bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients’ experiences and reported barriers to screening colonoscopy: A systematic review
Authors: McLachlan S. , Clements A. , Austoker J. 
Published: August 2020

1537 Background: Colonoscopy is a component of most colorectal screening programs, as a primary test or as follow-up to an abnormal FOB test. Little is known about why some patients do not comply with colonoscopy after being referred. Methods: A search strategy using three themes of screening, colonoscopy, and patient acceptance was developed and used in MEDLINE, EMBASE and PSYCHinfo (1996–2008). Retrieved citations were assessed for eligibility by two reviewers using prespecified criteria. A qualitative synthesis was conducted. Results: From an initial 3,174 studies, 264 were identified as potentially eligible for review. After full text assessment, 64 studies met eligibility criteria and were included in the final analysis. Six studies examined the experience of a primary colonoscopy by eliciting patients’ views soon after they had the test. Fifty-six studies addressed patient-reported concerns and barriers to an anticipated primary colonoscopy. Most patients perceived the laxative bowel preparation to be the most burdensome part and the greatest barrier to colonoscopy. Other reported difficulties included anxiety and anticipation of pain. Feelings of embarrassment and vulnerability occurred, particularly in women, and also acted as barriers to adherence. Inadequate knowledge about screening was common and was identified as an obstacle to the uptake of screening colonoscopy as was fear of finding cancer. Physician endorsement, having a family history, knowing someone with cancer, and perceived accuracy of the test were incentives to having a colonoscopy. The most common reported practical barriers were inconvenience, transportation, scheduling, and cost. Only two studies focused on colonoscopy as a secondary procedure in the screening context. Similar procedural, personal, and practical concerns were reported by patients in this setting. Conclusions: Bowel preparation, lack of awareness of the importance of screening, and feelings of vulnerability in women are all significant barriers to colonoscopy in the screening context. These obstacles need to be addressed, and further research undertaken on barriers to second line colonoscopy. No significant financial relationships to disclose.
Trends in screening for colorectal cancer in France
Authors: Viguier J. , Calazel Benque A. , Mahjoubi M. , Pivot X. , Morère J. , Blay J. , Coscas Y. , Roussel C. , Eisinger F. 
Published: August 2020

1538 Background: In France, after a pilot population-based screening program in 23 districts (2002–2003), a national organized program was progressively implemented starting in 2005. The EDIFICE 2 survey was conducted in 2008, 3 years after EDIFICE 1, to provide a better understanding of French people's participation in colorectal screening programs and to assess the evolution between the two periods. Methods: This second nationwide observational study, EDIFICE 2, was conducted in January 2008 among a representative sample of 1,801 subjects aged between 40 and 85 years old. The analysis focused on the target population of the national screening program (50–74 years old). Results: In 2008, 38% of subjects between 50 and 74 years (N = 928) had undergone a screening test for colorectal cancer (including fecal test or colonoscopy) versus 25% in 2005 (p < 0.05); 32% of the unscreened population (N = 575) planned to undergo a test. Colorectal cancer screening increased significantly in all age groups, especially between 65 and 69 years, and for both sexes. A most significant increase can be observed in districts with pilot programme (+ 21%). Factors influencing the probability of screening were: being encouraged by the family circle, living in a couple, the existence of a case of cancer (especially colorectal cancer) in the family circle, and fear of colorectal cancer. The main reasons for not performing the screening were: not feeling concerned, no recommendation by the GP, carelessness, no symptoms, and fear of exams or results. Conclusions: The objective rate of participation (50%), can be reached by motivating the unscreened population already planning to perform a test. The results in the pilot districts show the effectiveness of an organization of the screening. This trend of increasing testing will probably be confirmed in the future if the reasons for non-attendance in an organized program are addressed. No significant financial relationships to disclose.
Diverse cancer prevention needs in a population seeking risk assessment for gastrointestinal (GI) cancers
Authors: Hall M. J. , Rybak C. , Mazar C. , Balsham A. , Manne S. L. , Slater E. , Weinberg D. S. , Meropol N. J. 
Published: August 2020

