Aims
To examine the utility of the health belief model (HBM) and other socioeconomic factors in shaping cervical screening behaviors. Also, to provide recommendations on improving screening uptake.
...Methodology
A systematic literature search was conducted using the PubMed/MEDLINE, Cochrane/CENTRAL, and Web of Science databases for articles reporting on the factors associated with cervical screening using the HBM within the period from January of 2002 to January of 2023. Effect sizes for the various HBM constructs were pre‐determined using the log odds ratio (logOR) and expressed with their confidence intervals. All reporting was in line with the PRISMA guidelines.
Results
A total of 21 studies were included in the final analysis comprised of 15,365 participants. Our pooled analysis demonstrated that perceived susceptibility (OR: 1.40, 95% CI, 1.03–1.89), perceived benefits (OR: 1.30; 95% CI, 1.13–1.50), and self‐efficacy (OR: 1.11; 95% CI, 1.05–1.17) were significantly associated with both the uptake of and intention to adopt preventive measures against cervical cancer. Conversely, women with higher perceptions of barriers were less likely to adopt any measure for cervical cancer screening or prevention (OR: 0.72; 95% CI, 0.57–0.91). In terms of sociodemographic effectors, older age (OR: 1.09; 95% CI, 1.01–1.19), graduate/post‐graduate education (OR: 2.80; 95% CI, 1.46–5.37), higher knowledge of cervical cancer (OR: 2.21; 95% CI, 1.27–3.84), and being married (OR: 3.89; 95% CI, 1.38–10.92) were all associated with altering preventive behaviors and intentions toward cervical cancer.
Conclusion
This review delineates the most important and effective cognitive components that should be targeted within interventions aiming to promote cervical cancer prevention.
We investigated if female survival advantage trends in cancer are consistent within Jordanian patients with cancer across different age groups and nonsex specific cancer types. We explored the King ...Hussein Cancer Center registry for primary malignant tumors from 2006 to 2019. The registry (n = 16 454) was stratified into three groups based on age: children (<15 years), adolescents and young adults (AYA) (modified; 15‐49 years), and older adults (≥50 years). Kaplan‐Meier analysis was used to estimate the 5‐year all‐site cancer‐specific survival probabilities, which were compared using the log‐rank test by sex and age group. Out of 16 454 eligible records, 2286 (13.9%) were children, 5975 (36.3%) were AYAs, and 8193 (49.8%) were older adults. Males outnumbered females 10 339 (62.8%) to 6115 (37.2%). The 5‐year OS rates were 74.0% (71.6%‐76.4%) and 72.7% (69.9%‐75.5%) for pediatric males and females, respectively, 57.3% (55.6%‐59.0%) and 64.5% (62.6%‐66.4%) for male and female AYAs, respectively, and 37.5% (36.2%‐38.9%) and 44.2% (42.3%‐46.2%) for older adult males and females, respectively. Females demonstrated significantly better overall survival in the AYA and older adults' groups. In conclusion, females exhibit a survival advantage in terms of nonsex specific cancers. This advantage peaks at the AYA age stratum and mitigates thereafter. Further studies are warranted to examine the etiological factors behind such discrepancy on a site‐by‐site basis so that sex‐specific interventions can be designed and validated.
What's new?
Many global and population‐based studies have demonstrated a female advantage in terms of cancer incidence and survival in a broad range of nonsex specific cancers. This single‐centre study shows that females also have a significant advantage in terms of nonsex specific cancer survival in Jordan, a rapidly growing developing country. Moreover, the study found that this advantage was at its highest among adolescents and young adults, decreasing in older age groups. These findings point to the need to design and validate sex‐specific interventions for both cancer prevention and treatment in Jordan and elsewhere.
Aims
To report novel observations in five mesonephric‐like adenocarcinomas (MLAs) of the female genital tract.
Methods and results
We report two endometrial MLAs in association with endometrioid ...carcinoma and atypical hyperplasia and three (one endometrial, two ovarian) cases with a sarcomatoid component (mesonephric‐like carcinosarcoma). Pathogenic KRAS mutations, which are characteristic of MLA, were identified in all cases although interestingly, in one of the mixed carcinomas, this was confined to the endometrioid component. The concurrent MLA, endometrioid carcinoma and atypical hyperplasia components in one case harboured identical EGFR, PTEN and CCNE1 mutations, suggesting that the atypical hyperplasia gave rise to a Müllerian carcinoma with both endometrioid and mesonephric‐like components. The carcinosarcomas all contained a component of MLA and a sarcomatous component with chondroid elements. In the ovarian carcinosarcomas, the coexisting epithelial and sarcomatous components shared some mutations including KRAS and CREBBP, suggesting that they are clonally related. Furthermore, in one case CREBBP and KRAS mutations detected in the MLA and sarcomatous components were also detected in an associated undifferentiated carcinoma component, suggesting that it was clonally related to the MLA and sarcomatous components.
