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Meeta M, Digumarti L, Agarwal N, Vaze N, Shah R, Malik S. Clinical Practice Guidelines on Menopause: *An Executive Summary and Recommendations: Indian Menopause Society 2019-2020. J Midlife Health 2020; 11:55-95. [PMID: 33281418 PMCID: PMC7688016 DOI: 10.4103/jmh.jmh_137_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Meeta Meeta
- Gynecologist, Co-Director and Chief Consultant, Tanvir Hospital, Hyderabad, Telangana, India
| | - Leela Digumarti
- Gynecologist, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Visakhapatnam, Andhra Pradesh, India
| | - Neelam Agarwal
- Obs Gynae, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nirmala Vaze
- Consultant Obstetrician/Gynaecologist, Counselar Breast, Gynae Cancer & Menopause, Nagpur, India
| | - Rashmi Shah
- Gynecologist, Ex Senior Deputy Director, National Institute for Research in Reproductive Health (ICMR), Mumbai, India
| | - Sonia Malik
- Gynecologist, Director and HOD, Southend Fertility & IVF Centre, New Delhi, India
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2
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Hasanzadeh M, Sahmani R, Solhi E, Mokhtarzadeh A, Shadjou N, Mahboob S. Ultrasensitive immunoassay of carcinoma antigen 125 in untreated human plasma samples using gold nanoparticles with flower like morphology: A new platform in early stage diagnosis of ovarian cancer and efficient management. Int J Biol Macromol 2018; 119:913-925. [PMID: 30081127 DOI: 10.1016/j.ijbiomac.2018.08.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/28/2018] [Accepted: 08/02/2018] [Indexed: 12/25/2022]
Abstract
Ovarian cancer, as one of the most life-threatening malignancies among women worldwide, is usually diagnosed at the late stage despite up regulation of molecular markers such as carcinoma antigen 125 (CA 125) at the early stages of the malignancy. CA 125 is the only tumor marker recommended for clinical use in the diagnosis and management of ovarian cancer. The potential role of CA-125 for the early detection of ovarian cancer is controversial and has not yet been adopted for widespread screening efforts in asymptomatic women. Therefore, early detection of CA 125 in human biofluids is highly demanded. In the present study, a novel method was proposed for the fabrication of electrochemical immunosensor based reduced graphene oxide (RGO). Cysteamine capped gold nanoparticle (Cys-AuNPs) were deposited over the surface of ERGO probe using electrophoretic deposition method. These Cys-AuNPs/ERGO probes provide the favorable sites to attach the monoclonal antibody specific to CA 125 antigen. Cyclic voltammetry (CV), and square wave voltammetry (SWV) were applied for the electrochemical recognition of the biolayer. The represented signals demonstrates excellent figure of merits and good capability of the engineered immunosensor towards sensitive detection of CA 125. Quantitative measurements of CA 125 in human plasma samples have been demonstrated, showing the potential of the practical application of this novel immunosensor for the analysis of this biomarker in blood serum samples. This immunosensor has the ability of direct electron transfer as compared to earlier reported electrochemical immunosensors based electrochemical methods. Further, this immunosensor provides a very suitable and convenient alternative to replace the expensive commercially available methods such as immunohistochemistry. The following regression equation between the electrochemical current response and the CA 125 concentration range from 0.1 to 400 U/mL was found. The low limit of quantification for this immunosensor was 0.1 U/mL. To the best of our knowledge, this is the first reported on the direct immobilization of antibody on the surface of Cys-AuNPs/ERGO for fabrication of immunosensors.
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Affiliation(s)
- Mohammad Hasanzadeh
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Rahimeh Sahmani
- Department of Biochemistry, Higher Education Institute of Rab-Rashid, Tabriz, Iran
| | - Elham Solhi
- Pharmaceutical Analysis Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahad Mokhtarzadeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Shadjou
- Department of Nanochemistry, Nano Technology Research Center, Uremia University, Uremia 57154, Iran
| | - Soltanali Mahboob
- Department of Biochemistry, Higher Education Institute of Rab-Rashid, Tabriz, Iran
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3
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Hosseini ES, Meryet-Figuiere M, Sabzalipoor H, Kashani HH, Nikzad H, Asemi Z. Dysregulated expression of long noncoding RNAs in gynecologic cancers. Mol Cancer 2017. [PMID: 28637507 PMCID: PMC5480155 DOI: 10.1186/s12943-017-0671-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Cancers of the female reproductive system include ovarian, uterine, vaginal, cervical and vulvar cancers, which are termed gynecologic cancer. The emergence of long noncoding RNAs (lncRNAs), which are believed to play a crucial role in several different biological processes, has made the regulation of gene expression more complex. Although the function of lncRNAs is still rather elusive, their broad involvement in the initiation and progression of various cancers is clear. They are also involved in the pathogenesis of cancers of the female reproductive system. LncRNAs play a critical physiological role in apoptosis, metastasis, invasion, migration and cell proliferation in these cancers. Different expression profiles of lncRNAs have been observed in various types of tumors compared with normal tissues and between malignant and benign tumors. These differential expression patterns may lead to the promotion or suppression of cancer development and tumorigenesis. In the current review, we present the lncRNAs that show a differential expression between cancerous and normal tissues in ovarian, cervical and endometrial cancers, and highlight the associations between lncRNAs and some of the molecular pathways involved in these cancers.
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Affiliation(s)
- Elahe Seyed Hosseini
- Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Matthieu Meryet-Figuiere
- Normandie Univ, UNICAEN, INSERM, ANTICIPE U1086 (Interdisciplinary Research for Cancers prevention and treatment, axis BioTICLA (Biology and Innovative Therapeutics for Ovarian Cancer), Caen, France. .,UNICANCER, Comprehensive Cancer Centre François Baclesse, Caen, France.
| | - Hamed Sabzalipoor
- Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hamed Haddad Kashani
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Nikzad
- Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, Iran.
