Urogenital ageing and its effect on sexual health in older British women

Objective To provide information on the extent of problems of urogenital ageing in older British women.
Design A MORI survey of a representative population sample of older British women.
Setting Home interviews.
Participants Two thousand and forty-five women aged 55–85+.
Results Urogenital symptoms had affected 48.8% of the women at some time, but no more than 11% were currently affected by individual symptoms; however, these were often of long duration. The majority (73%) were not sexually active, with lack of a partner being a factor for many. There was also a decreasing prevalence of sexual activity with increasing age. Those sexually active in the 65–74 year old age group (   n = 148  ) tended to have a similar sexual frequency (at least once per month) compared with the younger women studied. Approximately 12% of those who reported dyspareunia and/or vaginal dryness claimed a severe problem; 33% did not seek professional advice and 36% resorted to an over the counter remedy. Use of hormone replacement therapy was generally of relatively short duration. There was a declining gradient of ever-use with age.
Conclusions The extent of significant urogenital symptoms is relatively low, but some women are seriously affected and use self-help as well as professional assistance. The extent of sexual activity in older women and factors affecting this have been defined, and the effect of urogenital symptoms on sexual activity demonstrated.     

The influence of age on prognosis in carcinoma of the cervix

Summary. Of 385 new patients with invasive carcinoma of the cervix FIGO stages IB—IV treated between 1970–1984 inclusive, 11% (43 patients) were aged ≤35 years. During the period studied there was a gradual rise in the proportion of such young women from 2% for the triennium 1970–1972 to 18% for 1982–1984. In women aged ≤35 years early stage disease predominated, 72% presenting with stage IB disease, compared with 29% in the older age group. For FIGO stage IB there was no significant difference in actuarial survival between younger and older patients ( P >0·1), both age groups having a 5-year survival rate of 81%. Similarly for FIGO stage II there was no difference in actuarial survival ( P >0·1) between younger and older patients who had 5-year survival rates of 66% and 63% respectively. In our experience the incidence of invasive carcinoma of the cervix in young women is rising, but stage for stage their survival is similar to that of older women.     

Cervical cancer in Canada: Changing patterns in incidence and mortality

Abstract. Liu S, Semenciw R, Probert A, Mao Y. Cervical cancer in Canada: Changing patterns in incidence and mortality.
Data on incidence of cervical cancer by histologic subtype and mortality for the Canadian provinces of Ontario, Saskatchewan, and British Columbia were used to examine time trends by age, calender period, and birth cohort. Age-adjusted incidence rate of squamous cell carcinoma of the cervix decreased from 11.1 per 100,000 women in 1970–72 to 5.3 in 1994–96, while the rate for cervical adenocarcinoma increased from 1.1 per 100,000 women to 1.5 over the same period. Age-adjusted mortality rate declined from 7.9 per 100,000 women in 1953–55 to 1.9 in 1995–97. The patterns in age-specific mortality rates in 1953–72 were different from those in 1973–97; younger women experienced larger reductions in mortality during the earlier period while older women benefited to a greater extent during the latter period. Age-period-cohort modeling showed that cohort effects were responsible for the decreasing trends in incidence of squamous cell carcinoma of the cervix and increasing trends in adenocarcinoma, and both period and cohort effects account for the observed trends in mortality. The results suggest that Pap smear screening has played a significant role in the reduction in squamous cell cervical carcinoma. The causes for the increase in cervical adenocarcinoma are unclear.     

Screening history preceding a diagnosis of cervical cancer in women age 65 and older

Objective

To characterize the antecedent screening of women 65 years of age and older diagnosed with cervical cancer.

Methods

Screening histories of women 65 years of age and older who were diagnosed with cervical cancer between 2003 and 2008 were examined utilizing the organization's databases and the regional Cancer Registry. Stopping screening was recommended at age 65 for members who had either 3 consecutive negative Paps or a single negative Pap plus HPV test (“cotest”).

Results

From 2003 through 2008 there were 56 Kaiser Permanente Northern California members 65 years of age and older diagnosed with cervical cancer. During the same time period there were 1,323,100 woman-years of membership in women age 65 and older. The risk of invasive cancer among women age 65 and older was 4.2/100,000/year in 2003-2008. 33 of 56 (59%) had one or more Pap smears prior to diagnosis. Of the 33, 14 women (25%) had 3 consecutive negative Pap smears prior to diagnosis. Three of 46,401 women with 1 or more negative cotests at age 65 and older were subsequently diagnosed with invasive cancer during 132,639 women-years of follow-up (2.3/100,000/year).

