Search

Cervical cancer is on the declining trend in India according to the population-based registries; yet it continues to be a major public health problem for women in India. Multifactorial causation, potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. This paper attempts to review the available knowledge regarding the epidemiology and pattern of cervical cancer; types of HPV (human papilloma virus) prevalent among cervical cancer patients and among women in general, high-risk groups such as commercial sex workers, and HIV (human immunodeficiency virus)-positive women; and the role of the national program on cancer in control efforts. The peak age of incidence of cervical cancer is 55-59 years, and a considerable proportion of women report in the late stages of disease. Specific types of oncogenic HPV-16, 18 have been identified in patients with cervical cancer. Other epidemiological risk factors are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness. A multipronged approach is necessary which can target areas of high prevalence identified by registries with a combination of behavior change communication exercises and routine early screening with VIA. Sensitizing the people of the area, including menfolk, is necessary to increase uptake levels. Vaccination against types 16 and 18 can also be undertaken after taking into confidence all stakeholders, including the parents of adolescent girls. Preventing and treating cervical cancer and reducing the burden are possible by targeting resources to the areas with high prevalence. [ABSTRACT FROM AUTHOR]

Worldwide, cervical cancer is considered to be the second commonest cancer as far as mortality and incidence is concerned and India contributes to about 20-30% of the global burden. This paper is based on analysis of records of persons suffering from various cancers over 25 years. Cervical cancer constituted 14.4% of all cancers of men and women put together, 28.8% of the cancers in women and 73.3% of all gynaecological cancer. The cases studied were divided into five Blocks: Block A 1983-1987; Block B 1988-1992; Block C 1993-1997; Block D 1998-2002 and Block E 2003-2007. A 2.34 times increase in cancer cases from Block A to Block E was seen; in women, overall cancer increased by 3.21 times; gynaecological cancer by 3.08 times; cervical cancer 2.91 and ovarian cancer 7.1 times. Cervical cancer in outpatients increased from 0.55% among all gynaecological cases in 1983, to 3.5% in 2007. Cervical cancer comprised of 1.05% of the newly registered outpatients and 70.09% of gynaecological cancer cases. Inpatient gynaecological cancer increased from 2.81% in 1983 to 9.81% in 2007. Out of all cervical cancer in women, cervical cancer was 34.7% in Block A (1983-1987) and 28.6 % in Block E (2003-2007). Of the cervical cancer cases, 43.8% belonged to the age group 30-49 years and 37.6% at 50-64 years. Cervical cancer in women with less than three births increased from 13.1% in Block A to 33.1% in Block E. The proportion of illiterate women or those with primary education was seven times more compared with those with secondary education. Our study revealed that cervical cancer still continues to rank first. Also the overall number of cancer cases has been increasing. [ABSTRACT FROM AUTHOR]

Skin cancers are relatively uncommon malignancies which have been seen worldwide; their incidence in India is less than 1% of all the cancers. The incidence of malignancy in scar tissues is 0.1-2.5%. Saree is a type of female costume and dhoti is a male costume which are unique to the Indian subcontinent. The persistent and the long term wearing of this costume results in depigmentation and glazing of the skin, acanthosis, scar and ulceration and subsequent, but very slow, malignant changes. The exact mechanism of the malignant transformation is unknown, but recurrent trauma over a long period with consequent interference with the healing process is a possible explanation. Very few papers have been published on saree cancer and no article on this topic is available on Medline and Pubmed. Khanolkar and Suryabai first described 'dhoti cancer' in 1945. We are presenting a rare case of saree cancer in a 70 year old women. She presented with an ulceroproliferative growth which measured 10 cm × 7 cm on the left loin, which turned out to be squamous cell carcinoma on biopsy. Wide excision with primary skin grafting was done. The post operative follow up of one year has shown her to be disease free. [ABSTRACT FROM AUTHOR]

Cumulatively, breast, cervical, ovarian, and uterine cancer account for more than 70% of cancers in women in India. Distinct differences in the clinical presentation of women with cancer suggest underlying differences in cancer biology and genetics. The peak age of onset of breast and ovarian cancer appears to be a decade earlier in India (age 45-50 years) than in high-income countries (age >60 years). Understanding these differences through research to develop diagnosis, screening, prevention, and treatment frameworks that ar e specific to the Indian population are critical and essential to improving women's health in India. Since the sequencing of the human genome in 2001, applications of advanced technologies, such as massively parallel sequencing, have transformed the understanding of the genetic and environmental drivers of cancer. How can advanced technologies be harnessed to provide health-care solutions at a scale and to a budget suitable for a country of 1·2 billion people? What research programmes are necessary to answer questions specific to India, and to build capacity for innovative solutions using these technologies? In order to answer these questions, we convened a workshop with key stakeholders to address these issues. In this Series paper, we highlight challenges in tackling the growing cancer burden in India, discuss ongoing genomics research and developments in infrastructure, and suggest key priorities for future research in cancer in India. [ABSTRACT FROM AUTHOR]

