No abstract

No abstract

BackgroundWomen from ethnic minority backgrounds are less likely to attend cervical screening, but further understanding of ethnic inequalities in cervical screening uptake is yet to be established. This study aimed to explore the socio-demographic and ethnicity-related predictors of cervical cancer knowledge, cervical screening attendance and reasons for non-attendance among Black women in London.MethodsA questionnaire was completed by women attending Black and ethnic hair and beauty specialists in London between February and April 2013. A stratified sampling frame was used to identify Black hair specialists in London subdivisions with >10% Black population (including UK and foreign-born). Fifty-nine salons participated. Knowledge of cervical cancer risk factors and symptoms, self-reported screening attendance and reasons for non-attendance at cervical screening were assessed.ResultsQuestionnaires were completed by 937 Black women aged 18–78, describing themselves as being predominantly from African or Caribbean backgrounds (response rate 26.5%). Higher educational qualifications (p < .001) and being born in the UK (p = .011) were associated with greater risk factor knowledge. Older age was associated with greater symptom knowledge (p < .001). Being younger, single, African (compared to Caribbean) and attending religious services more frequently were associated with being overdue for screening. Women who had migrated to the UK more than 10 years ago were less likely to be overdue than those born in the UK. Of those overdue for screening who endorsed a barrier (67/133), ‘I meant to go but didn’t get round to it’ (28%), fear of the test procedure (18%) and low risk perception (18%) were the most common barriers.ConclusionsEthnicity, migration and religiosity play a role in predicting cervical screening attendance among women from Black backgrounds. African women, those born in the UK and those who regularly attend church are most likely to put off attending. Additional research is needed to explore the attitudes, experiences and beliefs that explain why these groups might differ.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1096) contains supplementary material, which is available to authorized users.

Despite high tumour response rates to platinum-based chemotherapy in ovarian cancer survival is poor due to the emergence of drug resistance. Mechanistic studies in clinical material have been hampered by the unavailability of sensitive methods to detect the critical drug-induced effects in individual cells. A modification of the single cell gel electrophoresis (comet) assay allows the sensitive detection of DNA interstrand crosslinking in both tumour and normal cells derived directly from clinical material. Tumour cells isolated from 50 ovarian cancer patients were treated ex vivo with 100 mM cisplatin for 1 h and crosslink formation and repair (unhooking) measured. No significant difference in the peak level of crosslinking in tumour cells was observed between patients who were either newly diagnosed or previously treated with platinum-based therapy, or between tumour and mesothelial cells from an individual patient. This indicates no difference in cellular mechanisms such as drug transport or detoxification. In contrast, the percentage repair (unhooking) of DNA interstrand crosslinks was much greater in the group of treated patients. At 24 h in the 36 newly diagnosed patient tumour samples, only one gave 450% repair and 23 gave o10% repair; however, 19 out of 22 treated patient samples gave 410% repair and 14 showed 450% repair. The estimated median difference (newly diagnosed minus treated) was À52 (95% CI À67 to À28), and the P-value from a Mann -Whitney test was o0.001. In eight patients, it was possible to obtain tumour samples prior to any chemotherapy, and also on relapse or at interval debulking surgery following platinum-based chemotherapy. In these patients, the mean % repair prior to therapy was 2.85 rising to 71.23 following treatment. These data demonstrate increased repair of DNA interstrand crosslinks in ovarian tumour cells following platinum therapy which may contribute to clinical acquired resistance.

Background:There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study.Methods:Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I–V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications.Results:Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II–V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05).Conclusions:This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.

To evaluate the feasibility of total laparoscopic hysterectomy as the primary treatment for endometrial cancer in morbidly obese women, an audit was carried out during an 18-month period in a tertiary referral centre for gynaecological oncology. Four women who had laparoscopic surgery were compared with a similar cohort who had open surgery. The mean operating time was equivalent, without evidence of excess morbidity with the laparoscopic approach. However, inpatient stay was longer with open versus laparoscopic surgery (11.5 vs 4 days). Laparoscopic surgery is safe to use in morbidly obese women with endometrial cancer.

No abstract

SummaryThe surgical management of epithelial ovarian cancer in the South West of England was studied in the two years 1997-1998 in order to determine the factors that influence the outcome of surgery and to provide a baseline from which to assess the effect of centralisation of cancer services. All hospitals in the South West region of England participating in the Regional Cancer Organisation's longitudinal study of outcomes in gynaecological malignancies are included. Six hundred and eighty-two patients with epithelial ovarian cancer were registered with the RCO in the two-year study period. Five hundred and ninety-five women were offered primary cytoreductive surgery of which 438 were said to be optimally cytoreduced. Applying multivariate models to analyse the outcome of surgery, older patients (OR = 0.82 per 5-year increase in age, P = 0.0003), patients treated in hospitals managing fewer than ten cases of ovarian cancer per year (OR = 1.92, P = 0.02) and patients with FIGO stage 3 (OR = 0.02, P < 0.0001) or 4 (OR = 0.002, P < 0.0001) disease were less likely to be optimally cytoreduced. Gynaecological oncologists were 2.06 times more likely to attain optimal cytoreduction when compared to general gynaecologists and this was statistically significant (P = 0.01). The results from this study support the argument that limiting surgery for ovarian malignancy to specialised surgeons improves the extent of cytoreductive surgery. prior to the re-organisation of gynaecological cancer services, looking particularly at factors influencing the completeness of surgery at each stage of disease. This study, as well as providing a base-line against which future performance can be measured, enables us to estimate the increase in work load and the resource implications for the regional cancer centre if centralisation of ovarian cancer management is fully implemented. MATERIALS AND METHODSThe South and West Regional Cancer Organisation (RCO) Gynaecology Tumour Panel is constituted of a multidisciplinary team of experts involved in the management of gynaecological malignancies. In 1997, the RCO initiated a prospective longitudinal study of the management of gynaecological cancer to establish current patterns of care and facilitate development of services in the region (Jackson et al, 1997). A one-page minimum data-set for each major gynaecological cancer site was designed (Figure 1). After obtaining approval from all units managing gynaecological malignancies, copies of the minimum data set pro forma were circulated along with guidance notes that included outlines of American Society of Anesthesiologists (ASA) grading, FIGO staging, and histopathology information required. Treatment policies detailing accepted pre-operative and operative management of epithelial ovarian cancer were produced and circulated by the RCO to all participating hospitals (Appendix 1). To ensure uniform histopathological reporting, the RCO also circulated guidelines for participating histopathologists (Appendix 2). The clinician managing the case is re...