Conclusions

Most cervical cancers diagnosed at age 65 and older occur in women who have not met our criteria for stopping screening. A few cancers will continue to occur at age 65 and older despite multiple negative tests, as is true in other age groups. We currently have no evidence that these cancers would be prevented with continued screening at ages 65 and older.     

Screening practices and invasive cervical cancer risk in different age strata

Relative and population attributable risks for invasive cervical cancer in different age strata relative to screening practices have been estimated using data from a case-control study conducted since 1981 in the greater Milan area, northern Italy. A total of 548 women under 75 years of age with a histologically confirmed diagnosis of invasive cervical cancer were compared with 515 controls admitted to hospital for a spectrum of nongynecological, hormonal or neoplastic, acute conditions. The percentage of never-screened women increased with age: no Pap smear was reported in 34% of controls aged 44 years or younger and 63% of older women (greater than or equal to 65 years). A similar trend emerged in recency of Pap smear, with 14% of older controls and 52% of the younger group reporting a cervical smear within 3 years before the interview. The number of Pap smears was strongly and inversely related to cervical cancer risk at all ages. Compared with no Pap smear, three or more cervical smears decreased the risk of invasive cervical cancer by about 90%. Compared with women screened the last time 6 years before the interview or never, relative risks were about 60% lower in women reporting their last Pap within 2 years in all age groups. A slightly larger proportion of older cases were attributable to the absence or delay in the screening: population attributable risk estimates were 78% in women up to 55 years of age, and 86% in those 65 years or older. Thus, deficiencies in screening were greater at ages at which the incidence of disease was higher.     

Predicting chlamydial and gonococcal cervical infection: implications for management of cervicitis

OBJECTIVE: To define utility of age and cervical findings in predicting infection with Chlamydia trachomatis and Neisseria gonorrhoeae among women universally tested for both infections, and to assess the independent contribution of Gram stain (GS) smear of endocervical secretions. METHODS: Visits by women to Seattle sexually transmitted diseases clinics from 1995 through 1999 were retrospectively reviewed. All women had endocervical GS and cultures for C trachomatis and N gonorrhoeae performed. Predictive values of age, cervical signs, and inflammation on GS (more than 30 polymorphonuclear leukocytes per 1000x field) were calculated. RESULTS: Among 6230 women, prevalence of C trachomatis and N gonorrhoeae was 6.9% and 2.1%, respectively; 520 women (8.3%) had either organism detected. Age, cervical signs (mucopus, induced bleeding), and inflammation on endocervical GS were independently associated with infection. However, the positive predictive value (PPV) of any cervical finding for infection was less than 19% in women 25 years and older. Inflammation on endocervical GS was the sole indicator of infection in 79 of 520 (15%) infections, but was insensitive in the absence of mucopurulent cervicitis (sensitivity, 26%; PPV, 21%). CONCLUSION: Cervical signs suggesting chlamydial or gonococcal infection have higher positive predictive value (PPV) in younger women. The PPV of inflammation on endocervical GS is too low to recommend its use to direct empiric treatment in the absence of mucopurulent cervicitis, especially in women 25 years and older. Further, its low sensitivity in detecting infection in women without mucopurulent cervicitis does not justify routine use. Signs suggesting mucopurulent cervicitis should be interpreted in the context of age, and empiric treatment may not be indicated in women aged 25 years and older.     

Age at sexual initiation and number of sexual partners in the female Spanish population Results from the AFRODITA survey

Objectives

The AFRODITA study was designed to describe patterns relating to the number of lifetime sexual partners (SP) and age at first sexual intercourse (AFSI) by geographic region in a representative sample of Spanish women.

Study design

A representative sample of the female Spanish population was obtained using the Access Panel Technique. Postal questionnaires were sent to 11,086 women aged 18–70 years. Data were collected on AFSI, number of sexual partners, contraceptive methods, cervical cancer screening and socio-demographic characteristics.