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan, Iran
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4
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Mourits MJ, de Bock GH. European/U.S. Comparison and Contrasts in Ovarian Cancer Screening and Prevention in a High-Risk Population. Am Soc Clin Oncol Educ Book 2017; 37:124-127. [PMID: 28561729 DOI: 10.1200/edbk_180330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The history of screening and prevention of ovarian cancer among high-risk women in the United States and Europe is one of mutual inspiration, with researchers learning from each others' findings and insights and collaborating with investigators from both sides of the Atlantic ocean. Examples of simultaneous and joint development of knowledge and scientific points of view include the paradigm shift from ovarian to fallopian tube high-grade serous cancer and the cessation of simultaneous adoption of ovarian cancer screening by clinicians in both the United States and Europe. Examples of joint efforts with fruitful results include international collaboration in large population-based, genome-wide association studies and in epidemiologic database studies. Research in the field of hereditary ovarian cancer is a great example of mutual inspiration and joint efforts for the purpose of improving knowledge and health care for women with hereditary ovarian cancer.
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Affiliation(s)
- Marian J Mourits
- From the Departments of Gynecologic Oncology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - G H de Bock
- From the Departments of Gynecologic Oncology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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5
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Thomsen LH, Schnack TH, Buchardi K, Hummelshoj L, Missmer SA, Forman A, Blaakaer J. Risk factors of epithelial ovarian carcinomas among women with endometriosis: a systematic review. Acta Obstet Gynecol Scand 2016; 96:761-778. [DOI: 10.1111/aogs.13010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Line H. Thomsen
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | - Tine H. Schnack
- Gynecologic and Obstetric Department; Rigshospitalet University Hospital of Copenhagen; Copenhagen Denmark
| | | | | | - Stacey A. Missmer
- Department of Obstetrics; Gynecology and Reproductive Biology College of Human Medicine; Michigan State University; Boston MA USA
- Department of Epidemiology; Harvard T.H. Chan School of Public Health; Boston MA USA
| | - Axel Forman
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
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6
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Microfluidic multiplex biochip based on a point-of-care electrochemical detection system for matrix metalloproteinases. J Electroanal Chem (Lausanne) 2015. [DOI: 10.1016/j.jelechem.2015.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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7
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Raherinantenaina F, Rakotomena SD, Hasiniatsy NRE, Rakototiana FA, Rafaramino F, Ratsimba HNR. [A retrospective study of ovarian cancer with a median follow of 42 months]. Pan Afr Med J 2015; 20:211. [PMID: 26113942 PMCID: PMC4470446 DOI: 10.11604/pamj.2015.20.211.6113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 02/15/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | | | | | - Florine Rafaramino
- Service d'Oncologie-Hématologie-Radiothérapie, CHUJRA, Antananarivo Madagascar
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8
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Ebell MH, Culp M, Lastinger K, Dasigi T. A systematic review of the bimanual examination as a test for ovarian cancer. Am J Prev Med 2015; 48:350-6. [PMID: 25595604 DOI: 10.1016/j.amepre.2014.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 09/19/2014] [Accepted: 10/04/2014] [Indexed: 11/19/2022]
Abstract
CONTEXT An annual bimanual pelvic examination remains widely recommended for healthy women, but its inclusion may discourage attendance. Our goal was to determine the accuracy of the pelvic examination as a screening test for ovarian cancer and to distinguish benign from malignant lesions. EVIDENCE ACQUISITION PubMed was searched to identify studies evaluating the accuracy of the bimanual pelvic examination for ovarian cancer diagnosis. Data regarding study design, study quality, and test accuracy were abstracted. Heterogeneity was evaluated and meta-analysis performed where appropriate, including bivariate receiver operating characteristic curves. EVIDENCE SYNTHESIS Eight studies in screening populations (n=36,599) and seven studies in symptomatic patients (n=782) were identified. Search was completed in November 2013; included studies were published between 1988 and 2009. Screening studies were homogeneous; the summary estimates of sensitivity and specificity of the pelvic examination as a screening test for ovarian cancer were 0.44 and 0.98 (positive likelihood ratio, 24.7; negative likelihood ratio, 0.57). For distinguishing benign versus malignant lesions, there was considerable heterogeneity, with a range of sensitivity from 0.43 to 0.93 and specificity from 0.53 to 0.91. CONCLUSIONS The bimanual pelvic examination lacks accuracy as a screening test for ovarian cancer and as a way to distinguish benign from malignant lesions. In a typical screening population, the positive predictive value of an abnormal pelvic examination is only 1% (95% CI=0.67%, 3.0%). Its inclusion in a health maintenance examination cannot be justified on the basis of using it to screen for ovarian cancer.
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Affiliation(s)
- Mark H Ebell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - MaryBeth Culp
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia.
| | - Krista Lastinger
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Tara Dasigi
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
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9
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JAMMAL MILLENAPRATA, DA SILVA ALLISONARAÚJO, FILHO AGRIMALDOMARTINS, DE CASTRO CÔBO ELIÂNGELA, ADAD SHEILAJORGE, MURTA EDDIEFERNANDOCANDIDO, NOMELINI ROSEKEILASIMÕES. Immunohistochemical staining of tumor necrosis factor-α and interleukin-10 in benign and malignant ovarian neoplasms. Oncol Lett 2015; 9:979-983. [PMID: 25624918 PMCID: PMC4301559 DOI: 10.3892/ol.2014.2781] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 11/21/2014] [Indexed: 01/29/2023] Open
Abstract
Ovarian cancer is the ninth most common malignancy and the fifth leading cause of cancer death in women in the USA. The majority of malignant tumors of the ovary are diagnosed at an advanced stage, making it the most fatal gynecological cancer. The aim of the current study was to determine whether there are differences in immunohistochemical tissue staining of cytokine tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) between benign tumors and malignant primary ovarian cancer. In total, 28 patients undergoing surgery for ovarian cysts were evaluated, and a diagnosis of benign neoplasm (n=14) or malignant neoplasm (n=14) was determined. An immunohistochemical study of histological sections of ovarian tumors was conducted. The results were analyzed using Fisher's exact test, with P<0.05 indicating a statistically significant difference. Immunohistochemical staining of IL-10 was increased in malignant tumors compared with benign tumors (P=0.0128). For TNF-α, the immunohistochemical staining was more intense in malignant neoplasms, however, a statistically significant difference was not observed. These results indicate that the analysis of cytokines may be useful as a potential tissue marker of ovarian malignancy.