Background:A Population-Based Cancer Registry (PBCR) was set up in Sikkim (a state in the North Eastern India) in 2003. We examined incidence rates by ethnic groups from 2003-2008.Methods:Age-adjusted incidence rates (AARs) per 100 000 person-years were calculated by direct method using the world standard population, and analysed by ethnic group (Bhutia, Rai and other).Result:There were a total of 1148 male and 1063 female cases of cancer between 2003 and 2008 on the Sikkim PBCR. The overall AARs were 89.4 and 99.4 per 100 000 person-years in males and females, respectively. Incidence rates were highest amongst the Bhutia group (AAR=172.4 and 147.4 per 100 000 person-years in males and females, respectively), and the largest difference in rates were observed for stomach cancers with AARs being 12.6 and 4.7 times higher in the Bhutia group compared with other ethnic groups in males and females, respectively.Conclusion:These observations call for further epidemiological investigations and the introduction of screening programmes. [ABSTRACT FROM AUTHOR]

Few studies have examined social factors related to breast cancer screening in Asian Indian women in the Midwestern US . This cross-sectional, community-based survey utilized constructs of the Health Belief Model to examine factors associated with breast cancer screening among Asian Indian women in metropolitan Detroit, Michigan. Of the 160 participants, 63.8% reported receiving both a clinical breast exam and mammogram within the past 2 years. Women were more likely to screen for breast cancer if they had a college education, lived in the US for more years, perceived that breast cancer screening is useful in detecting breast cancer early, agreed that mammography was important, and received a recommendation by a healthcare provider to get a mammogram. These findings highlight the need for further research on regional differences in breast cancer screening knowledge, behaviors and predictors among Asian Pacific Islanders subgroups such as Asian Indian women who recently immigrated to the US. [ABSTRACT FROM AUTHOR]

Breast cancer is the most frequently occurring malignancy among women in India, however, the recorded stage distribution at presentation in India is less favorable than in Europe. Health beliefs are important in help-seeking for potential symptoms of disease, which may be particularly important among women who do not have access to breast screening programs. The purpose of this study was to examine Indian women's beliefs about breast cancer and help-seeking for the disease and how these beliefs related to their intentions to seek help for a symptom of breast cancer. Furthermore, the study aimed to examine differences in the beliefs of urban- and rural-based women. Of 800 women, 685 were recruited in Allahabad in Northern India (response rate 86%). The women completed a questionnaire examining beliefs about breast cancer and help-seeking. One in four women reported that they would delay seeking help for at least one month following the discovery of a symptom of breast cancer. Rural respondents held more negative beliefs about breast cancer and were also more likely to report less positive attitudes toward help-seeking and a belief that they would be discouraged from seeking help. The findings of the study provide suggestions for the targeting of an intervention aimed at improving early detection and help-seeking for breast cancer symptoms. This may be of particular importance in India where a breast cancer screening program does not currently exist and is being debated. [ABSTRACT FROM AUTHOR]