Results

The average AFSI was 20.9 years. AFSI below the age of 19 years was reported by 30.8% of the women. Among sexually active women, 70.6% reported being monogamous and 6.4% reported ≥5 lifetime sexual partners. Younger age at interview was strongly related to earlier AFSI and to higher number of lifetime sexual partners. Women younger than 25 were 39 times more likely to have an AFSI before age 18 than women over age 55. The percentage of women aged less than 25 reporting two or more sexual partners was four times higher than that of women 56 and older. In the multivariate analysis, having two or more sexual partners was independently associated with young age, early AFSI, having ever used oral contraceptives, living in an urban area, having had a screening Pap test in the last 3 years, having a sexually transmitted infection and nuliparity.

Conclusions

This study confirms important changes in the sexual behaviour of Spanish women. Younger cohorts show a younger age at sexual initiation and higher number of sexual partners. These are key factors that may induce changes in the human papillomavirus (HPV) prevalence and the cervical cancer incidence in Spain.     

Histologic findings from the cervix among older women with abnormal cervical cytology

OBJECTIVE: The aim of this study was to determine rates of cervical neoplasia among women at least 50 years of age referred for colposcopy after abnormal cytology and to compare these to younger women. METHODS: From a prospectively accrued database of 2825 women undergoing colposcopy in the gynecology clinic of an urban public hospital, women at least 50 years of age with a known cytologic abnormality were selected for retrospective analysis. Demographic and medical information collected at colposcopy and subsequent histology was reviewed. Cytology results were based on the Bethesda system, and histology was reported as grades of cervical intraepithelial neoplasia (CIN). Statistical analysis was by t test, chi(2) test, and Mann-Whitney U test. RESULTS: Among 325 women at least age 50, cervical histologic results were benign or atypical for 147 (45%), CIN1 for 28 (9%), CIN2 for 21 (6%), CIN3 for 49 (15%), cancer for 11 (3%), and ungraded dysplasia for 7 (2%), with no biopsy performed for 62 (19%) women. Symptoms were more common among women with cancer (6/11 or 55%) than those without (62/263 or 21%, P = 0.01). Negative histology (80/231 or 35%), CIN3 (49/231 or 21%), and cancer (9/231 or 4%) were more common among older than younger women (287/1403 or 20%, 199/1403 or 14%, and 11/1403 or 1%, respectively), while atypia (438/1403 or 31%), CIN1 (321/1403 or 23%), and CIN2 (147/1403 or 10%) were more common among younger than older women (53/231 or 23%, 23/231 or 10%, and 17/231 or 7%, respectively, P < 0.04). Differences in the distribution of cervical histology results remained significant among women with ASCUS (P = 0.001) but not those with LSIL (P > 0.9), HSIL (P > 0.07), or cancer (P > 0.4). CONCLUSIONS: Most older women are referred for colposcopy with lesser grades of abnormality, but cervical cancers are found across all cytologic grades and were more common in symptomatic women. Compared to younger women with abnormal cytology, women at least 50 years of age with ASCUS had higher rates of negative evaluations and high grade but not low- or mid-grade lesions.     

Age-specific differences in treatment and survival of ovarian cancer patients in the province of Limburg, the Netherlands, 1986–92

de Rijke JM, Schouten LJ, Volovics A, van der Putten HWHM. Age-specific differences in treatment and survival of ovarian cancer patients in the province of Limburg, the Netherlands, 1986–92. Int J Gynecol Cancer 1998; 8 : 150–157.
The objective of this study was to investigate age-specific differences in treatment and survival of patients with epithelial ovarian cancer diagnosed in the period 1986–92 in Middle and Southern Limburg, the Netherlands.
Data about the treatment of epithelial ovarian cancer patients were derived from the population-based Maastricht Cancer Registry and retrospectively evaluated. Observed and relative survival rates were calculated according to age, stage, period of incidence and histology. Differences in survival between three age groups were explored with univariate and multivariate analyses. The patients were followed until January 1, 1994.
The total study group comprised 367 epithelial ovarian cancer patients; 86 were younger than 55 years at diagnosis, 152 were 55–69 years and 129 were aged 70 years or older. Stage III (FIGO) was the most common stage at diagnosis in the three age groups. Older women (70 +) were more likely to have received no treatment or only one treatment modality than were younger women ( P < 0.001). Five-year relative survival decreased with age: 54%, 34% and 17% in the three age groups 0–54, 55–69 and 70 + years, respectively ( P = 0.000). Multivariate regression analysis revealed that age at diagnosis was an independent significant prognostic factor.
Several exposure factors in elderly women may explain the differences in treatment and survival, such as additional comorbid conditions, more aggressive tumor growth, physicians' reluctance to treat elderly patients and less favorable social conditions.     

