Abstract Objective An organized cervical cancer (CC) screening program was introduced in Slovenia in 2003. With the purpose of clinical audit we analyzed the clinicopathological characteristics of CC ...patients for the period between 2003 and 2005. Study design The retrospectively collected data of 450 CC patients were presented at three Advisory Boards of Gynecologic Oncology in Slovenia. They were stratified for stage, tumor characteristics and treatment methods according to gynecologic examination attendance in the last 5 years preceding the diagnosis of CC (attenders vs. nonattenders). Results In the period of observation, 242 women (53.8%) visited their gynecologists in the 5-year period prior to diagnosis of CC. Squamous cell carcinoma was present in 378 women (84.0%), adenocarcinoma in 45 (10.0%), adenosquamous carcinoma in 24 (5.3%) and other types in 3 women (0.7%). Attenders were significantly more frequently diagnosed with squamous cell carcinoma than nonattenders (chi-square = 5.13; P < 0.05). Attenders were significantly more frequently diagnosed in stage IA than in stage IB (chi-square = 22.35; P < 0.01). Similarly, in attenders stage I was significantly more frequent than stage II (chi-square = 18.81; P < 0.01). Pathologic smears of women with CC in the last 5-year period were most frequently evaluated as Pap II in the years 2003 and 2004 (in 39.1 and 26.4% of women, respectively) and as Pap III (in 27.9% of women) in 2005. Surgery was performed in 282 women (62.7%), radiotherapy in 158 (35.1%), symptomatic therapy in 9 (2.0%) and chemotherapy alone in 1 (0.2%) woman. In attenders, surgery alone was the most frequent treatment method (chi-square = 91.18; P < 0.01). Conclusion Only in attenders a significant redistribution of CC stages in favor of early stages is observed, and in these women more conservative and less extensive treatment methods could be applied.
HPV AND CERVICAL CANCER PREVENTION Marjetka Uršič-Vrščaj; Milan Bašković; Sonja Bebar ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Letnik:
78
Journal Article
Recenzirano
Odprti dostop
Background: The causal role of human papilloma virus (HPV) in all cancers of the uterine cervix has been firmly established biologically and epidemiologically. HPV types 16 and 18 account for about ...70 % of the cases worldwide. HPV has been recognized as a necessary cause of cervical cancer, meaning that in the absence of the persistent presence of HPV DNA in the cervical cells, cervical cancer will not occur. Thus preventive strategies based on HPV testing in screening programmes or HPV type-specific vaccination are based on solid ground. Most cancers of the vagina and anus are likewise caused by HPV 16, as are a siteable fraction of cancers of the vulva, the penis and the oropharynx. Cervical cancer screening can be a highly effective secondary intervention. In the developing countries these programmes are either not available or are ineffective. HPV vaccination represents the most effective intervention in that scenario. Prophylactic vaccination with human papillomavirus (HPV) virus-like particle (VPL) vaccines against HPV 16 and HPV 18, has transformed our prospects for reducing the in- cidence of cervical cancer on global scale. HPV vaccines are immunogenic, well tolerated and show remarkable efficacy. Screening will have to continue, as two of the 15 oncogenic HPV types are in the vaccines and for two to three decades at least unvaccinated sexually active women still remain at risk for the disease. Conclusions: If vaccination, screening and HPV testing are combined then the virtual elimination of cervical cancer is possible.
Okužbe s humanimi virusi papiloma (HPV) so zelo pogoste spolno prenosljive bolezni, ki se značilno pojavijo kmalu po začetku spolne dejavnosti. Breme z njimi povezanih bolezni, rakavih in nerakavih, ...je veliko za ženske in moške. HPV, ki prinašajo veliko tveganje, visokotvegani ali onkogeni HPV pri ženskah povzročajo raka materničnega vratu, nožnice in zunanjega spolovila, pri moških pa raka penisa ter pomemben delež raka žrela in raka zadnjika pri ženskah in moških. Pred nekaj leti sta bili izdelani cepivi, ki preprečujeta okužbo z 2 genotipoma, ki povzročata raka (HPV 16 in 18). Pri neokuženih osebah v približno 95 % učinkovito preprečujeta bolezni, ki jih povzročata oba genotipa, ne zdravita pa okužbe. Profilaktični cepivi sta prvi, ki so ju naredili, da bi pri človeku preprečevali raka.
AimsTo investigate the presumed influence of hormone replacement therapy (HRT) on the progression of and death due to breast cancer.MethodsIn order to make a detailed analysis, we selected a group of ...21 patients with the diagnosis of invasive breast cancer who had HRT after primary surgical treatment. Each patient from the selected group was compared with two patients from the control group with the diagnosis of invasive breast cancer who did not have HRT after primary surgical treatment. The control cases were matched to selected HRT patients with regard to age at time of the diagnosis, year of diagnosis, diameter of the tumour, metastatic spread in the axillary lymph nodes, and disease-free interval until applying HRT. The same criteria were applied in all analyses. The data were analysed by odds ratio (OR) calculation with a confidence interval of 95%, taking into account residual malignancy and death due to breast cancer in both groups (including carcinoma in the contralateral breast).ResultsHRT was applied in 21 patients treated for breast cancer. In 33% of them, radical mastectomy revealed metastases in the axillary lymph nodes. Hormone receptors could not be found in 57% of patients. In the majority of patients the tumour measured 17.6 mm in diameter. HRT was started on average 62 months (range 1–180 months) after diagnosis, and lasted an average of 28 months (range 3–72 months). All 21 patients used oestradiol as HRT, i.e. a non-conjugated oestrogen. Combined hormonal therapy (oestrogens + progestagens) was given to 95% of patients with median age of 47 years (range 41–59 years) at the beginning of HRT. Relapse was observed in four patients (19%) of the HRT group; of these, one had a carcinoma of the contralateral breast. In the control group, relapse was observed in five patients (11%); one of these five patients had a carcinoma of the contralateral breast. In the HRT group, there were no deaths among the patients with confirmed relapse, while one patient died in the control group. The estimated risk (OR=1.74, 95% CI 0.34–8.88) of relapse of breast cancer was calculated by comparing data from HRT users, who had received HRT for 28 months (range 3–72 months) on average, with data from the control group. The estimated risk of breast cancer relapse in HRT users who had been receiving HRT for less than 24 months was 0.65 (OR=0.65, 95% CI 0.02–7.85).ConclusionDespite the inherent limitations of retrospective data and the need for prospective randomized trials to assess the possible influence of HRT on progression after breast cancer treatment, the present observations suggest that HRT treatment for less than 24 months does not appear to have a pronounced adverse effect on cancer outcome. Nevertheless, until appropriate clinical trials determine that HRT is safe, caution is needed.
