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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Women's Health".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 21203

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Special Issue Editor

Prof. Dr. Jan Y. Verbakel

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Guest Editor

1. Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
2. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
Interests: point-of-care testing; risk prediction modelling; infectious diseases; antibiotic prescribing; diagnostic research; pediatrics; gynaecological cancer

Special Issue Information

Dear Colleagues,

Early diagnosis of symptomatic gynaecological cancer is likely to improve patient outcomes, including survival. The primary care practitioner has a key role to play in this; they must recognize the symptoms and signs of gynaecological cancer and make prompt evidence-based decisions regarding further investigation and referral. However, this is often difficult as many of the symptoms of gynaecological cancers are nonspecific and are more likely to be caused by benign rather than malignant disease. As primary care is generally the first point of patient contact, those working in this setting usually encounter cancer patients at an earlier, and possibly less symptomatic, stage than practitioners in secondary care. Despite these challenges, research has improved our understanding of the symptoms patients present to primary care with, and a range of tests and prediction tools now exist to aid early diagnosis. Primary care practitioners can also play a key role in gynaecological cancer prevention. A significant proportion of gynaecological cancer is preventable either through lifestyle changes such as weight loss, or, for cervical cancer, vaccination and/or engagement with screening programs.

In this Special Issue, we concentrate on gynaecological cancer and focus on the three most common forms that a primary care practitioner is likely to encounter: ovarian, endometrial, and cervical cancer.

Prof. Dr. Jan Y. Verbakel
Guest Editor

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Keywords

risk prediction modelling
gynaecological cancer
endometrial cancer
ovarian cancer
cervical cancer
cancer prevention
early cancer diagnosis
cancer referrals
general practice
oncology

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Published Papers (5 papers)

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Research

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11 pages, 1294 KiB

Open AccessArticle

Comparisons of Effectiveness in Differentiating Benign from Malignant Ovarian Masses between Conventional and Modified Risk of Malignancy Index (RMI)

by Charuwan Tantipalakorn, Dangcheewan Tinnangwattana, Thitikarn Lerthiranwong, Suchaya Luewan and Theera Tongsong

Int. J. Environ. Res. Public Health 2023, 20(1), 888; https://doi.org/10.3390/ijerph20010888 - 3 Jan 2023

Viewed by 5729

Abstract

Objective: To compare the predictive performance in differentiating benign from malignant ovarian masses between the modified risk malignancy index (RMI) and the conventional RMI (RMI-1 and RMI-2). Methods: Women scheduled for elective surgery because of adnexal masses were recruited to undergo pelvic sonography within 24 h before surgery to assess the sonographic characteristics of the masses, focusing on loculi, solid part, ascites, bilateralness, papillary projection, and color flow mapping (CFM). Preoperative CA-125 levels were also measured. Modified RMI, RMI-1, and RMI-2 systems were used to predict malignant masses. The gold standard was pathological or intraoperative diagnosis. Results: A total of 342 ovarian masses, benign: 243 (71.1%); malignant: 99 (28.9%), meeting the inclusion criteria were analyzed. The sensitivity and the specificity of the modified RMI (87.9% and 81.9%) were significantly higher than those of RMI-1 (74.7% and 84.4%), and RMI-2 (79.8% and 81.1%, respectively). Based on ROC curves, the area under the curves were 0.930, 0.881 and 0.882 for modified RMI, RMI-1 and RMI-2, respectively. Conclusion: Modified RMI had better predictive performance than the conventional RMI in differentiating between benign and malignant ovarian masses. Modified RMI may be useful to help general gynecologists or practitioners to triage patients with an adnexal mass, especially in settings of low resources. Full article

(This article belongs to the Special Issue Risk Prediction Tools for Gynaecological Cancer in Primary Care)

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11 pages, 1330 KiB

Open AccessArticle

Metabolic Activity of Visceral Adipose Tissue Is Associated with Metastatic Status of Lymph Nodes in Endometrial Cancer: A ¹⁸F-FDG PET/CT Study

by Kisoo Pahk, Ki-Jin Ryu, Chanmin Joung, Hyun Woo Kwon, Sanghoon Lee, Hyuntae Park, Tak Kim, Jae Yun Song and Sungeun Kim

