update archive 2001
Every month, Judy Knapp, Ph.D., MSW, gynecologic social worker at the
University of Pittsburgh Cancer Institute and EyesOnThePrize.org board
member, summarizes important research findings in gynecologic oncology.
December 2001: The relationship
between dietary antioxidant intake and ovarian cancer risk
November 2001: Quality
of life in women with gynecologic cancers
September 2001: The role
of pap smears in women with hysterectomies
July 2001: The use of
hCG in diagnosis and management of Gestational Trophoblastic Disease
June 2001: Research findings
on cervical cancer from ASCO
May 2001: HRT risk with
December 2001: The relationship between dietary antioxidant intake and
ovarian cancer risk
In 1976, 121,700 registered nurses across the US began participating
in a long-term epidemiological study of womens health, the Nurses
Health Study. Involvement in the study requires that the participants
complete a mailed health information survey every six months throughout
the rest of their lives. Data regarding food intake was initially collected
starting in 1980, then broadened four years later with the inclusion
of a 126 item food frequency questionnaire. Using this large database,
Dr. Kathleen Fairfield and her colleagues from Harvard University examined
prospectively the relationship between dietary intake of antioxidants
and the risk of ovarian cancer.
Data from 80,326 participants were analyzed; of this group, there were
316 cases of ovarian cancer from 1980 through 1996. Statistical analysis
controlled for known ovarian cancer risk factors such as age, body mass
index, use of oral contraceptives, number of pregnancies, history of
tubal ligation, lactation history, age at first menses, first birth
and menopause, caffeine use, smoking history, and family history of
ovarian cancer. Variables of interest were alcohol, total fat, fiber,
folate, Vitamins E, C, and A, lutein, and retinol intake. Both food
and dietary supplement sources of antioxidants were included in the
The researchers conclude that, based on their analyses of these data,
there was no relationship between consumption of antioxidants and ovarian
cancer risk. Additionally, there was no statistically significant association
between the intake of specific vegetables or fruits and the risk of
ovarian cancer, although women who reported 7 or more servings per week
of green leafy vegetables were seen to have a 14% decrease in their
risk. Of note, high levels of fruit and vegetable intake during adolescence,
as reported by study participants in their adulthood, was associated
with a 46% reduction in risk.
Cancer, Vol. 92, No. 9 (November 1, 2001), pages 2318
November 2001: Quality of life in women with gynecologic cancers
Quality of life is a key concept in cancer care, one that concerns
both patients and their professional health care providers. Basically,
it encompasses three separate components -- physical, psychological
and social functioning. Physical functioning refers to both disease
and treatment-related effects. Psychological well-being includes cognitive
and emotional functioning, as well as spirituality. And social functioning
encompasses capacity for leisure and work activities, social interaction
and interpersonal relationships. Without question, there are many ways
that each of these aspects of human functioning can be affected by the
diagnosis and treatment of a gynecologic cancer.
A group of researchers in China studied the changes in quality of life
of a group of 144 women over a period of 24 months from diagnosis. The
average age of the women was 51 years of age. Over one-third of the
group had cervix cancer, 30% had ovarian cancer, and 20% had cancer
of the uterus. Treatment data showed that 46% had surgery, 29% had radiation
treatment and 26% had chemotherapy.
Several factors were found to affect overall health status. Patients
who had surgery demonstrated the highest global health rating, followed
by those who had radiation, then those who received chemotherapy. Younger
women, interestingly, showed lower overall health scores than did older
women. Another notable finding was that quality of life prior to diagnosis
was not related to subsequent quality of life, as reported by this group.
The bulk of impact on quality of life was seen in the first six months
after the end of treatment. After that time point, scores on specific
aspects of life quality, such as cognitive, emotional, social and physical
function, stabilized. This was also the case for the global measure
abstract of the results of this study can be found at: http://www.idealibrary.com/links/doi/10.1006/gyno.2001.6345/
This paper was published in the journal Gynecologic Oncology, Volume
September 2001: The role of pap smears in women with hysterectomies
The American Cancer Societys guidelines indicate that women with
a history of hysterectomy should continue to have screening done with
routine Pap smears, regardless of the reason for the surgery. However,
the US Preventive Services Task Force has recommended this screening
only if the cervix was left in place or the diagnosis was cervical cancer.
To examine this question, researchers at the Division of Cancer Prevention
of the Center for Disease Control have taken information from surveys
of American women and hospitals to characterize both the use of and
the need for Pap smears in women who have undergone hysterectomies.
According to their analyses, one in five women have had hysterectomy;
of this group, almost 10% were due to a primary diagnosis of cervical
cancer. Approximately 75% of all women were estimated to have had a
Pap smear within the past three years. Following the US Preventive Task
Force recommendation, only 7-15% of these women met the criteria for
needing routine Pap testing.