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Affiliation(s)
- MILLENA PRATA JAMMAL
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - ALLISON ARAÚJO DA SILVA
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - AGRIMALDO MARTINS FILHO
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - ELIÂNGELA DE CASTRO CÔBO
- Department of Special Pathology, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - SHEILA JORGE ADAD
- Department of Special Pathology, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - EDDIE FERNANDO CANDIDO MURTA
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - ROSEKEILA SIMÕES NOMELINI
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
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10
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Miller JW, Baldwin LM, Matthews B, Trivers KF, Andrilla CH, Lishner D, Goff BA. Physicians' beliefs about effectiveness of cancer screening tests: a national survey of family physicians, general internists, and obstetrician-gynecologists. Prev Med 2014; 69:37-42. [PMID: 25038531 PMCID: PMC4539137 DOI: 10.1016/j.ypmed.2014.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/04/2014] [Accepted: 07/09/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study physicians' beliefs about the effectiveness of different tests for cancer screening. METHODS Data were examined from the Women's Health Survey of 1574 Family Medicine, Internal Medicine, and Obstetrics-Gynecology physicians to questions about their level of agreement about the clinical effectiveness of different tests for breast, cervical, ovarian, and colorectal cancer screening among average risk women. Data were weighted to the U.S. physician population based on the American Medical Association Masterfile. Multivariable logistic regression identified physician and practice characteristics significantly associated with physicians' beliefs. RESULTS There were 1574 respondents, representing a 62% response rate. The majority of physicians agreed with the effectiveness of mammography for women aged 50-69years, Pap tests for women aged 21-65years, and colonoscopy for individuals aged ≥50years. A substantial proportion of physicians believed that non-recommended tests were effective for screening (e.g., 34.4% for breast MRI and 69.1% for annual pelvic exam). Physicians typically listed their respective specialty organizations as a top influential organization for screening recommendations. CONCLUSIONS There were several substantial inconsistencies between physician beliefs in the effectiveness of cancer screening tests and the actual evidence of these tests' effectiveness which can lead both to underuse and overuse of cancer screening tests.
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Affiliation(s)
- Jacqueline W Miller
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Barbara Matthews
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Katrina F Trivers
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - C Holly Andrilla
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Denise Lishner
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Barbara A Goff
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
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11
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Ovarian cancer screening practices of obstetricians and gynecologists in puerto rico. BIOMED RESEARCH INTERNATIONAL 2014; 2014:920915. [PMID: 25371904 PMCID: PMC4209753 DOI: 10.1155/2014/920915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/13/2014] [Accepted: 05/23/2014] [Indexed: 11/18/2022]
Abstract
Background. Ovarian cancer is the most fatal malignancy of the female genital tract and is associated with high mortality. The American Congress of Obstetricians and Gynecologists (ACOG) and the United States Preventive Services Task Force (USPSTF) recommend against screening for ovarian cancer in asymptomatic, average-risk women. Objective. To assess the ovarian cancer screening practices in asymptomatic, average-risk women among obstetricians and gynecologists (Ob/Gyn) in Puerto Rico. Methodology. From 2011 to 2012, self-administered anonymous questionnaires were mailed to all licensed obstetricians and gynecologists in PR. Results. Response rate was 25%. Overall, 53.9% were screening for the disease. Reported screening methods were CA-125 and transvaginal ultrasound (TVUS), 39.2%, TVUS only, 30.4%, and CA-125 only, 9.8%. In the logistic regression model, the odds that a given health practitioner routinely screened for ovarian cancer in the asymptomatic, average-risk population increased by 8% with every unit increase in his or her years in practice. Conclusion. The majority of the practicing Ob/Gyn in PR who participated are not following the guidelines established by the ACOG and the USPSTF for ovarian cancer screening.
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12
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Larson CA. Prophylactic bilateral oophorectomy at time of hysterectomy for women at low risk: acog revises practice guidelines for ovarian cancer screening in low-risk women. ACTA ACUST UNITED AC 2014; 21:9-12. [PMID: 24523599 DOI: 10.3747/co.21.1721] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
On March 9, 2010, Richard J. Ablin phd, who was much involved in the discovery of prostate-specific antigen (psa), made national news with his quote, in an Op-Ed piece published in The New York Times and a sub-sequent March 22, 2010, U.S. National Public Radio interview, that “It’s no better than a coin toss”—de-scribing the psa test’s ability to predict prostate cancer in men[...]
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Affiliation(s)
- C A Larson
- University of Kentucky, Lexington, KY, U.S.A
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13
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Nolen BM, Lokshin AE. Biomarker testing for ovarian cancer: clinical utility of multiplex assays. Mol Diagn Ther 2013; 17:139-46. [PMID: 23552992 DOI: 10.1007/s40291-013-0027-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The improved detection of ovarian cancer at the earliest stages of development would confer a significant benefit in the therapeutic efficacy and overall survival associated with this devastating disease. The inadequate performance of currently used imaging modalities and the CA 125 biomarker test have precluded the establishment of screening programs and hindered the development of diagnostic tests for ovarian cancer. Two recently completed large clinical trials of ovarian cancer screening have reported findings of mixed impact, further clouding the issue. Considerable effort has been applied to the development of multiplexed biomarker-based tests and the most recent advances are discussed here. Within the clinical setting of pelvic mass differential diagnosis and triage, several significant advancements have been achieved recently, including the US Food and Drug Administration-approved Risk of Ovarian Malignancy Algorithm and OVA1 tests. The development and evaluation of those tests are described in this review. Thus while effective routine screening for ovarian cancer remains a lofty goal, advancement within the clinical management of pelvic mass diagnoses appears to be near at hand.
