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Espey D, Castro G, Flagg T, Landis K, Henderson JA, Benard VB, Royalty JE. Strengthening breast and cervical cancer control through partnerships: American Indian and Alaska Native Women and the National Breast and Cervical Cancer Early Detection Program. Cancer 2014; 120 Suppl 16:2557-65. [PMID: 25099898 DOI: 10.1002/cncr.28824] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/28/2014] [Accepted: 04/29/2014] [Indexed: 11/05/2022]
Abstract
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has played a critical role in providing cancer screening services to American Indian and Alaska Native (AI/ANs) women and strengthening tribal screening capacity. Since 1991, the NBCCEDP has funded states, tribal nations, and tribal organizations to develop and implement organized screening programs. The ultimate goal is to deliver breast and cervical cancer screening to women who do not have health insurance and cannot afford to pay for these services. The delivery of clinical services is supported through complementary program efforts such as professional development, public education and outreach, and patient navigation. This article seeks to describe the growth of NBCCEDP's tribal commitment and the unique history and aspects of serving the AI/AN population. The article describes: 1) how this program has demonstrated success in improving screening of AI/AN women; 2) innovative partnerships with the Indian Health Service, state programs, and other organizations that have improved tribal public health infrastructure; and 3) the evolution of Centers for Disease Control and Prevention work with tribal communities.
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Affiliation(s)
- David Espey
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Affiliation(s)
- Karl U Petry
- Frauenklinik, Klinikum Wolfsburg, Wolfsburg, Germany
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Watson M, Benard V, Thomas C, Brayboy A, Paisano R, Becker T. Cervical cancer incidence and mortality among American Indian and Alaska Native women, 1999-2009. Am J Public Health 2014; 104 Suppl 3:S415-22. [PMID: 24754650 PMCID: PMC4035877 DOI: 10.2105/ajph.2013.301681] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We analyzed cervical cancer incidence and mortality data in American Indian and Alaska Native (AI/AN) women compared with women of other races. METHODS We improved identification of AI/AN race, cervical cancer incidence, and mortality data using Indian Health Service (IHS) patient records; our analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. Age-adjusted incidence and death rates were calculated for AI/AN and White women from 1999 to 2009. RESULTS AI/AN women in CHSDA counties had a death rate from cervical cancer of 4.2, which was nearly twice the rate in White women (2.0; rate ratio [RR] = 2.11). AI/AN women also had higher incidence rates of cervical cancer compared with White women (11.0 vs 7.1; RR = 1.55) and were more often diagnosed with later-stage disease (RR = 1.84 for regional stage and RR = 1.74 for distant stage). Death rates decreased for AI/AN women from 1990 to 1993 (-25.8%/year) and remained stable thereafter. CONCLUSIONS Although rates decreased over time, AI/AN women had disproportionately higher cervical cancer incidence and mortality. The persistently higher rates among AI/AN women compared with White women require continued improvements in identifying and treating cervical cancer and precancerous lesions.
