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Screening for cervical cancer: A new scope for general practitioners? Results of the first year of colposcopy in general practice
334
Citations from the literature
Clear cell carcinoma
of the endometrium
Webb GA; Lagios MD Department of Obstetrics and Gynecology, Children’s Hospital of San Francisco, San Francisco, CA, USA AM. J. OBSTET. GYNECOL.; 156/6 (1486-1491) 1987 In a clinical-pathologic review of 825 cases of endometrial carcinoma diagnosed between 1955 and 1984, 735 cases were confirmed as endometrial carcinoma. From this group 29 cases of clear cell carcinoma of the endometrium were found represeinting a 4% frequency. Clear cell carcinoma of the endometrium was found in an older group of women, all postmenopausal. No relationship to the use of estrogen could be demonstrated. The frequency of clear cell carcinoma of the endometrium dropped from 6% in the group diagnosed between 1955 and 1969 to 3Vo in the group diagnosed between 1970 and 1984, although the numbers of cases of endometrial cancer rose from 194 to 525 in the comparative time span. Clear cell carcinoma of the endometrium has a poorer prognosis, with a 64% 5-year survival rate compared with an 80% 5-year survival rate for adenocarcinoma, not otherwise stated. Three patients died after 5 years of disease. Treatment is still not satisfactory, but the proved therapy remains total abdominal hysterectomy plus salpingo-oophorectomy. The role of adjunctive therapy has not been established.
Screening for cervical cancer: A new scope for general practitioners? Results of the first year of colposcopy in general practice
Chomet J Crouch Hall Road Surgery, London N8 SHJ, UK BR. MED. J.; 29416583 (1326-1328) 1987 A survey was carried out over one year of all the women who attended a colposcopy clinic in a general practice. During the year 1254 women underwent cytological screening in the practice and 197 of these underwent colposcopy. Of 79 women with abnormal smears that suggested cervical intraepithelial neoplasia, 62 (79%) were confirmed by biopsy to have cervical premalignancy. In addition, the remaining 118 women with normal or inflammatory smears underwent colposcopy either because of their history or because they requested the investigation. A general underestimate of cervical intraepithelial neoplasia when cytology alone was used was discovered. Seven out of 28 women with inflammatory smears were found to have important cervical premalignancy. Mildly dyskaryotic smears led to a falsely reassuring estimate of the degree of severity of cervical lesions. Seven out of 13 patients who underwent colposcopy because they were thought to be at high risk of neoplasia because of a history of genital warts, unexplained recurrent cystitis, heroin abuse, or immunosuppression had cervical intraepithelial neoplasia proved at biopsy. This report shows that both in screening for and in the follow up of known cervical disease a normal smear cannot guarantee normal pathology. Diagnostic colposcopy is a valuable complementary investigation that could be carried out in a general practice.
Int J Gynecol Obstet 26
Oral contraceptives
and neoplasia:
1987 update
Huggins CR; Zucker PK The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA FERTIL. STERIL.; 47/5 (733-761) 1987 Combined OCs have been used by millions of women in the United States for more than 25 years. During this time, the steroid content of these pills has been markedly reduced from the high initial levels. All of the new formulations introduced in the past 15 years contain 50 mug or less of EEsub 2. The progestogen components are 1 mg or less of norethindrone, 1 mg ethynodiol diacetate, and 0.075 mg or less of levonorgestrel. Investigations in the past 6 years have contributed significant new knowledge to our understanding of the relationships between OCs and neoplasia. The pool of ever-users of OCs continues to grow substantially. The lag-time from first use is now well into and beyond the range accepted as necessary to promote carcinogenesis. The numbers of longterm users of OCs continue to grow. The investigate studies are much better able to define critical and confounding data items. The analyses of these data have become much more sophisticated and refined. In the United States, because of the suspected association with neoplasia in animals, the 17hydroxyprogesterone are not in use. Reports of an association between sequential OCs and endometrial carcinoma have contributed to withdrawal of the sequential formulations from the United States market. The problems in investigating neoplasia and OCs include the following: (1) absence of a suitable animal model, (2) long lag-time from exposure to development of disease, (3) low incidence of specific neoplastic diseases, and (4) multiple etiologic factors in the study population. The principal investigative methods in the human being are various epidemiologic approaches. The methodologies most frequently used are (1) case reports (tumor registries), (2) disease rates and trends, (3) case-comparison (retrospective) studies, and (4) cohort (prospective) studies. These methods cannot prove a causal relationship between exposure to a possible carcinogen and the occurrence of disease. Case must be taken not to extrapolate epidemiologic conclusions to dissimilar populations. Consistent evidence (positive or negative) confirmed by multiple epidemiologic approaches, can be used to guide physicians and regulatory agencies in formulating policy for the clinical use of OCs.
