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Cancers
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Gynecologic Cancer: Risk Factors, Interception and Prevention
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Gynecologic Cancer: Risk Factors, Interception and Prevention

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Epidemiology and Prevention".

Deadline for manuscript submissions: 20 January 2025 | Viewed by 4021

Special Issue Editors

Dr. Brandy Heckman-Stoddard

E-Mail Website
Guest Editor
Division of Cancer Prevention, National Cancer Institute, Rockville, MD 20850, USA
Interests: breast cancer prevention; ovarian cancer prevention; endometrial cancer prevention; cervical cancer prevention; HPV; prevention/interception clinical trials
Dr. Goli Samimi

E-Mail Website
Guest Editor
Division of Cancer Prevention, National Cancer Institute, Rockville, MD 20850, USA
Interests: ovarian cancer prevention; endometrial cancer prevention; BRCA1/2 mutations; cancer genetics; gynecologic cancer prevention/interception clinical trials

Special Issue Information

Dear Colleagues, 

Gynecologic cancers, including ovarian, endometrial and cervical cancers, account for approximately 100,000 new cases and over 30,000 deaths per year in the US. The prevention and interception of these cancers would greatly impact outcomes and significantly reduce mortality rates. For ovarian cancer, screening in the general population is not considered effective, and therefore most cases of this cancer are diagnosed at a late stage with a poor survival rate. Endometrial cancer incidence and mortality is markedly increasing in recent years, due in large part to increasing obesity rates. Cervical cancer has had the benefit of the availability of both screening and prevention. Equity in the dissemination and implementation of these prevention and screening methods is essential for early diagnosis and treatment. These opportunities and challenges related to the diagnosis and high mortality of these gynecologic cancers emphasize the importance of identifying women at higher risk for these cancer types, and providing prevention/interception interventions to decrease the incidence and improve outcomes.

Dr. Brandy Heckman-Stoddard
Dr. Goli Samimi
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ovarian cancer
  • endometrial cancer
  • cervical cancer
  • HPV
  • cancer prevention
  • gynecologic cancer risk reduction
  • gynecologic cancer interception
  • gynecologic cancer clinical trials

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Published Papers (4 papers)