Gastrostomy tubes in patients with recurrent gynaecological cancer and intestinal obstruction

Objective Women with recurrent gynaecological cancers who are not suitable for exenterative surgery commonly present with gastrointestinal dysfunction. This paper is a retrospective review of the use of gastrostomy tubes in such women.
Methods We performed a chart review of women with recurrent gynaecological cancer who had a gastrostomy tube placed between January 1991 and April 1998.
Results Thirty-nine women (mean age 53.2 years, range 17–82) had a gastrostomy tube placed. Twenty-eight (72%) had ovarian cancer, eight (21%) had cervical cancer, two had endometrial cancer and one had vaginal cancer. In 14 women a gastrostomy tube was placed as the sole procedure for palliation (11 elective, 3 emergency). In the remaining 25 women, who underwent major surgery, a gastrostomy tube was placed in anticipation of, or in the presence of, significant intestinal distension and expected prolonged post-operative ileus. eleven women (28%) died without leaving hospital after their operation (median 11 days, range 2–36). All but one of the 28 women who left hospital had satisfactory oral intake. Twenty-one women (54%) died with the gastrostomy tube in place (median 28 days, range 2–157) and 18 (46%) had the gastrostomy tube removed (median 14.5 days, range 9–180), 13 of whom (33%) have since died (median 167 days, range 77 days–7 years). Five women (13%) are alive (median 2.2 years, range 10 months–4.5 years). There were no problems which required the gastrostomy tube to be removed.
Conclusion Gastrostomy tubes have an important role in the treatment of women with recurrent gynaecological cancer, allowing gastric drainage and decompression without the disadvantages of nasogastric tubes.     

Invasive cervical cancer and human immunodeficiency virus (HIV) infection: a South African perspective

Abstract. Moodley M, Moodley J, Kleinschmidt I. Invasive cervical cancer and human immunodeficiency virus (HIV) infection: a South African perspective.
The aim of this study was to compare the prevalence and presentation of cervical cancer in HIV-positive and HIV-negative women in our local population. Six hundred and seventy-two patients with cervical cancer presented to the gynecology oncology unit of King Edward VIII Hospital, South Africa. The HIV seroprevalence among these patients was 21%. There was an increase in the background prevalence of HIV infection (1.6–32.5%) as well as a quadrupling in the prevalence of HIV infection among patients with invasive cervical cancer (5–21%) over a 10-year period. The mean ages of the HIV-negative patients and HIV-positive patients were 55.2 and 39.8 years, respectively. Most of the HIV-positive patients were in the 30- to 40-year-old age group (51%), whereas the majority of patients who were HIV negative were in the 50- to 60-year-old age group (36%). The majority of patients, irrespective of HIV status, were more likely to have late stage disease than early stage disease. There was an increase in HIV infection in patients with both types of background prevalence and among patients with invasive cervical cancer. The mean age of HIV-positive patients was 15 years younger than that of the HIV-negative patients. The majority of patients, irrespective of HIV status, presented with late stage disease.     

Possible correlation of leptin with body fat distribution and adiposity: Evaluation of serum leptin in South Indian population