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Affiliation(s)
- Meg Watson
- Meg Watson, Vicki Benard, Cheryll Thomas, and Annie Brayboy are with the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Roberta Paisano is with the Indian Health Service (IHS), Albuquerque, NM. Thomas Becker is with the Department of Public Health and Preventive Medicine, Oregon Health & Science University School of Medicine, Portland
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Montealegre JR, Zhou R, Amirian ES, Follen M, Scheurer ME. Nativity disparities in late-stage diagnosis and cause-specific survival among Hispanic women with invasive cervical cancer: an analysis of Surveillance, Epidemiology, and End Results data. Cancer Causes Control 2013; 24:1985-94. [PMID: 23934001 PMCID: PMC4115245 DOI: 10.1007/s10552-013-0274-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 07/31/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE While cervical cancer screening and risk behaviors have been found to vary among US- and foreign-born Hispanic women, many cancer epidemiology studies have conceptualized Hispanics as a homogenous group. Here, we examine differences in cervical cancer stage at diagnosis and survival among Hispanic women by nativity. METHODS We use data from the Surveillance, Epidemiology, and End Results program, 1998-2008. Nativity was based on place of birth and was categorized as US versus foreign born. Distant and regional tumors were classified as late stage, while local tumors were classified as early stage. RESULTS Forty-seven percent of cases of invasive cervical cancer among Hispanics were diagnosed at a late stage, and over half of invasive cervical cancer cases were among foreign-born women. Foreign-born Hispanic women were significantly more likely than US-born Hispanics to have late-stage diagnosis, after adjusting for age at diagnosis and tumor histology (adjusted odds ration = 1.09, p value = 0.003). There was heterogeneity in the association between nativity and survival by stage at diagnosis. Among cases with early-stage diagnosis, survival was poorer among foreign-born versus US-born Hispanics after adjusting for age at diagnosis, histology, and cancer-directed therapy [adjusted hazard ratios (HR) = 1.31, p value = 0.030]. However, among cases with late-stage diagnosis, survival was better among foreign-born Hispanics (adjusted HR = 0.81, p value < 0.001). CONCLUSIONS We hypothesize that nativity differences in survival may be indicative of diverse risk, screening, and treatment profiles. Given such differences, it may be inappropriate to aggregate Hispanics as a single group for cervical cancer research.
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Affiliation(s)
- Jane R Montealegre
- Division of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA,
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Rauh-Hain JA, Clemmer JT, Bradford LS, Clark RM, Growdon WB, Goodman A, Boruta DM, Schorge JO, del Carmen MG. Racial disparities in cervical cancer survival over time. Cancer 2013; 119:3644-52. [PMID: 23913530 DOI: 10.1002/cncr.28261] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/04/2013] [Accepted: 05/28/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND The purpose of this study is to examine changes over time in survival for African American (AA) and white women diagnosed with cervical cancer (CC). METHODS Surveillance, Epidemiology, and End Results (SEER) Program data from 1985 to 2009 were used for this analysis. Racial differences in survival were evaluated between African American (AA) and white women. Kaplan-Meier and Cox proportional hazards survival methods were used to assess differences in survival by race at 5-year intervals. RESULTS The study sample included 23,368 women, including 3886 (16.6%) who were AA and 19,482 (83.4%) who were white. AA women were older (51.4 versus 48.9 years; P<.001) and had a higher rate of regional (38.3% versus 31.8%; P<.001) and distant metastasis (10.7% versus 8.7%; P<.001). AA less frequently received cancer-directed surgery (32.4% versus 46%; P<.001), and more frequently radiotherapy (36.3% versus 26.4%; P<.001). Overall, AA women had a hazard ratio (HR) of 1.41 (95% confidence interval=1.32-1.51) of cervical cancer (CC) mortality compared with whites. Adjusting for SEER registry, marital status, stage, age, treatment, grade, and histology, AA women had an HR of 1.13 (95% confidence interval=1.05-1.22) of CC-related mortality. After adjusting for the same variables, there was a significant difference in CC-specific mortality between 1985 to 1989 and 1990 to 1994, but not after 1995. CONCLUSIONS After adjusting for race, SEER registry, marital status, stage, age, treatment, grade, and histology, there was a significant difference in CC-specific mortality between 1985 to 1989 and 1990 to 1994, but not after 1995.
