial cancer is the commonest gynaecological cancer. Its relative increase in incidence over recent decades has been generally associated with a reduction in mortality. Evidence is presented to show a considerable variation in incidence worldwide; Australia, like England and Wales, has a comparatively low incidence. The incidence is highest in parts of the United States where it has shown an annual fall of nearly 3% between 1973 and 1987. The influence of hysterectomy, oral contraception and hormone replacement therapy at the menopause are discussed relative to incidence and prevention of the disease. Obesity and its prevention are also shown to have an influence on incidence and its ethnic variation worldwide. Despite a minor improvement in survival in FIGO published figures, the recent COSA-UK-NZ 'high risk' trial highlights the importance to the patient of closely monitored clinical trials.     

Cervical Cancer Incidence Trends in Canada: A 30-Year Population-Based Analysis

ObjectivesTo use the most recent data to update the trend in cervical cancer incidence in Canada over the 30 year period from 1978 to 2009.MethodsRegistered cases of cervical cancer and the corresponding person years for the Canadian population were retrieved from an online data repository of the International Agency on Research on Cancer and from Statistics Canada for the period 1978 to 2009. Annual age-standardized rates were estimated for all data combined and for each province separately. The ages of cases were aggregated into three groups: 25 to 39, 40 to 59, and 60 to 75 years. Joinpoint regression analysis was used to describe the trend across age groups and provinces.ResultsBetween 1978 and 2006, the age-adjusted cervical cancer rate in Canada decreased from 20.05 to 12.66 per 100 000 females; after 2006 the rate increased.Greater reductions were observed in the older age groups.The average annual percentage change (AAPC) was ? 1.1% (95% CI ? 1.1% to 0.09%), ? 1.8% (95% CI ? 2.5% to ? 1.2%), and ? 2.6% (95% CI ? 3.9% to ? 1.4%) for age groups 25 to 39, 40 to 60, and 60 to 75, respectively. The AAPC varied between provinces, ranging from ? 0.22% (95% CI ? 1.4% to 0.9%) in Saskatchewan to ? 3.02% (95% CI ? 4.5% to ? 1.5%) in Newfoundland and Labrador. In Ontario the incidence of cervical cancer increased annually between 2006 and 2009. The trend in British Columbia included a significant change of slope in 1984.ConclusionThe incidence of cervical cancer decreased in Canada and across all provinces between 1978 and 2009. The decrease was greater in older women.     

National Trends in Cervical Cancer Screening in Adolescents

Study ObjectiveTo characterize patterns of cervical cancer screening among adolescents ages 14-20 years before and after the 2009 American College of Obstetrics and Gynecology recommendations.DesignRetrospective cohort study.SettingNational Ambulatory Medical Care Survey 2005-2016 data.ParticipantsFemale adolescents and young women ages 14-26 years.InterventionsMultivariable logistic regression models identified independent predictors of unindicated cervical cancer screening at office-based visits among adolescents ages 14-20 years.Main Outcome MeasuresCervical cancer screening in women ages 14-20 and 21-26 years in 2 time periods: 2005-2008 and 2009-2016.ResultsBetween 2005 and 2016, 11,768 office visits were among adolescents ages 14-20 years. Overall, the cervical cancer screening rate for young women ages 14-20 years was 4.0%, which decreased from 4.5% to 0.4% (P = .008) during the study period. Adolescents who received cervical cancer screening during an office visit were older (18-20 years: 24.1% vs 14-17 years: 8.2%; P < .001), had a preventive care visit (preventive care: 79.7% vs other visit types: 20.3%; P < .001), and saw an obstetrician/gynecologist (obstetrician/gynecologist: 74.81% vs other specialties: 25.1%; P < .001). After adjusting for age, year, period, insurance status, region, and provider type, screening for cervical cancer was associated with living in the Southern region of the United States (adjusted odds ratio, 1.88; 95% confidence interval, 1.09-3.25; P = .02) and public insurance (adjusted odds ratio, 0.47, 95% confidence interval, 0.34-0.64; P < .001).ConclusionDespite recommendations, cervical cancer screening continued to occur in the adolescent population—especially older adolescents—creating unnecessary costs and potential harms. These findings show a slow uptake of guidelines nationally and the need for initiatives that encourage implementation of performance measures for providers, including ongoing provider and patient education.     

