Cervical Cancer: Screening Pap Smears tied to higher Cure Rate

Population based cohort study, Sweden, 2012

Screening Pap Smears tied to higher Cure Rate
Screening Pap Smears tied to higher Cure Rate

Another good reason for women to have regular Pap smears.: ” Women with screen-detected cervical cancer had a 26% absolute increase in cure rate as compared with women who were symptomatic at diagnosis, results of a Swedish study showed. ”

Abstract

Objective
To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death.

Design
Nationwide population based cohort study.

Setting
Sweden.

Participants
All 1230 women with cervical cancer diagnosed during 1999-2001 in Sweden prospectively followed up for an average of 8.5 years.

Main outcome measures
Cure proportions and five year relative survival ratios, stratified by screening history, mode of detection, age, histopathological type, and FIGO (International Federation of Gynecology and Obstetrics) stage.

Results
In the screening ages, the cure proportion for women with screen detected invasive cancer was 92% (95% confidence interval 75% to 98%) and for symptomatic women was 66% (62% to 70%), a statistically significant difference in cure of 26% (16% to 36%). Among symptomatic women, the cure proportion was significantly higher for those who had been screened according to recommendations (interval cancers) than among those overdue for screening: difference in cure 14% (95% confidence interval 6% to 23%). Cure proportions were similar for all histopathological types except small cell carcinomas and were closely related to FIGO stage. A significantly higher cure proportion for screen detected cancers remained after adjustment for stage at diagnosis (difference 15%, 7% to 22%).

Conclusions
Screening is associated with improved cure of cervical cancer. Confounding cannot be ruled out, but the effect was not attributable to lead time bias and was larger than what is reflected by down-staging. Evaluations of screening programmes should consider the assessment of cure proportions.

Read Screening Pap Smears Tied to Higher Cure Rate, by Charles Bankhead, MedPage Today, March 02, 2012

Sources: Screening and cervical cancer cure: population based cohort study, BMJ, March 01, 2012

Overall Incidence of Testicular Cancer on the Rise in the United States

Testis Cancer Rates Continue to Rise

Overall Incidence of Testicular Cancer on the Rise in the US
Testis cancer rates continue to rise

The incidence of testicular cancer has increased among American males over 15 years of age for more than 20 years and while overall incidence is still highest among Caucasian males, the greatest increase was observed in the Hispanic community, according to a new study at the 108th Annual Scientific Meeting of the American Urological Association.

DES Action USA commented: ” Experts speculate prenatal estrogen exposures may be to blame.  All men – and especially DES Sons – should practice testicular self-exam regularly!

Read Testis Cancer Rates Continue to Rise
By Charles Bankhead, MedPage Today, May 07, 2013

Sources: American Urological Association, May 03, 2013

Use of Robots for Hysterectomy Soars, but with Little Benefit

Why are gynecologists pushing robotic hysterectomies?

Use of Robots for Hysterectomy Soars, but with Little BenefitRobotically assisted hysterectomy increased dramatically from 2007 to 2010, despite higher cost and similar complication rates compared with laparoscopic procedures, a review of data from more than 400 hospitals showed. “

Read Use of Robots for Hysterectomy Soars, but with Little Benefit
by Charles Bankhead, MedPage Today.

Comparative Effectiveness Research on Robotic Surgery

During the last 10 years, the use of robotic-assisted surgery has substantially increased, beginning with urologic procedures and expanding to include gynecologic procedures and many others. Robotic-assisted surgery is a type of minimally invasive procedure that in fact facilitates laparoscopic surgery. Both approaches provide benefits compared with open surgery, including smaller incisions, shorter hospital stays, less postoperative pain, and possibly quicker return to function. As of 2009, more than 200 000 robotically assisted operations had been performed worldwide. The reason for its rapid dissemination in the United States may be linked to a number of converging factors, including better ergonomics for the surgeon, marketing campaigns, and the national fascination with technology and innovation. Under other circumstances, this might be an unparalleled success story of US medical ingenuity. However, critics of robotic surgery claim that it is more expensive without providing a concomitant benefit. Sources.

Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease

Abstract

Importance
Although robotically assisted hysterectomy for benign gynecologic conditions has been reported, little is known about the incorporation of the procedure into practice, its complication profile, or its costs compared with other routes of hysterectomy.

Objectives
To analyze the uptake of robotically assisted hysterectomy, to determine the association between use of robotic surgery and rates of abdominal and laparoscopic hysterectomy, and to compare the in-house complications of robotically assisted hysterectomy vs abdominal and laparoscopic procedures.

Design, Setting, and Patients
Cohort study of 264 758 women who underwent hysterectomy for benign gynecologic disorders at 441 hospitals across the United States from 2007 to 2010.

Main Outcome Measures
Uptake of and factors associated with utilization of robotically assisted hysterectomy. Complications, transfusion, reoperation, length of stay, death, and cost for women who underwent robotic hysterectomy compared with both abdominal and laparoscopic procedures were analyzed.

Results
Use of robotically assisted hysterectomy increased from 0.5% in 2007 to 9.5% of all hysterectomies in 2010. During the same time period, laparoscopic hysterectomy rates increased from 24.3% to 30.5%. Three years after the first robotic procedure at hospitals where robotically assisted hysterectomy was performed, robotically assisted hysterectomy accounted for 22.4% of all hysterectomies. The rates of abdominal hysterectomy decreased both in hospitals where robotic-assisted hysterectomy was performed as well as in those where it was not performed. In a propensity score–matched analysis, the overall complication rates were similar for robotic-assisted and laparoscopic hysterectomy (5.5% vs 5.3%; relative risk [RR], 1.03; 95% CI, 0.86-1.24). Although patients who underwent a robotic-assisted hysterectomy were less likely to have a length of stay longer than 2 days (19.6% vs 24.9%; RR, 0.78, 95% CI, 0.67-0.92), transfusion requirements (1.4% vs 1.8%; RR, 0.80; 95% CI, 0.55-1.16) and the rate of discharge to a nursing facility (0.2% vs 0.3%; RR, 0.79; 95% CI, 0.35-1.76) were similar. Total costs associated with robotically assisted hysterectomy were $2189 (95% CI, $2030-$2349) more per case than for laparoscopic hysterectomy.

Conclusions and Relevance
Between 2007 and 2010, the use of robotically assisted hysterectomy for benign gynecologic disorders increased substantially. Robotically assisted and laparoscopic hysterectomy had similar morbidity profiles, but the use of robotic technology resulted in substantially more costs.