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Affiliation(s)
- J Alejandro Rauh-Hain
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Vasilevska M, Ross SA, Gesink D, Fisman DN. Relative risk of cervical cancer in indigenous women in Australia, Canada, New Zealand, and the United States: A systematic review and meta-analysis. J Public Health Policy 2012; 33:148-64. [DOI: 10.1057/jphp.2012.8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Becker TM, Espey DK, Lawson HW, Saraiya M, Jim MA, Waxman AG. Regional differences in cervical cancer incidence among American Indians and Alaska Natives, 1999-2004. Cancer 2008; 113:1234-43. [PMID: 18720379 DOI: 10.1002/cncr.23736] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Reports from limited geographic regions indicate higher rates of cervical cancer incidence in American Indian and Alaska Native (AI/AN) women than in women of other races. However, accurate determinations of cervical cancer incidence in AI/AN women have been hampered by racial misclassification in central cancer registries. METHODS The authors linked data from cancer registries participating in the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) Program with Indian Health Service (IHS) enrollment records to improve identification of AI/AN race. NPCR and SEER data were combined to estimate annualized age-adjusted rates (expressed per 100,000 persons) for the diagnosis years 1999 to 2004. Analyses focused on counties known to have less racial misclassification, and results were stratified by IHS Region. Approximately 56% of AI/ANs in the US reside in these counties. The authors examined overall and age-specific incidence rates and stage at diagnosis for AI/AN women compared with non-Hispanic white (NHW) women. RESULTS Invasive cervical cancer incidence rates among AI/AN women varied nearly 2-fold across IHS regions, with the highest rates reported in the Southern Plains (14.1) and Northern Plains (12.5); the lowest rates were in the Eastern region and the Pacific Coast. Overall, AI/AN women had higher rates of cervical cancer than NHW women and were more likely to be diagnosed with later stage disease. CONCLUSIONS The wide regional variation of invasive cervical cancer incidence indicates an important need for health services research regarding cervical cancer screening and prevention education as well as policy development regarding human papillomavirus vaccine use, particularly in the regions with high incidence rates. Cancer 2008;113(5 suppl):1234-43. Published 2008 by the American Cancer Society.
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Affiliation(s)
- Thomas M Becker
- Department of Public Health and Preventive Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon 97202-3098, USA.
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Wingo PA, King J, Swan J, Coughlin SS, Kaur JS, Erb-Alvarez JA, Jackson-Thompson J, Arambula Solomon TG. Breast cancer incidence among American Indian and Alaska Native women: US, 1999-2004. Cancer 2008; 113:1191-202. [PMID: 18720389 DOI: 10.1002/cncr.23725] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Breast cancer is a leading cause of cancer morbidity and mortality among American Indian and Alaska Native (AI/AN) women. Although published studies have suggested that breast cancer rates among AI/AN women are lower than those among other racial and ethnic populations, accurate determinations of the breast cancer burden have been hampered by misclassification of AI/AN race. METHODS Cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program were combined to estimate age-adjusted rates for the diagnosis years 1999 through 2004. Several steps were taken to reduce the misclassification of AI/AN race: linking cases to Indian Health Service (IHS) patient services database, restricting analyses to Contract Health Service Delivery Area counties, and stratifying results by IHS region. RESULTS Breast cancer incidence rates among AI/AN women varied nearly 3-fold across IHS regions. The highest rates were in Alaska (134.8) and the Plains (Northern, 115.9; Southern, 115.7), and the lowest rates were in the Southwest (50.8). The rate in Alaska was similar to the rate among non-Hispanic white (NHW) women in Alaska. Overall, AI/AN women had lower rates of breast cancer than NHW women, but AI/AN women were more likely to be diagnosed with late-stage disease. CONCLUSIONS To the authors' knowledge, this report provides the most comprehensive breast cancer incidence data for AI/AN women to date. The wide regional variation indicates an important need for etiologic and health services research, and the large percentage of AI/AN women with late-stage disease demands innovative approaches for increasing access to screening.
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Affiliation(s)
- Phyllis A Wingo
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA
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Wiggins CL, Espey DK, Wingo PA, Kaur JS, Wilson RT, Swan J, Miller BA, Jim MA, Kelly JJ, Lanier AP. Cancer among American Indians and Alaska Natives in the United States, 1999-2004. Cancer 2008; 113:1142-52. [PMID: 18720375 DOI: 10.1002/cncr.23734] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Charles L Wiggins
- New Mexico Tumor Registry, University of New Mexico Cancer Center, Albuquerque, New Mexico 87131-0001, USA.