Background: Prevalence estimates of cervical intraepithelial neoplasia (CIN) among HIV-infected women in India have been based on cervical cytology, which may have underestimated true disease burden. We sought to better establish prevalence estimates and evaluate risk factors of CIN among HIV-infected women in Pune, India using colposcopy and histopathology as diagnostic tools. Methodology: Previously unscreened, non-pregnant HIV-infected women underwent cervical cancer screening evaluation including standardized diagnostic colposcopy by a gynecologist. Histopathologic confirmation was conducted among consenting women with clinical suspicion of CIN. The prevalence of CIN was evaluated by a composite diagnosis based on colposcopy and histopathology results. Multivariable ordinal logistic regression analysis was conducted to determine independent predictors of increasing severity of CIN. Results: The median age of the n = 303 enrolled HIV-infected women was 30 years (interquartile range, 27-34). A majority of the participants were widowed or separated (187/303, 61.7%), more than one-third (114/302, 37.7%) were not educated beyond primary school, and nearly two-thirds (196/301, 64.7%) had a family per capita income of <1,000 Indian Rupees (∼US$22) per month. Cervical high-risk HPV-DNA was detected in 41.7% (124/297) of participants. The composite colposcopichistopathologic diagnoses revealed no evidence of CIN in 220 out of 303 (72.6%) women, CIN1 in 33/303 (10.9%), CIN2 in 31/ 303 (10.2%), CIN3 in 18/303 (5.9%) and 1 (0.3%) woman was diagnosed with ICC. Thus, over a quarter of the participants [83/ 303: 27.7% (95% CI: 22.7-33.1)] had ≤CIN1 lesions and a sixth [50/303: 16.5% (95% CI: 12.2-21.9)] had evidence of advanced (≥CIN2) neoplastic disease. The independent predictors of increasing severity of CIN as revealed by a proportional oddsmodel using multivariable ordinal logistic regression included (i) currently receiving antiretroviral therapy [adjusted odds ratios (aOR): 2.24 (1.17, 4.26), p = 0.01] and (ii) presence of cervical high-risk HPV-DNA [aOR: 1.93 (1.13, 3.28), p = 0.02]. Conclusions: HIV-infected women in Pune, India have a substantial burden of cervical precancerous lesions, which may progress to invasive cervical cancer unless appropriately detected and treated. Increased attention should focus on recognizing and addressing this entirely preventable cancer among HIV-infected women, especially in the context of increasing longevity due to antiretroviral therapy. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is the most common malignancy affecting females worldwide but conventional risk factors are able to explain only a small proportion of these cases. A possible viral etiology for breast cancer has been proposed and Epstein-Barr Virus (EBV) is a widely researched candidate virus. The aim of the present study, first one of its kind from India, was to determine if there is a greater association of EBV infection with breast cancer patients as compared to patients with benign breast diseases. Methods: We looked for expression of Epstein-Barr Virus Nuclear Antigen-1 (EBNA-1) in breast cancer tissue specimens by employing immunohistochemistry (IHC). We also measured levels of anti-EBNA-1 Immunoglobulin (IgG) antibodies in stored sera of these patients using commercial Enzyme linked Immunosorbent Assay (ELISA) kit. Patients with benign breast diseases were used as a comparison group for both immunohistochemical and serological analysis. Results: 58 cases of malignant breast disease and 63 of benign breast disease (controls) were included in the study. Using manufacturer determined cut-off of 3 IU/ml, 50/55 tested (90.9%) cases and 27/33 tested (81.8%) controls were seropositive for anti-EBNA-1 IgG. Mean antibody levels were significantly higher for cases (54.22 IU/ml) as compared to controls (18.68 IU/ml). IHC for EBNA-1 was positive in 28/51 cases (54.9%). No IHC positivity was noted in the tested 30 controls. Our results show that EBNA-1 expression is seen in a significant proportion of breast cancer tissue specimens from rural India and as compared to patients with benign breast diseases these patients also have a higher immunological response against EBNA-1. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tamoxifen is being used in patients with estrogen receptor positive breast cancer as an adjuvant or palliative hormonal therapy. western studies have found a 30% incidence of gallstones in patients who are taking Tamoxifen and they have proved a significant association between the two. OBJECTIVES: The objective of the study was to find out the association of Tamoxifen use and gallstone formation in postmenopausal breast cancer patients in a South Indian population. METHODS: Ninety patients who had undergone surgery for invasive breast cancer in our institute, and were receiving adjuvant Tamoxifen, were recruited for the study. An equal number of age-matched postmenopausal women were taken as controls. All of them underwent an abdominal ultrasound screening test for gallstones. Presence or absence of gallstones was noted down from their ultrasound scan reports. Pretreatment status of the gall bladder was assessed from the preoperative scan reports. RESULTS: an odds ratio of 1 was derived when the case group was compared with the control group. CONCLUSIONS: In our study we could not establish that an association existed between Tamoxifen use and gallstone formation in postmenopausal south Indian women. [ABSTRACT FROM AUTHOR]

BACKGROUND: The incidence of breast cancer is on the rise in India, breast cancer is the second most common malignancy in Indian women. AIM: The aim of this study was to find out the association of various risk factors with breast cancer among women in Delhi. SETTINGS AND DESIGN: This was a case-control study in Lok Nayak Hospital, Delhi. METHODS AND MATERIAL: 332 women were studied. Subjects were women with breast cancer (N = 115) and age matched Control subjects (N-217) without breast cancer, attending Lok Nayak Hospital during 2006. Subjects were interviewed using a pretested questionnaire. The risk factors studied were: age, parity, socioeconomic status, marital status, breast feeding, menarche, menopause, family history. STATISTICAL ANALYSIS: Data was expressed in proportion. RESULTS AND CONCLUSIONS: Age of the patient ranged from 25 to 80 years. In this study, 69 (60%) cases and 127 (58.5%) controls were illiterate, the mean duration sum of total breast feeding for all children was 6.58 years in cases and 7.4 years in controls (OR = 1.91; 95% CI, 1.17 - 3.13) (P < 0.006). In the present study 52.9% of the cases and 47.9% of controls had attained menopause before the age of 45 years, and a higher number of controls were living with spouses than cases (P < 0.0001). A larger number of controls (150, 69.1%) were living in urban areas than cases (65, 56.5%) (P<0.05). There was a significant difference between breast cancer cases and controls in relation to place of residence, occupation, marital status, body mass index and breast feeding. [ABSTRACT FROM AUTHOR]

