WOMEN´s CANCER - Women's Health Highlights: Recent Findings (continued)

Women's Health Highlights: Recent Findings
Cervical Cancer
•Many young women have not received the HPV vaccine.
This survey found that more than 60 percent of 1,011 young women aged 13 to 26 years knew about Gardasil®, the vaccine against human pappiloma virus (HPV) that causes cervical cancer. However, only 30 percent of those aged 13 to 17 and 9 percent of those aged 18-26 had received the vaccine. Because the vaccine is most beneficial when given before young women become sexually active, the authors urge practitioners and parents to step up efforts to educate young women about the importance of receiving the vaccine early. Caskey, Lindau, and Alexander, J Adolesc Health 45(5):453-462, 2009 (AHRQ grant HS15699).

•Less than 25 percent of physicians report guideline-consistent recommendations for cervical cancer screening.
Researchers used a large, nationally representative sample of primary care physicians to identify current Pap test screening practices in 2006-2007. They used clinical vignettes to describe women by age and sexual and screening history to elicit physicians' recommendations. Guideline-consistent recommendations varied by physician specialty: obstetrics/gynecology 16.4 percent, internal medicine 27.5 percent, and family/general practice 21.1 percent. Yabroff, Saraiya, Mesisner, et al., Ann Intern Med 151(9):602-611, 2009 (AHRQ grant HS10565).

•A majority of older women think lifelong cervical cancer screening is important.
Researchers conducted face-to-face interviews with 199 women aged 65 and older to determine their views about continuing to receive Pap tests to screen for cervical cancer. Most of the women were minorities, and about 45 percent were Asian. Despite recent changes in clinical recommendations to stop Pap screening in women older than 65, more than two thirds of the women in this study felt that lifelong screening was either important or very important. Most of the women (77 percent) planned on being screened for the rest of their lives. Sawaya, Iwaoka-Scott, Kim, et al., Am J Obstet Gynecol 200(1):40.e1-40.e7, 2009. See also Huang, Perez-Stable, Kim, et al., J Gen Intern Med 23(9):1324-1329, 2008 (AHRQ grant HS10856).

•Instituting new processes can reduce diagnostic errors in Pap smear interpretation.
Lean methods are used to weigh the expenditure of resources against value received. For this study, researchers compared the diagnostic accuracy of Pap tests procured by five clinicians before (5,384 controls) and after (5,442 cases) implementing a process redesign using Lean methods. Following process redesign, there was a significant improvement in Pap smear quality, and the case group showed a 114 percent increase in newly detected cervical intraepithelial cancer following a previous benign Pap test. Raab, Andrew-Jaja, Grzybicki, et al, J Low Genit Tract Dis 12(2):103-110, 2008 (AHRQ grant HS13321).

Ovarian Cancer
•Study finds racial disparities in receipt of chemotherapy after ovarian cancer surgery.
Researchers examined 11 years of data for 4,264 women aged 65 or older who were diagnosed with stage IC-IV ovarian cancer (cancer in one or both ovaries with early signs of spreading) to examine receipt of chemotherapy, which is recommended following surgery to remove the cancer. They found that just over 50 percent of black women received chemotherapy following surgery, compared with nearly 65 percent of white women; survival rates did not differ between the two groups of women, but women in the lowest socioeconomic group were more likely to die than those in the highest group. Du, Sun, Milam, et al., Int J Gynecol Cancer 18(4):660-669, 2008 (AHRQ grant HS16743).

•One type of chemotherapy for ovarian cancer carries an elevated risk for hospitalization.
Researchers studied 9,361 women aged 65 and older who were diagnosed with stage IC to IV ovarian cancer between 1991 and 2002. Of the 1,694 patients who received nonplatinum chemotherapy, 8 percent were hospitalized because of a gastrointestinal ailment, compared with 6.6 percent of the 1,363 women who received platinum-based chemotherapy and 6.4 percent of the 3,094 women who received platinum-taxane therapy. Receipt of nonplatinum chemotherapy was also associated with a higher risk of hospitalization for infections, hematologic problems (e.g., anemia), and thrombocytopenia (low blood platelet count). Nurgalieva, Liu, and Du, Int J Gynecol Cancer 19(8):1314-1321, 2009 (AHRQ grant HS16743).