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Espey DK, Wu XC, Swan J, Wiggins C, Jim MA, Ward E, Wingo PA, Howe HL, Ries LAG, Miller BA, Jemal A, Ahmed F, Cobb N, Kaur JS, Edwards BK. Annual report to the nation on the status of cancer, 1975–2004, featuring cancer in American Indians and Alaska Natives. Cancer 2007; 110:2119-52. [PMID: 17939129 DOI: 10.1002/cncr.23044] [Citation(s) in RCA: 389] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- David K Espey
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Abstract
Human papilloma viruses (HPV) of the high-risk type cause almost all cervical carcinomas and some other anogenital tumors. Development of a carcinoma is uncommon; most infections heal spontaneously. When carcinomas develop, the latent phase is at least 8, more often 15-30 years. A negative HPV test thus excludes the risk of developing cervical carcinoma for many years. The approved vaccine against HPV 6/11/16/18 and the soon-to-be-approved one against HPV 16/18 are extremely safe and effective. Vaccinated individuals are almost 100% protected by the vaccines containing virus-like particles. Current studies suggest that 70-80% of high-grade cervical neoplasias can be avoided, as well as other vaginal, vulvar, and anal neoplasias. The yearly costs for treating precursors of these cancers exceed the cost of vaccinating all girls born in a given year. Thus HPV vaccination is cost effective, even when a modified cancer screening program is retained.
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Affiliation(s)
- K U Petry
- Frauenklinik, Klinikum der Stadt Wolfsburg, Sauerbruchstrasse 7, 38440 Wolfsburg, Deutschland.
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Howe HL, Wu X, Ries LAG, Cokkinides V, Ahmed F, Jemal A, Miller B, Williams M, Ward E, Wingo PA, Ramirez A, Edwards BK. Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations. Cancer 2006; 107:1711-42. [PMID: 16958083 DOI: 10.1002/cncr.22193] [Citation(s) in RCA: 331] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate annually to provide U.S. cancer information, this year featuring the first comprehensive compilation of cancer information for U.S. Latinos. METHODS Cancer incidence was obtained from 90% of the Hispanic/Latino and 82% of the U.S. populations. Cancer deaths were obtained for the entire U.S. population. Cancer screening, risk factor, incidence, and mortality data were compiled for Latino and non-Latino adults and children (incidence only). Long-term (1975-2003) and fixed-interval (1995-2003) trends and comparative analyses by disease stage, urbanicity, and area poverty were evaluated. RESULTS The long-term trend in overall cancer death rates, declining since the early 1990s, continued through 2003 for all races and both sexes combined. However, female lung cancer incidence rates increased from 1975 to 2003, decelerating since 1991 and breast cancer incidence rates stabilized from 2001 to 2003. Latinos had lower incidence rates in 1999-2003 for most cancers, but higher rates for stomach, liver, cervix, and myeloma (females) than did non-Latino white populations. Latino children have higher incidence of leukemia, retinoblastoma, osteosarcoma, and germ-cell tumors than do non-Latino white children. For several common cancers, Latinos were less likely than non-Latinos to be diagnosed at localized stages. CONCLUSIONS The lower cancer rates observed in Latino immigrants could be sustained by maintenance of healthy behaviors. Some infection-related cancers in Latinos could be controlled by evidence-based interventions. Affordable, culturally sensitive, linguistically appropriate, and timely access to cancer information, prevention, screening, and treatment are important in Latino outreach and community networks.
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Affiliation(s)
- Holly L Howe
- North American Association of Central Cancer Registries, Springfield, Illinois 62704-6495, USA.