Background:  Leptin, an adipocyte-derived hormone, is known to play an important role in body fat. Gender, age, degree of obesity and sex steroids are expressed differentially in men and women.
Methods:  We measured serum leptin, testosterone and β-estradiol concentration by radioimmunoassay in 300 subjects (60 normal weight, 60 underweight, 60 overweight, 60 obese and 60 morbidly obese) by age group (18–40 years and 41–62 years), using full-length recombinant human leptin as a standard.
Results:  The present study found that morbidly obese and obese men and women older than 50 years had 50–70% higher body mass index (BMI)-adjusted leptin levels than younger subjects. In addition, obese and underweight subjects showed a tendency towards lower BMI-adjusted leptin levels in younger than older, in both men and women subjects. Multiple regression analysis showed that age was positively correlated with leptin in both genders, even if the slope of rise was twice as high in women than in men. Together, these results indicate that in both genders, most prominently in females, aging is associated with increased leptin production that is independent from the amount of fat and/or the role of sex hormones.
Conclusion:  In conclusion, our data show that serum leptin concentrations in men and women gradually increase during aging, being higher in women than in men, but they are independent from BMI and other hormones. The inclusion of several hormones in our regression model showed that only testosterone in men, and estradiol and androstenedione in women were independent contributions to serum leptin levels, possibly accounting for part of the leptin sexual dimorphism in a south Indian population.     

Ethnic differences in patterns of care of stage 1A(1) and stage 1A(2) cervical cancer: a SEER database study.

OBJECTIVE: The aim of this study was to evaluate patterns of care for women with Stage 1A(1) and 1A(2) cervical cancer utilizing the SEER database. METHODS: Review of SEER data from 11 registries from 1990 to 1995 was performed. Data from 2358 women were reviewed and stratified by substage, ethnicity, type of therapy, and age. RESULTS: Three remarkable differences among subgroups were identified. (1) Among women >/=35 years of age, whites were more likely to have Stage 1A(1) cancer than blacks or Hispanics; OR (95% CI) = 1.56 (1. 05, 2.31) and 1.41 (1.04, 1.91), respectively. (2) Patients >/=35 years of age were more likely to undergo hysterectomy than younger patients both for 1A(1) and 1A(2) stages; OR (95% CI) = 2.31 (1.68, 3.19) and 2.78 (2.21, 3.50), respectively, with Mantel-Haenszel test of independence chi(2) = 102.9943, P value < 0.001. (3) Black and Hispanic women >/=35 years of age with 1A(2) disease were less likely to have a hysterectomy than whites. Only 15% of Hispanic patients and 9% of blacks over the age of 35 and with Stage 1A(2) were treated via hysterectomy, compared to 76% of white women. Differences in hysterectomies for <35 years of age, 1A(1) patients approached but did not reach statistical significance: blacks 36% versus Hispanic/whites 59%, P value = 0.07. CONCLUSIONS: Older white women were more likely to have cervical carcinoma diagnosed at an earlier stage (1A(1)) than age-matched blacks or Hispanics. Older patients, across all ethnic groups analyzed, were also more likely to be treated for both Stage 1A(1) and 1A(2) disease via hysterectomy than younger patients. Ethnic differences in the management of women with Stage 1A(2) cervical cancer do exist: older minority women are less likely to have a hysterectomy and more likely to be treated via fertility-sparing, less definitive procedures than whites.     

DNA flow cytometry in stage IB and II cervical carcinoma

In a retrospective study the prognostic significance of nuclear DNA content was investigated, as measured by flow cytometry, of the tumor specimens from 212 women with nonpretreated FIGO stage IB and II cervical cancer. One-hundred and thirty cases (62%) were found to be diploid, whereas 82 (38%) were aneuploid. Univariate analysis of the follow-up data showed an increased relative risk (RR) for recurrence free survival (RFS) for stage II tumors (RR = 1.87, 95% CI: 1.13–3.10, P = 0.015) and for age (RR = 1.52, 95% CI: 0.66–3.52 and RR = 2.35, 95% CI: 1.19–4.65, P = 0.032). Ploidy showed a relative risk of 1.33 (95% CI: 0.83–2.13, NS). In addition, univariate analysis of overall survival (OS) revealed similar results. For the subgroup of patients with primary surgery ( n = 151), positive pelvic nodes (RR = 5.38, 95% CI: 2.70–10.71, P = 0.0001) and parametrial extension (RR = 2.53, 95% CI: 1.24–5.17, P = 0.011) were significant factors for OS after univariate analysis, the estimated effects on RFS were slightly smaller. Multivariate analysis of RFS for the whole study population showed age, histologic grade and stage with a slightly increased risk, but no effect was significant. Ploidy with an RR of 0.97 (95% CI: 0.58–1.62) seems to have no influence on prognosis. For the subgroup with primary surgery, ploidy again failed statistical significance with an RR of 1.20 (95% CI: 0.58–2.49). Our results suggest that abnormalities of the nuclear DNA content in this homogeneous group of patients are associated with clinical and morphological prognosticators, however, ploidy is not an independent prognostic factor for RFS, or for the whole study population or for the subgroup with primary surgery.     

