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Oropharyngeal cancers include malignancies that occur where the oral cavity and pharynx merge, including in the palatine and lingual tonsils, the posterior 1/3 (base) of the tongue, the soft palate, [...]

Although cervical cancer rates in the U.S. have declined sharply, certain groups remain at elevated risk, including Appalachian women. To establish culturally-relevant cervical cancer prevention programs requires a comprehensive, current understanding of the factors which influence women's decisions to undergo Pap tests. Since most studies that found low rates of Pap test use in Appalachia were carried out decades ago, an in-depth update is warranted. Local, trained interviewers conducted interviews with rarely or never screened Appala chian women from Kentucky and West Virginia. Sessions were tape recorded, transcribed, and content analyzed. Participants (N = 25) suggested the following positive influences on obtaining screening: having an orientation toward the use of preventive health services; having health insurance and access to a good medical environment; and mainraining a flexible enough schedule to keep appointments. Screening barriers included: fear of subjecting oneself to medical scrutiny because of obesity or being a smoker: inadequate health care access such as clinician shortages, scarcity of specialty providers, long travel time to services, and clinic schedules that do not accommodate working women; and lack of providers' recommendations. Rarely mentioned were some previously reported factors including male relatives' refusal to permit Pap tests, concern over privacy, and lack of belief in Pap tests. KEYWORDS. Appalachia, rural women, attitudes/perceptions, cervical cancer, screening

Background: Perceived control has been suggested as a modifiable factor associated with health-related quality of life (HRQOL). However, the relationship between perceived control and HRQOL has not been evaluated in patients with heart failure (HF). The purpose of this study was to determine whether perceived control independently predicts HRQOL in HF patients. Methods: A total of 423 HF patients were included. Hierarchical linear regression was performed to determine the independent association of perceived control to HRQOL after controlling for covariates. Results: Higher levels of perceived control were associated with better HRQOL in univariate analysis. However, this relationship was strongly attenuated after controlling for relevant demographic, clinical, and psychological factors; the variance in HRQOL explained by the addition of perceived control to this model was small (1.4%). Conclusions: We found only a weak relationship between perceived control and HRQOL when considered in the presence of demographic, clinical, and psychological factors. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) is estimated to play an etiologic role in 40-50% of penile cancers worldwide. Estimates of HPV prevalence in U.S. penile cancer cases are limited. Methods: HPV DNA was evaluated in tumor tissue from 79 invasive penile cancer patients diagnosed in 1998-2005 within the catchment areas of seven U.S. cancer registries. HPV was genotyped using PCR-based Linear Array and INNO-LiPA assays and compared by demographic, clinical, and pathologic characteristics and survival. Histological classification was also obtained by independent pathology review. Results: HPV DNA was present in 50 of 79 (63%) of invasive penile cancer cases. Sixteen viral genotypes were detected. HPV 16, found in 46% (36/79) of all cases (72% of HPVpositive cases) was the most prevalent genotype followed equally by HPV 18, 33, and 45, each of which comprised 5% of all cases. Multiple genotypeswere detected in 18% of viral positive cases. HPV prevalence did not significantly vary by age, race/ethnicity, population size of geographic region, cancer stage, histology, grade, penile subsite, or prior cancer history. Penile cases diagnosed in more recent years were more likely to be HPV-positive. Overall survival did not significantly vary by HPV status. Conclusion: The relatively high prevalence of HPV in our study population provides limited evidence of a more prominent and, possibly, increasing role of infection in penile carcinogenesis in the U.S. compared to other parts of the world. [ABSTRACT FROM AUTHOR]