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Schorge JO, Lea JS, Garner EO, Duska LR, Miller DS, Coleman RL. Cervical adenocarcinoma survival among Hispanic and white women: a multicenter cohort study. Am J Obstet Gynecol 2003; 188:640-4. [PMID: 12634634 DOI: 10.1067/mob.2003.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We compared the clinical outcome of cervical adenocarcinoma in Hispanic and white women to determine whether race was an independent predictor of survival. STUDY DESIGN All women who were diagnosed with cervical adenocarcinoma at three institutions between 1982 and 2000 were identified. Medical records were reviewed retrospectively. Hispanic and white cohorts were matched 1:2 for age, stage of disease, date of diagnosis, tumor size, histologic subtype, grade, and invasive depth. RESULTS The 65 Hispanic patients were more likely to be treated at the public hospital (71% vs 14%; P <.001) than the 122 matched white patients. Most Hispanic patients (72%) and white patients (76%) presented with early (stage IA-IIA), not advanced (IIB-IVB), disease. Early (81% vs 81%, P =.65), advanced (37% vs 26%, P =.21), and overall 5-year survival rates (67% vs 68%, P =.57) were similar among Hispanic and white patients, respectively. The relative risk of race on recurrence was 1.22 (95% CI, 0.56-2.42) and on survival was 0.72 (95% CI, 0.36-1.44). CONCLUSION Hispanic race is not an independent predictor of survival in cervical adenocarcinoma.
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Affiliation(s)
- John O Schorge
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75390, USA.
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Abstract
BACKGROUND Results from recent studies suggest that Hispanic women in the United States may underuse cancer screening tests and face important barriers to screening. METHODS We examined the breast and cervical cancer screening practices of Hispanic women in 50 states, the District of Columbia, and Puerto Rico from 1998 through 1999 by using data from the Behavioral Risk Factor Surveillance System. RESULTS About 68.2% (95% confidence interval [CI] = 66.3 to 70.1%) of 7,253 women in this sample aged 40 years or older had received a mammogram in the past 2 years. About 81.4% (95% CI = 80.3 to 82.5%) of 12,350 women aged 18 years or older who had not undergone a hysterectomy had received a Papanicolaou test in the past 3 years. Women with lower incomes and those with less education were less likely to be screened. Women who had seen a physician in the past year and those with health insurance coverage were much more likely to have been screened. For example, among those Hispanic women aged 40 years or older who had any health insurance coverage (n = 6,063), 72.7% (95% CI 70.7-74.6%) had had a mammogram in the past 2 years compared with only 54.8% (95% CI 48.7-61.0%) of women without health insurance coverage (n = 1,184). CONCLUSIONS These results underscore the need for continued efforts to ensure that Hispanic women who are medically underserved have access to cancer screening services.
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Affiliation(s)
- Steven S Coughlin
- Epidemiology and Health Services Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, USA.
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Abstract
We carried out a clinic-based case-control study to assess serum micronutrients as risk factors for cervical dysplasia among Southwestern American Indian women, a group with high rates of cervical preinvasive lesions. Cases were American Indian women with biopsy-proven cervical intraepithelial neoplasia (CIN I or CIN II/III). Controls were from the same Indian Health Service clinics with normal cervical epithelium. We interviewed women about histories of sexually transmitted diseases, sexual behavior, diet, hygienic practices, cigarette smoking, and reproductive factors. Laboratory assays included serum for retinol (vitamin A), ascorbic acid (vitamin C), alpha-tocopherol (vitamin E), and red blood cell folate levels, DNA for human papillomavirus (HPV) typing, and tests for other sexually transmitted diseases. The strongest risks for cervical dysplasia were associated with cervical HPV infection [odds ratio (OR) = 3.2, 95% confidence interval (CI) = 2.2-4.6 and OR = 7.9, 95% CI = 4.8-13.1 for CIN I and CIN II/III, respectively]. With adjustments made for HPV infection and other relevant confounders, subjects in the lowest serum retinol quartile were at increased risk of CIN I compared with women in the highest quartile (OR = 2.3, 95% CI = 1.3-4.1). The data suggest that low serum alpha-tocopherol was associated with CIN I/III, although the adjusted OR was not statistically significant (OR = 2.0, 95% CI = 0.9-4.8). Low serum ascorbic acid and red blood cell folate were not associated with cervical dysplasia.
