Cervical cancer control includes primary prevention through vaccination to prevent human papillomavirus (HPV) infection and secondary prevention through screening to detect and treat cervical precancerous lesions. This review summarizes the evidence for the population impact of vaccines against oncogenic HPV types in reducing the prevalence of cervical precancerous lesions. We examine the gradual shift in screening technology from cervical cytology alone to cytology and HPV cotesting, and finally to the recognition that HPV testing can serve alone as the new screening paradigm, particularly in the initial post-vaccination era. We should expect an impact on screening performance and practices, as cohorts of HPV-vaccinated girls and adolescents reach cervical cancer screening age. In preparation for changes in the screening paradigm for the vaccination era, we propose that policymaking on cervical cancer screening should mirror current practices with other cancers as benchmarks. Cervical precancerous lesions will become a very rare condition following the widespread implementation of HPV vaccines with broader coverage in the number of preventable oncogenic types. Irrespective of screening technology, the false positive results will far outnumber the true positive ones, a tipping point that will herald a new period when the harms from cervical cancer screening will outweigh its benefits. We present a conceptual framework to guide decision making when we reach this point within 25–30 years.
BackgroundSystematic symptom reporting by patients and the use of questionnaires such as the Edmonton Symptom Assessment System (ESAS) have potential to improve clinical encounters and patient satisfaction. We review findings from published studies of the ESAS to guide use of the system and to focus research. MethodsA systematic search for articles from 1991 through 2007 found thirty-nine peer-reviewed papers from 25 different institutions, thirty-three of which focused on patients with cancer. Observations, data, and statistics were collated according to relevance, reliability, validity, and responsiveness. ResultsFindings apply predominantly to symptomatic palliative patients with advanced cancer who were no longer receiving active oncologic therapies. Uncertainty about summarizing findings arises from frequent modification of the ESAS (altered items, scales, and time periods). Overall, reliability is established for daily administration. Scores are skewed, with a floor effect, but the relative order of symptoms by mean scores is similar across studies. Emotional symptoms are poorly captured by the depression and anxiety items. An equally weighted summation of scores may estimate a construct of "physical symptom distress," which in turn is related to performance status, palliative goals, quality of life, and well-being. ConclusionsThe ESAS is reliable, but it has restricted validity, and its use requires a sound clinical process to help interpret scores and to give them an appropriate level of attention. Research priorities are to further develop the ESAS for assessing a greater number of important physical symptoms (and to target "physical symptom
women (cutoff was low-grade squamous intraepithelial lesions [LSIL] or worse). For a disease threshold of cervical intraepithelial neoplasia of grade 2 or worse, specificity significantly declined at the atypical squamous cells of undetermined significance cutoff for studies A (86.6% to 75.3%) and C (42.5% to 15.5%), and at the LSIL cutoff for study C (61.9% to 37.6%). Sensitivity remained nearly unchanged between readings, except in study C, in which reread performance was superior (91.3% vs 71.9% for the LSIL cutoff). CONCLUSIONS: A reduction in the diagnostic accuracy of Pap cytology was observed when revealing patients' cervical HPV status, possibly due to a heightened awareness of potential abnormalities, which led to more false-positive results. Cancer (Cancer Cytopathol) 2015;123:745-54.
SummaryOne hundred insulin-dependent diabetic patients (age < 45 years, 53 smokers) were foliowed for six years. The age, duration of diabetes and mean glycated haemoglobin levels, were comparable between the smokers and non-smokers. Microvascular complications (retinopathy and increased urine albumin excretion) were commoner and more severe in the smoking group at six years, particularly in heavy smokers. Of the 45 original smokers reviewed at six years, 12 (27%) had stopped, six of whom had developed microvascular complications. Only two of the 'heavy' initial smokers, likely to be at most risk, had stopped smoking, and three original nonsmokers had started smoking.Keywords: insulin-dependent diabetes, diabetic nephropathy, diabetic retinopathy, smoking, ischaemic heart disease A diabetic patient who smokes has a 4-6 fold increased risk of developing ischaemic heart disease compared with a non-smoking, nondiabetic subject." 2 Smoking may also promote the development and progression of diabetic microvascular disease, particularly diabetic nephropathy.""4 Unfortunately, many young people with diabetes start smoking,5 and smoking prevalence amongst diabetic patients is similar to the non-diabetic population.6 Anti-smoking counselling has little initial impact on smoking habits, although long-term data is lacking.7'8This study followed the smoking habits and the development of microvascular complications over six years in a cohort of young adult smokers with insulin-dependent diabetes mellitus (IDDM). The degree of nicotine dependence was measured by urine cotinine, a metabolite of nicotine. Patients and methodsFifty-three smokers with IDDM were recruited consecutively into a programme of anti-smoking counselling.7 None stopped smoking following this. During the same period, 47 patients who had never smoked were identified as a control group. At recruitment the two groups were comparable for age, duration of diabetes, and glycated haemoglobin (HbAl) concentration (table 1).In all patients urine cotinine was measured as an objective assessment of the smoking load over the previous 24 hours.9 All non-smokers had a cotinine:creatine ratio (COT:CR) < 1.5 jug/mg. The smoking group was subdivided into 29 'light' smokers (COT:CR<7 ug/mg) and 24 'heavy' smokers (COT:CR> 7 p,g/mg).Six years later, the two groups of patients were followed-up. Background retinopathy was defined as microaneurysms, haemorrhages or hard exudates in one or both eyes; proliferative retinopathy by the presence of soft exudates (cotton wool spots), active neovascularisation, or previous photocoagulation therapy. Nephropathy was identified by the measurement of urinary albumin excretion (Beckman rate nephelometric analyser) in at least two early morning urine specimens over a six-month period. A timed overnight urine sample confirmed the presence of microalbuminuria (urinary albumin excretion rate of 20-200 pig/min). Macroproteinuria (albustix positive) was confirmed by a 24 h urinary protein excretion of > 500 mg. Results are given as mean (SD) o...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.