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Affiliation(s)
- Brian M Nolen
- University of Pittsburgh Cancer Institute, Hillman Cancer Center, 5117 Centre Avenue 1.18, Pittsburgh, PA 15213, USA.
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14
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Henderson JT, Harper CC, Gutin S, Saraiya M, Chapman J, Sawaya GF. Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists. Am J Obstet Gynecol 2013; 208:109.e1-7. [PMID: 23159688 DOI: 10.1016/j.ajog.2012.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/02/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Less-than-annual cervical cancer screening is now recommended for most US women, raising questions about the need for routine annual bimanual pelvic examinations. Little is known about clinicians' bimanual pelvic examination practices, their beliefs about its importance, or the reasoning underlying its performance in asymptomatic women. STUDY DESIGN We conducted a nationwide survey of US obstetrician-gynecologists. Respondents (n = 521) reported their examination practices and beliefs based on vignettes for asymptomatic women across the lifespan. RESULTS Nearly all obstetrician-gynecologists perform bimanual pelvic examinations in asymptomatic women across the lifespan, although it is viewed as less important for a newly sexually active 18-year-old. Reasons cited as very important included adherence to standard medical practices (45%), patient reassurance (49%), detection of ovarian cancer (47%), and identification of benign uterine (59%) and ovarian (54%) conditions. CONCLUSION Obstetrician-gynecologists perform bimanual pelvic examinations in the vast majority of asymptomatic women, but the importance placed on the examinations and reasons for conducting them vary.
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15
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Kauffman RP, Griffin SJ, Lund JD, Tullar PE. Current recommendations for cervical cancer screening: do they render the annual pelvic examination obsolete? Med Princ Pract 2013; 22:313-22. [PMID: 23328247 PMCID: PMC5586750 DOI: 10.1159/000346137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 11/22/2012] [Indexed: 01/28/2023] Open
Abstract
The development of a screening test for cervical dysplasia has been a major force in diminishing the worldwide incidence of invasive cervical cancer. Screening intervals recommended by professional organizations have changed over the past half century. Recognition of the human papillomavirus (HPV) as the causative agent and enhanced understanding of the natural history of HPV and cervical dysplasia in different age groups have prompted the American College of Obstetricians and Gynecologists and other professional societies to defer Pap smear screening to intervals no less than 2 years apart in women 21-29, and every 3 years in women 30 and over assuming no prior history of cervical dysplasia. Screening should start no sooner than age 21. These recommendations more closely resemble those currently practiced in Europe and other parts of the developed world. Those who have undergone hysterectomy no longer need screening unless high-grade dysplasia was present. Although the value of pelvic examination is not debated in women with symptoms referable to the female genital tract, the endorsement by several professional societies of less than annual cervical cancer screening in healthy women also begs the question of whether annual pelvic examination (speculum and/or bimanual examination) benefits asymptomatic women. Some sexually transmitted infections are amenable to self-insertion of a vaginal probe or detectable by voided urine specimen. Bimanual examination is insensitive in detecting early ovarian cancer with a high false-positive rate leading to patient anxiety, excessive diagnostic testing, and unnecessary surgical procedures. Future study should focus on the frequency in which healthy asymptomatic women should undergo pelvic examination.
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Affiliation(s)
- Robert P Kauffman
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX 79106, USA.
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16
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Hopkins K, Grossman D, White K, Amastae J, Potter JE. Reproductive health preventive screening among clinic vs. over-the-counter oral contraceptive users. Contraception 2012; 86:376-82. [PMID: 22520645 PMCID: PMC4418512 DOI: 10.1016/j.contraception.2012.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/06/2012] [Accepted: 03/07/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Interest is growing in moving oral contraceptives over-the-counter (OTC), although concerns exist about whether women would continue to get preventive health screening. STUDY DESIGN We recruited cohorts of US-resident women who obtained oral contraceptives from US family planning clinics (n=532) and OTC from pharmacies in Mexico (n=514) and interviewed them four times over 9 months. Based on self-reports of having a Pap smear within 3 years or ever having had a pelvic exam, clinical breast exam and testing for sexually transmitted infections (STIs), we assessed the prevalence of preventive screening using Poisson regression models. RESULTS The prevalence of screening was high for both groups (>88% for Pap smear, pelvic exam and clinical breast exam and >71% for STI screening), while the prevalence ratios for screening were higher for clinic users, even after multivariable adjustment. CONCLUSIONS Results suggest that most women would obtain reproductive health preventive screening if oral contraceptives were available OTC, and also highlight the need to improve access to preventive screening for all low-income women.
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Affiliation(s)
- Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, TX 78712, USA.
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17
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Stormo AR, Cooper CP, Hawkins NA, Saraiya M. Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women. Prev Med 2012; 54:415-21. [PMID: 22484240 DOI: 10.1016/j.ypmed.2012.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 03/20/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine physicians' beliefs about the pelvic examination and identify physician characteristics associated with routine use of this procedure in the United States. METHODS A total of 1250 United States family/general practitioners, internists, and obstetrician/gynecologists who participated in the 2009 DocStyles survey completed questions on beliefs regarding the utility of routine pelvic examinations for cancer screening. The survey also asked participants how often they performed this procedure as part of a well-woman exam, to screen for ovarian and other gynecologic cancers, to screen for sexually transmitted infections, and as a prerequisite for prescribing hormonal contraception. RESULTS A total of 68.0% of obstetrician/gynecologists, 39.2% of family/general practitioners, and 18.7% of internists reported routinely performing pelvic examinations for all the purposes examined (<0.001). Adjusted analyses revealed that the factors most strongly associated with use of pelvic examinations for all purposes were being an obstetrician/gynecologist (odds ratio 8.5; 95% confidence interval 5.8-12.6) and believing that this procedure is useful to screen for gynecologic cancers (odds ratio 3.8; 95% confidence interval 2.6-5.5). CONCLUSION Misconceptions about the utility of pelvic examinations to screen for gynecologic cancers are common. More effective strategies to change physicians' beliefs regarding the value of performing pelvic examinations in asymptomatic women are needed.
