Ethnic Disparities in Cervical Cancer Survival Among Medicare Eligible Women in a Multiethnic Population

To determine predictors of cervical cancer survival by socioeconomic status (SES), urbanization, race/ethnicity, comorbid conditions, and treatment among elderly Medicare-eligible women whose conditions were diagnosed with cervical cancer in a multiethnic population. Methods: A total of 538 women with cervical cancer aged 65 years or older were identified from 1999 to 2001 from the Texas Cancer Registry and were linked with the state Medicare data and Texas Vital Records to determine survival times. All women had similar access to care through Medicare fee-for-services insurance. A composite measure of SES was created using census tract-level data as was urbanization. Treatment and comorbid conditions were available from the Medicare data. Cox proportional hazards modeling was used for all-cause and cervical cancer-specific survival analysis. Results: Increased age (P \u3c 0.0001) and advanced tumor stage (P \u3c 0.0001) were associated with poorer all-cause and cervical cancer-specific survival. Having a comorbid condition was associated with all-cause survival (P \u3c 0.01) but not cervical cancer-specific mortality. After adjusting for confounders, women receiving some form of treatment were almost half as likely to die with cervical cancer (adjusted hazard ratio = 0.68; 95% confidence interval, 0.52-0.89). After adjustment for all confounders, Hispanic women consistently had lower all-cause and cervical cancer-specific mortality rates relative to non-Hispanic white and non-Hispanic black women. Conclusions: Among women with similar health care coverage, Hispanic women had consistently lower all-cause and cervical cancer-specific mortality rates than other older women whose conditions were diagnosed with this disease in Texas. The presence of comorbid conditions and treatment were important predictors of survival, yet these factors do not explain the survival advantage for Hispanic women

Knowledge About the Human Papillomavirus Vaccine Among Employees at a Tertiary Cancer Center: Room for Improvement

Introduction: The human papillomavirus (HPV) vaccine is recommended by the U.S. Centers for Disease Control and Prevention for routine vaccination of boys and girls to protect against HPV-related cancers and genital warts. To meet the Healthy People 2020 target for HPV vaccination, health care providers must understand the importance of strongly recommending the HPV vaccine to all eligible adolescents. We sought to determine HPV vaccination patterns among employees at a tertiary cancer center and their children and attitudes regarding HPV vaccination among the employees. Methods: All employees at a tertiary cancer center were invited to participate in a cross-sectional survey administered online during July and August 2015. The survey included questions about HPV vaccination of participants and their children, including reasons why vaccine-eligible employees and children had not been vaccinated. Results: Of those eligible, 13% of male and 33% of female employees and 44% of daughters and 24% of sons of employees had completed the vaccine series. The main reasons for not completing the series or not having one’s son completing the series were not knowing that the vaccine was needed and vaccine not recommended by a health care provider. The main reasons for not having one’s daughter complete the series were the two aforementioned reasons and daughter not yet sexually active. Conclusion: Opportunities exist to educate health care workers about the benefits of the HPV vaccine and to increase the number of providers who recommend HPV vaccination to their patients

Social Factors Affecting Treatment of Cervical Cancer: Ethical Issues and Policy Implications

Health care in the United States has become a privilege rather than a right. Patients who have the greatest need are the ones most likely to be denied this privilege. Despite recent advances in disease detection and treatment, many patients do not receive even the bare minimum of care. The high complexity of the health care system in the setting of patients with low levels of health literacy significantly affects the ability to seek and receive treatment in a timely fashion. In addition, lack of insurance, transportation, and social support further complicate access to care. To truly provide a standard of care to all patients, regardless of resources, our health care system must evolve to address the needs of the population. In this paper, we report a tragic case where social factors affected the outcome of a single mother with advanced cervical cancer

An economic and disease transmission model of human papillomavirus and oropharyngeal cancer in Texas