PREGNANCY
AND DELIVERY
Plasma renin activity and CAMP in tertiination induced by sulprostone
of pregnancy
Saarikoski S; Saastamoinen J; Penttila I; Castren 0 Department of Obstetrics and Gynecology, University of Central Hospital of Kuopio SF-70210 Kuopio, Finland BR. J. OBSTET. GYNAECOL.; 9414 (328-332) 1987 Plasma renin activity (PRA), plasma concentrations of cyclic adenosine-3,5’-monophosphate (CAMP) and the serum levels of oestradiol, progesterone, chorionic gonadotropin, potassium, sodium and calcium were estimated
Citations from the literature
Clear cell carcinoma
of the endometrium
Webb GA; Lagios MD Department of Obstetrics and Gynecology, Children’s Hospital of San Francisco, San Francisco, CA, USA AM. J. OBSTET. GYNECOL.; 156/6 (1486-1491) 1987 In a clinical-pathologic review of 825 cases of endometrial carcinoma diagnosed between 1955 and 1984, 735 cases were confirmed as endometrial carcinoma. From this group 29 cases of clear cell carcinoma of the endometrium were found represeinting a 4% frequency. Clear cell carcinoma of the endometrium was found in an older group of women, all postmenopausal. No relationship to the use of estrogen could be demonstrated. The frequency of clear cell carcinoma of the endometrium dropped from 6% in the group diagnosed between 1955 and 1969 to 3Vo in the group diagnosed between 1970 and 1984, although the numbers of cases of endometrial cancer rose from 194 to 525 in the comparative time span. Clear cell carcinoma of the endometrium has a poorer prognosis, with a 64% 5-year survival rate compared with an 80% 5-year survival rate for adenocarcinoma, not otherwise stated. Three patients died after 5 years of disease. Treatment is still not satisfactory, but the proved therapy remains total abdominal hysterectomy plus salpingo-oophorectomy. The role of adjunctive therapy has not been established.
Screening for cervical cancer: A new scope for general practitioners? Results of the first year of colposcopy in general practice
Chomet J Crouch Hall Road Surgery, London N8 SHJ, UK BR. MED. J.; 29416583 (1326-1328) 1987 A survey was carried out over one year of all the women who attended a colposcopy clinic in a general practice. During the year 1254 women underwent cytological screening in the practice and 197 of these underwent colposcopy. Of 79 women with abnormal smears that suggested cervical intraepithelial neoplasia, 62 (79%) were confirmed by biopsy to have cervical premalignancy. In addition, the remaining 118 women with normal or inflammatory smears underwent colposcopy either because of their history or because they requested the investigation. A general underestimate of cervical intraepithelial neoplasia when cytology alone was used was discovered. Seven out of 28 women with inflammatory smears were found to have important cervical premalignancy. Mildly dyskaryotic smears led to a falsely reassuring estimate of the degree of severity of cervical lesions. Seven out of 13 patients who underwent colposcopy because they were thought to be at high risk of neoplasia because of a history of genital warts, unexplained recurrent cystitis, heroin abuse, or immunosuppression had cervical intraepithelial neoplasia proved at biopsy. This report shows that both in screening for and in the follow up of known cervical disease a normal smear cannot guarantee normal pathology. Diagnostic colposcopy is a valuable complementary investigation that could be carried out in a general practice.
Int J Gynecol Obstet 26
Oral contraceptives
and neoplasia:
1987 update
Huggins CR; Zucker PK The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA FERTIL. STERIL.; 47/5 (733-761) 1987 Combined OCs have been used by millions of women in the United States for more than 25 years. During this time, the steroid content of these pills has been markedly reduced from the high initial levels. All of the new formulations introduced in the past 15 years contain 50 mug or less of EEsub 2. The progestogen components are 1 mg or less of norethindrone, 1 mg ethynodiol diacetate, and 0.075 mg or less of levonorgestrel. Investigations in the past 6 years have contributed significant new knowledge to our understanding of the relationships between OCs and neoplasia. The pool of ever-users of OCs continues to grow substantially. The lag-time from first use is now well into and beyond the range accepted as necessary to promote carcinogenesis. The numbers of longterm users of OCs continue to grow. The investigate studies are much better able to define critical and confounding data items. The analyses of these data have become much more sophisticated and refined. In the United States, because of the suspected association with neoplasia in animals, the 17hydroxyprogesterone are not in use. Reports of an association between sequential OCs and endometrial carcinoma have contributed to withdrawal of the sequential formulations from the United States market. The problems in investigating neoplasia and OCs include the following: (1) absence of a suitable animal model, (2) long lag-time from exposure to development of disease, (3) low incidence of specific neoplastic diseases, and (4) multiple etiologic factors in the study population. The principal investigative methods in the human being are various epidemiologic approaches. The methodologies most frequently used are (1) case reports (tumor registries), (2) disease rates and trends, (3) case-comparison (retrospective) studies, and (4) cohort (prospective) studies. These methods cannot prove a causal relationship between exposure to a possible carcinogen and the occurrence of disease. Case must be taken not to extrapolate epidemiologic conclusions to dissimilar populations. Consistent evidence (positive or negative) confirmed by multiple epidemiologic approaches, can be used to guide physicians and regulatory agencies in formulating policy for the clinical use of OCs.
PREGNANCY
AND DELIVERY
Plasma renin activity and CAMP in tertiination induced by sulprostone
of pregnancy
Saarikoski S; Saastamoinen J; Penttila I; Castren 0 Department of Obstetrics and Gynecology, University of Central Hospital of Kuopio SF-70210 Kuopio, Finland BR. J. OBSTET. GYNAECOL.; 9414 (328-332) 1987 Plasma renin activity (PRA), plasma concentrations of cyclic adenosine-3,5’-monophosphate (CAMP) and the serum levels of oestradiol, progesterone, chorionic gonadotropin, potassium, sodium and calcium were estimated