One of the arguments for continuing this screening after hysterectomy
for non-cancerous indications is the need to check for vaginal cancer
or precancerous cell changes. However, Dr. Saraiya and her associates
indicate that the incidence of vaginal cancer is very low for women
with benign hysterectomy, and therefore does not justify the cost of
the test in this group. According to this work, only women who had their
hysterectomy for cervical cancer or those who did not have cancer, but
still have a cervix, benefit from routine screening with Pap smears.
Making this shift in patient and physician behaviors will allow greater
efforts to be directed to screening women who have the greatest need
those who still have a uterus.
This paper appears in the August 2001 issue of Obstetrics and
July 2001: The use of hCG in diagnosis and management of Gestational Trophoblastic
Human chorionic gonadatropin (hCG) is normally produced by women's
bodies during pregnancy, and can be found in urine or blood samples.
However, elevated levels of hCG can also indicate the possibility of
gestational trophoblastic disease (GTD) or choriocarcinoma when pregnancy
tissue is no longer present in the body. GTD occurs in women of child-bearing
age, and is treated with chemotherapy and/or surgery. Treatment continues
until the hCG level falls and consistently remains at a very low reading.
Hence, both the initial diagnosis and ongoing treatment of GTD is based
on this blood test.
Laurence Cole, PhD and his research associates published a study in
The Lancet last year on the incidence of falsely elevated hCG
levels in women being treated for GTD. Using a technique to block certain
antibodies which can interfere with hCG testing, Dr. Cole identified
24 inaccurate hCG readings out of 60 samples tested at his facility,
USA hCG Reference Service. From his research, it can be seen that the
blood tests commonly used in the United States to assess hCG have a
high rate of false positive readings.
A more complete discussion of this important topic can be found Dr.
Cole's article reproduced by permission on the the EyesonthePrize.org
Website or you can visit the site for Dr.
Cole's laboratory at the University of New Mexico. Dr. Cole is
a member of the Medical Advisory Panel
June 2001: Gleanings about cervical cancer from the American Society of
Clinical Oncology 2001 meeting
The annual meeting of the American Society of Clinical Oncologists
took place May 12 - May 15, 2001; included in this year's program were
several presentations on cancer of the cervix. Here is an overview of
some of the information to come out of this conference.
Diagnosis: In an effort to evaluate screening techniques for
cervical cancer, researchers at Duke University compared three methods
of obtaining Pap smears from the endocervix to see which was most sensitive
to malignant changes, and found that the ThinPrep spatula and endocervical
brush had the highest accuracy of both positive and negative results.
The researchers indicate that adequate sampling of the endocervix is
critical for diagnosis, particularly in adenocarcinoma.
Treatment: There is a growing body of research literature focused
on the use of combination chemotherapy and radiation therapy for inoperable
cervix cancer. Randomized clinical trials have been conducted by several
national collaborative research groups showing that cisplatinum, alone
or in combination with other drugs, has produced three-year survival
rates of between 65 and 87%. In this form of treatment, low-dose chemotherapy
is given once a week and radiation is given daily; investigators believe
that chemotherapy acts to enhance radiation effects.
Recurrence: Ongoing research is also underway into the most
effective chemotherapy drugs for recurrent or metastatic cervix cancer.
Most large clinical trials now include a measurement of quality of life,
so that a better understanding of the relationship between each treatment
and the patients' perception of their well-being can become clearer.
Ultimately, this information will help each woman make more fully informed
Additional information from the conference proceedings is available
(free registration required).
May 2001: What are the risks of using hormone replacement therapy (HRT)
after surgery for uterine cancer?
A recently published study by a group of researchers in California
addressed this question that uterine cancer survivors often face. Using
medical records, these investigators matched 75 women who received hormones
after their surgery with 75 women who did not. The pairs were matched
on age by decade, stage of cancer, number of children, surgery, post-operative
radiation treatment, presence of other health problems, and several
specific cancer indicators such as lymph node status. Hormones were
given in pill form, by transdermal patch or vaginal cream for women
in the treatment group; initiation of therapy usually took place within
the first year after cancer diagnosis.
The highest risk of cancer recurrence exists within the first year
after treatment. In this study, the average length of follow-up was
almost 7 years for hormone users and 5 years 9 months for nonusers.
There were 2 recurrences in the hormone treatment group over the course
of the project, and 11 in the group that did not receive hormone treatment.
Of the women who had recurrences, only one in each group had died from
cancer. The amount of time to cancer recurrence was statistically significantly
different between the two groups, with the hormone replacement group
having a longer period of being disease-free.
Prior to this work, there were no studies of the relationship between
hormone replacement therapy and uterine cancer recurrence that used
a control group. With the well-documented cardiac and bone health benefits
that hormone replacement provides to postmenopausal women, this study
gives a stronger basis for the discussion and decision-making process
between an endometrial cancer survivor and her oncologist.
(Estrogen replacement therapy in endometrial cancer patients: A matched
control study. K. Suriano, M. McHale, C. McLaren, K. Li, A. Re &
P. Disaia. Obstetrics and Gynecology, April 2001.)
Go to 2002-03 Research Updates