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Hall R, Medina-Lara A, Hamilton W, Spencer A. Women's priorities towards ovarian cancer testing: a best-worst scaling study. BMJ Open 2022; 12:e061625. [PMID: 36581964 PMCID: PMC9438192 DOI: 10.1136/bmjopen-2022-061625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate the importance of key characteristics relating to diagnostic testing for ovarian cancer and to understand how previous test experience influences priorities. DESIGN Case 1 best-worst scaling embedded in an online survey. SETTING Primary care diagnostic testing in England and Wales. PARTICIPANTS 150 women with ovaries over 40 years old living in England and Wales. METHODS We used best-worst scaling, a preference-based survey method, to elicit the relative importance of 25 characteristics relating to ovarian cancer testing following a systematic review. Responses were modelled using conditional logit regression. Subgroup analysis investigated variations based on testing history. MAIN OUTCOME MEASURES Relative importance scores. RESULTS 'Chance of dying from ovarian cancer' (0.380, 95% CI 0.26 to 0.49) was the most important factor to respondents, closely followed by 'test sensitivity' (0.308, 95% CI 0.21 to 0.40). In contrast, 'time away from usual activities' (-0.244, 95% CI -0.33 to -0.15) and 'gender of healthcare provider' (-0.243, 95% CI -0.35 to -0.14) were least important to respondents overall. Women who had previously undergone testing placed higher importance on certain characteristics including 'openness of healthcare providers' and 'chance of diagnosing another condition' at the expense of reduced emphasis on characteristics such as 'pain and discomfort' and 'time away from usual activities'. CONCLUSIONS The results clearly demonstrated items at the extreme, which were most and least important to women considering ovarian cancer testing. Differences in priorities by testing history demonstrate an experience effect, whereby preferences adapt over time based on evidence and experience. Acknowledging these differences helps to identify underlying barriers and facilitators for women with no test experience as well as shortcomings of current service based on women with experience.
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Affiliation(s)
- Rebekah Hall
- Health Economics Group, University of Exeter Medical School, Exeter, UK
| | | | - Willie Hamilton
- Primary Care Diagnostics, University of Exeter Medical School, Exeter, UK
| | - Anne Spencer
- Health Economics Group, University of Exeter Medical School, Exeter, UK
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Collins K, Hamlyn T, Bruxner G, Kothari A. Dangers in the dark: Calling for a safer practice of transvaginal ultrasonography. Australas J Ultrasound Med 2021; 24:5-12. [PMID: 34765410 DOI: 10.1002/ajum.12234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/13/2020] [Accepted: 10/02/2020] [Indexed: 11/08/2022] Open
Abstract
Background The intimate examination is an important component of the assessment of a patient presenting with obstetric or gynaecological concerns. Ultrasound practitioners, like any other medical practitioner, are in a unique and privileged position. During the examination, the sonographers engage in a very close and personal interaction with an individual whom they have likely never met. They are also most likely unfamiliar with their social situation, cultural background, previous experiences with the healthcare profession and more importantly, any history of sexual trauma. It is an extremely sensitive area of practice which places a great deal of responsibility on the clinician to ensure that they not only protect their patient from psychological distress, but also themselves, from the threat of litigation arising from such distress. Aims This paper highlights the current governance requirements for sonographers and makes suggestions to support them in safeguarding their patients and themselves from allegations of unprofessional conduct, until such a regulatory body exists. Materials and Methods A wide-ranging review of the literature exploring the perceptions of female patients regarding intimate sonographic examination was performed using standard search engines. Additionally, grey literature was searched for policy statements and government regulatory documents for guidance on the topic. Results Although much research has been undertaken in this field across diverse cultures and knowledge in this area is ever increasing; however, the guidelines for sonographers appear to be site specific and variable. At present, there is no overarching governance for sonographers, as there is with practitioners registered with the Australian Health Practitioner Regulation Agency. Discussion While there are practice standards for the purposes of Medicare set out by the Diagnostic Imaging Accreditation Scheme, there is no regulatory professional standard that sonographers are held accountable to. This is problematic and has the potential for inadvertent boundary transgression by the practitioner, as there is also no existing framework for management of such incidents in an equitable manner. Conclusion The intimate examination is generally well tolerated; however, there is a subset of the population who are vulnerable to psychological distress arising from the examination. The sonographer must be astute to signs of distress and act in accordance with the intimate examination guidelines set out by AHPRA, for the dual purpose of protecting their patients against harm and also themselves from the threat of litigation.