Int. J. Environ. Res. Public Health 2022, 19(1), 92; https://doi.org/10.3390/ijerph19010092 - 22 Dec 2021

Cited by 4 | Viewed by 2939

Abstract

Obesity contributes to increased cancer incidence and aggressiveness in patients with endometrial cancer. Inflamed metabolic activity of visceral adipose tissue (VAT) is regarded as a key underlying mechanism of adverse consequences of obesity. The aim of this study was to investigate the association between inflammatory metabolic activity of VAT evaluated by ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and metastatic status of lymph nodes (LN) in patients with endometrial cancer. In total, 161 women with newly diagnosed endometrial cancer, who received preoperative 18F-FDG PET/CT, were enrolled. VAT inflammatory metabolic activity was defined as V/S ratio and measured from the maximum standardized uptake value (SUVmax) of VAT normalized to the SUVmax of subcutaneous adipose tissue (SAT). The positive LN metastasis group exhibited a significantly higher V/S ratio than the negative LN metastasis group. Systemic inflammatory surrogate markers including high sensitivity C-reactive protein, spleen SUVmax, and bone marrow SUVmax were also higher in the LN metastasis group than in the negative LN metastasis group, showing significant correlations with V/S ratio. In multivariate logistic regression analysis, V/S ratio was independently associated with LN metastasis. V/S ratio is independently associated with the LN metastasis status in patients with endometrial cancer. This finding could be useful as a potential surrogate marker of obesity-induced VAT inflammation associated with tumor aggressiveness. Full article

(This article belongs to the Special Issue Risk Prediction Tools for Gynaecological Cancer in Primary Care)

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13 pages, 827 KiB

Open AccessArticle

Different Influences of Endometriosis and Pelvic Inflammatory Disease on the Occurrence of Ovarian Cancer

by Jing-Yang Huang, Shun-Fa Yang, Pei-Ju Wu, Chun-Hao Wang, Chih-Hsin Tang and Po-Hui Wang

Int. J. Environ. Res. Public Health 2021, 18(16), 8754; https://doi.org/10.3390/ijerph18168754 - 19 Aug 2021

Cited by 2 | Viewed by 3248

Abstract

To compare the rate and risk of ovarian cancer in patients with endometriosis or pelvic inflammatory disease (PID). A nationwide population cohort research compared the risk of ovarian cancer in 135,236 age-matched comparison females, 114,726 PID patients, and 20,510 endometriosis patients out of 982,495 females between 1 January 2002 and 31 December 2014 and ended on the date of confirmation of ovarian cancer, death, or 31 December 2014. In order to reduce the unbalanced characteristics, propensity score matching (PSM) was performed for 20,478 females in each subgroup. The incidence rate (per 100,000 person–years) of ovarian cancer was 8.74 (95% CI, 7.16–10.66) in comparison, 9.26 (7.54–11.39) in PID, and 28.73 (21.07–39.16) in endometriosis cohorts. The adjusted hazard ratio (aHR) of ovarian cancer was 1.17 (p = 0.296) in PID and 3.12 (p < 0.001) in endometriosis cohorts, compared with the comparison cohort in full cohort, using the multiple Cox regression model. The aHR of ovarian cancer was 0.83 (p = 0.650) in PID and 3.03 (p = 0.001) in endometriosis cohorts, compared with the comparison cohort after performing PSM. In the full cohort and PSM population, the cumulative incidence rate of ovarian cancer was significantly higher in patients with endometriosis than in those with PID or in the comparison cohort (p < 0.001 and p < 0.001). In conclusion, after considering the differences in the impacts of exposure to endometriosis or PID, patients with endometriosis were more likely to develop ovarian cancer. Full article

(This article belongs to the Special Issue Risk Prediction Tools for Gynaecological Cancer in Primary Care)

