Biomedical subjects

Walter Kinney

Publications and source records attributed to Walter Kinney.

5 recordsLinked to original sources

PubMed2006

On maintaining the balance.

Recent studies have shown an association of loop electrocautery excision procedure (LEEP) with subsequent obstetric complications, including preterm birth. These data necessitate a reevaluation of how LEEP is used, particularly in cases where the presence of a high-grade lesion has not been established. In the 2001 consensus guidelines, nonadolescent women with high-grade cytology and subsequent negative colposcopy and endocervical curettage are recommended to undergo LEEP for further evaluation. Given the new information on potential obstetric complications and the rising age of childbearing, it is debatable whether the benefits of LEEP in this situation truly outweigh the risks for all women, regardless of age, who have not completed childbearing. We urge the committee charged with revising the guidelines to carefully consider this issue.

Electrosurgery↗

PubMed2004

Cervical cancer control, priorities and new directions.

Cervical cancer is caused by infection with a range of high risk "oncogenic" human papillomavirus (HPV) types, and it is now accepted that >99% of cervical cancer is initiated by HPV infection. The estimated lifetime risk of cervical cancer is nevertheless relatively low (less than 1 in 20 for most community based studies). Although sensitivity and specificity of the available diagnostic techniques are suboptimal, screening for persistent HPV infection is effective in reducing the incidence of cervical cancer. Infection can be detected by molecular techniques or by cytological examination of exfoliated cervical cells. Persistent infection is the single best predictor of risk of cervical cancer. The latest findings of HPV and cervical cancer research need to be widely disseminated to the scientific and medical societies that are updating screening and management protocols, public health professionals, and to women and clinicians. This report reviews current evidence, clinical implications and directions for further research in the prevention, control and management of cervical cancer. We report the conclusions of the Experts' Meeting at the EUROGIN 2003 conference.

Female↗

PubMed2003

Screening interval and risk of invasive squamous cell cervical cancer.

To compare the risks of developing invasive squamous cell cervical cancer associated with screening intervals of 1, 2, and 3 years after a negative cervical smear. We conducted a matched case-control study of invasive squamous cell cervical cancer patients (n = 482) diagnosed between 1983 and 1995 among long-term members of a large health maintenance organization. Controls were matched for age, length of membership, and race (n = 934). Screening interval was time between the last negative cervical smear and the case diagnosis date. The main outcome measure was the relative odds of invasive disease associated with 1-year, 2-year, and 3-year intervals. The odds ratio for a 2-year versus a 1-year interval was 1.72 (95% confidence interval 1.12, 2.64, P =.013) and for a 3-year versus a 1-year interval was 2.06 (95% confidence interval 1.21, 3.50, P =.007). The odds ratio for a 3-year versus a 2-year interval was 1.20 (95% confidence interval 0.65, 2.21, P =.561). Controlling for ever having had an abnormal cervical smear or a previous consecutive negative smear did not substantially change these results. In this large health plan, the relative risks of invasive squamous cell cervical cancer were significantly greater for 2-year and 3-year cervical cancer screening intervals compared with a 1-year interval, but not for a 3-year interval compared with a 2-year interval. Our findings need to be placed in the context of the low absolute risks of developing invasive cervical cancer during the first 3 years after a negative cervical smear before making policy recommendation.

Adult↗

PubMedDate not supplied

Cervical cancer after multiple negative cytologic tests in long-term members of a prepaid health plan.

OBJECTIVE: To estimate squamous cell cervical cancer incidence within 3.5 years of 1, 2 and > or = 3 consecutive, normal cytologic tests. STUDY DESIGN: Data were from a case-control study of cervical cancer screening efficacy. Long-term members of a prepaid health plan diagnosed with cancer from 1983 to 1995 (the cases) were grouped by number of prior conventional cytologic tests and by time from the last negative screening test to the diagnosis date. Women from the population at risk were estimated by multiplying the timated by multiplying the proportions of women without cancer (the matched controls) in each screening category by the numbers of long-term of the numbers of long-term female members enrolled from male members enrolled from 1983 to 1995. RESULTS: Of an estimated 6,802,641 woman-years of observation, 129 cases were diagnosed within 3.5 years of > or = 21 negative screening test. After > or = 3 consecutive negative tests, incidence per 100,000 woman-years grouped by time from the last negative screening test were: 1.43 (26/1,813,552) 0-18 months later, 4.24 (17/400,584) 19-30 months later and 4.73 (10/211,217) 31- 42 months later. CONCLUSION: The first 18 months after the last negative screening Pap test in women with > or = 3 prior negative tests, cancer incidence increases to an estimated 4-5 per 100,000 woman-years in each of the subsequent 2 years.

Adult↗

PubMedDate not supplied

Stage at diagnosis and mortality in patients with adenocarcinoma and adenosquamous carcinoma of the uterine cervix diagnosed as a consequence of cytologic screening.

OBJECTIVE: To determine if cytologic screening is associated with early stage at diagnosis of and decreased mortality from invasive adenocarcinoma and adenosquamous carcinoma of the uterine cervix. STUDY DESIGN: We retrospectively reviewed the medical records of all 169 women diagnosed with invasive adenocarcinoma or adenosquamous carcinoma of the cervix in a prepaid health plan during 1988-1994. Differences in stage and survival were assessed in relation to screening history and symptoms. RESULTS: Among the 169 cases, late-stage disease was present in 19/169 women (11.2%) at the time of diagnosis, and 24/269 (14.2%) women died of the disease during the three-year follow-up period. Women whose cancer was screen detected numbered 48/169 (28.4%) and were less likely to present with late-stage disease than non-screen-detected women: 2/48 (4.2%) versus 17/121 (14.0%) (P = .05). A mortality advantage at three years from diagnosis was associated with screen-detected cancers: 1/48 (2.1%) versus 23/121 (19.0%) (P = .002), and this advantage persisted after controlling for stage at diagnosis. CONCLUSION: Invasive adenocarcinomas and adenosquamous carcinomas of the cervix detected by screening are found at an earlier stage and are associated with lower disease-specific mortality than those not detected by screening.

Adenocarcinoma↗