Trends in Uterine Cancer Mortality in the Americas, 1955-1988

Trends in uterine cancer mortality over the period 1955-1988 were analyzed for 14 selected Latin American countries and for the United States and Canada on the basis of the official death certification data from the World Health Organization database. In the late 1960s uterine cancer mortality in Latin America ranged from 7.8/100,000 in the Dominican Republic to 26.4/100,000 in Venezuela and was around 10/100,000 in the United States and Canada. Over the last two decades most Latin American countries (with the exception of the Dominican Republic and Ecuador) showed declines in mortality rates ranging from about 10% in Argentina and Mexico to 25-35% in Cuba, Chile, Uruguay, and Venezuela. These declines were however appreciably smaller than those in the United States and Canada, where falls in uterine cancer mortality approached 50%. In comparison with recent rates in the United States and Canada (around 5/100,000), mortality from uterine cancer was still high in all Central and South American countries (between 11 and 20/100,000), with the sole exception of Puerto Rico (6.3/100,000). The highest rates were in Paraguay and Ecuador (over 20/100,000). The overall variation in all age-standardized uterine cancer mortality in Latin America remained around threefold during the period 1965-1988 (i.e., between 22/100,000 in Paraguay and 6.3/100,000 in Puerto Rico). However, if the United States and Canada were also considered, the ratio between the highest and lowest mortality rate at all ages increased from about threefold during the period 1965-1969 to over four-fold in the late 1980s. This diverging pattern between North and Latin America was even clearer in young women (20-44 years), when most uterine cancer originates from the cervix, and less evident in the elderly. In the young, recent upward trends were observed in Argentina, Costa Rica, and the Dominican Republic. These mortality patterns are discussed with reference to risk factor exposure, cytologic screening programs, changes in hysterectomy rates, treatment, and case ascertainment and certification.     

妊娠合并宫颈癌一例

妊娠合并宫颈癌较为罕见,早期临床表现并不典型。由于缺乏妇科肿瘤筛查意识,易与胎膜早破、先兆早产等疾病相混淆,导致治疗延误。妊娠合并宫颈癌的治疗尚无成熟且规范的方案,尤其是妊娠中期宫颈癌的治疗存在很大争议,需要根据病理检查、分期、胎儿发育情况及孕妇的妊娠期望等制定个体化综合治疗方案。回顾性分析1例以阴道流血流液入院,经保守治疗失败后,行剖宫产术终止妊娠的中期妊娠合并宫颈癌的诊治经过,并对相关文献进行复习,以期为疾病的诊治提供经验。     

Intraepithelial and Invasive Squamous Cell Neoplasia of the Vulva: Trends in Incidence,Recurrence, and Survival Rate in Norway

Objective: To characterize time trends in incidence of intraepithelial and invasive vulvar neoplasia, transition of intraepithelial vulvar neoplasia to invasive cancer, and survival rate based on a total population.Methods: The Cancer Registry of Norway was used to identify all Norwegian inhabitants diagnosed during 1956–1990 with squamous cell carcinoma of the vulva, and all those with intraepithelial vulvar neoplasia diagnosed during 1973–92.Results: The incidence rate of intraepithelial neoplasia increased three-fold from 1973–77 to 1988–92, and 3.4% changed into invasive disease. Multivariate analyses identified age as a significant variable. The age-adjusted incidence rate for squamous cell carcinoma was constant for the whole period. The ratio between recurrence and the total number of invasive cancer varied from 21% to 31%. The 5-year survival rates have not changed significantly over the period. Age was revealed as a strong prognostic factor, showing an excess death rate by increasing age.Conclusion: The incidence of vulvar intraepithelial neoplasia has increased substantially over the last 40 years, but that of invasive vulvar cancer has not changed appreciably.     

早期宫颈癌手术方式的新趋势

宫颈癌是女性最常见的恶性肿瘤之一,治疗方法主要包括手术治疗和放射治疗,化疗广泛应用于与手术、放疗配合的综合治疗和晚期复发性宫颈癌的治疗,其中早期宫颈癌常采用经开腹或微创路径的手术治疗.2018年公布的宫颈癌微创手术临床试验(LACC)结果,首次对早期宫颈癌微创手术的近期、远期治疗效果和肿瘤学风险提出质疑,认为宫颈癌微创...     