Background. Asthma is a chronic inflammatory respiratory disease, characterized by episodic and reversible airflow obstruction and airway hyperresponsiveness and is influenced by both genetic and environmental factors. Methods. The Burden of Obstructive Lung Disease (BOLD) survey was used to determine the prevalence of self-reported asthma in a target population of 325,000 adults aged ≥40 in Southeastern Kentucky. Postbronchodilator spirometry was used to classify subjects based on lung function. Risk factors for asthma in this population, in particular indoor usage of biomass fuels, were evaluated. Results. The overall study population was comprised of 508 individuals, with 15.5% reporting current asthma and 5.8% reporting former asthma. In this population, the following risk factors for asthma were identified: female sex, smoking, less than a high school education, increasing body mass index (BMI), and a history of cooking indoors with coal and wood. Cooking indoors with wood and coal for more than 6 months of one's life was shown to significantly increase the odds of reporting current asthma (odds ratio (OR) = 2.3, confidence interval (CI) 1.1, 5.0), whereas no effect was seen from a history of heating indoors with wood and coal (OR = 0.8, CI 0.4, 1.8). Conclusions. Current or former asthma was reported by 21.3% of the adult population. A history of using biomass fuels when cooking indoors significantly increased the risk of reporting current asthma in this population. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the association between self-perceived mental health status and mammography screening in Kentucky. Methods: Using a cross-sectional design, we examined survey data from the 2002 Kentucky Behavioral Risk Factor Surveillance System (BRFSS) for women aged ≥40. Mental health status was measured by the reported number of days that mental health was not good; the number of days feeling sad, blue, or depressed; and the number of days feeling worried, tense, or anxious. The outcome was mammography within the last 2 years. Three logistic regression analyses were performed, one with each of the mental health status questions as the predictor variable. Analyses controlled for age, race, marital status, education, income, and health insurance status. Results: The numbers of poor mental health days, depressed days, and anxious days were found to be significant or near-significant predictors of recent mammography. Odds ratios (ORs) comparing women reporting 30 poor mental health days, depressed days, or anxious days with similar women reporting zero days were estimated to be 1.68 (95% confidence interval [CI] 1.08–2.63), 1.49 (0.93–2.40), and 1.46 (0.96–2.23), respectively. Conclusions: Self-reported poor mental health, depression, and anxiety may be associated with nonreceipt of regular mammography screening. How mental health symptoms and self-reported poor mental health status contribute to decreased mammography screening should be explored. [ABSTRACT FROM AUTHOR]

Background: An emerging literature suggests that violence against women (VAW), particularly sexual violence, may increase the risk of acquiring a sexually transmitted infection (STI) and, therefore, may be associated with cervical cancer development. The purpose of this cross-sectional analysis was to determine if women who had experienced violence had higher prevalence rates of invasive cervical cancer. Methods: Women aged 18–88 who joined the Kentucky Women's Health Registry (2006–2007) and completed a questionnaire were included in the sample. Multivariate logistic regression analyses were used to adjust odds ratio (OR) for confounders (e.g., age, education, current marital status, lifetime illegal drug use, and pack-years of cigarette smoking). Results: Of 4732 participants with no missing data on violence, cervical cancer, or demographic factors, 103 (2.1%) reported ever having cervical cancer. Adjusting for demographic factors, smoking, and illegal drug use, experiencing VAW was associated with an increased prevalence of invasive cervical cancer (adjusted OR [aOR] = 2.6, 95% CI = 1.7-3.9). This association remained significant when looking at three specific types of VAW: intimate partner violence (IPV) (aOR = 2.7, 95% CI = 1.8-4.0), adult exposure to forced sex (aOR = 2.6, 95% CI = 1.6-4.3), and child exposure to sexual abuse (aOR = 2.4, 95% CI = 1.4-4.0). Conclusions: Rates of cervical cancer were highest for those experiencing all three types of VAW relative to those never experiencing VAW. Because VAW is common and has gynecological health effects, asking about VAW in healthcare settings and using this information to provide tailored healthcare may improve women's health outcomes. [ABSTRACT FROM AUTHOR]