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Affiliation(s)
- Kelly Collins
- Wesley Hospital Auchenflower Queensland Australia.,University of Queensland St Lucia Queensland Australia
| | - Tina Hamlyn
- Redcliffe Hospital Redcliffe Queensland Australia
| | - George Bruxner
- University of Queensland St Lucia Queensland Australia.,Metro North Mental Health Service Brisbane Queensland Australia
| | - Alka Kothari
- University of Queensland St Lucia Queensland Australia.,Redcliffe Hospital Redcliffe Queensland Australia
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Henrichsen TL, Maturen KE, Robbins JB, Akin EA, Ascher SM, Brook OR, Dassel M, Friedman L, Learman LA, Patlas MN, Sadowski EA, Saphier C, Wasnik AP, Glanc P. ACR Appropriateness Criteria® Postmenopausal Acute Pelvic Pain. J Am Coll Radiol 2021; 18:S119-S125. [PMID: 33958106 DOI: 10.1016/j.jacr.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
Acute pelvic pain is a common presenting complaint in both the emergency room and outpatient settings. Pelvic pain of gynecologic origin in postmenopausal women occurs less frequently than in premenopausal women; however, it has important differences in etiology. The most common causes of postmenopausal pelvic pain from gynecologic origin are ovarian cysts, uterine fibroids, pelvic inflammatory disease, and ovarian neoplasm. Other etiologies of pelvic pain are attributable to urinary, gastrointestinal, and vascular systems. As the optimal imaging modality varies for these etiologies, it is important to narrow the differential diagnosis before choosing the initial diagnostic imaging examination. Transabdominal and transvaginal ultrasound are the best initial imaging techniques when the differential is primarily of gynecologic origin. CT with intravenous (IV) contrast is more useful if the differential diagnosis remains broad. MRI without IV contrast or MRI without and with IV contrast, as well as CT without IV contrast may also be used for certain differential considerations. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia, Vice Chair of Research, Department of Radiology, Medstar Georgetown University Hospital
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Cleveland Clinic, Cleveland, Ohio, American Congress of Obstetricians and Gynecologists, Director, Center of Endometriosis, Co-director, Chronic Pelvic Pain, Associate Program Director, Fellowship in Minimally Invasive Gynecologic Surgery, Cleveland Clinic
| | - Lucas Friedman
- University of California Riverside, Riverside, California, American College of Emergency Physicians
| | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, American Congress of Obstetricians and Gynecologists, Dean, Virginia Tech Carilion School of Medicine
| | - Michael N Patlas
- McMaster University, Hamilton, Ontario, Canada, Editor-in-Chief, Canadian Association of Radiologists Journal
| | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey, American Congress of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Ovarian cancer screening: Current status and future directions. Best Pract Res Clin Obstet Gynaecol 2020; 65:32-45. [PMID: 32273169 DOI: 10.1016/j.bpobgyn.2020.02.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 02/08/2023]
Abstract
Ovarian cancer is the third most common gynaecological malignancy and the most lethal worldwide. Most patients are diagnosed with advanced disease which carries significant mortality. Improvements in treatment have only resulted in modest increases in survival. This has driven efforts to reduce mortality through screening. Multimodal ovarian cancer screening using a longitudinal CA125 algorithm has resulted in diagnosis at an earlier stage, both in average and high risk women in two large UK trials. However, no randomised controlled trial has demonstrated a definitive mortality benefit. Extended follow up is underway in the largest trial to date, UKCTOCS, to explore the delayed reduction in mortality that was noted. Meanwhile, screening is not currently recommended in the general population Some countries offer surveillance of high risk women. Novel screening modalities and longitudinal biomarker algorithms offer potential improvements to future screening strategies as does the development of better risk stratification tools.