Conclusions
Our observations provide additional evidence that MLAs have a Müllerian origin and characterise mesonephric‐like carcinosarcomas in which chondroid elements appear to be characteristic. In reporting these findings, we provide recommendations for distinction between a mesonephric‐like carcinosarcoma and a MLA with a spindle cell component.
Report of novel observations in mesonephric‐like adenocarcinomas and mesonephric‐like carcinosarcomas of the female genital tract.
Background
Pediatric intracranial germ cell tumors (iGCT) are rare, with limited data available from Arabic countries.
Methods
We retrospectively reviewed the medical charts of children <18 years ...diagnosed with iGCT at King Hussein Cancer Center/Jordan (January 2003 to December 2020) for clinical characteristics, treatment, and morbidities.
Results
Sixteen patients had germinoma; median age was 6.9 years and median symptoms duration 8 months. Nine tumors were suprasellar, five pineal, and two bifocal. Four were metastatic. Eight patients had slightly elevated beta subunit human chorionic gonadotropin and 11 patients had resection/biopsy. Fifteen patients received chemotherapy; mostly carboplatin (450 mg/m2)/etoposide, which had low toxicity. All patients received radiotherapy (different doses and fields). At median follow‐up of 7.7 years, one tumor recurred (progression‐free survival: 91% ± 8%). Twelve patients who continued follow‐up had stable visual and endocrine deficits to their initial presentation. Five finished or are finishing diploma and seven had poor school performance (four left school). Six patients were diagnosed with nongerminomatous germ cell tumor; median symptom duration was 1 month. Three tumors were pineal, two suprasellar, and one at quadrigeminal plate. Three were metastatic. Five tested patients had high tumor markers and four had resection/biopsy. All patients received chemotherapy, and then five received craniospinal radiation. Two patients are alive, two died with tumor progression, one died in remission with electrolyte imbalance, and one developed leukemia and died with septic shock.
Conclusions
We achieved excellent survival in treating germinoma using a feasible protocol for low middle‐income countries. However, patients encountered significant morbidities exacerbated by delayed diagnosis and unnecessary surgical interventions despite abnormal tumor markers. Raising awareness on iGCT symptomatology and diagnosis may help limit these morbidities.
Celebrities' health decisions have long been associated with heightened awareness and health trend changes. This is the first study conducted in an Arab population investigating the impact of ...international celebrity news on local communities using the case of Angelia Jolie's (AJ) prophylactic mastectomy and oophorectomy surgeries. The objective was to measure the effect of publicized medical information on cancer genetic testing knowledge, attitudes, and practices (KAP). This is a cross‐sectional study using a semi‐structured, self‐administered questionnaire for clinic visitors at the King Hussein Cancer Center (KHCC). We had predominantly female (n = 262, 66.3%) and healthy participants (n = 248, 66.5%). Approximately 80.7% (n = 330) recognized AJ, the actress, and of these, 71% (n = 232) were aware of her recent diagnosis and prophylactic surgeries. Males reported a higher knowledge score (p < .001). However, females had more initiative to seek information (18.3% vs. 10.1%; p = .04). People aware of Angelina's prophylactic procedures were inclined to seek information regarding cancer genetics (20.8% vs. 9.6% p = .003). Breast and ovarian cancer patients were more likely than other cancer patients to encourage family members to undergo prophylactic surgery in case of BRCA1/2 mutations (39.2% vs. 17.1% p = .03). Ninety‐three percent of the sample lacked knowledge regarding the availability of cancer genetic testing in Jordan. Results highlight a clear effect of celebrity medical news on our population, as well as openness to consider genetic testing as an early detection tool for women with a family history of breast and/or ovarian cancer. Generalization of these results to the population of Jordan requires further studies.
