Cervical Cancer

Anal cancer accounts for 1.5% of digestive system malignancies inthe United States. In the past 30 years, substantial progress has beenmade in understanding the pathophysiology and treatment of thedisease. Anal cancer was once believed to be caused by chronic localinflammation of the perianal area, and treatment was abdominoperinealresection. From epidemiologic and clinical studies, we nowknow that the development of anal cancer is associated with humanpapillomavirus infection and that the disease has a pathophysiologysimilar to that of cervical cancer. Less invasive treatments have alsobeen developed, and the majority of patients with anal cancer can nowbe cured with preservation of the anal sphincter using concurrentexternal-beam radiation therapy and fluorouracil (5-FU)/mitomycin(Mutamycin) chemotherapy. Current areas under investigation includethe incorporation of platinum agents into the chemotherapyregimen and the use of cytologic screening studies for high-riskpopulations.

NEW ORLEANS-In women with locally advanced cervical cancer, smoking is an independent risk factor for a significantly worse outcome, a new study from the Gynecologic Oncology Group (GOG) has shown.

ROCKVILLE, Maryland-Physicians can discontinue cervical cancer screening for many women age 65 and older, and delay screening for some young women until age 21, according to new guidelines developed by the US Preventive Services Task Force (USPSTF).

During 1973–1999, both the incidenceof and death rates forcervical cancer decreased byapproximately 50% in the UnitedStates. For 2002, approximately13,000 new cases of invasive cervicalcancer are expected, and approximately4,100 women will die of the disease.Although invasive cervical cancer canbe prevented by regular screening, theprevalence of Pap testing remains relativelylow among minority populationssuch as Hispanic women.

NEW ORLEANS-In the treatment of locoregionally advanced cervical cancer, the addition of cisplatin (Platinol)-containing chemotherapy to a radiation therapy regimen significantly improves overall and disease-free survival, according to RTOG 90-01. Patricia J. Eifel, MD, of the Department of Radiation Oncology, M.D. Anderson Cancer Center, presented the data at the American Society for Therapeutic Radiology and Oncology plenary session (abstract plenary 1).

Over the past few decades, we have gained a better understanding of the risk factors associated with the recurrence of endometrial cancer. Adjuvant postoperative radiotherapy in an intermediate-risk group of

In their review, Drs. Kim, Alvarez, and Omura have outlined a diverse group of clinical trials in a very limited space. Their summary highlights some of the most important insights gained from these trials, placing particular emphasis on the role and perspective of the Gynecologic Oncology Group (GOG). Although their review appropriately divides these studies into three major groups (early cervical cancer, locally advanced cervical cancer, and vulvar cancer), the results also reveal common themes that can be used to guide the overall management of women with carcinomas of the female lower genital tract.

Two things become apparent to the reader of this excellent article. First, the National Cancer Institute clearly had great foresight in 1970, when they began funding the Gynecologic Oncology Group (GOG) so that phase I, II, and III trials could be conducted in a systematic manner. Second, the authors have written a thorough review of over 3 decades of research into the biology and clinical aspects of cervical and vulvar cancer. In this short space, it would be impossible to adequately comment on the 50 studies reviewed by the authors. However, based on these studies, I would posit the rationale for a paradigm shift in the staging of cervical cancer, and would add (to paraphase Mark Twain), "the report of the complete demise of hydroxyurea as a radiation sensitizer may be an exaggeration."

Two recent multicenter randomized trials have greatly advanced our understanding of the role of postoperative radiation therapy in operable cervical cancer. In locally advanced cervical cancer, such studies have shown a

Handbook of Gynecologic Oncology, edited by Drs. Barakat, Bevers, Gershenson, and Hoskins, is a first-edition clinical handbook formulated primarily for fellows in gynecologic oncology as well as for interested fellows in medical oncology and radiation oncology. The textbook presents concise summaries of the critical issues in the care of gynecologic cancer patients and would also be of interest to residents preparing for their gynecologic oncology rotations, obstetrician/gynecologists, other physicians who care for gynecologic cancer patients, and practicing gynecologic oncologists.

New clinical practice guidelines, published in a recent issue of the Journal of the American Medical Association (287:2120-2129, 2002), recommend that women who receive borderline Papanicolaou (Pap) test results designated as atypical squamous cells of undetermined significance (ASCUS)-a finding in more than 2 million American women each year-undergo testing for human papillomavirus (HPV). In clinical studies, HPV has been shown to be the primary causal factor in the development of cervical cancer.

Topoisomerase inhibitors have been widely studied for the treatment of refractory or recurrent cervical cancer. Various schedules have been used, with response rates ranging from 13% to 20%. The combination of cisplatin and irinotecan (CPT-11, Camptosar) is being studied in cervical cancer.

Despite a tight proposed domestic budget for fiscal 2003, President Bush wants to increase spending on the National Breast and Cervical Cancer Early Detection Program administered by the Centers for Disease Control and Prevention (CDC).

The association between HIV infection and the development of cancer was noted early in the acquired immunodeficiency syndrome (AIDS) epidemic. The AIDS-defining malignancies are Kaposi’s sarcoma, intermediate- or high-grade B-cell non-Hodgkin’s lymphoma (NHL), and cervical cancer. All of these cancers feature specific infectious agents in their etiology. These agents are human herpesvirus 8/Kaposi’s sarcoma-associated herpesvirus, or HHV-8/KSHV (implicated in Kaposi’s sarcoma), Epstein-Barr virus, or EBV (in primary central nervous system lymphoma and a subset of systemic B-cell NHL) and human papillomavirus, or HPV (in cervical cancer).[1]

Fenretinide (N-4-hydroxyphenyl-retinamide, or 4-HPR) is a semisynthetic retinoid that was initially developed as a low-dose chemopreventative agent.[1-3] Unlike other naturally occurring retinoids such as all-trans, 13-cis, and 9-cis retinoic acids, fenretinide does not induce systemic catabolism that interferes with the maintenance of effective plasma levels during long-term use. This characteristic, combined with the agent’s low toxicity and its ability to block aspects of carcinogenesis, provided the rationale for the development of fenretinide in lower doses as a chemoprevention agent for breast, prostate, and bladder cancer.