1539 Background: Demand for hereditary cancer risk assessment has increased dramatically in the past decade. However, the population seeking risk assessment for GI cancers is heterogeneous, requiring primary (PP), secondary (SP), and tertiary (TP) prevention strategies. In an effort to improve targeting of prevention resources, we examined clinical cancer prevention needs as well as 1) estimates of personal risk, 2) risk beliefs 3) interest in genetic testing (GT) among individuals seeking GI risk evaluation. Methods: The Gastrointestinal Tumor Risk Assessment Program (GI-TRAP) offers risk assessment to persons seeking evaluation for a risk of a GI or related cancer. Following informed consent, participants complete a health history questionnaire prior to counseling, education, and genetic services. Results: In total, 398 individuals from 278 families were evaluated (1999–2008)( Table 1 ). Moderate-to-high risk persons with SP needs (i.e. intensive screening, chemoprevention, and genetic testing), dominated the population (281/398, 70.6%), mainly due to significant family history (FHx) of GI-related cancer (236/281, 84.0%) and/or personal history (PHx) of colorectal polyps (128/281, 45.6%). Individuals at high-risk due to a PHx of cancer were infrequent (68/398, 17.1%); here, TP needs focused on GT were common, as interest was highest in this group (p<0.01). A low-risk group (49/411, 11.9%) with minimal PHx or FHx, had mainly PP needs (i.e. risk factor management, education related to appropriate screening). Nonetheless, prior to counseling, the magnitude of personal estimated risk in this group paralleled that of the higher risk groups. Conclusions: Perceived cancer risks and beliefs may not reflect true prevention needs. Risk stratification strategies are critical for targeting education, risk counseling, and/or GT resources while maximizing current prevention goals. [Table: see text] No significant financial relationships to disclose.
Evaluation of Smad2/3 and Smad4 as inhibitors of estrogens and Ski protein as a predictive factor in T1, T2 N0 breast carcinomas
Authors: Koumoundourou D. S. , Kassimatis T. I. , Tzorakoleftherakis E. 
Published: August 2020

1543 Background: Smad proteins are TGF-β intracellular substrates, and Ski protein is a negative regulator of TGF-pathway. Tamoxifen's inhibition in breast cancer cells is mediated through TGF-β and Smad proteins. The purpose of our study was to investigate the activation of Smad2/3, Smad4, and Ski proteins in breast carcinomas and correlate their expression with each other and with hormonal receptors, as well as with other clinicopathological parameters such as the tumor size and grade, and the Distant Disease Free and the Overall Survival. Methods: One hundred forty-seven paraffin-embedded specimens from 22 in situ and 125 invasive ductal node-negative carcinomas were used, for which we had a mean follow-up time of 96 months. ER and PR status, as well as the expression of Smad2/3, Smad4, and Ski proteins were evaluated using immunohistochemistry. Staining of 5% of the tumor cells was adopted as a threshold. SPSS13 for windows was used for the statistical analysis of the results. Results: Smad2/3 and Smad4 were strongly correlated with each other (p < 0,001) and inversely correlated with patients’ DDFS (Kaplan-Meier plots, p = 0,004 for Smad2/3 and p = 0,026 for Smad4) and OS (Kaplan-Meier plots, p = 0,034 for Smad2/3 and p = 0,017 for Smad4). Smad2/3 was proved to be an independent prognostic factor in grade 1 tumors, while Smad4 was inversely correlated with PR expression (p = 0,028) and had a strong prognostic value in ER+ tumors (p = 0,02). Ski protein had a strong association with tumor grade (p < 0.001) and was found to be an independent prognostic factor in Cox regression analysis (p = 0,006, exp(B) = 4,98). Conclusions: Smad 2/3 and Smad 4 not only are tumor suppressor molecules, but also inhibit ER dependent gene expression. This inhibition is lost when Smad's expression is reduced, and that is a potent explanation for Smad 4 prognostic value in ER positive tumors. Moreover the correlation with PR expression, may be due to the fact that PR is an indicator of ER pathway's integrity and also to PR's enallaktiki activation by ER-β. From the other hand, Ski protein acts as an oncogene in breast carcinogenesis and contributes to the development of a more aggressive tumor phenotype. No significant financial relationships to disclose.
Risk factors of cervical neoplasia in a low income sector under control program in a developing country
Authors: Zarba J. J. , Holgado S. , Sanchez Segura M. , Gonzalez A. , Gonzalez A. , Cano Busnelli V. M. , Lorente C. E. , Elias de Vacaflor A. 
Published: August 2020