Atypical teratoid/rhabdoid tumor (AT/RT) is a rare tumor of the CNS mostly seen in infants and is often associated with a dismal outcome. Despite the heterogeneous morphology and/or immunoprofile, ...its diagnosis nowadays relies on the negative INI‐1/BAF47 nuclear immunostain in tumor cells. We aim to investigate a number of immunohistochemical antibodies as potential diagnostic and prognostic markers. All AT/RT cases in patients younger than 18 years of age were included. Demographics, clinical features and outcome were collected. Immunostains tested included SALL‐4, OCT3/4, CD99, FLI‐1, cyclin‐D1, β‐catenin, P53, P16, CDX2 and WT‐1. Nineteen cases (10 males) were identified at our center between 2004‐2013 with a median age of 24 months. Ten (52.6%) cases were supratentorial. Six (42.9%) cases showed metastasis at time of presentation. Chemotherapy was administered to 10 (62.5%) and radiotherapy to seven (43.8%). The median overall survival was 11 months. A single long‐term survival of 104 months was identified. Pathologically, most cases showed an admixture of rhabdoid cells and/or small cells and/or pale cells in variable proportions. Of all tested antibodies, only positivity for FLI‐1 was associated with improved survival (P = 0.0012), while positivity for cyclin‐D1 showed a trend toward improved survival (P = 0.0547). CDX2 was positive only in the single long‐term survival. Interestingly, two cases showed co‐expression of CD99 and FLI‐1, and some were positive for SALL‐4. In conclusion, FLI‐1 and cyclin‐D1 are potential prognostic markers associated with better outcome. Occasional AT/RT cases might co‐express CD99 and FLI‐1 as well as SALL‐4, a potential diagnostic pitfall with Ewing sarcoma/ primitive neuroectodermal tumors and germ cell tumors, respectively.
This scoping review examines controllable predisposing factors attributable to cancer in the Middle East and North Africa (MENA) region's adult population, highlighting opportunities to enhance ...cancer prevention programs.
We systematically searched the PubMed, Science Direct, and CINAHL, EMBASE, and Cochrane Library databases from 1997 to 2022 for articles reporting on the impact of modifiable risk factors on adult patients with cancer in the MENA region.
The review identified 42 relevant articles, revealing that tobacco consumption, obesity, physical inactivity, and diet are significant modifiable risk factors for cancer in the region. Tobacco smoking is a leading cause of lung, bladder, squamous cell carcinoma, and colorectal cancer. A shift towards a westernized, calorie-dense diet has been observed, with some evidence suggesting that a Mediterranean diet may be protective against cancer. Obesity is a known risk factor for cancer, particularly breast malignancy, but further research is needed to determine its impact in the MENA region. Physical inactivity has been linked to colorectal cancer, but more studies are required to establish this relationship conclusively. Alcohol consumption, infections, and exposure to environmental carcinogens are additional risk factors, although the literature on these topics is limited.
The review emphasizes the need for further research and the development of targeted cancer prevention strategies in the MENA region.
Biallelic mismatch repair deficiency (bMMRD) is a cancer predisposition syndrome affecting primarily individuals from consanguinous families resulting in multiple childhood cancers including high ...grade gliomas (HGG). This is the first study to assess the prevalence of bMMRD among patients with HGG in countries where consanguinity is high. We collected molecular and clinical information on all children diagnosed with HGG and supratentorial primitive neuroectodermal tumors (sPNET) between 2003 and 2013 at King Hussein Cancer Center, Jordan. Comparison was made to a similar cohort from Toronto. Clinical data regarding presence of café au lait macules(CAL), family history of cancer, consanguinity, pathology and treatment were collected. Tumors were centrally reviewed and tested for MMRD by immunohistochemistry of the corresponding proteins. Forty‐two patients fulfilled the inclusion criteria, including 36 with HGG. MMRD was observed in 39% of HGG of whom79% also lost MMR staining in the corresponding normal cells suggestive of bMMRD. P53 dysfunction was highly enriched in MMR deficient tumors (p = 0.0003).The frequency of MMRD was significantly lower in Toronto cohort (23%, p = 0.03). Both evidence of CAL and consanguinity correlated with bMMRD (p = 0.005 and 0.05,respectively) but family history of cancer didn't. HGG with all three bMMRD risk factors had evidence of MMRD and all children affected by multiple bMMRD related cancers had identical gene loss by immunohistochemical staining. In Jordan, the frequency of clinical and immunohistochemical alterations suggestive of bMMRD in pediatric HGG is high. Genetic testing will enable appropriate counseling and cancer screening to improve survival of these patients.
What's new?
Homozygous germline mutations in mismatch repair (MMR) genes can result in biallelic MMR deficiency (bMMRD), a devastating childhood cancer syndrome frequently associated with consanguinity. This study suggests that in Jordan, where consanguinity is common, the prevalence of MMR dysfunction among pediatric patients with high grade glioma (HGG) may be alarmingly high. In the Jordan cohort, bMMRD occurrence was correlated with consanguinity and presence of café au lait macules. Because bMMRD‐related HGGs do not respond to conventional treatment regimens and additional tumor development is common, accurate diagnosis is essential. The findings presented here emphasize the importance of genetic testing.
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