Cutaneous Metastatic Disease in Cervical Cancer: A Case Report

BackgroundCervical cancer metastasizes to skin in < 2% of patients. Cutaneous metastases can be confused with dermatitis. Their presence signals a poor prognosis.CaseA 66-year-old postmenopausal woman with a diagnosis of stage IVa cervical carcinoma was treated with radical concurrent chemotherapy and radiation. Two months after completing treatment, the patient noted maculopapular skin lesions in the lower abdomen. These were confirmed on biopsy as metastases from the cervical cancer. The cutaneous metastases progressed rapidly to involve the inguinal regions, vulva, and perineum. Further assessment ruled out metastases to other organs. Despite six courses of palliative combination chemotherapy, the patient's disease progressed, and she died six months after the appearance of the cutaneous metastases.ConclusionWe reviewed the details of 47 reported cases of cutaneous metastases of cervical carcinoma. In the majority of these cases, patients presented within 10 years of initial diagnosis and died within a mean of 8.5 months from cutaneous metastasis.     

Trends in twin births in New South Wales, Australia, 1990-1999.

OBJECTIVE: To examine trends in gestational age and the mode of delivery of twins. METHOD: All twin births in New South Wales, Australia from 1990 through 1999 were analyzed. RESULTS: Twin births increased from 1922 (2.2%) in 1990 to 2522 (2.9%) in 1999. Twins born preterm (<37 weeks) increased from 40.8 to 48.8%. The increase in preterm twin births was associated with increases in induction of labor and cesareans before labor at 32-36 weeks. The rate of fetal deaths decreased by 49% and Apgar scores <4 at 5 min by 28%. CONCLUSIONS: A greater than expected increase in preterm twins was largely explained by an increase in elective deliveries at 35-36 weeks' gestation. Increasing maternal age does not appear to have contributed to the increase in preterm twin births. Lower rates of fetal death and low Apgar scores were achieved seemingly at the price of delivering more infants before term.     

Maternal Mortality in Australia

Further improvement in the maternal mortality rate and/or the maintenance of the present excellent results in Australia requires study of maternal morbidity (i.e. the deaths prevented), as well as heeding the clinical lessons in those deaths that do occur.     

Unsafe Abortion: Global and Regional Incidence,Trends, Consequences,and Challenges

ObjectiveThis review aims to provide the latest global and regional estimates of the incidence and trends in induced abortion, both safe and unsafe. A related objective is to document maternal mortality due to unsafe abortion. The legal context of abortion and the international discourse on preventing unsafe abortion are reviewed to highlight policy implications and challenges in preventing unsafe abortion.Methods and Data SourcesThis review is based on estimates of unsafe abortion and maternal mortality ratios. These estimates are arrived at using the database on unsafe abortion maintained by the World Health Organization. Additional data from the Demographic and Health Surveys and the United Nations Population Division are used for further analysis of abortion and mortality estimates.ResultsEach year 42 million abortions are estimated to take place, 22 million safely and 20 million unsafely. Unsafe abortion accounts for 70 000 maternal deaths each year and causes a further 5 million women to suffer temporary or permanent disability. Maternal mortality ratios (number of maternal deaths per 100 000 live births) due to complications of unsafe abortion are higher in regions with restricted abortion laws than in regions with no or few restrictions on access to safe and legal abortion.ConclusionLegal restrictions on safe abortion do not reduce the incidence of abortion. A woman’s likelihood to have an abortion is about the same whether she lives in a region where abortion is available on request or where it is highly restricted. While legal and safe abortions have declined recently, unsafe abortions show no decline in numbers and rates despite their being entirely preventable. Providing information and services for modern contraception is the primary prevention strategy to eliminate unplanned pregnancy. Providing safe abortion will prevent unsafe abortion. In all cases, women should have access to post-abortion care, including services for family planning. The Millennium Development Goal to improve maternal health is unlikely to be achieved without addressing unsafe abortion and associated mortality and morbidity.     

Effect of Paraaortic Lymphadenectomy on 5-Year Survival in Early Stage Cervical Cancer

This study includes 278 patients with Stages 1 and 2 cervical cancer subjected to type 3 hysterectomy and lymphadenectomy. The incidence of lymph node metastasis and effect of paraaortic lymphadenectomy on 5-year survival were evaluated. The overall incidences of pelvic and paraaortic lymph node involvement were 24.1% and 8.0%, respectively. The overall 5-year survival rate was 83.8%. The 5-year survival of patients subjected to both pelvic and paraaortic lymphadenectomy was found to be 84.6%; the figure was 80.9% for patients subjected to only pelvic lymphadenectomy. No statistical difference in survival was found between patients with and without paraaortic lymphadenectomy.     