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Vesco KK, Marshall LM, Nelson HD, Humphrey L, Rizzo J, Pedula KL, Cauley JA, Ensrud KE, Hochberg MC, Antoniucci D, Hillier TA. Surgical menopause and nonvertebral fracture risk among older US women. Menopause 2012; 19:510-6. [PMID: 22547252 PMCID: PMC3342015 DOI: 10.1097/gme.0b013e318239caeb] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether older postmenopausal women with a history of bilateral oophorectomy before natural menopause (surgical menopause) have a higher risk of nonvertebral postmenopausal fracture than women with natural menopause. METHODS We used 21 years of prospectively collected incident fracture data from the ongoing Study of Osteoporotic Fractures, a cohort study of community-dwelling women without previous bilateral hip fracture who were 65 years or older at enrollment, to determine the risk of hip, wrist, and any nonvertebral fracture. χ(2) and t tests were used to compare the two groups on important characteristics. Multivariable Cox proportional hazards regression models stratified by baseline oral estrogen use status were used to estimate the risk of fracture. RESULTS Baseline characteristics differed significantly among the 6,616 women within the Study of Osteoporotic Fractures who underwent either surgical (1,157) or natural (5,459) menopause, including mean age at menopause (44.3 ± 7.4 vs 48.9 ± 4.9 y, P < 0.001) and current use of oral estrogen (30.2% vs 6.5%, P < 0.001). Fracture rates were not significantly increased for surgical versus natural menopause, even among women who had never used oral estrogen (hip fracture: hazard ratio [HR], 0.87; 95% CI, 0.63-1.21; wrist fracture: HR, 1.10; 95% CI, 0.78-1.57; any nonvertebral fracture: HR, 1.11; 95% CI, 0.93-1.32). CONCLUSIONS These data provide some reassurance that the long-term risk of nonvertebral fracture is not substantially increased for postmenopausal women who experienced premenopausal bilateral oophorectomy, compared with postmenopausal women with intact ovaries, even in the absence of postmenopausal estrogen therapy.
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Affiliation(s)
- Kimberly K Vesco
- Science Programs Department, Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA.
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Nolen BM, Lokshin AE. Protein biomarkers of ovarian cancer: the forest and the trees. Future Oncol 2012; 8:55-71. [PMID: 22149035 DOI: 10.2217/fon.11.135] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The goal of effective population-based screening for ovarian cancer remains elusive despite intense efforts aimed at improving upon biomarker and imaging modalities. While dozens of potential serum biomarkers for ovarian cancer have been identified in recent years, none have yet overcome the limitations that have hindered the clinical use of CA-125. Avenues of opportunity in biomarker development are emerging as investigators are beginning to appreciate the significance of remote, as well as local or regional, sources of biomarkers in the construction of diagnostic panels, as well as the importance of evaluating biomarkers in prediagnostic settings. As the list of candidate biomarkers of ovarian cancer continues to grow, refinements in the methods through which specific proteins are selected for further development as components of diagnostic panels are desperately sought. Such refinements must take into account both the bioinformatic and biological significance of each candidate. Approaches incorporating these considerations may potentially overcome the challenges to early detection posed by the histological heterogeneity of ovarian cancer. Here, we review the recent progress achieved in efforts to develop diagnostic biomarker panels for ovarian cancer and discuss the challenges that remain.
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Affiliation(s)
- Brian M Nolen
- University of Pittsburgh Cancer Institute, Hillman Cancer Center, 5117 Centre Avenue 1.18, Pittsburgh, PA 15213, USA
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Harris R, Sawaya GF, Moyer VA, Calonge N. Reconsidering the criteria for evaluating proposed screening programs: reflections from 4 current and former members of the U.S. Preventive services task force. Epidemiol Rev 2011; 33:20-35. [PMID: 21666224 DOI: 10.1093/epirev/mxr005] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In 1968, Wilson and Jungner published 10 "principles" for evaluating screening programs (Public Health Papers No. 34. Geneva, Switzerland: World Health Organization), criteria widely used since then. The 4 authors of this review (all current or former members of the U.S. Preventive Services Task Force) have found a different paradigm more useful for evaluating screening programs. This review was written independently of the USPSTF; the authors speak only for themselves and not for the USPSTF. They suggest evaluating screening programs not as a checklist but as a balance between the magnitude of benefits and the magnitude of harms, each estimated from a systematic review of the evidence. To emphasize a focus on health outcomes, the authors suggest reframing the target of screening as an umbrella concept: the "predictor of poor health." Evaluation groups should weigh health benefits and harms to estimate net benefits and then consider whether these net benefits justify the resources required. The final decision about implementation should be made by a democratic process that considers both the panel's evaluation of the evidence and nonevidence factors (e.g., resources available, other priorities, the informed population's preferences). The authors hope these suggestions stimulate further discussion about the optimal way to evaluate proposed screening programs.
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Affiliation(s)
- Russell Harris
- Cecil G. Sheps Center for Health Services Research, 725 Martin Luther King, Campus Box 7590, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA.
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Rao A, Carter J. Ultrasound and ovarian cancer screening: is there a future? J Minim Invasive Gynecol 2011; 18:24-30. [PMID: 21195955 DOI: 10.1016/j.jmig.2010.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 09/09/2010] [Accepted: 09/16/2010] [Indexed: 12/20/2022]
Abstract
Ovarian cancer is a leading cause of death due to gynecologic malignant disease. Advances in ultrasound have improved the ability to identify the more subtle characteristics of adnexal masses, resulting in an increasing volume of research addressing its use to accurately predict whether masses are benign or malignant, and the inclusion of ultrasound in large-scale studies addressing screening for ovarian cancer. Herein, we explore some of the factors that make screening for ovarian cancer challenging, review the major trials addressing the effect of ovarian cancer screening, and examine data relating to more recent advances in ultrasound technology.
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Affiliation(s)
- Archana Rao
- Sydney Gynaecological Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia.
