The overall acceptability of self-sampled cervical screening, coupled with economic and effective care, provides opportunities for expanding screening services. Importantly, this can provide a creative screening alternative for women who do not participate in traditional cytological screening, and may ultimately reduce health disparities and prevent cervical disease.

Objective-Vulvodynia is a chronic pain syndrome of unknown etiology with scant data on frequency. This study assessed the prevalence of vulvodynia symptoms in a sample of U.S. women and compared health characteristics of symptomatic and asymptomatic women.Study Design-A phone survey contacted 2,127 U.S. households to identify 100 symptomatic women, who were matched on age and time-zone to 325 asymptomatic controls. Odds ratios and logistic regression were used to model associations between pain, medical conditions, and healthcare utilization variables.Results-Current vulvar pain of at least 6 months duration was reported by 3.8% of respondents, with a 9.9% lifetime prevalence. Forty-five percent of women with pain reported an adverse effect on their sexual life and 27% an adverse effect on their life style. Cases more frequently reported repeated urinary tract infections (OR, 6.15; 95% CI,) and yeast infections (OR, 4.24; 95% CI,). Associations existed with chronic fatigue syndrome (OR, 2.78; 95% CI, 1.33-6.19), fibromyalgia (OR, 2.15; 95% CI, 1.06-4.36), depression (OR, 2.99; 95% CI,, and irritable bowel syndrome (OR, 1.86; 95% CI,).Conclusions-Lifetime chronic vulvar pain was less prevalent in this national sample of women than previous data suggest and was correlated with several co-morbid chronic medical conditions and substantial reduction in self-reported quality of life.

Between 2001–2005, U.S. Blacks experienced a 32% higher pancreatic cancer death rate than Whites. Smoking, diabetes, and family history may explain some of this disparity, but prospective analyses are warranted. From 1984–2004, there were 6,243 pancreatic cancer deaths among Blacks (n=48,252) and Whites (n=1,011,864) in the Cancer Prevention Study II cohort. Multivariate Cox proportional hazards models yielded hazards ratios for known and suspected risk factors. Population attributable risks were computed and their impact on age-standardized mortality rates evaluated. Blacks in this cohort had a 42% increased risk of pancreatic cancer mortality compared to Whites (HR=1.42; 95% CI 1.28 to 1.58). Current smoking increased risk by >60% in both races; although Blacks smoked less intensely, risks were similar to Whites (HRBlack=1.67, 95% CI 1.28 to 2.18; HRWhite=1.82, 95%CI 1.7 to 1.95). Obesity was significantly associated with pancreatic cancer mortality in Black men (HR=1.66, 95% CI 1.05 to 2.63), White men (HR=1.42; 95% CI 1.25 to 1.60) and White women (HR=1.37; 95% CI 1.22 to 1.54); results were null in Black women. The PAR due to smoking, family history, diabetes, cholecystectomy, and overweight/obesity was 24.3% in Whites and 21.8% in Blacks. Smoking and overweight/obesity play a substantial a role in pancreatic cancer. Variation in the impact of these factors underscores the need to evaluate disease on the race-sex level. The inability to attribute excess disease in Blacks to currently known risk factors, even when combined with suspected risks, points to yet undetermined factors that play a role in the disease process.

Colorectal cancer (CRC) is a leading cause of cancer-related death in the United States. Despite evidence that screening reduces CRC incidence and mortality, only about 60% of age-eligible adults are up-to-date on CRC screening. This analysis aims to identify self-reported barriers to CRC screening among patients in a safety-net healthcare setting. Participants were recruited from safety-net primary care sites that were participating in a trial to increase CRC screening. At baseline, patients (n = 483) completed self-report surveys that assessed demographics, healthcare and CRC screening. Barriers to CRC screening were assessed through an open-ended question. Using a basic text analysis, data were coded and organized into key topics. Overall, 65.2% ever had CRC screening; 46.4% were up-to-date. Of those who described barriers (n = 198), 22.9% said they were not due for screening or their provider had not recommended it. Other common barriers included fear or worry about the procedure or outcome, financial challenges such as lack of insurance or cost of testing, and logistic challenges such as transportation and time. Fewer said that screening was of low importance or mentioned discomfort with the procedure or colonoscopy preparation. In this safety-net setting, CRC screening rates were lower than national rates. These qualitative results are similar to quantitative findings reported in the literature but the qualitative data add to our understanding of patient-reported concerns and challenges faced by safety-net patients. These results may be applied to developing targeting communication or intervention strategies to improve CRC screening rates within safety-net health centers.

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