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Affiliation(s)
- A S Yeo
- Department of Public Health and Preventive Medicine, Oregon Health Sciences University, Portland 92701-3098, USA
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Cervical Cytology Practice Guideline of the American Society of Cytopathology: . J Low Genit Tract Dis 2001; 5:160-84. [DOI: 10.1097/00128360-200107000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cervical Cytology Practice Guideline of the American Society of Cytopathology. J Low Genit Tract Dis 2001; 5:160-84. [DOI: 10.1046/j.1526-0976.2001.53008-2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Schiff M, Miller J, Masuk M, van Asselt King L, Altobelli KK, Wheeler CM, Becker TM. Contraceptive and reproductive risk factors for cervical intraepithelial neoplasia in American Indian women. Int J Epidemiol 2000; 29:983-90. [PMID: 11101538 DOI: 10.1093/ije/29.6.983] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To evaluate contraceptive and reproductive risk factors for cervical intraepithelial neoplasia (CIN) in southwestern American Indian women. METHODS We conducted a clinic-based case-control study. Cases were American Indian women with biopsy-proven CIN I, CIN II or CIN III. Controls were from the same clinics and had normal cervical epithelium. All subjects underwent structured interviews focused on contraceptive and reproductive factors. Laboratory assays included polymerase chain reaction (PCR)-based tests for cervical human papillomavirus (HPV) infection. RESULTS We enrolled 628 women in the study. The strongest risk factors for CIN II/III included HPV infection (adjusted odds ratio [OR] = 7.9, 95% CI : 4.7-13.2), and low income (OR = 3.1, 95% CI : 1.7-5.7). The use of an intrauterine device (IUD) ever (OR = 3.0, 95% CI : 1.4-6.1) and currently (OR = 4.1, 95% CI : 1.1-14.6), and > or = 3 vaginal deliveries (OR = 5.2, 95% CI : 2.4-11.1) were associated with CIN II/III. History of infertility was also associated with CIN II/III (OR = 2.1, 95% CI : 1.0-4.2). CONCLUSIONS The data suggest that history of infertility, IUD use and vaginal deliveries were associated with CIN among American Indian women.
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Affiliation(s)
- M Schiff
- University of New Mexico School of Medicine, 2211 Lomas, NE Albuquerque, NM 87131, USA.
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Smith HO, Tiffany MF, Qualls CR, Key CR. The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States--a 24-year population-based study. Gynecol Oncol 2000; 78:97-105. [PMID: 10926787 DOI: 10.1006/gyno.2000.5826] [Citation(s) in RCA: 473] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare the age-adjusted incidence and survival for invasive adenocarcinoma and squamous cell carcinoma of the uterine cervix using population-based data. METHODS The SEER database was used to identify all cases of cervical cancer registered between 1973 and 1996. Stage was defined as localized, regional, or distant. Age-adjusted incidence rates were analyzed statistically using the Jonchkeere-Terpstra exact test for trends. Relative and observed survival rates, respectively, were compared using z tests and log-rank tests. RESULTS The age-adjusted incidence rates per 100,000 for all invasive cervical cancers decreased by 36.9% over 24 years [12.35 (1973-1977) vs 7.79 (1993-1996)]. Similarly, the age-adjusted incidence rates for squamous cell carcinoma declined by 41.9% [9.45 (1973-1977) vs 5.49 (1993-1996)]. In contrast, the age-adjusted incidence rates for adenocarcinoma increased by 29.1% [1.34 (1973-1977) vs 1.73 (1993-1996)]. The proportion of adenocarcinoma increased 107.4% relative to all cervical cancer, 95.2% relative to squamous cell carcinoma, and 49.3% relative to the population of women at risk [10. 8% vs 22.4% (P < 0.001), 12.4% vs 24.0% (P < 0.001), and 1.40 vs 2. 09 per 100,000 women (P < 0.001), respectively]. Observed survival rates for adenocarcinoma vs squamous cell carcinoma were poorer for regional (P = 0.04), but not localized or distant disease. CONCLUSIONS Over the past 24 years, the incidence of all cervical cancer and squamous cell carcinoma has continued to decline. However, the proportion of adenocarcinoma relative to squamous cell carcinoma and to all cervical cancers has doubled, and the rate of adenocarcinoma per population at risk has also increased. These results suggest that current screening practices in the United States are insufficient to detect a significant proportion of adenocarcinoma precursor lesions.