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Update in women's health for the general internist. J Gen Intern Med 2011; 26:207-13. [PMID: 20824360 PMCID: PMC3019328 DOI: 10.1007/s11606-010-1503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 08/02/2010] [Accepted: 08/18/2010] [Indexed: 11/01/2022]
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Aguirre A, Ardeshirpour Y, Sanders MM, Brewer M, Zhu Q. Potential role of coregistered photoacoustic and ultrasound imaging in ovarian cancer detection and characterization. Transl Oncol 2011; 4:29-37. [PMID: 21286375 PMCID: PMC3026406 DOI: 10.1593/tlo.10187] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/27/2010] [Accepted: 09/28/2010] [Indexed: 11/18/2022] Open
Abstract
Currently, there is no adequate technology to detect early stage ovarian cancers. Most of the cancers in the ovary are detected when the cancer has already metastasized to other parts of the body. As a result, ovarian cancer has the highest mortality of all gynecologic cancers with a 5-year survival rate of 30% or less. Thus, there is an urgent need to improve the current diagnostic techniques. Photoacoustic imaging (PAI) is an emerging modality with a great potential to assist ultrasound for detecting ovarian cancer noninvasively. In this article, we report the first study of coregistered ultrasound and PAI of 33 ex vivo human ovaries. An assessment of the photoacoustic images has revealed light absorption distribution in the ovary, which is directly related to the vasculature distribution and amount. Quantification of the light absorption levels in the ovary has indicated that, in the postmenopausal group, malignant ovaries showed significantly higher light absorption than normal ones (P = .0237). For these two groups, we have obtained a sensitivity of 83% and a specificity of 83%. This result suggests that PAI is a promising modality for improving ultrasound diagnosis of ovarian cancer.
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Affiliation(s)
- Andres Aguirre
- Biomedical Ultrasonic and Optical Imaging Laboratory, Electrical and Computer Engineering Department, University of Connecticut, Storrs, CT, USA
| | - Yasaman Ardeshirpour
- Biomedical Ultrasonic and Optical Imaging Laboratory, Electrical and Computer Engineering Department, University of Connecticut, Storrs, CT, USA
| | - Mary M Sanders
- Department of Pathology and Laboratory Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Molly Brewer
- The Carole and Ray Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT, USA
| | - Quing Zhu
- Biomedical Ultrasonic and Optical Imaging Laboratory, Electrical and Computer Engineering Department, University of Connecticut, Storrs, CT, USA
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High-Resolution Signal Processing in Magnetic Resonance Spectroscopy for Early Cancer Diagnostics. ADVANCES IN QUANTUM CHEMISTRY 2011. [DOI: 10.1016/b978-0-12-386477-2.00006-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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26
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Screening of high-risk groups for breast and ovarian cancer in Europe: a focus on the Jewish population. Oncol Rev 2010. [DOI: 10.1007/s12156-010-0056-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Kim S, Dolecek TA, Davis FG. Racial differences in stage at diagnosis and survival from epithelial ovarian cancer: a fundamental cause of disease approach. Soc Sci Med 2010; 71:274-281. [PMID: 20483517 PMCID: PMC3176671 DOI: 10.1016/j.socscimed.2010.03.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 03/15/2010] [Accepted: 03/23/2010] [Indexed: 11/17/2022]
Abstract
Associations between race, socioeconomic status (SES) and health outcomes have been well established. One of the ways in which race and SES affect health is by influencing one's access to resources, which confers ability to avoid or mitigate adverse outcomes. The fundamental cause of disease approach argues that when a new screening tool is introduced, individuals with greater resources tend to have better access to the innovation, thus benefiting from early detection and leading to better survival. Conversely, when there is no established screening tool, racial and SES differences in early detection may be less pronounced. Most ovarian cancer is diagnosed at advanced stages, because of the lack of an effective screening tool and few early symptoms. However, once detected, racial differences may still be observed in mortality and survival outcomes. We examined the racial differences in diagnosis and survival among ovarian cancer cases diagnosed during 1994-1998, in Cook County, Illinois (N = 351). There were no racial differences in the stage at diagnosis: 51.7% of white and 52.9% of black women were diagnosed at later stages (III and IV). Only age was associated with the stage at diagnosis. Tumor characteristics also did not differ between white and black women. Compared to white women, black women were less likely to be married, less educated, more frequently used genital powder, had tubal ligation, and resided in higher poverty census tracts. As of December 31, 2005, 44.3% of white and 54.5% of black women had died of ovarian cancer. Controlling for known confounding variables, the hazard ratio for ovarian cancer death between black and white women was 2.2. The findings show that fundamental cause perspective provides a potential framework to explore subtleties in racial disparities, with which broader social causes may be accounted for in explaining post diagnosis racial differences.
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Affiliation(s)
- Seijeoung Kim
- University of Illinois at Chicago, School of Public Health, Division of Health Policy and Administration, Chicago, IL 60612, United States.