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Risk of endometrial cancer in asymptomatic postmenopausal patients with thickened endometrium: data from the FAME-Endo study: an observational register study. Arch Gynecol Obstet 2018; 298:813-820. [PMID: 30182190 DOI: 10.1007/s00404-018-4885-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/22/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the risk for endometrial cancer (EC) in a large series of asymptomatic patients with thickened endometrium at ultrasound examination based on previously published data of a theoretical cohort. METHODS In a prospective register study, a total of 1024 women with thickened endometrium in ultrasound examination undergoing histological diagnosis by dilation, hysteroscopy and curettage were evaluated. 124 patients were excluded due to current medication with tamoxifen and/or presence of HNPCC leaving 900 patients for further analysis. RESULTS Mean [standard deviation (SD)] age of patients was 65.6 (8.6) years. Mean (SD) endometrial thickness was 11.9 (5.8) mm. 32 and 6 cases of EC and complex endometrial hyperplasia with atypia were found, respectively. In the univariate analysis, a statistically significant association between endometrial thickness, current use of antihypertensive medication, number of deliveries, and the presence of endometrial fluid in preoperative vaginal ultrasound (p < 0.05) with EC was found. A multivariate logistic regression model incorporating these parameters showed a statistically significant independent association of endometrial thickness, number of deliveries, and the presence of endometrial fluid in preoperative vaginal ultrasound (p < 0.05), but not current use of antihypertensive medication, with EC. Using a cut-off of the endometrial thickness of > 11 mm, the risk for "EC alone" and "EC and complex endometrial hyperplasia with atypia combined" was found to be 6.7% and 7.9%, respectively. CONCLUSIONS Our data compare favorably to a theoretical cohort suggesting a clinically reasonable cut-off of > 11 mm endometrial thickness to discriminate between "normal" and "pathological". The data regarding "risk for endometrial cancer" can be used for counseling affected women.
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Okeji MC, Udoh BE, Ihudiebube-Splendor CN, Izge IY, Ekuma KO, Emeter JO. Assessment of women's attitude to and perception of transvaginal sonography in Nigeria. Technol Health Care 2017; 25:797-802. [PMID: 28436409 DOI: 10.3233/thc-170842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the attitude to and perception of transvaginal sonography (TVS) among Nigerian women of mixed educational status in order to ascertain factors that may prevent them from submitting to TVS when recommended. METHODS A Cross-sectional survey was adopted for the study. Subjects were enrolled from one missionary, one government and eight private hospitals. The instruments for data collection were visual analogue scale (VAS), to ascertain patients' pain/discomfort experience, and a researcher-developed semi-structured questionnaire. The level of pain/discomfort on the VAS was categorized into four on a scale of 100. The categories were: 0-5 (no pain), 6-40 (mild pain), 41-74 (moderate pain), and 75-100 (severe pain). RESULTS The majority (50.6%) of the respondents who attained secondary education had positive attitude to TVS. The majority majority of the respondents (63.1%) preferred female sonographers. A majority of the respondents (54.1%) perceived TVS as not embarrassing, 78% did not consider it stressful, 96.9% reported that the sonographers were professional, 46.7% felt that a chaperon was needed, 98.4% reported there was enough privacy and 84.7% reported they needed prior information. Most of the respondents (82%) were willing to consent to TVS in future, 90.5% reported no pain, 8.6% reported mild pain/discomfort and 0.9% reported moderate pain. CONCLUSIONS Majority of our respondents had a positive attitude to TVS and were willing to consent to TVS in future, hence it was acceptable to them. It was however observed that acceptability increased with increasing education.