•Less access to effective treatment may explain poorer survival of elderly black women with ovarian cancer.
Researchers studied 5,131 elderly women diagnosed with ovarian cancer between 1992 and 1999 with up to 11 years of followup. Overall, 72 percent of white women and 70 percent of black women were diagnosed with stage III or IV (advanced) disease, however, fewer blacks received chemotherapy than whites (50 vs. 65 percent, respectively). Among those with stage IV disease, those who underwent ovarian surgery and received adjuvant chemotherapy were 50 percent less likely to die during the followup period compared with those who did not, regardless of race. Du, Sun, Milam, et al., Int J Gynecol Cancer 18:660-669, 2008 (AHRQ grant HS16743).

•Evidence does not support use of genomic tests to detect ovarian cancer.
According to this scientific review, there is no evidence relevant to the impact of genomic tests for ovarian cancer on health outcomes in asymptomatic women. The researchers used model simulations to predict the usefulness and efficacy of genomic tests for ovarian cancer. The model simulations suggest that annual screening, even with a highly sensitive test, will not reduce ovarian cancer mortality, and that frequent screening has a very low positive predictive value. Genomic Tests for Ovarian Cancer Detection and Management, Evidence Report/ Technology Assessment No. 145 (AHRQ Publication No. 07-E001)* (AHRQ Contract 290-02-0025).

Other Cancers
•A family history of colon cancer does not negatively affect survival for women diagnosed with the same cancer.
Researchers tracked nearly 1,400 women who were diagnosed with invasive colon cancer and found that women who had two or more relatives with colorectal cancer appeared to have a lower risk of dying from the disease compared with women who had no family history of the cancer. Of the 262 women who had a family history of colorectal cancer, 44 died of the disease; of the 1,129 women who had no family history of the disease, 224 died. Thus, determining a family history of colorectal cancer appears to be a cost-effective way to identify individuals who may be at risk for the condition. Kirchhoff, Newcomb, Trentham-Dietz, et al., Fam Cancer 7(4):287-292,2008 (AHRQ grant HS13853).

•Women's perception of risk affects screening for colon cancer but not cervical or breast cancer.
Researchers interviewed 1,160 white, black, Hispanic, and Asian women (aged 50 to 80) about their perceived risk for breast, cervical, and colon cancer and compared their perceived risk with their screening behavior. The women's perceived lifetime risk of cancer varied by ethnicity, with Asian women generally perceiving the lowest risk and Hispanic women the highest risk for all three types of cancer. Nearly 90 percent of women reported having a mammogram, and about 70 percent of the women reported having a Pap test in the previous 2 years; 70 percent of the women were current with colon cancer screening. There was no relationship between screening and perception of risk for cervical or breast cancer; however, a moderate to very high perception for colon cancer risk was associated with nearly three times higher odds of having undergone colonoscopy within the last 10 years. Kim, Perez-Stable, Wong, et al., Arch Int Med 168(7):728-734, 2008 (AHRQ grant HS10856).

•Among older patients with early-stage lung cancer, women live longer than men, regardless of treatment choice.
Researchers examined differences between women and men in the natural history of lung cancer, after controlling for unrelated causes of death and type of treatment among 18,967 Medicare patients with stages I and II non-small cell lung cancer who were diagnosed between 1991 and 1999. They found that the women lived longer than the men, regardless of the type of treatment they received, and that the women's longer survival was independent of differences in life expectancy between men and women due to unrelated causes of death. They found improved survival advantages even among untreated women, suggesting that lung cancer in women has a different natural history and potentially a different tumor biology. Wisnivesky and Halm, J Clin Oncol 25(13):1705-1712, 2007 (AHRQ grant HS13312).

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Women's Health Highlights: Recent Findings (continued)