1545 Background: There are a high number of risk factors (RF) in cervical neoplasias, most of them related with human papilloma virus infection: women with history of multiple sex partners (MSP), with early onset of sexual intercourse (EOSI),and non-previous cervical Papanicolaou (Pap) smear (NPAP).Objective: To determine the presence of RF in the studied population, the frecuency and types of lesions found, and the correlation between non-previous pap smear and underlying pathology. Methods: The population included in the study were 14,021 patients from institutions of public (PU) (n = 7523) and private (PRI) (n = 6499) sectors in the province of Tucumán–the average age being 34 and 43 years old, respectively–studied between 2007 and 2008, in a routine screening for CC with Pap testing. Both sectors include mostly low income people with none or limited health insurance. All testings were performed under methodologic norms of a CC Detection Program. The RF analized were: NPAP, EOSI, and MSP. Cervical lesions were studied with Bethesda System 2001. The statistic applied was the exploratory analysis. Results: NPAP in PU n = 4562 (75.76%), PRI n = 3247 (81.66%). EOSI with mean age being in PU 17 years old (sD 3.55) and PRI 19 (sD 5.33).MSP above 4 partners PU n= 482 (6.55%) PRI n= 161 (2.75%).Frecuency of LSIL in PU n= 30 (0,40%) PRI n = 50 (0.80%).HSIL in PU n = 29 (0.39%) PRI n = 28 (0.45%).Ca INV in PU n = 6 (0.08%) PRI n = 3 (0.05%). ASCUS in PU n = 24 (0.32%) PRI n = 10 (0.16%). Asociation between NPAP and cervical pathology was found p = 0.024 < 0.05 given that 100/142 (70.42%) patients with lesion had NPAP and 42/142 (29.57%) paitents had previous Pap. Conclusions: The results in this sample indicate low Pap coverture is mantained in PU and PRI sectors and the need to approach the population under 20 years old in Tucuman, Argentina, to prevent CC. No significant financial relationships to disclose.
The UICC Cervical Cancer Initiative: A comprehensive program for cervical cancer prevention worldwide including a fellowship program
Authors: Harford J. 
Published: August 2020

1547 Background: HPV vaccines and new screening tools have the potential to make cervical cancer largely a disease of the past. The UICC Cervical Cancer Initiative (CCI) is a comprehensive program that aims to increase awareness and education, and support screening, vaccination, and treatment via four key components: advocacy; public information; professional education; and pilot projects. CCI is global in scope, but emphasis is placed on resource-poor settings where mortality and morbidity rates from cervical cancer and HPV-related infections are highest. Lack of appropriate professional knowledge has recurrently been identified as one of the major hindrances to national cancer control programs and lack of access to diagnosis and treatment. Methods: A comprehensive educational package developed by a task force of experts will serve as a basis for train the trainer courses. CCI curriculum materials are practical and reader-friendly with an interdisciplinary approach. UICC has developed a dedicated fellowship program to support the implementation of the CCI. Special attention is given to south-to-south knowledge transfer by encouraging workshops within regions and in local languages. Professional education is one of the key components of UICC projects in Tanzania and Nicaragua, which aim to showcase the impact of comprehensive education on cervical cancer control. The fellowships support these efforts via opportunities for appropriate training of health practitioners, policy-makers, educators, researchers, and technicians. Results: See www.uicc.org for information about study grants, training workshops, technology transfer, and training for nurses, investigators, and pathologists. Expert reviewers ensure each project is judged according to preset criteria. Conclusions: Knowledge transfer between professionals and a lay audience is critical for long-term sustainability. The UICC cervical cancer curriculum supported by a dedicated fellowship program and a train the trainer approach is one route to achieving success. Key factors include: identification of host institutions and reviewers, continual funding, evaluation and implementation plans per trainee, as well as a sharing best practice forum. No significant financial relationships to disclose.
Misuse of suncare products: Toward a protocol for sunscreen application
Authors: Issachar N. , Nkengne A. , Bertin C. , Robert C. 
Published: August 2020