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Affiliation(s)
- M C Okeji
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria
| | - B E Udoh
- Department of Radiography and Radiological Sciences, Faculty of Allied Medical Sciences, University of Calabar, Cross River State, Nigeria
| | - C N Ihudiebube-Splendor
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria
| | - I Y Izge
- Department of Radiography, Faculty of Clinical Science, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria
| | - K O Ekuma
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria
| | - J O Emeter
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria
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Okeji MC, Agwuna KK, Ihudiebube-Splendor CN, Izge IY, Ekuma KK, Emeter JO. Transvaginal Sonography: perception and attitude of Nigerian women. BMC WOMENS HEALTH 2017; 17:54. [PMID: 28750613 PMCID: PMC5532778 DOI: 10.1186/s12905-017-0413-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 07/19/2017] [Indexed: 11/16/2022]
Abstract
Background To assess the attitude to and perception of transvaginal sonography (TVS) among Nigerian women of mixed educational status in order to ascertain factors that may prevent them from submitting to TVS when recommended. Methods A Cross-sectional survey was adopted for the study. In all, one missionary, one government and eight private hospitals were enlisted. The instruments for data collection were visual analogue scale (VAS), to ascertain patients’ pain/discomfort experience, and a researcher-developed semi-structured questionnaire. The level of pain/discomfort on the VAS was categorized into four on a scale of 100. The categories were: 0–5 (no pain), 6–40 (mild pain), 41–74 (moderate pain), and 75–100 (severe pain). Results Majority (50.6%) of the respondents who attained secondary education had positive attitude to TVS. Also majority of the respondents (63.1%) preferred female sonographers. Majority of the respondents (54.1%) perceived TVS as not embarrassing, 78% did not consider it stressful, 96.9% reported that the sonographers were professional, 46.7% felt that a chaperon was needed, 98.4% reported there were enough privacy and 84.7% reported they needed prior information. Most of the respondents (82%) were willing to consent to TVS in future, 90.5% reported no pain, 8.6% reported mild pain/discomfort and 0.9% reported moderate pain. Conclusions Majority of our respondents had positive attitude to TVS and were willing to consent to TVS in future, hence it was acceptable to them. It was however observed that acceptability increased with increasing academic status.
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Affiliation(s)
- Mark C Okeji
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria.
| | - Kennedy K Agwuna
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Chika N Ihudiebube-Splendor
- Department of Radiation Medicine, Faculty of Medicine, College of Medicine, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria
| | - Iliyasu Y Izge
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Kelechi K Ekuma
- Department of Radiography, Faculty of Clinical Science, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria
| | - Jennifer O Emeter
- Department of Radiography, Faculty of Clinical Science, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria
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Thoirs K, Deed K, Childs J. Transvaginal sonography: Sonographer reflections on patient experience using a critical incident technique. SONOGRAPHY 2017. [DOI: 10.1002/sono.12104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kerry Thoirs
- School of Health Sciences; University of South Australia; SA Australia
| | - Kathryn Deed
- School of Health Sciences; University of South Australia; SA Australia
| | - Jessie Childs
- School of Health Sciences; University of South Australia; SA Australia
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Psychosocial Factors Associated With Withdrawal From the United Kingdom Collaborative Trial of Ovarian Cancer Screening After 1 Episode of Repeat Screening. Int J Gynecol Cancer 2016. [PMID: 26222482 DOI: 10.1097/igc.0000000000000507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) aims to establish the efficacy of 2 different ovarian cancer screening schedules. The psychosocial substudy examines the psychological factors associated with the screening program. METHODS Women aged 50 to 75 years from 16 UK gynecologic centers randomized to annual multimodal screening or ultrasound screening (US) groups were followed up for 7 years. Psychosocial data from women who withdrew from the study after a repeat screen were examined. RESULTS Sixteen percent (3499/21,733) of women requiring a repeat screening test in addition to annual screen withdrew from the study: 12.9% (1560/12,073) from the multimodal group and 20.1% (1939/9660) from the US group. An estimated relative risk of withdrawal is 1.46 (95% confidence interval, 1.36-1.56; P ≤ 0.001) for the US arm. High anxiety trait and increased psychological morbidity significantly influenced withdrawal, even when age, screening center, and group were taken into account (P < 0.001). The risk of withdrawal decreased significantly the longer a woman stayed in UKCTOCS, irrespective of the number of screens and intensity in the preceding year. CONCLUSIONS Withdrawal rate was greater in women undergoing US screening and in those who had repeats earlier in UKCTOCS. Having a high predisposition to anxiety, high current state anxiety, and above threshold general psychological morbidity all increased the withdrawal rate.