Incidence of cancer of the corpus uteri in the elderly in Canada, after adjustment for previous hysterectomy

The objectives of this study were first, to describe the trends in rates of cancer of the corpus uteri in Canada between 1969 and 1990 after adjustment for previous hysterectomy and second, to assess the role of improved diagnosis in recent periods. Cases were defined as women of ages 65 years and older with a diagnosis of cancer of the corpus uteri. Rates were calculated using national data and adjusted to reflect previous hysterectomy. A chart review was performed at a regional cancer centre to obtain information on stage of the disease, duration of the symptoms and initial method of diagnosis. Age-specific rates, adjusted for previous hysterectomy, showed increases in women aged 70–74, 75–79 and 80–84 years. The cohort analysis revealed that the 1915–19 birth cohort experienced a high incidence of cancer of the corpus uteri in women aged 55–69 years at diagnosis. Stage I disease was more common in recent periods at the regional centre (71.1%, 74.1% and 92.3% for 1969–72, 1980–81 and 1990–91; χ² for linear trend 10.676, P  = 0.001). In 1990–91, 6.7% of cases were identified by endometrial biopsy. In conclusion, incidence adjusted for hysterectomy prevalence is increasing in women aged 65–84 years in Canada. There is increased risk for women 55–69 years of age born in 1915–19 cohort. There is weak evidence of improved diagnosis in elderly women in recent periods.     

Acceptance of Mementos of Fetal and Perinatal Loss in a South Australian Population

Summary: A package of mementos of a fetal or perinatal loss has been shown to help with the grieving process. The level of acceptance and the factors influencing acceptance of these mementos in a South Australian population was examined over a 27-month period. Data were available on 447 women and the acceptance rate was 79.6%. Major influences on the acceptance of mementos were maternal age and gestational age. Mothers in the 20–30 year age group were more likely to accept mementos than younger and older mothers. This age-related effect was more noticeable among genetic terminations and neonatal deaths than among spontaneous abortions or stillbirths. Memento acceptance of miscarriages and stillbirths over 20 weeks' gestation was significantly greater than for younger gestation. These findings may have an impact on the psychosocial management of perinatal loss. The high level of acceptance of these mementos is encouraging and vindicates our current practice which we recommend to others involved in the management of perinatal loss.     

Type of human papillomavirus and expression of p53 in elderly women with cervical cancer

To clarify the age-related genetic events in cervical cancer in elderly (>==65 years) women, 66 tissue specimens obtained from patients with stage Ib-IIb cervical carcinoma among two groups of women, 64 years of age or younger and 65 years of age and older, were analyzed for human papillomavirus (HPV) typing via polymerase chain reaction, the expression of p53 via immunohistochemical study, and clinical behavior. The prevalence of HPV DNA was higher in the younger group than in the older group (84.0 vs. 50.0%) as was the detection rate of HPV 16 (44.0 vs. 6.3%). In contrast, HPV 18, 33, 52, 58, and X were frequently detected in older patients. The positive rate of p53 overexpression in the older group was similar to that in the younger group (46.7 vs. 48.8%). There was no significant difference in the incidence of lymph node metastasis, histology, and the distribution of clinical stage between the two groups. Thus, in elderly Japanese women with stage Ib-IIb, the association of HPV of types other than HPV 16 is suggested to influence the progression of cervical cancer.     

Cervicovaginal fibronectin and cervical length at 23 weeks of gestation: relative risk of early preterm delivery