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Affiliation(s)
- H O Smith
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA
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del Carmen MG, Montz FJ, Bristow RE, Bovicelli A, Cornelison T, Trimble E. Ethnic differences in patterns of care of stage 1A(1) and stage 1A(2) cervical cancer: a SEER database study. Gynecol Oncol 1999; 75:113-7. [PMID: 10502436 DOI: 10.1006/gyno.1999.5543] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- M G del Carmen
- Department of Gynecology and Obstetrics, The Johns Hopkins Hospital and Medical Institutions, Houck 248, Baltimore, Maryland, 21287, USA
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Abstract
Worldwide, cancer of the cervix is the second leading cause of cancer death in women: each year, an estimated 500,000 cases are newly diagnosed. Among populations, there are large differences in incidence rates of invasive cervical cancer: these reflect the influence of environmental factors, screening Papanicolaou (Pap) tests, and treatment of pre-invasive lesions. The high-risk human papillomavirus (HPV) subtypes 16, 18, 31, 33, and 51 have been recovered from more than 95% of cervical cancers. We have made great strides in understanding the molecular mechanism of oncogenesis of this virus, focusing on the action of the E6 and E7 viral oncoproteins. These oncoproteins function by inactivating cell cycle regulators p53 and retinoblastoma (Rb), thus providing the initial event in progression to malignancy. Cervical cancers develop from precursor lesions, which are termed squamous intraepithelial lesions (SIL) and are graded as high or low, depending on the degree of disruption of epithelial differentiation. Viral production occurs in low-grade lesions and is restricted to basal cells. In carcinomas, viral DNA is found integrated into the host genome, but no viral production is seen. The well-defined pre-invasive stages, as well as the viral factors involved at the molecular level, make cervical carcinoma a good model for investigating immune therapeutic alternatives or adjuvants to standard treatments.
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Affiliation(s)
- W M Schoell
- Division of Gynecologic Oncology, University of Miami School of Medicine, Florida, USA.
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Abstract
BACKGROUND Incidence of and mortality from cardiovascular disease, cancer, diabetes, and other chronic diseases are rapidly increasing among American Indians; however, the utilization of preventive services for these conditions is not well characterized in these ethnic groups. METHODS We interviewed 1,273 American Indian adults in New Mexico, ages 18 years and older, by telephone regarding routine health checks, including blood pressure, blood cholesterol, mammograms, clinical breast exams, Pap smears, influenza and pneumonia vaccinations, and diabetes using items from the CDC Behavioral Risk Factor Surveillance System. RESULTS We found that utilization of preventive service was surprisingly high among rural American Indians. Routine health checks and blood pressure checks within the past year were reported by more than 70% of the population. Blood cholesterol checks (41.1%) and pneumonia vaccinations (30.7%) were less commonly reported. Utilization of cancer screening for the most common women's cancers was also high. Most women reported ever having a Pap smear test (88.3%), a clinical breast examination (79.5%), and a mammogram (75.6%). The prevalence of diagnosed diabetes (8.8% overall and 26.4% for ages 50 years and older) greatly exceeds the nationwide prevalence. CONCLUSIONS The utilization of preventive services delivered by a unique governmental partnership is high among American Indians in New Mexico and, except for cholesterol screening, is comparable with rates for the U.S. population. Because cardiovascular disease is on the rise, more attention to preventive services in this arena is warranted. The high and increasing prevalence of diagnosed diabetes suggests that aggressive diabetes screening and interventions are needed.