In 2017, 46,157 and 3,127 new oropharyngeal cancer (OPC) cases were reported in the U.S. and Texas, respectively. About 70% of OPC were attributed to human papillomavirus (HPV). However, only 51% of U.S. and 43.5% of Texas adolescents have completed the HPV vaccine series. Therefore, modeling the demographic dynamics and transmission of HPV and OPC progression is needed for accurate estimation of the economic and epidemiological impacts of HPV vaccine in a geographic area. An age-structured population dynamic model was developed for the U.S. state of Texas. With Texas-specific model parameters calibrated, this model described the dynamics of HPV-associated OPC in Texas. Parameters for the Year 2010 were used as the initial values, and the prediction for Year 2012 was compared with the real age-specific incidence rates in 23 age groups for model validation. The validated model was applied to predict 100-year age-adjusted incidence rates. The public health benefits of HPV vaccine uptake were evaluated by computer simulation. Compared with current vaccination program, increasing vaccine uptake rates by 50% would decrease the cumulative cases by 4403, within 100 years. The incremental cost-effectiveness ratio of this strategy was $94,518 per quality-adjusted life year (QALY) gained. Increasing the vaccine uptake rate by 50% can: (i) reduce the incidence rates of OPC among both males and females; (ii) improve the quality-adjusted life years for both males and females; (iii) be cost-effective and has the potential to provide tremendous public health benefits in Texas

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Circulating Tumor Cells In Advanced Cervical Cancer: NRG Oncology-Gynecologic Oncology Group Study 240 (NCT 00803062)

To isolate circulating tumor cells (CTCs) from women with advanced cervical cancer and estimate the impact of CTCs and treatment on overall survival (OS) and progression-free survival (PFS). 7.5 mL of whole blood was drawn pre-cycle 1 and 36 days post-cycle 1 from patients enrolled on Gynecologic Oncology Group 0240, the phase III randomized trial that led directly to regulatory approval of the anti-angiogenesis drug, bevacizumab, in women with recurrent/metastatic cervical cancer. CTCs (defined as anti-cytokeratin positive/anti-CD45 negative cells) were isolated from the buffy coat layer using an anti-EpCAM antibody-conjugated ferrofluid and rare earth magnet, and counted using a semi-automated fluorescence microscope. The median pre-cycle 1 CTC count was 7 CTCs/7.5 mL whole blood (range, 0–18) and, at 36 days post-treatment, was 4 (range, 0–17). The greater the declination in CTCs between time points studied, the lower the risk of death (HR 0.87; 95% CI, 0.79–0.95). Among patients with high (≥ median) pre-treatment CTCs, bevacizumab treatment was associated with a reduction in the hazard of death (HR 0.57; 95% CI, 0.32–1.03) and progression (PFS HR 0.59; 95% CI, 0.36–0.96). This effect was not observed with low (< median) CTCs. CTCs can be isolated from women with advanced cervical cancer and may have prognostic significance. A survival benefit conferred by bevacizumab among patients with high pre-treatment CTCs may reflect increased tumor neovascularization and concomitant vulnerability to VEGF inhibition. These data support studying CTC capture as a potential predictive biomarker

Spatial Organization and Molecular Correlation of Tumor-Infiltrating Lymphocytes Using Deep Learning on Pathology Images

Beyond sample curation and basic pathologic characterization, the digitized H&E-stained images of TCGA samples remain underutilized. To highlight this resource, we present mappings of tumorinfiltrating lymphocytes (TILs) based on H&E images from 13 TCGA tumor types. These TIL maps are derived through computational staining using a convolutional neural network trained to classify patches of images. Affinity propagation revealed local spatial structure in TIL patterns and correlation with overall survival. TIL map structural patterns were grouped using standard histopathological parameters. These patterns are enriched in particular T cell subpopulations derived from molecular measures. TIL densities and spatial structure were differentially enriched among tumor types, immune subtypes, and tumor molecular subtypes, implying that spatial infiltrate state could reflect particular tumor cell aberration states. Obtaining spatial lymphocytic patterns linked to the rich genomic characterization of TCGA samples demonstrates one use for the TCGA image archives with insights into the tumor-immune microenvironment