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Jacobs IJ, Menon U, Ryan A, Gentry-Maharaj A, Burnell M, Kalsi JK, Amso NN, Apostolidou S, Benjamin E, Cruickshank D, Crump DN, Davies SK, Dawnay A, Dobbs S, Fletcher G, Ford J, Godfrey K, Gunu R, Habib M, Hallett R, Herod J, Jenkins H, Karpinskyj C, Leeson S, Lewis SJ, Liston WR, Lopes A, Mould T, Murdoch J, Oram D, Rabideau DJ, Reynolds K, Scott I, Seif MW, Sharma A, Singh N, Taylor J, Warburton F, Widschwendter M, Williamson K, Woolas R, Fallowfield L, McGuire AJ, Campbell S, Parmar M, Skates SJ. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 2016; 387:945-956. [PMID: 26707054 PMCID: PMC4779792 DOI: 10.1016/s0140-6736(15)01224-6] [Citation(s) in RCA: 651] [Impact Index Per Article: 81.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ovarian cancer has a poor prognosis, with just 40% of patients surviving 5 years. We designed this trial to establish the effect of early detection by screening on ovarian cancer mortality. METHODS In this randomised controlled trial, we recruited postmenopausal women aged 50-74 years from 13 centres in National Health Service Trusts in England, Wales, and Northern Ireland. Exclusion criteria were previous bilateral oophorectomy or ovarian malignancy, increased risk of familial ovarian cancer, and active non-ovarian malignancy. The trial management system confirmed eligibility and randomly allocated participants in blocks of 32 using computer-generated random numbers to annual multimodal screening (MMS) with serum CA125 interpreted with use of the risk of ovarian cancer algorithm, annual transvaginal ultrasound screening (USS), or no screening, in a 1:1:2 ratio. The primary outcome was death due to ovarian cancer by Dec 31, 2014, comparing MMS and USS separately with no screening, ascertained by an outcomes committee masked to randomisation group. All analyses were by modified intention to screen, excluding the small number of women we discovered after randomisation to have a bilateral oophorectomy, have ovarian cancer, or had exited the registry before recruitment. Investigators and participants were aware of screening type. This trial is registered with ClinicalTrials.gov, number NCT00058032. FINDINGS Between June 1, 2001, and Oct 21, 2005, we randomly allocated 202,638 women: 50,640 (25·0%) to MMS, 50,639 (25·0%) to USS, and 101,359 (50·0%) to no screening. 202,546 (>99·9%) women were eligible for analysis: 50,624 (>99·9%) women in the MMS group, 50,623 (>99·9%) in the USS group, and 101,299 (>99·9%) in the no screening group. Screening ended on Dec 31, 2011, and included 345,570 MMS and 327,775 USS annual screening episodes. At a median follow-up of 11·1 years (IQR 10·0-12·0), we diagnosed ovarian cancer in 1282 (0·6%) women: 338 (0·7%) in the MMS group, 314 (0·6%) in the USS group, and 630 (0·6%) in the no screening group. Of these women, 148 (0·29%) women in the MMS group, 154 (0·30%) in the USS group, and 347 (0·34%) in the no screening group had died of ovarian cancer. The primary analysis using a Cox proportional hazards model gave a mortality reduction over years 0-14 of 15% (95% CI -3 to 30; p=0·10) with MMS and 11% (-7 to 27; p=0·21) with USS. The Royston-Parmar flexible parametric model showed that in the MMS group, this mortality effect was made up of 8% (-20 to 31) in years 0-7 and 23% (1-46) in years 7-14, and in the USS group, of 2% (-27 to 26) in years 0-7 and 21% (-2 to 42) in years 7-14. A prespecified analysis of death from ovarian cancer of MMS versus no screening with exclusion of prevalent cases showed significantly different death rates (p=0·021), with an overall average mortality reduction of 20% (-2 to 40) and a reduction of 8% (-27 to 43) in years 0-7 and 28% (-3 to 49) in years 7-14 in favour of MMS. INTERPRETATION Although the mortality reduction was not significant in the primary analysis, we noted a significant mortality reduction with MMS when prevalent cases were excluded. We noted encouraging evidence of a mortality reduction in years 7-14, but further follow-up is needed before firm conclusions can be reached on the efficacy and cost-effectiveness of ovarian cancer screening. FUNDING Medical Research Council, Cancer Research UK, Department of Health, The Eve Appeal.