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Affiliation(s)
- F D Gilliland
- Department of Medicine, New Mexico Tumor Registry, University of New Mexico Health Sciences Center, Albuquerque 87131, USA
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Abstract
BACKGROUND Native Americans have been reported to have lower cancer incidence and mortality than other racial groups in the U.S., although some have questioned whether this was due to racial misclassification. This study provides improved estimates of cancer mortality, determined from a sampling of people who live on Indian reservations. METHODS The authors reviewed death certificates from U.S. counties that contain Indian lands, excluding certain areas with known problems of racial misclassification. Age-adjusted mortality rates for specific types of cancer were calculated using U.S. Census population figures, and these rates were compared with rates for all races in the U.S. RESULTS This sample included 38% of the American Indian and Alaska Native populations. The age-adjusted annual mortality rate for all cancers combined was 148.2 per 100,000 for both genders, 133.1 for females, and 167.2 for males. The rates for males and for both genders combined, but not for females, were significantly lower than the U.S. rates for all races (P < 0.05). Females had significantly lower rates of death from carcinoma of the lung and breast and significantly higher rates of death from carcinoma of the cervix and gallbladder (P < 0.05). Males had significantly lower rates of death from carcinoma of the lung, colon, and prostate, and significantly higher rates of liver carcinoma. Both genders combined had significantly lower rates of death from lung and colon carcinoma and significantly higher rates of death from stomach, liver, kidney, and gallbladder carcinoma. Geographic differences were substantial, with the Northern and Plains regions experiencing much higher mortality from lung, colon, and breast carcinoma than the Southwest region. CONCLUSIONS Compared with the general U.S. population, Native Americans experience quite different patterns of cancer mortality. Cancer prevention and control programs should be designed specifically for this minority population.
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Affiliation(s)
- N Cobb
- Indian Health Service, Cancer Prevention and Control Program, Albuquerque, New Mexico 87110, USA
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Abstract
BACKGROUND Mass screening for cervical cancer has considerably reduced invasive cancer rates; however, Hispanic Americans have not fully benefited. This study examined the relationship of demographic, socioeconomic, and acculturation factors to diagnostic stage prior to preventive interventions in a large Hispanic community (San Diego, CA, 1988-1991). METHODS Age-adjusted incidence rates (IR) were estimated for three subareas: Hispanic community targeted with interventions, comparison Hispanic community, and remainder of county. Incident cases of cervical cancer in the California Cancer Registry were used to calculate incidence rate ratios (IRR) of in situ to invasive stage cancer and estimate differences in early detection between Hispanics and white non-Hispanics. Multiple logistic regression was used to examine the relationship of cancer stage to census-linked income, education, poverty status, foreign birth, and language spoken. RESULTS The in situ cervical cancer IR is significantly lower for Hispanics than for white non-Hispanics in all three regions (P < 0.05). The overall IRR is 3.65 (95% CI 3.19, 4.18) for white non-Hispanics compared with 1.09 (95% CI 0.86, 1.38) for Hispanics. Hispanics in census tracts in the highest versus remaining quartiles for percentage of language-isolated households are at greater risk for invasive stage (OR = 2.10, 95% CI 1.27, 3. 40). White non-Hispanic women residing in census tracts in the highest versus lowest quartile of adults with less than 12 years education are at greater risk for invasive stage (OR = 2.10, 95% CI 1.31, 3.38). CONCLUSIONS Results show efforts aimed at cervical cancer early detection for Hispanic women are needed and well targeted. White non-Hispanic women in low-education communities are also at risk. Population-based methods in this study can focus efforts in communities needing preventive interventions.
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Affiliation(s)
- S L Howe
- Graduate School of Public Health, San Diego State University, San Diego, California, 92182, USA
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