WASHINGTON-Health and Human Services Secretary Tommy Thompson has given nine more states the go-ahead to extend Medicaid benefits to uninsured women diagnosed with cancer under the federal Breast and Cervical Cancer Prevention and Treatment Act of 2000.

HOUSTON, Texas-Irinotecan (Camptosar) is active in platinum-refractory cervical cancer and should be tested with cisplatin (Platinol) in randomized trials, declared Claire F. Verschraegen, MD. The use of irinotecan might enable clinicians in developing countries (where radiotherapy equipment is in short supply) to downsize many cervical cancers to resectable size, Dr. Verschraegen added. She is assistant professor in the Division of Cancer Medicine Section of Gynecologic and Medical Therapeutics at the University of Texas M. D. Anderson Cancer Center in Houston, Texas.

CHICAGO-Cisplatin-based chemoradiotherapy has greater efficacy than previous regimens in treating cervical cancer, but toxicity needs to be reduced, stated William Small, Jr., MD. He is assistant professor of radiology, Division of Radiation Oncology, at Northwestern University’s Robert H. Lurie Comprehensive Cancer Center in Chicago.

WASHINGTON-Three states have won approval of their plans to expand Medicaid benefits to uninsured women diagnosed through the National Breast and Cervical Cancer Early Detection Program, administered by the Centers for Disease Control and Prevention. Maryland, New Hampshire, and West Virginia were approved by the Department of Health and Human Services under the Breast and Cervical Cancer and Prevention and Treatment Act (BCCPT), which Congress enacted last year.

The aging of the population is a social phenomenon that will present a challenge to clinical practice in the 21st century. Women constitute a majority of the elderly population as they outlive males by 5 to 7 years. Ovarian,

Declines in cervical cancer incidence and mortality reported in the United States since the 1950s have been attributed to early detection and treatment of precancerous and cancerous lesions through the use of the Pap test. More than 50 million

WASHINGTON-A new analysis of data from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) shows that among women who received their first NBCCEDP Pap test between 1991 and 1998, American Indian and Alaskan Native (AI/AN) women had the highest proportion of abnormal Pap tests, while white women had the highest rate of serious cervical lesions detected by biopsy.

Congress finally passed a bill (H.R. 4386/S. 662) that allows states to provide medical treatment for women with breast and cervical cancer. At their option (there is no requirement), states can treat women who have tested positive in a screening

WASHINGTON-President Clinton has signed the Breast and Cervical Cancer Prevention and Treatment Act of 2000 into law. The Act provides $990 million over 10 years to expand the treatment options for uninsured, low-income women diagnosed with breast or cervical cancer in a nationwide program run by the Centers for Disease Control and Prevention (CDC).

Although the causes and natural histories of breast and cervical cancer are different, the public health responses to these diseases have been similar. Early detection of breast cancer and primary prevention of cervical cancer are possible through community-based screening programs; however, early detection of both breast and cervical cancer is less common among low-income women (defined as up to 250% of poverty level, depending on family size). This report presents morbidity and mortality data regarding breast and cervical cancer, screening recommendations, an update on the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), and recommended priority activities for the NBCCEDP. The NBCCEDP is a major public health effort to increase breast and cervical cancer screening among uninsured, low-income women.

WASHINGTON-More than 2.5 million mammograms and Papanicolaou tests were provided to women in the first 9 years of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), managed by the Centers for Disease Control and Prevention (CDC). The total includes 1,157,207 mammograms and 1,353,684 Pap tests administered from 1991 through September 1999.

The premise that early diagnosis of certain types of malignancies improves outcome and survival is a cornerstone of modern medicine. Routine use of the Pap smear has been associated with reduced mortality from cervical cancer. Randomized trials

Politics may have a little something to do with nearing congressional passage of a bill (S. 662/H.R. 1070) that would allow states to provide medical treatment via Medicaid for low-income women who have been diagnosed with breast or cervical cancer through the CDC’s National Breast and Cervical Cancer Early Detection Program. In the decade that the program has existed, about 1 to 1.5 million women have been screened, with 6,000 cases of breast cancer and 500 of cervical cancer being found. But once diagnosed, these women, whose incomes are too high for Medicaid and who do not have personal health insurance, have to search for “donated” medical care. The Senate bill, originally sponsored by now-deceased Sen. John Chafee, passed the Senate Finance Committee at the end of June. It now goes to the floor, where passage seems assured. The House bill, which passed in May, is sponsored by Rep. Rick Lazio (R-NY), now knee-deep in a high-profile New York Senate race with Hillary Clinton. House Republicans are eager to give Lazio something to talk about. The cost of the measure will be about $50 million a year to the federal government, which contributes about $3 for each $1 that states contribute to the Medicaid pot. Nonetheless, the Senate Finance Committee was concerned enough about a potential precedent to include in its report a sentence saying that this benefit “shall not be viewed as a precedent for extending Medicaid eligibility body-part by body-part.”

NEW YORK-A randomized trial enrolling 150,000 women and funded by the US National Cancer Institute is underway in India to screen for breast and cervical cancer using simple methods.

Patients with locally advanced cervical cancer comprise a significant proportion of the total population with cervical cancer, particularly in developing countries. The inability to control pelvic tumors is still a significant