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Affiliation(s)
- Ian J Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; University of New South Wales, Sydney, NSW, Australia; Centre for Women's Health, Institute of Human Development, University of Manchester, Manchester, UK.
| | - Usha Menon
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK.
| | - Andy Ryan
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | | | - Matthew Burnell
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Jatinderpal K Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Nazar N Amso
- Obstetrics and Gynaecology, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Sophia Apostolidou
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Elizabeth Benjamin
- Research Department of Pathology, Cancer Institute, University College London Hospital, London, UK
| | - Derek Cruickshank
- Department of Gynaecological Oncology, James Cook University Hospital, Middlesbrough, UK
| | - Danielle N Crump
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Susan K Davies
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Anne Dawnay
- Clinical Biochemistry, University College London Hospital, London, UK
| | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast, UK
| | - Gwendolen Fletcher
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Jeremy Ford
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Malomatia (Information, Communication and Technology QATAR) Qatari Shareholding Company, Qatar
| | - Keith Godfrey
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - Richard Gunu
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Mariam Habib
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Medical Research Council Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - Rachel Hallett
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; School of Medical Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Jonathan Herod
- Department of Gynaecology, Liverpool Women's Hospital, Liverpool, UK; Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Howard Jenkins
- Department of Gynaecological Oncology, Royal Derby Hospital, Derby, UK
| | - Chloe Karpinskyj
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Simon Leeson
- Department of Gynaecological Oncology, Llandudno Hospital, Gwynedd, UK
| | - Sara J Lewis
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - William R Liston
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Alberto Lopes
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK; Derriford Hospital, Plymouth, Devon, UK
| | - Tim Mould
- Department of Gynaecological Oncology, University College London Hospital, London, UK; Department of Gynaecological Oncology, Royal Free Hospital, London
| | - John Murdoch
- Department of Gynaecological Oncology, St Michael's Hospital, Bristol, UK
| | - David Oram
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - Dustin J Rabideau
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Karina Reynolds
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - Ian Scott
- Department of Gynaecological Oncology, Royal Derby Hospital, Derby, UK
| | - Mourad W Seif
- Central Manchester Foundation Trust, St Mary's Hospital, Manchester, UK; Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Aarti Sharma
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Department of Gynaecological Oncology, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Naveena Singh
- Department of Pathology, Barts Health National Health Service Trust, London, UK
| | - Julie Taylor
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Fiona Warburton
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Public Health England, London, UK
| | - Martin Widschwendter
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Karin Williamson
- Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham, UK
| | - Robert Woolas
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Sussex, UK
| | | | | | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Steven J Skates
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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11
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Kim C, Cushman M, Khodneva Y, Lisabeth LD, Judd S, Kleindorfer DO, Howard VJ, Safford MM. Risk of Incident Coronary Heart Disease Events in Men Compared to Women by Menopause Type and Race. J Am Heart Assoc 2015; 4:JAHA.115.001881. [PMID: 26133958 PMCID: PMC4608073 DOI: 10.1161/jaha.115.001881] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background We examined whether type of menopause affects sex differences in coronary heart disease (CHD) events and whether the impact is similar in blacks and whites. Methods and Results Participants were enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007 without CHD at baseline (n=23 086). Cox regression models were used to calculate the hazard of incident nonfatal CHD (definite or probable myocardial infarction) and acute