| | - Therese A Dolecek
- University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics, Chicago, IL 60612, United States
| | - Faith G Davis
- University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics, Chicago, IL 60612, United States
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Dolecek TA, McCarthy BJ, Joslin CE, Peterson CE, Kim S, Freels SA, Davis FG. Prediagnosis Food Patterns Are Associated with Length of Survival from Epithelial Ovarian Cancer. ACTA ACUST UNITED AC 2010; 110:369-82. [DOI: 10.1016/j.jada.2009.11.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 08/13/2009] [Indexed: 11/25/2022]
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Cass I. The search for meaning-symptoms and transvaginal sonography screening for ovarian cancer: silent no more. Cancer 2009; 115:3606-8. [PMID: 19598208 DOI: 10.1002/cncr.24403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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The Future of Cancer Screening. Prim Care 2009; 36:623-39. [DOI: 10.1016/j.pop.2009.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yoon PW, Scheuner MT, Jorgensen C, Khoury MJ. Developing Family Healthware, a family history screening tool to prevent common chronic diseases. Prev Chronic Dis 2008; 6:A33. [PMID: 19080039 PMCID: PMC2644613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Family health history reflects the effects of genetic, environmental, and behavioral factors and is an important risk factor for a variety of disorders including coronary heart disease, cancer, and diabetes. In 2004, the Centers for Disease Control and Prevention developed Family Healthware, a new interactive, Web-based tool that assesses familial risk for 6 diseases (coronary heart disease, stroke, diabetes, and colorectal, breast, and ovarian cancer) and provides a "prevention plan" with personalized recommendations for lifestyle changes and screening. The tool collects data on health behaviors, screening tests, and disease history of a person's first- and second-degree relatives. Algorithms in the software analyze the family history data and assess familial risk based on the number of relatives affected, their age at disease onset, their sex, how closely related the relatives are to each other and to the user, and the combinations of diseases in the family. A second set of algorithms uses the data on familial risk level, health behaviors, and screening to generate personalized prevention messages. Qualitative and quantitative formative research on lay understanding of family history and genetics helped shape the tool's content, labels, and messages. Lab-based usability testing helped refine messages and tool navigation. The tool is being evaluated by 3 academic centers by using a network of primary care practices to determine whether personalized prevention messages tailored to familial risk will motivate people at risk to change their lifestyles or screening behaviors.
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Affiliation(s)
| | | | | | - Muin J. Khoury
- Centers for Disease Control and Prevention, Atlanta, Georgia
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32
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Frangos JE, Alavian CN, Kimball AB. Acne and oral contraceptives: Update on women's health screening guidelines. J Am Acad Dermatol 2008; 58:781-6. [DOI: 10.1016/j.jaad.2007.12.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 12/19/2007] [Accepted: 12/28/2007] [Indexed: 10/22/2022]
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33
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Bermejo-Pérez MJ, Márquez-Calderón S, Llanos-Méndez A. Cancer surveillance based on imaging techniques in carriers of BRCA1/2 gene mutations: a systematic review. Br J Radiol 2008; 81:172-9. [PMID: 18208856 DOI: 10.1259/bjr/21074350] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We have systematically reviewed the literature focusing on the performance of surveillance programmes and imaging techniques for the early diagnosis of breast and ovarian cancer in women carrying mutations in BRCA1/2 genes. A search for relevant articles published between 1996 and 2005 (inclusive) was run on Medline, Embase and other databases. Of the 749 articles retrieved, only 13 met the inclusion criteria. Of these, 12 provided information on breast cancer surveillance, 1 on ovarian cancer surveillance and a further study addressed both cancer types. A critical appraisal of the studies was performed using a tool for the quality assessment of diagnostic accuracy studies (QUADAS). The synthesis of results is qualitative. All studies on imaging techniques for the diagnosis of breast cancer indicated that screening MRI had the highest sensitivity (between 77% and 100%). Breast cancer surveillance programmes, including MRI, achieved the highest diagnostic performance (between 83% and 95%) for all women. However, it must be taken into account that biases that may affect the validity of the outcomes were seen in the evaluated studies. Also, MRI is an expensive test with a low positive predictive value and, to date, MRI screening has not been proven to reduce mortality rates in women carrying BRCA1/2 gene mutations. As a result of the scant information and low quality of the papers reviewed, no definitive conclusion could be drawn on the performance of ovarian cancer surveillance in women carrying BRCA1/2 mutations.
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Ryerson AB, Eheman C, Burton J, McCall N, Blackman D, Subramanian S, Richardson LC. Symptoms, diagnoses, and time to key diagnostic procedures among older U.S. women with ovarian cancer. Obstet Gynecol 2007; 109:1053-61. [PMID: 17470582 DOI: 10.1097/01.aog.0000260392.70365.5e] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the types of symptoms and diagnostic procedures reported in Medicare claims 12 months before diagnosis for women with ovarian cancer by stage, and to assess the association between types of symptoms and time to key diagnostic procedures. METHODS Medicare claims linked to records in the Surveillance, Epidemiology, and End Results (SEER) cancer registries were used to examine diagnosis and procedure codes in 3,250 women aged 65 years and older before a diagnosis of ovarian cancer. RESULTS Over 81% of women with ovarian cancer had at least one target sign or symptom before diagnosis. Gastrointestinal symptoms such as nausea and vomiting (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.40-2.98), and constipation, diarrhea, or other digestive disorders (aOR 2.01, 95% CI 1.58-2.56) were associated with later-stage cancer. In contrast, gynecologic symptoms such as abnormal bleeding (aOR 0.44, 95% CI 0.34-0.58) and genital organ pain (aOR 0.66, 95% CI 0.53-0.80) were associated with earlier disease. Among those with at least one symptom, the rate at which women with gynecologic symptoms went to surgery was higher (hazard ratio 5.5, 95% CI 5.1-6.0) than the rate for women with other nongastrointestinal ovarian cancer-related symptoms. CONCLUSION Women with ovarian cancer presenting with gastrointestinal symptoms were more likely to have later-stage disease and longer time to key diagnostic tests than those with gynecologic symptoms. Clinicians should be aware of the potential for unresolved gastrointestinal symptoms to be indicators for ovarian cancer.
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Affiliation(s)
- A Blythe Ryerson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Affiliation(s)
- William F Miser
- Department of Family Medicine, The Ohio State University College of Medicine and Public Health, 2231 North High Street, Room 203, Columbus, OH 43201, USA.
