Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women

Concurrent chemoradiotherapy (CCRT) is the standard treatment for local advanced cervical cancer. However, for elderly patients, studies are limited and the outcomes are controversial | BMC Cancer

Methods: We retrospectively analyzed the elderly cervical cancer patients treated with radical RT or CCRT between January 2006 and December 2014. For external beam radiotherapy, 50Gy in 25 fractions or 50.4Gy in 28 fractions were delivered via 3-dimensional conformal radiation therapy or intensity modulated radiation therapy. High-dose-rate intracavitary brachytherapy was performed with a dose of 30-36Gy in 5–7 fractions to point A. Concurrent chemotherapy regimens included weekly cisplatin and paclitaxel.

Conclusion: Elderly cervical cancer patients could tolerate radical RT and CCRT very well and get a favored survival. Compared with RT, CCRT could improve the survival of elder cervical cancer patients with similar nonhematological toxicity. CCRT should be considered in elderly cervical cancer patients.

Full reference: Wang, W. et al. (2017) Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women. BMC Cancer 17:510

HPV cervical cancer test introduced in England

BBC Health News. Published online: 4 July 2016

Illustration showing an artists interpretation of a Cervical cancer cell

The NHS in England is introducing a “superior” test for cervical cancer, following a successful pilot programme. Experts say it is a switch that could pick up an extra 600 cancers a year.

Women invited for a routine smear test will now automatically be checked for an infection called HPV (Human Papilloma Virus), which has been strongly linked to cervical cancer. Until now, an HPV test has only been done if doctors noticed abnormal cells in the smear sample.

Public Health Minister for England Jane Ellison said: “These changes are a breakthrough in the way we test women for cervical disease. The new test is more accurate, more personal and will reduce anxiety among women.

Read the full news story here

Human papillomavirus detection in a “Digital” age

Justin A. Bishop and Patrick K. Ha. Cancer.  Published online: 17 March 2016

http://wellcomeimages.org/indexplus/obf_images/c6/26/0192446f76f518f60f888ada8c67.jpg

Image source: Wellcome Images // CC BY-NC-ND 4.0 

Image shows a high power view of squamous mucosa of the cervix, with mild abnormalities related to human papillomavirus (HPV) infection.

It is increasingly important to identify the presence of human papillomavirus (HPV) in patients with oropharyngeal squamous cell carcinoma, because HPV status is now useful for clinical trial stratification, prognostic determination, diagnosis in patients with neck masses, and identification of the primary tumor site. Therefore, it is important that the technique used for identification be feasible, accurate, reproducible, and cost effective. The authors summarize these aspects of HPV detection and the use of newer digital polymerase chain reaction technology for this purpose.

Read the abstract here

Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: A systematic review and meta-analysis of randomised trials

European Journal of Cancer: November 2015 Volume 51, Issue 16, Pages 2375–2385

Introduction
Population coverage for cervical cancer screening is an important determinant explaining differences in the incidence of cervical cancer between countries. Offering devices for self-sampling has the potential to increase participation of hard-to-reach women.

Methods
A systematic review and meta-analysis were performed to evaluate the participation after an invitation including a self-sampling device (self-sampling arm) versus an invitation to have a sample taken by a health professional (control arm), sent to under-screened women.

Results
Sixteen randomised studies were found eligible. In an intention-to-treat analysis, the pooled participation in the self-sampling arm was 23.6% (95% confidence interval (CI) = 20.2–27.3%), when self-sampling kits were sent by mail to all women, versus 10.3% (95% CI = 6.2–15.2%) in the control arm (participation difference: 12.6% [95% CI = 9.3–15.9]). When women had to opt-in to receive the self-sampling device, as used in three studies, the pooled participation was not higher in the self-sampling compared to the control arm (participation difference: 0.2% [95% CI = −4.5–4.9%]).

Conclusion
An increased participation was observed in the self-sampling arm compared to the control arm, if self-sampling kits were sent directly to women at their home address. However, the size of the effect varied substantially among studies. Since participation was similar in both arms when women had to opt-in, future studies are warranted to discern opt-in scenarios that are most acceptable to women.

via Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: A systematic review and meta-analysis of randomised trials – European Journal of Cancer.

Understanding cervical screening non-attendance among ethnic minority women in England

British Journal of Cancer (2015) 113, 833–839

Background:

Women from Black, Asian and Minority Ethnic (BAME) backgrounds are less likely to attend cervical screening than White British women. This study explored sociodemographic and attitudinal correlates of cervical screening non-attendance among BAME women.
Methods:

Women (30–60 years) were recruited from Indian, Pakistani, Bangladeshi, Caribbean, African and White British backgrounds (n=720). Participants completed structured interviews.
Results:

BAME women were more likely to be non-attenders than white British women (44–71% vs 12%) and fell into two groups: the disengaged and the overdue. Migrating to the United Kingdom, speaking a language other than English and low education level were associated with being disengaged. Being overdue was associated with older age. Three attitudinal barriers were associated with being overdue for screening among BAME women: low perceived risk of cervical cancer due to sexual inactivity, belief that screening is unnecessary without symptoms and difficulty finding an appointment that fits in with other commitments.
Conclusions:

BAME non-attenders appear to fall into two groups, and interventions for these groups may need to be targeted and tailored accordingly. It is important to ensure that BAME women understand cancer screening is intended for asymptomatic women and those who have ceased sexual activity may still be at risk.

via British Journal of Cancer – Understanding cervical screening non-attendance among ethnic minority women in England.

Factors associated with type-specific persistence of high-risk human papillomavirus infection: A population-based study

International Journal of Cancer: Accepted manuscript online: 3 AUG 2015

Abstract

Persistent genital infection with high-risk (HR) human papillomavirus (HPV) is a prerequisite for cervical cancer development. The aim of this study was to identify factors associated with type-specific persistence of HR HPV infections. From a population-based cohort of 40 399 women participating in cervical cancer screening established during 2002–2005, we selected all HR HPV-positive women (N=7778). During follow-up (2005–2008), we collected cervical samples from these women and tested them for HPV DNA to determine type-specific HR HPV persistence in the interval 1–4.5 years after enrolment. Data on hospitalisations, prescriptions and socioeconomic factors were obtained from nationwide registers. Women with abnormal cytology at baseline or who had undergone conisation during follow-up were excluded. Factors associated with persistence were identified by logistic regression analysis. The overall rate of HR HPV persistence was 31.4%. The risk for persistence was significantly increased among women with a previous episode of genital warts (OR, 1.35; 95% CI, 1.04-1.74), current use of oral contraceptives (OR, 1.35; 95% CI, 1.13-1.63) or use of systemic glucocorticoids (OR, 2.04; 95% CI, 1.16-3.56). The number of pregnancies or births or use of a hormonal intrauterine device, hormonal therapy or non-steroidal anti-inflammatory drugs was not associated with risk for HR HPV persistence. A history of genital warts and current use of oral contraceptives or systemic glucocorticoids increased the risk, potentially indicating a decreased immune response to HPV infection. These findings suggest that host immune response characteristics are important in HR HPV persistence and consequently in cervical cancer development.

via Factors associated with type-specific persistence of high-risk human papillomavirus infection: A population-based study – Stensen – International Journal of Cancer – Wiley Online Library.