CHD death, adjusting for age, age at last menstrual period <45 years, region, education level, income, diabetes, smoking, systolic blood pressure, lipid levels, albumin-creatinine ratio, physical activity, C-reactive protein, body mass index, waist circumference, and medication use. White women in natural menopause (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.31, 0.66) and surgical menopause (HR, 0.65; 95% CI, 0.42, 0.99) had a reduced hazard of nonfatal events, compared to white men. Black women in natural menopause (HR, 0.69; 95% CI, 0.47, 1.03), but not surgical menopause (HR, 0.81; 95% CI, 0.51, 1.29), had a marginally reduced hazard of nonfatal events, compared to black men. Women had lower risk of acute CHD death than men regardless of their menopause type and race. Conclusions Sex differences in the risk of incident CHD events were larger among whites than blacks and varied by type of menopause. Women consistently had a lower risk of incident CHD death than men, but the magnitude of sex differences was greater in whites than blacks for nonfatal events, regardless of menopause type.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine and Obstetrics & Gynecology, University of MichiganAnn Arbor, MI
- Correspondence to: Catherine Kim, MD, MPH, 2800 Plymouth Rd, Building 16, Room 430W, Ann Arbor, MI 48109. E-mail:
| | - Mary Cushman
- Department of Medicine, University of VermontBurlington, VT
| | - Yulia Khodneva
- Division of Preventive Medicine, University of Alabama at BirminghamAL
| | - Lynda D Lisabeth
- Department of Epidemiology, University of Michigan School of Public HealthAnn Arbor, MI
| | - Suzanne Judd
- Department of Epidemiology, University of Alabama at BirminghamAL
| | | | | | - Monika M Safford
- Division of Preventive Medicine, University of Alabama at BirminghamAL
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12
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Deed K, Childs J, Thoirs K. What are the perceptions of women towards transvaginal sonographic examinations? SONOGRAPHY 2014. [DOI: 10.1002/sono.12008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kathryn Deed
- School of Health Sciences; University of South Australia; Adelaide South Australia Australia
| | - Jessie Childs
- School of Health Sciences; University of South Australia; Adelaide South Australia Australia
| | - Kerry Thoirs
- School of Health Sciences; University of South Australia; Adelaide South Australia Australia
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13
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Wang X, Yang H, Zhang H, Shi T, Ren W. Transvaginal sonographic features of perineal masses in the female lower urogenital tract: a retrospective study of 71 patients. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:702-710. [PMID: 24254259 DOI: 10.1002/uog.13251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 10/11/2013] [Accepted: 10/15/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To assess the transvaginal ultrasonographic features of perineal masses in the lower urogenital tract in a cohort of 71 women. METHODS Seventy-one women with perineal masses were referred consecutively for transvaginal ultrasonography. Two-dimensional (2D) ultrasound was used to scan the pelvic floor, including the urethra, vagina and rectum, and identify any possible areas of interest. A static three-dimensional (3D) sonographic reconstruction of the pelvic anatomy was created to further delineate the relation of the lesions with their neighboring structures. Ultrasound results were compared retrospectively with surgical pathology outcome when possible. RESULTS Seventy-nine cystic, cystic-solid or solid masses were detected on transvaginal 2D ultrasonography in the 71 women: in 44 patients, 47 anechoic cystic masses were identified and diagnosed as vaginal wall cysts; in 19 patients, 23 hyperechoic cystic masses were diagnosed as vaginal epidermoid cysts; in each of two patients, a hypoechoic cystic-solid mass showing blood-flow signals on color Doppler imaging was diagnosed as urogenital angiomyofibroblastoma; in each of three patients, a hypoechoic cyst was diagnosed as urethral diverticulum; and in three patients with a known history of gynecological malignancy, solid heterogeneous masses with blood flow signals on color Doppler imaging were diagnosed as metastatic cancer. In all patients, 3D ultrasonography delineated the anatomical relationship of these masses to the vagina, urethra and rectum. CONCLUSIONS Transvaginal 2D and 3D ultrasonography is an accurate, non-invasive, cost-effective diagnostic modality for the delineation of congenital, septic and neoplastic lower urogenital tract perineal masses in women.
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Affiliation(s)
- X Wang
- Department of Ultrasound Medicine, Shengjing Hospital affiliated to China Medical University, Shenyang, China
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