BACKGROUND: Breast cancer accounts for 19-34% of all cancer cases among women in India. There is a high mortality due to late stage diagnosis as patients usually present at an advanced stage because of lack of awareness and nonexistent breast cancer screening programs. AIM: To determine the awareness about breast cancer among women in an urban resettlement colony in Delhi. SETTINGS AND DESIGN: A community based, cross-sectional study carried out in a resettlement colony in South Delhi. MATERIALS AND METHODS: Semi-structured interview schedule was used to collect information regarding breast cancer. Modified Kuppuswamy scale was used for assessing the socio-economic status. RESULTS AND CONCLUSIONS: A total of 333 women were included. The mean age was 36 years±15.1 and 46% were illiterate. Only 185 (56%) women were aware of breast cancer; among them, 51% knew about at least one of the signs /symptoms, 53% were aware that breast cancer can be detected early, and only 35% mentioned about risk factors. Thus, awareness about breast cancer is low amongst women in this community. There is a need for awareness generation programs to educate women about breast cancer, propagation of correct messages and promote early detection of breast cancer. [ABSTRACT FROM AUTHOR]

The article reports on how medical personnel can help in managing the psychological issues faced by women with incurable cervical cancer in India. Caregivers must be aware of the macro level issues such as poverty, inadequacy of health care services and gender issues such as patriarchy because these issues contributed to the oppression, submission and exploitation of Indian women.

Cervical screening in India. Cervical screening is a new concept in India. In order to assess the acceptability of cervical screening, perceptions, and preferences among women, and reasons for noncompliance with screening, a review was undertaken wherein women were offered the opportunity to undergo a free screen. Screening was undertaken using VIA, VILI, and HCII tests following counselling, and the service was provided in a location close to their homes. Understanding noncompliance Five hundred randomly selected women who did not attend the screening programme were interviewed by a medical officer. She used a structured questionnaire based upon feedback from a series of focus group discussions. The questionnaire included 24 potential reasons for noncompliance and was undertaken by 469 women, 61% of whom were illiterate and 75% were housewives. Most came from poor socioeconomic backgrounds (86%) and the majority (61%) were < 40 years of age. Reasons for nonattendance varied. Among 232 (49.5%) women who were unwilling to attend, 46.1% believed that there was no need for a checkup as they were not sick, while others expressed fears about the cancer detection test (36.2%). Some women felt that they might also experience problems reported by a relative/neighbour following testing (27.6%). Among other responses, the most common was a fatalistic approach to destiny (18.5%). Over 40% of nonattendees were willing to accept screening but could not attend the clinic due to various reasons, the commonest being work or family commitments. In this group 26.5% of respondents claimed that their husband/in-laws did not allow them to be tested. One in 20 women claimed to have been advised against testing by their doctor. A small number (5.8%) attended clinic without being tested; some became impatient with waiting, were scared by the instruments or refused to be seen by a male doctor (2.1%). Post-screening feedback Women (N = 498) from 13 randomly selected villages who underwent screening were interviewed by a female social worker. Most reported no pain or only slight discomfort during screening (94.2%). Some experienced post-screening issues such as burning sensation (5.8%), vaginal discharge (12%) or bleeding (3.8%). Seven women subsequently sought medical attention for post-screening problems. The majority of women were satisfied with the screening service (94.6% selected the top three of six rating options) and 97% said they would recommend the test to others. A small number (18/498) said their husbands were unhappy with screening. The most common reasons for dissatisfaction with the screening were pain/discomfort during or after screening, long waiting time, failure to address other health complaints, and inadequate explanation regarding followup. Improving screening Noncompliance remains a major barrier to screening in India, reflecting the absence of a preventative health orientation, and the lack of empowerment of women. This review showed that screening is generally well accepted among women, suggesting it should integrate with primary healthcare. To maximise the uptake of screening and satisfaction therewith, the interviewed women made the following suggestions. (i) Other medical problems should be addressed. (ii) Medical assistance could be offered to children. (iii) Medicines should be provided free of charge. (iv) Female doctors are preferred. (v) Men should be included in group counselling meetings. [ABSTRACT FROM AUTHOR]