Objectives To establish the prevalence of cervicovaginal fetal fibronectin positivity at 23 weeks of gestation in a routine population of singleton pregnancies and determine the relative risk of spontaneous delivery before 33 weeks in women with a fibronectin positive result.
Design Prospective clinical study.
Setting Inner city antenatal clinic.
Population Singleton pregnancies attending for routine antenatal care.
Methods Cervicovaginal fetal fibronectin and cervical length were measured at 23 weeks of gestation. The distribution of fibronectin positivity within subgroups according to maternal characteristics was calculated and the relative risk of spontaneous delivery before 33 weeks was estimated.
Main outcome measures Prevalence of a fibronectin positive result and its relation to cervical length measurement and spontaneous preterm delivery before 33 weeks.
Results Of 5146 women participating in the study, 182 (3.5%) had a fibronectin positive result and 76 (1.5%) had a cervical length of ≤ 15 mm. Fibronectin positive women were more likely to be Afro-Caribbean in origin, to have had a previous second trimester miscarriage and to have a short cervix. In the 5068 women who were managed expectantly, the significantly independent relative risk of spontaneous delivery at < 33 weeks was 46.2 (95% CI 18.8–113.6), for cervical length of ≤ 15 mm, 8.1 (95% CI 3.8–17.5) for a fibronectin positive result, and 4.4 (95% CI 2.2–9.1) for cigarette smoking.
Conclusion Fibronectin positivity at 23 weeks of gestation provides useful prediction of pregnancies at risk of spontaneous preterm delivery before 33 weeks, with a relative risk that is twice as high as cigarette smoking, but is a sixth of that of cervical length.     

A PCR study on the coexistence of herpes simplex virus, cytomegalovirus and human papillomavirus DNAs in cervical neoplasia

There is strong epidemiological and biological evidence that the development of squamous cell carcinoma of the cervix is a multistep process in which human papillomaviruses (HPVs) play a crucial but not total role and where the synergistic effect of herpes simplex virus (HSV) and human cytomegalovirus (HCMV) has been suggested. The presence of HPV, HSV and HCMV deoxyribonucleic acids (DNAs) was assessed by a polymerase chain reaction (PCR) in cervical biopsies obtained from 41 women with cervical neoplasia (21 high-grade cervical intra-epithelial neoplasia (CIN) and 20 squamous cell cancers) and 33 controls. Human papillomavirus 16 DNA was significantly more common in high-grade CIN (57%) and cancer (50%) than in normal cervix (9%). Herpes simplex virus and HCMV DNAs were present in 12% and 21% of normal cervices, 19% and 24% of high-grade CIN, and 25% and 25% of cancers, respectively. After adjustment for patients' age, coinfection associating high-risk HPVs (HPV 16 and/or HPV 18) and herpes viruses (HCMV and/or HSV) were observed in cervical neoplasia (odds ratio (OR) = 19.11; 95% confidence interval (CI): 2.14–170.36). Conversely, the OR for infection by HPV 16 and/or HPV 18 alone did not reach statistical significance (OR = 7.22; 95% CI: 0.85–61.16). Moreover infection by HCMV and/or HSV alone (OR = 0.89; 95% CI: 0.33–2.24) was not associated with cervical neoplasia. Our results support the role of HSV and HCMV as cofactors of HPV 16 and HPV 18 in cervical neoplasia.     

The impact of age in the outcome of patients with advanced or recurrent cervical cancer after platinum-based chemotherapy

OBJECTIVES: Cervical cancer is a disease of middle-aged and elderly but still there are young women diagnosed with advanced disease that is incurable with local treatment and is treated with platinum-based combination chemotherapy. It is unknown whether these young patients have a poorer outcome compared to older patients or whether elderly patients have inferior outcome than younger patients when treated with combination chemotherapy. METHODS: We compared the outcome between young (<35), elderly (>70) and middle-aged (35-70) women who were treated with platinum-based combination chemotherapy for advanced, recurrent or persistent disease. RESULTS: Two hundred and eighteen patients were included in our database. The baseline clinical and disease characteristics were not different between age groups but anemia and thrombocytosis were more frequent in younger patients. Median survival for all patients was 13.4 (95%CI 11-15.8) months while survival of patients<35 years of age was 9 months (95% CI 5.8-12), of patients older than 70 was 10 months (95% CI 6.9-13) of patients 35 to 70 years of age was 14.5 months (95% CI 11-18) (p=0.004). Multiple factors were significant for survival in univariate analysis but only weight loss, pain score and relapse inside an irradiated filed were significant predictors of outcome in multivariate analysis. CONCLUSIONS: Very young (<35) and elderly (>70) patients have a worse prognosis after treatment with combination chemotherapy for advanced or recurrent cervical cancer. Nevertheless, this difference is not significant when adjusted for other prognostic factors.