1548 Background: Increasing awareness of the UV-induced skin carcinogenesis has led to a significant demand for improved photo-protection both in UVB and UVA ranges. Sunscreen products are subjected to strict efficacy controls relying on standardized UV protection measurements and are widely recommended by oncologists and dermatologists in order to prevent skin cancers. However, sunscreen effectiveness depends not only on the quality of the product itself but also on the way people use it in real life. Misuse of suncare products might even lead to opposite deleterious effects. We conducted three successive studies in order to validate a sunscreen application protocol. Methods: Three studies were done on healthy volunteers who were asked to apply a sunscreen product as they usually do without any guidance or following a protocol of product application. Spontaneous application was evaluated in the first study (N = 17). Two application protocols were successively tested (N = 31) where both quantity of product and quality of sunscreen spreading were assessed (without and with the protocol) by three independent evaluators using photos taken under UVA light. Results: Spontaneous application of sunscreen resulted in an heterogeneous application of only 27% of the quantity recommended following COLIPA guidelines. Two application protocols giving practical informations concerning the quantity and the way to spread the product on each body anatomical sites were successively evaluated. Use of the application protocols improved both the quantity of suncare product and the homogeneity of product spreading with an highly significant improvement resulting from the use of the final and improved application protocol tested in the third study (p < 0.02). Conclusions: The correct use of sunscreens is a public health issue about which the public still requires considerable education. We propose that, in addition to the usual photoprotection recommendations (i.e., clothing protection and avoidance of middle day exposure), population should be trained to use validated protocols for sunscreen application. [Table: see text]
Phase II trial of bevacizumab in combination with temozolomide and regional radiation therapy for up-front treatment of patients with newly diagnosed glioblastoma multiforme
Authors: Lai A. , Nghiemphu P. , Green R. , Spier L. , Peak S. , Phuphanich S. , Fehrenbacher L. , Kolevska T. , Polikoff J. , Cloughesy T. 
Published: August 2020

2000 Background: Bevacizumab (BV) is a humanized monoclonal antibody directed against the vascular endothelial growth factor (VEGF). Based on the promising activity of BV in the treatment of recurrent glioblastoma, we are conducting a phase II trial to determine whether up-front treatment of newly diagnosed GBM with BV may be more advantageous than withholding BV until recurrence. In this trial, we evaluate the safety and efficacy of BV combined with standard of care radiation (RT) and temozolomide (TMZ) and radiation (RT) for newly-diagnosed GBM. Methods: This is a phase II trial with a 10-patient pilot and 60-patient expansion phases. Newly-diagnosed GBM patients with no prior treatments are eligible. Primary outcome measure is overall survival; the secondary outcome measure is TTP and 12-month survival. Therapy began between 3–5 weeks of surgery with BV (10 mg/kg every 2 weeks), TMZ (75 mg/m2 daily), and external beam RT (30 x 200 Gy) on the same day. After completion of radiation, patients are then placed on a maintenance phase of BV (10mg/kg every 2 weeks) and TMZ (150–200 mg/m2 5 out of every 28 days) until progression or 24 months in which patients are then maintained on BV only. Results: 70 of 70 projected GBM patients have been enrolled between August 2006 and November 2008 at UCLA and Kaiser Permanente (KP) (Northern and Southern California). All patients had resections to ensure that frozen tissue (>200mg) was collected. The median age was 57.4 years (range 31–75). MGMT methylation analysis has been performed on 52/70 patients with ∼40% showing methylation. Severe adverse events to date have included ischemic stroke, pulmonary embolus, wound breakdown, GI bleeding/perforation, and renal dysfunction. Isolated cases of retinal detachment and optic neuropathy have also been observed. As of now, 35/70 patients are off study (26 due to progression and 9 due to SAE). Preliminary TTP by Kaplan-Meier analysis is promising compared to that of a UCLA/KP control group of patients that received the conventional RT/TMZ regimen. Conclusions: Addition of BV to the standard regimen of TMZ and RT for newly-diagnosed GBM is well-tolerated and shows promising efficacy. More detailed analysis of safety and efficacy will presented. [Table: see text]
NABTT 0306: A randomized phase II trial of EMD 121974 in conjunction with concomitant and adjuvant temozolomide with radiation therapy in patients with newly diagnosed glioblastoma multiforme (GBM)
Authors: Nabors L. B. , Mikkelsen T. , Batchelor T. , Lesser G. , Rosenfeld M. , Ye X. , Piantadosi S. , Olson J. , Brem S. , Grossman S. 
Published: August 2020