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16 pages, 1677 KiB  
Article
Five-Year Relative Survival Rates of Women Diagnosed with Uterine Cancer by County-Level Socioeconomic Status Overall and across Histology and Race/Ethnicity
by Akemi T. Wijayabahu, Jennifer K. McGee-Avila, Meredith S. Shiels, Alfonsus Adrian H. Harsono, Rebecca C. Arend and Megan A. Clarke
Cancers 2024, 16(15), 2747; https://doi.org/10.3390/cancers16152747 - 1 Aug 2024
Viewed by 359
Abstract
Understanding socioeconomic factors contributing to uterine cancer survival disparities is crucial, especially given the increasing incidence of uterine cancer, which disproportionately impacts racial/ethnic groups. We investigated the impact of county-level socioeconomic factors on five-year survival rates of uterine cancer overall and by histology [...] Read more.
Understanding socioeconomic factors contributing to uterine cancer survival disparities is crucial, especially given the increasing incidence of uterine cancer, which disproportionately impacts racial/ethnic groups. We investigated the impact of county-level socioeconomic factors on five-year survival rates of uterine cancer overall and by histology across race/ethnicity. We included 333,013 women aged ≥ 30 years with microscopically confirmed uterine cancers (2000–2018) from the Surveillance, Epidemiology, and End Results 22 database followed through 2019. Age-standardized five-year relative survival rates were compared within race/ethnicity and histology, examining the differences across tertiles of county-level percent (%) <high-school education, %<150 percent poverty, %unemployment, median household income, and %urbanicity. Overall age-adjusted five-year relative survival was 77.7%. Rates were lowest among those residing in the least advantaged counties (tertile 3) and highest among the most advantaged (tertile 1): education (74.7% vs. 80.2%), poverty (72.9% vs. 79.8%), unemployment (75.7% vs. 80.5%), and income (73.3% tertile 1 vs. 78.1% tertile 3). Impact of county-level socioeconomic characteristics on survival across histology was minimal. We observed considerable survival disparities among NH-Black and NH-Native American/Alaskan Native women, regardless of tumor and socioeconomic characteristics. These findings add to our understanding of how county-level socioeconomic characteristics affect uterine cancer survival inequalities among racial/ethnic groups. Full article
(This article belongs to the Special Issue Gynecologic Cancer: Risk Factors, Interception and Prevention)
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11 pages, 1160 KiB  
Article
Genetic Testing Uptake among Ovarian Cancer Survivors in the Genetic Risk Analysis in Ovarian Cancer (GRACE) Study
by Larissa L. White, Jennifer K. Sawyer, Jamilyn M. Zepp, Yolanda K. Prado, Ana A. Reyes, Mahesh Maiyani, Elizabeth Shuster, Rachel Zucker, Nora B. Henrikson, Alan F. Rope, Sheila Weinmann, Heather S. Feigelson and Jessica Ezzell Hunter
Cancers 2024, 16(14), 2563; https://doi.org/10.3390/cancers16142563 - 17 Jul 2024
Viewed by 808
Abstract
Background: Recommendations state all people with ovarian cancers (OCs) receive genetic counseling, but testing uptake is only between 15 and 31%. Those with a prior diagnosis of OC who have not received genetic testing represent a missed opportunity for life-saving genetic risk information. [...] Read more.
Background: Recommendations state all people with ovarian cancers (OCs) receive genetic counseling, but testing uptake is only between 15 and 31%. Those with a prior diagnosis of OC who have not received genetic testing represent a missed opportunity for life-saving genetic risk information. The Genetic Risk Analysis in ovarian CancEr (GRACE) study aimed to evaluate the feasibility of the retrospective identification (“Traceback”) of individuals diagnosed with OC. Methods: This nonrandomized intervention study within two integrated health care systems identified participants with a history of OC between 1998 and 2020 who did not have genetic testing or testing limited to BRCA1/2. Participants received clinical genomic sequencing via a custom 60 gene panel. This study measured the feasibility of the Traceback methodology in OC survivors. Results: The initial cohort included 929 individuals, of which 57% had no prior genetic testing. Of the 302 eligible for recruitment, 88 consented to participate. We were able to outreach 97% of the eligible population using contact information from medical records. The stage at diagnosis was the only factor associated with consent. Of the 78 who returned their saliva sample, 21% had pathogenic/likely pathogenic variants, and 79% had negative results. Conclusion: The GRACE study resulted in a 29% uptake of genetic testing in OC survivors. The time since diagnosis did not have an impact on consent or ability to contact. GRACE can inform the implementation of future Traceback programs, providing guidance on how to prevent and mitigate the burden of OC and other hereditary cancers. Full article
(This article belongs to the Special Issue Gynecologic Cancer: Risk Factors, Interception and Prevention)
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26 pages, 4539 KiB  
Systematic Review
Effects of Weight Loss on Key Obesity-Related Biomarkers Linked to the Risk of Endometrial Cancer: A Systematic Review and Meta-Analysis
by Angela D. Clontz, Emma Gan, Stephen D. Hursting and Victoria L. Bae-Jump
Cancers 2024, 16(12), 2197; https://doi.org/10.3390/cancers16122197 - 11 Jun 2024
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Abstract
Endometrial cancer (EC) includes various histologic types, with estrogen-dependent endometrioid carcinoma being the most common. Obesity significantly increases the risk of developing this type, especially in postmenopausal women, due to elevated estrogen production by adipocytes. This review examines the impact of weight loss [...] Read more.
Endometrial cancer (EC) includes various histologic types, with estrogen-dependent endometrioid carcinoma being the most common. Obesity significantly increases the risk of developing this type, especially in postmenopausal women, due to elevated estrogen production by adipocytes. This review examines the impact of weight loss from different interventions on reducing obesity-related risk factors for endometrioid EC. A systematic review and meta-analysis were conducted on three weight loss interventions: bariatric surgery, pharmacotherapy, and lifestyle changes. The effects of these interventions on inflammatory biomarkers (CRP, TNF-α, IL-6) and hormones (leptin, estrogen) were analyzed. Data from controlled studies were pooled to assess the significance of weight loss in reducing these biomarkers. Despite heterogeneity, bariatric surgery resulted in an overall 25.8% weight reduction, outperforming lifestyle and pharmacotherapy interventions. Weight loss reduced CRP levels by 33.5% and IL-6 levels by 41.9%. TNF-α levels decreased by 13% with percent weight loss over 7%. Leptin levels also decreased significantly, although the exact weight loss percentage was not statistically significant. Weight loss effectively reduces proinflammatory markers and hormones associated with increased risk of endometrioid EC. The strengths of this review include a comprehensive examination of different weight-loss interventions and a large pool of participants. However, limitations include high heterogeneity among studies and only 43% of the participants being postmenopausal. Limited data on sex hormones and racial disparities underscore the need for further research. Full article
(This article belongs to the Special Issue Gynecologic Cancer: Risk Factors, Interception and Prevention)
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15 pages, 2157 KiB  
Systematic Review
Imiquimod Is Effective in Reducing Cervical Intraepithelial Neoplasia: A Systematic Review and Meta-Analysis
by Balázs Hamar, Brigitta Teutsch, Eszter Hoffmann, Péter Hegyi, Andrea Harnos, Péter Nyirády, Zsombor Hunka, Nándor Ács, Ferenc Bánhidy and Zsolt Melczer
Cancers 2024, 16(8), 1610; https://doi.org/10.3390/cancers16081610 - 22 Apr 2024
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Abstract
Introduction: Topical Imiquimod is an immune response modifier approved for the off-label use of vulvar intraepithelial neoplasia. We conducted this systematic review and meta-analysis to investigate the efficacy and safety of Imiquimod in treating cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV)-positive patients. [...] Read more.
Introduction: Topical Imiquimod is an immune response modifier approved for the off-label use of vulvar intraepithelial neoplasia. We conducted this systematic review and meta-analysis to investigate the efficacy and safety of Imiquimod in treating cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV)-positive patients. Methods: The study was prospectively registered (CRD420222870) and involved a comprehensive systematic search of five medical databases on 10 October 2022. We included articles that assessed the use of Imiquimod in cervical dysplasia and HPV-positive patients. Pooled proportions, risk ratios (RRs), and corresponding 95% confidence intervals (CIs) were calculated using a random effects model to generate summary estimates. Statistical heterogeneity was assessed using I2 tested by the Cochran Q tests. Results: Eight articles reported on 398 patients who received Imiquimod out of 672 patients. Among CIN-2–3 patients, we observed a pooled regression rate of 61% (CI: 0.46–0.75; I2: 77%). When compared, Imiquimod was inferior to conization (RR: 0.62; CI: 0.42–0.92; I2: 64%). The HPV clearance rate in women who completed Imiquimod treatment was 60% (CI: 0.31–0.81; I2: 57%). The majority of side effects reported were mild to moderate in severity. Conclusions: Our findings indicate that topical Imiquimod is safe and effective in reducing cervical intraepithelial neoplasia and promoting HPV clearance. However, it was found to be inferior compared to conization. Imiquimod could be considered a potential medication for high-grade CIN patients and should be incorporated into guidelines for treating cervical dysplasia. Full article
(This article belongs to the Special Issue Gynecologic Cancer: Risk Factors, Interception and Prevention)
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