Methylation is the primary route of metabolism of inorganic arsenic in humans, and previous studies showed that interindividual differences in arsenic methylation may have important impacts on susceptibility to arsenic-induced cancer. To date, the factors that regulate arsenic methylation in humans are mostly unknown. Urinary arsenic methylation patterns and genetic polymorphisms in methylenetetrahydrofolate reductase (MTHFR) and glutathione S-transferase (GST) were investigated in 170 subjects from an arsenic-exposed region in Argentina. Previous studies showed that subjects with the TT/AA polymorphisms at MTHFR 677 and 1298 have lower MTHFR activity than others. In this study, it was found that subjects with the TT/AA variant of MTHFR 677/1298 excreted a significantly higher proportion of ingested arsenic as inorganic arsenic and a lower proportion as dimethylarsinic acid. Women with the null genotype of GSTM1 excreted a significantly higher proportion of arsenic as monomethylarsonate than women with the active genotype. No associations were seen between polymorphisms in GSTT1 and arsenic methylation. This is the first study to report (1) associations between MTHFR and arsenic metabolism in humans, and (2) gender differences between genetic polymorphisms and urinary arsenic methylation patterns. Overall, this study provides evidence that MTHFR and GSTM1 are involved in arsenic metabolism in humans, and polymorphisms in the genes that encode these enzymes may play a role in susceptibility to arsenic-induced cancer. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer incidence rates arc higher in Kentucky than in the United States in general, and there are regional variations within the state. Methods: This study investigates these variations in relation to life-style and health behaviors, combining data from the Kentucky Behavioral Risk Factor Surveillance System BRFSS). and from the Kentucky Cancer Registry. We used Kentucky's fifteen Area Development Districts (ADDs) as units of analysis across a five-year period from 1993 to 97. Results; Differences were observed across ADDs. ADDs with a higher prevalence of risk factors, with the exception ot chronic alcohol drinking, had lower CRC rates. ADDs with a higher proportion of respondents having had recent routine check-ups had higher CRC incidence rates. Conclusions: In general. healthier lifestyles and positive health-related behaviors were associated with increased colorectal cancer incidence. This may be explained by the tendency for healthier individuals to receive regular check-ups and screening. thus increasing the detection rate of colorectal cancer. [ABSTRACT FROM AUTHOR]

Abstract: The use of generic antiepileptic drugs (AEDs) in patients with epilepsy is controversial. The purpose of this study is to identify patient characteristics associated with increased odds of receiving a generic AED product. A large commercial database was used to identify patients with a primary diagnosis of epilepsy who were prescribed an AED during a three-month window. Data analysis found that those ≥65years old had 15.7% greater odds of receiving a generic AED (OR=1.157; 95% CI=1.056–1.268). Patients with Medicaid were found to have 2.44 times the odds of having had a generic AED prescription (OR=2.44; CI=2.168–2.754). Patients residing in the Northeast had 12.6% decreased odds of receiving a generic AED (OR=0.874; CI=0.821–0.931). These patient characteristics could signify certain health care disparities and may represent potential confounders to future observational studies. [Copyright &y& Elsevier]

Objective: The study aimed to determine the baseline prevalence of human papillomavirus (HPV) types in invasive vulvar cancer (IVC) and vulvar intraepithelial neoplasia 3 (VIN 3) cases using data from 7 US cancer registries., Materials and Methods: Registries identified eligible cases diagnosed in 1994 to 2005 and requested pathology laboratories to prepare 1 representative block for HPV testing on those selected. Hematoxylin-eosin-stained sections preceding and following those used for extraction were reviewed to confirm representation. Human papillomavirus was detected using L1 consensus polymerase chain reaction (PCR) with PGMY9/11 primers and type-specific hybridization, with retesting of samples with negative and inadequate results with SPF10 primers. For IVC, the confirmatory hematoxylin-eosin slides were re-evaluated to determine histological type. Descriptive analyses were performed to examine distributions of HPV by histology and other factors., Results: Human papillomavirus was detected in 121/176 (68.8%) cases of IVC and 66/68 (97.1%) cases of VIN 3 (p < .0001). Patients with IVC and VIN 3 differed by median age (70 vs 55 y, p = .003). Human papillomavirus 16 was present in 48.6% of IVC cases and 80.9% of VIN 3 cases; other high-risk HPV was present in 19.2% of IVC cases and 13.2% of VIN 3 cases. Prevalence of HPV differed by squamous cell carcinoma histological subtype (p < .0001) as follows: keratinizing, 49.1% (n = 55); nonkeratinizing, 85.7% (n = 14), basaloid, 92.3% (n = 14), warty 78.2% (n = 55), and mixed warty/basaloid, 100% (n = 7)., Conclusions: Nearly all cases of VIN 3 and two thirds of IVC cases were positive for high-risk HPV. Prevalence of HPV ranged from 49.1% to 100% across squamous cell carcinoma histological subtypes. Given the high prevalence of HPV in IVC and VIN 3 cases, prophylactic vaccines have the potential to decrease the incidence of vulvar neoplasia.