2001 Background: EMD 121974 (cilengitide) is a selective integrin receptor inhibitor that is well tolerated and has demonstrated biological activity in patients with malignant glioma. The objectives of this phase II trial were to determine safety when combined with chemoradiation and estimate the overall survival for two different doses in newly diagnosed GBM. Methods: A total of 112 patients were accrued onto the trial through the NABTT CNS consortium. Cilengitide was administered by one-hour infusion twice a week with 18 patients treated in a safety run-in phase of 6 patients at the tested dose levels of 500 mg, 1000 mg, and 2000 mg. After safety completion, 94 patients were randomly assigned to either 500 mg or 2000 mg groups. To date, 55 out of 112 (49%) patients have died. Overall survival was estimated using all patients in this trial regardless of their treating dose. Results: The median age was 55 years old (range: 22–88) and the median KPS was 90 (range: 60–100). 86 out of the 112 (76.8%) had a craniotomy as their initial surgical procedure and 25 patients (22%) had a biopsy. There were no DLTs during the safety run-in phase. The estimated median survival time is 18.9 months (95% CI: 16.3 -30.0 months) for patients treated with RT+TMZ+EMD. The trial was closed to accrual on December 31, 2007. To date, 89 out of 112 patients were alive 12 months from their initial diagnosis. The overall survival at 12 months for all patients is 79.5% (95% CI: 71–87%). MGMT methylation status and survival based on dose levels received are not currently available. Conclusions: EMD 121974 (cilengitide) is well-tolerated when combined with standard chemoradiation (TMZ+RT) and may improve survival for patients newly diagnosed with GBM given the substantial differences between the estimated median survival and that seen in the EORTC study (Stupp, N Engl J Med, 2005). [Table: see text]
NABTT-0702: A phase II study of R-(-)-gossypol (AT-101) in recurrent glioblastoma multiforme (GBM)
Authors: Fiveash J. B. , Chowdhary S. A. , Peereboom D. , Mikkelsen T. , Nabors L. B. , Lesser G. J. , Rosenfeld M. R. , Ye X. , Grossman S. A. 
Published: August 2020

2010 Background: R-(-)-gossypol (AT-101) is an oral bcl-2 family protein inhibitor (Bcl-2, Bcl-XL, Mcl-1, Bcl-W) and potent inducer of proapoptotic proteins. A prior study of racemic gossypol demonstrated objective responses in patients with malignant glioma. The objectives of this trial were to determine the efficacy and safety of the more active (-) enantiomer of gossypol (AT-101) in patients with recurrent GBM. Methods: Fifty-six patients with recurrent GBM were enrolled in this multi-institution phase II clinical trial through the NABTT CNS consortium designed to detect a 33% increase in overall survival (OS, primary endpoint) from 5 to 6.65 months with Power/Alpha 80%/0.01. All patients had received prior radiation and none had received more than two prior treatments. Patients taking P450-inducing anticonvulsants were not eligible. AT-101 was administered at 20 mg PO per day for 21 of 28 days in repeated cycles. Radiographic assessment of tumor response was made at q 8-week intervals. Results: Fifty-six patients were enrolled with a median age of 59 (range 34–79) and KPS of 80 (range 60–100). Grade 3 or greater adverse events possibly or probably related to AT-101 included fatigue (n = 2), ileus (n = 1), elevated cardiac troponin T levels (n = 1), elevated GGT (n = 1), and thrombocytopenia (n = 1). Response data is available for 43 patients. OS determination is ongoing. Seven patients (16%) had stable disease as the best response. One partial response (centrally reviewed) was observed. No complete responses were observed. Although treatment is ongoing, two patients are without progression after more than 7 months of therapy. Conclusions: AT-101 is well tolerated and without unique toxicities in patients with recurrent GBM. Further follow-up will determine the impact of AT-101 on OS and whether any tissue correlate is predictive of efficacy. No significant financial relationships to disclose.