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After Treatment, Women Remain at Higher Risk for Cervical CancerWomen diagnosed with and treated for a precursor to cervical cancer called cervical intraepithelial neoplasia (CIN) remain at above-average risk for developing invasive cervical cancer for two decades following treatment, according to a study in the November 19 issue of the British Medical Journal. The findings contrast with past studies that found that cervical cancer risk is not increased in the 8 years following CIN treatment.
Eero Pukkala, Ph.D., at the Helsinki University Central Hospital in Helsinki, Finland, and colleagues identified 7,564 women who had been treated for CIN between 1974 and 2001. They identified 22 new cases of invasive cervical cancer among the women, 2.8 times the rate observed in the general population.
Although women who have undergone treatment for CIN remain at above-average risk of developing cervical cancer for 20 years, with risk increasing during the second decade, scientists still say current treatment works effectively. The authors suggest that women with mild or moderate cases of CIN remain at greatest risk because patients don't get follow-up screenings as regularly as women with severe CIN.
One-third of Cancer Deaths Caused by Modifiable Lifestyle Factors
Basic health and lifestyle risks cause approximately one in three cancer deaths worldwide, according to a study in the November 19 issue of The Lancet.
In 2001, 7 million people died of cancer. Majid Ezzati, Ph.D., of the Harvard School of Public Health in Boston, and colleagues used data from the Comparative Risk Assessment project and the World Health Organization in statistical models to estimate that 2.43 million of those 7 million deaths could have been prevented with changes in lifestyle or the surrounding environment. Nine modifiable risk factors—obesity, low fruit and vegetable intake, physical inactivity, smoking, alcohol, unsafe sex, urban air pollution, indoor smoke from household use of coal, and contaminated injections in health care settings—are associated with one-third of cancer deaths around the world.
Europe and Central Asia had the highest proportion of deaths attributed to these risk factors. The leading risk factors for cancer death were smoking and alcohol use, in addition to low fruit and vegetable intake in low- and middle-income countries, and overweight and obesity in high-income countries.
Radiation Therapy Associated With Increased Risk of Pelvic Fracture
Women older than 65 years who underwent radiation therapy as a treatment for cervical, rectal, or anal cancer are at an increased risk of pelvic fractures, according to a new study.
Nancy Baxter, M.D., Ph.D., of the University of Minnesota in Minneapolis, and colleagues examined medical records from 6,428 women aged 65 years and older who had been diagnosed with cervical, rectal, or anal cancer between 1986 and 1999. Women who underwent radiation therapy for any of the three cancers were at an increased risk of pelvic fracture. Women diagnosed with anal cancer and treated with radiation therapy were at the highest risk of fractures.
The authors' findings suggest that older women undergoing radiation therapy for cervical, rectal, and anal cancer should be counseled about the risks of radiation therapy and should use preventive strategies to prevent fractures. In an accompanying editorial, William Small, Jr., M.D., at Northwestern University in Chicago advises doctors to consider the use of agents that reduce the toxic effects of radiation or improve bone strength, and he urges scientists to conduct further research on such agents as preventive measures against bone fracture.
The study was published in the November 23/30 issue of the Journal of the American Medical Association.
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