Lung cancer rates in Appalachian Kentucky are almost twice national rates; colorectal cancer rates are also elevated. Although smoking prevalence is high, it does not explain all excess risk. The area is characterized by poverty, low educational attainment, and unemployment. Coal production is a major industry. Pyrite contaminants of coal contain established human carcinogens, arsenic (As), chromium (Cr), and nickel (Ni). We compared biological exposure to As, Cr, and Ni for adults living in Appalachian Kentucky with residents of Jefferson, a non-Appalachian, urban county. We further compared lung and colon cancer rates, demographics, and smoking prevalence across the study areas. Toenail clipping analysis measured As, Cr, and Ni for residents of 23 rural Appalachian Kentucky counties and for Jefferson County. Reverse Kaplan-Meier statistical methodology addressed left-censored data. Appalachian residents were exposed to higher concentrations of As, Cr, and Ni than Jefferson County residents. Lung cancer incidence and mortality rates in Appalachia are higher than Jefferson County and elsewhere in the state, as are colorectal mortality rates. Environmental factors may contribute to the increased concentration of trace elements measured in residents of the Appalachian region. Routes of human exposure need to be determined.

This study identified correlates of human papillomavirus (HPV) vaccine acceptance among college-aged women. Data were collected by self-administered questionnaire. In multivariate analyses, women having vaginal sex (past 12 months) were nearly four times more likely to indicate acceptance (P = 0.0001). Those reporting ever having a sexually transmissible infection (STI; P = 0.03) and those indicating ever having an abnormal Pap test (P = 0.03) were more likely to indicate acceptance. Thus, three forms of 'exposure' (having sex, having an STI or abnormal Pap) may be linked to vaccine acceptance among young women attending universities. The findings suggest that opportunities may exist for clinic-based HPV vaccine promotion among this population of women.

Factors associated with perceived risk, interest in screening information, and interest in being screened for lung cancer were examined among current and recent former smokers. Cross-sectional data were analyzed from 585 current and former smokers who participated in 12-month follow-up telephone interviews as part of a population-based cessation intervention trial. Current smokers who were thinking about or preparing to quit were more likely to perceive risk of lung cancer and be interested in lung cancer screening information than those who were not motivated to quit or who were in the process of actively quitting or maintaining abstinence. Smokers who participate in lung cancer screening may be motivated to participate in a broad range of tobacco dependence treatment options., (Copyright 2006 Wiley Periodicals, Inc.)

Background: Kentucky's elevated cervical cancer incidence and mortality rates are well documented. However, in Kentucky, as in the United States as a whole, cervical cancer incidence and mortality have been decreasing., Methods: To determine if the incidence and mortality declines in Kentucky are similar in different geographic regions of the state, incidence and mortality data for the six-year period 1995-2000 were analyzed by five geographic subdivisions., Results: Overall, both incidence and mortality rates declined during the six-year period; however, there were variations in the decline by geographic subdivisions. In 1995-2000, the greatest percentage decrease (43%) in incidence rates among the geographic subdivisions occurred in Fayette/Jefferson counties while their mortality rates increased (12%). Conversely, the Appalachian region of the state had a lower percentage decrease (11%) in incidence with a concurrent percentage decrease in mortality (45%)., Conclusions: Intensified screening efforts may have resulted in increased detection of early stage cervical disease; which provided a subsequent reduction in mortality for the Appalachian region of the state, while Fayette/Jefferson County has a mortality rate that slopes upward necessitating additional investigation.

Lung cancer incidence and mortality rates in Kentucky greatly surpass those of other states and the nation as a whole. Not only is this one of the most common cancers, with 3800 newly diagnosed cases per year in the Commonwealth, it is also one of the most fatal. And, unlike many other types of cancer, it is highly preventable, as about 90% are caused by cigarette smoking. In this paper we present lung cancer rates across different groups and trends of the disease over time. We also discuss comparative statistics related to stage at which lung and other major cancers are diagnosed and their survival patterns. Smoking data from the Behavioral Risk Factor Surveillance System are presented and compared across different states in relation to lung cancer occurrence. Finally, both lung cancer and smoking trends within Kentucky are compared, showing how both are substantially higher in the Appalachian region of the state.