Caesarean Section in South Australia, 1986

A profile of Caesarean section in South Australia was obtained by analysing the 19,800 births in the perinatal statistics collection in 1986. The Caesarean confinement rate was 19.0%, of which 9.0% were elective sections and 9.9% emergency sections. The rates were highest in large metropolitan hospitals. Elective rates were highest in metropolitan private hospitals, among older women, among those with a previous perinatal death or where a fetal malpresentation occurred. Emergency sections were more common in primigravidas, non-Caucasian women, those with a poor pregnancy history, few antenatal visits and a medical or obstetric complication of pregnancy. The obstetric complications most commonly encountered with Caesarean sections were fetopelvic disproportion, fetal distress, malposition or malpresentation, pregnancy hypertension and uterine inertia. Neonates born by emergency section were more likely to be premature, or low birth-weight and to manifest depression of vital signs compared with vaginal births. They also required more intensive resuscitation and neonatal care, and neonatal death occurred more frequently. Morbidity was much lower in neonates born by elective than emergency section.     

SEER Data, Corpus Uteri Cancer: Treatment Trends versus Survival for FIGO Stage II, 1988–1994

OBJECTIVE: 1998 Surveillance, Epidemiology, and End Results (SEER) data estimate an 83.1% 5-year survival rate for corpus uteri adenocarcinoma FIGO stage II. The SEER data were evaluated to determine whether primary treatment differences using simple hysterectomy or radical hysterectomy, with or without radiation, altered disease survival. MATERIALS AND METHODS: SEER incidence data for FIGO II uterine corpus cancer of adenocarcinoma histology from 1988 to 1994 were stratified by hysterectomy type (simple versus radical) and whether radiation was given. Survival rates were calculated using a relative survival method and are expressed as percentages. Statistical analysis was done using a Z test. RESULTS: The 5-year cumulative survival rate for patients with stage II uterine corpus adenocarcinoma who received surgery alone as primary therapy was 84.36% with simple hysterectomy and 92.96% with radical hysterectomy (P<0.05). Survival for patients who received combination radiation and surgery as primary therapy was 82.77% with simple hysterectomy and 88.02% with radical hysterectomy (P<0.05). Pelvic and para-aortic nodes were negative. There was no significant survival difference for radiation versus no radiation in either surgical group. CONCLUSION: Radical hysterectomy is associated with better survival when compared to simple hysterectomy for FIGO II corpus uteri adenocarcinoma.     

Trends in Contraception and Sterilization in Australia

Life-history data collected in a national survey of women in 1986 are used to derive the first national estimates of trends in contraception and sterilization in Australia over the last 30 years. The pill rapidly became the method of choice after its release in 1961. The intrauterine device, the other truly modern method, has never attained the same popularity. The move toward sterilization dates from the early 1970s and has been so complete that women of 35 or older are now more likely to be protected by a ligation or laparoscopic sterilization than by the pill or, indeed, by all other methods combined. Unmarried women are now indistinguishable from married women on the basis of their use of contraception, and childless married women are now more likely to be using a reversible method than married women with children.     

Trends in Invasive Cancer of the Cervix Uteri in New South Wales, 1973–1982

Summary: Data from the New South Wales (NSW) Central Cancer Registry comprising all new cases of, and deaths from, invasive cancer of the cervix uteri registered in persons aged 15 years and over for the 10-year period 1973 to 1982 were examined using log-linear regression to determine whether incidence and mortality had been changing in NSW. Allowing for the estimated fraction of women who had undergone hysterectomy, this cancer had decreased significantly in incidence (- 1.3% per year) as well as mortality (-3.6%). There were no significant trends in relation to age at diagnosis, stage at diagnosis or histological type. Overall, younger age at diagnosis was associated with an earlier stage at presentation and there was no evidence for a trend towards more severe disease in young women during the 10-year period. No evidence was found for an increasing incidence of adenocarcinoma. By 1982 the age-standardized incidence rate was 10.4 per 100,000 (12.5 per 100,000 after adjustment for the hysterectomy fraction). Cancer of the cervix uteri was more common in Inner and Western Sydney and less common in the Northern Metropolitan region of Sydney and rural New South Wales.