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Review

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15 pages, 2684 KiB

Open AccessReview

Diagnostic Test Accuracy of First-Void Urine Human Papillomaviruses for Presence Cervical HPV in Women: Systematic Review and Meta-Analysis

by Peter Bober, Peter Firment and Ján Sabo

Int. J. Environ. Res. Public Health 2021, 18(24), 13314; https://doi.org/10.3390/ijerph182413314 - 17 Dec 2021

Cited by 18 | Viewed by 3900

Abstract

First-void urine usually contains exfoliated cells of the debris and mucus from the female genital organs and cervix, i.e., high concentration of human papillomavirus deoxyribonucleic acid (HPV DNA). We conducted a meta-analysis of published data and determined an accuracy of HPV detection in first-void urine compared to the women’s cervix. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we carried out a comprehensive literature search. Eligible articles published from 2011 until 2021 were gathered by searching Embase, PubMed and Cochrane Library Central databases. The patient selection, index test, standard test, and patient flow were the factors involved in quality evaluation. A meta-analysis of 15 studies (3412 women) based on 5054 potential records was conducted. Pooled sensitivity for high-risk HPV detection in urine of 78% (70–84%) and specificity of 89% (81–94%) were calculated. Any HPV detection in urine of 87% (74–94%) and 91% (83–96%) were pooled sensitivity and specificity, respectively. HPV 16 and 18 had a pooled sensitivity of 77% (76–77%) and specificity of 98% (98–98%). Meta-analysis indicated variations between the pooled specificities and sensitivities. In meta-regression analysis, a heterogeneity in accuracy by using covariates (bias in patient selection, purpose, sample timing, storage temperature and HPV detection method) were not detected. Our meta-analysis demonstrates the accuracy of detection of HPV in urine for the presence of cervical HPV. Although progress is continuously made in urinary HPV detection, further studies are needed to evaluate and to improve the accuracy of the first-void urine test in order to be comparable with other screening methods. Full article

(This article belongs to the Special Issue Risk Prediction Tools for Gynaecological Cancer in Primary Care)

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12 pages, 632 KiB

Open AccessReview

Interventions Preventing Vaginitis, Vaginal Atrophy after Brachytherapy or Radiotherapy Due to Malignant Tumors of the Female Reproductive Organs—A Systematic Review

by Adrianna Wierzbicka, Dorota Mańkowska-Wierzbicka, Stanisław Cieślewicz, Marta Stelmach-Mardas and Marcin Mardas

Int. J. Environ. Res. Public Health 2021, 18(8), 3932; https://doi.org/10.3390/ijerph18083932 - 8 Apr 2021

Cited by 10 | Viewed by 4409

Abstract

Background: Radiotherapy, as a method of treatment of cervical and uterine cancers, may induce severe late-onset vaginal side effects. Unfortunately, little evidence on the management of adverse effects has been presented. This study aimed to evaluate the available interventions which reduce symptoms of vaginitis and vaginal atrophy by improving dyspareunia, mucosal inflammation, vaginal pH and vaginal dryness in women who have undergone brachytherapy or radiotherapy due to uterine or cervical malignancies. Materials and methods: A comprehensive literature search was performed following PRISMA guidelines. The systematic search was conducted using electronic databases, namely Scopus, Web of Science and PubMed, between October and November 2020 to identify randomized controlled trials (RCT) and, prospective randomized studies (PRS). Results: The analyzed population consists of 376 patients with uterine or cervical cancer, treated with hyaluronic acid, vitamin A, vitamin E, alpha-tocopherol acetate and dienestrol. Intervention with HA along with vitamin A and vitamin E revealed advantage in endpoints such as reduced dyspareunia, vaginal mucosal inflammation, vaginal dryness, bleeding, fibrosis and cellular atypia. Administration of alpha-tocopherol acetate reduced vaginal mucosal inflammation and improved vaginal acanthosis, whereas dienestrol resulted in reduced dyspareunia, vaginal caliber and bleeding. Conclusions: Vaginal suppositories were found to be clinically effective at the management of late-onset vulvovaginal side effects after radiotherapy. Full article

(This article belongs to the Special Issue Risk Prediction Tools for Gynaecological Cancer in Primary Care)

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