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Abstract
In 2005, more than 22,000 American women were diagnosed with ovarian cancer and 16,000 women died from the disease. The five-year relative survival rate for stage III and IV disease is 31%, and the five-year relative survival rate for stage I is 95%. Early diagnosis should lower the fatality rate. Unfortunately, early diagnosis is difficult because of the physically inaccessible location of the ovaries, the lack of specific symptoms in early disease, and the limited understanding of ovarian oncogenesis. Screening tests for ovarian cancer need high sensitivity and specificity to be useful because of the low prevalence of undiagnosed ovarian cancer. Because currently available screening tests do not achieve high levels of sensitivity and specificity, screening is not recommended for the general population. The theoretical advantage of screening is much higher for women at high risk (such as those with a strong family history of ovarian cancer and those with BRCA 1 or BRCA 2 mutations). However, even for women at high risk, no prospective studies have shown benefits of screening. The public health challenge is that 90% of ovarian cancer occurs in women who are not in an identifiable high-risk group, and most women are diagnosed with advanced-stage disease. Currently available tests (CA-125, transvaginal ultrasound, or a combination of both) lack the sensitivity and specificity to be useful in screening the general population. Ongoing clinical trials are assessing whether new tumor markers, including those generated by proteomic and genomic studies, will prove useful.
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Lacey JV, Greene MH, Buys SS, Reding D, Riley TL, Berg CD, Fagerstrom RM, Hartge P. Ovarian Cancer Screening in Women With a Family History of Breast or Ovarian Cancer. Obstet Gynecol 2006; 108:1176-84. [PMID: 17077240 DOI: 10.1097/01.aog.0000239105.39149.d8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate positive predictive values of CA 125 or transvaginal ultrasonography screening for ovarian cancer according to family history of breast or ovarian cancer. METHODS In the screening arm of a randomized controlled trial of screening compared with usual care, 28,460 women with family history data received baseline and annual CA 125 and transvaginal ultrasonography examinations. We analyzed CA 125 and transvaginal ultrasonography results from the first four rounds of screening. We classified women as average (n=22,687), moderate (n=2,572), or high (n=2,163) risk based on family history, or high risk due to a personal history of breast cancer (n=1,038). Cancers were identified by active follow-up of women with abnormal screening results and annual questionnaires. We calculated positive predictive values for screening combinations. RESULTS Similar proportions (4.8-5.0%) of women in each group had abnormal screening results. Higher-risk women were more likely than lower-risk women to undergo biopsy after a positive screen. Screening identified 43 invasive ovarian cancers. The positive predictive values for abnormal screening results were 0.7% in average-risk, 1.3% in moderate-risk, and 1.6% in high-risk groups; one ovarian cancer occurred among the breast cancer survivors. The positive predictive values for postbaseline abnormal screening results were also higher in the higher-risk groups. The positive predictive values did not significantly differ across risk groups. CONCLUSION Probabilities of abnormal annual CA 125 and transvaginal ultrasonography screens were similar across groups based on family history of breast or ovarian cancer. However, ovarian cancer was more likely to be diagnosed after an abnormal screening result among women at higher family history-based risk than among women at lower risk. LEVEL OF EVIDENCE I.
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Affiliation(s)
- James V Lacey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20892, USA.
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Peter I, Chin K. Overview of genetic testing in cancer. Per Med 2006; 3:325-333. [PMID: 29788654 DOI: 10.2217/17410541.3.3.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Until recently, hereditary tendencies toward multiple diseases, including cancer, were mainly determined by examining the family history of the affected individuals. However, the Human Genome Project has ushered in a genomics revolution and boosted the diagnostic testing industry with the emergence of genetic tests that may be used for the diagnosis and management of both inherited and noninherited malignancies. Genetic tests are already available to identify patients carrying cancer susceptibility genes and predict drug response, thus enabling physicians to carefully tailor a more personalized drug regimen that is more likely to result in a favorable outcome for the patient. However, before gene-based tests become widely available, thought leaders and society in general need to understand and discuss the major technical, ethical and economic ramifications of genetic testing. These issues are currently being reviewed by government, academia, regulatory agencies and professional societies using evidence-based principles.
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Affiliation(s)
- Inga Peter
- Institute for Clinical Care Research, Tufts-New England Medical Center, 750 Washington St., NEMC #63, Boston, MA 02111, USA.
| | - Kevin Chin
- Bristol-Myers Squibb, Pharmaceutical Research Institute, Wallingford, CT, USA
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Lambaudie E, Collinet P, Vinatier D. Tumeurs de l'ovaire et CA 125 en 2006. ACTA ACUST UNITED AC 2006; 34:254-7. [PMID: 16529967 DOI: 10.1016/j.gyobfe.2006.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Accepted: 01/12/2006] [Indexed: 11/20/2022]
Abstract
The authors propose to report progress on the use of the CA 125 serum assay. It affects three situations: screening, diagnosis and the follow-up of the patients dealt with ovarian tumour either of benign or malignant nature. For each situation the interest and the relevance of CA 125 assay will be approached.
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Affiliation(s)
- E Lambaudie
- Service de gynécologie chirurgicale, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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Abstract
PURPOSE OF REVIEW Ovarian cancer is an important cause of death among women with a malignant gynecological tumor. Cure rates for the disease at an early stage are around 80-90%, but survival is only 50% as the majority of women already show advanced disease upon diagnosis. The combination of gynecological examination, ultrasonography, and systemic tumor marker assay is considered to be a good strategy for the early diagnosis of ovarian neoplasia. RECENT FINDINGS Today, new technologies such as ultrasonography and tumor marker assay have increased the diagnosis rate for adnexal masses. These non-invasive methods, however, frequently do not distinguish benign conditions from malignant ones, which results in unnecessary surgery. Transvaginal ultrasonography is useful for diagnosing adnexal masses, but benign and malignant adnexal masses can present similar morphological characteristics. Combination with color Doppler ultrasonography and/or tumor markers may improve the accuracy of the method. Gene-expression array, proteomics and mathematical models form new approaches, but proper prospective studies are needed to validate them. SUMMARY The techniques of pelvic examination, ultrasonography, color Doppler ultrasonography, and tumor markers can be indicated for the diagnosis of ovarian cancer. The differentiation between benign and malignant ovarian tumor is, however, a clinical challenge. Until better diagnostic methods become available, patients and their physicians can use these techniques to decide on management.
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Affiliation(s)
- Eddie F C Murta
- Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
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Affiliation(s)
- Usha Menon
- Gynaecology Cancer Research Centre, Department of Gynaecological Oncology, Institute of Women's Health, University College London, London, UK
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