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Trials Examine Approaches for Cervical Cancer Screening, Treatment in Low-Resource SettingsTwo randomized trials of different approaches for cervical cancer screening in low-resource or high-risk settings have shown that the approaches are safe and feasible, according to a series of articles in the November 2 issue of the Journal of the American Medical Association.
In a study of 6,555 women in South Africa, researchers tested two screen-and-treat approaches using either human papillomavirus (HPV) DNA testing or visual inspection with acetic acid (VIA). Women with either a positive VIA or HPV test were randomly assigned to receive cryotherapy or to a delayed evaluation group. The screen-and-treat approach resulted in a lower prevalence of high-grade cervical cancer precursor lesions compared with delaying follow-up by 6 or 12 months.
This approach, the authors noted, overcomes two of the greatest barriers to cervical cancer prevention in low-resource settings—they do not use cytology-based screening programs or colposcopy services.
In a second study, researchers examined the effectiveness of a screen-and-treat approach in underserved communities of Latina women. Almost 4,000 women who were screened with a Pap test were randomly assigned to either a usual care group and discharged immediately after their Pap test or to a single-visit group, in which women were asked to wait in the doctor's office until the results of their Pap test were available. Women who had a diagnosis of either high-grade squamous intraepithelial lesion (HGSIL)–atypical glandular cells of undetermined significance (AGUS) or suspicion of carcinoma were treated immediately with a large-loop electrosurgical excision procedure.
The authors of this study conclude that this single-visit program was feasible and was a practical approach to ensuring timely follow-up of severely abnormal Pap test results in this population.
Screening, Treatment Both Contributed to Decline in Breast Cancer Deaths
Early breast cancer detection and improved adjuvant treatment have both contributed to the decrease in breast cancer death rates over the past 10–15 years, concludes a new study.
The breast cancer death rate decreased 24% between 1990 and 2000. The National Institutes of Health chose seven research groups from around the country to use statistical models to estimate the contributions of breast cancer screening and improvements in adjuvant treatments to this decline.
Donald A. Berry, Ph.D., of the University of Texas M. D. Anderson Cancer Center in Houston, and colleagues report in the October 27 issue of the New England Journal of Medicine that from 28% to 65% of the reduction in breast cancer deaths can be attributed to screening, with adjuvant treatment accounting for the rest. The variability in the quantitative estimates, the authors conclude, demonstrates the interplay between screening and treatment in contributing to changes in mortality.
Statin Use and Cholesterol Levels Not Associated With Breast Cancer Risk
Cholesterol levels or use of lipid-lowering drugs such as statins are not associated with breast cancer risk, according to a study in the October 24 Archives of Internal Medicine.
Some laboratory studies suggest that statins inhibit tumor development, and some epidemiologic studies have suggested that statins are associated with a decreased risk of various cancers.
In the new study, researchers analyzed data from the 80,000 participants of the Nurses' Health Study and found that statin use was not associated with breast cancer risk, even when analyzed by duration of use. Similarly, there was no difference in breast cancer risk between the high-cholesterol and low-cholesterol groups.
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