2,432 results on '"Warner, K."'
Search Results
2. Dedicated financial hardship screening adds value to routine distress screening among gynecologic cancer patients
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Liang, Margaret I., Dholakia, Jhalak D., Lee, Grace M., Wang, Lingling, Kako, Tavonna D., Blair, Isabella, Williams, Courtney P., Arend, Rebecca C., Huh, Warner K., Rocque, Gabrielle B., and Pisu, Maria
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- 2024
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3. Corrigendum to “Beyond Sedlis—A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis” [Gynecologic Oncology 162 (2021) 532–538]
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Levinson, Kimberly, Beavis, Anna L, Purdy, Christopher, Rositch, Anne F, Viswanathan, Akila, Wolfson, Aaron H, Kelly, Michael G, Tewari, Krishnansu S, McNally, Leah, Guntupalli, Saketh R, Ragab, Omar, Lee, Yi-Chun, Miller, David S, Huh, Warner K, Wilkinson, Kelly J, Spirtos, Nicola M, Le, Linda Van, Casablanca, Yovanni, Holman, Laura L, Waggoner, Steven E, and Fader, Amanda N
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Reproductive medicine - Abstract
The authors regret that the version of Table 3 originally published in this article was incorrect. The online version has now been updated and the correct table can be found below. The authors would like to apologise for any inconvenience caused. Table 3. Comparison of 3 yr RFS, nomogram recurrence risk, and Sedlis criteria for predictor variable combinations. [Table Presented]
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- 2021
4. Quality of Life and Adverse Events: Prognostic Relationships in Long-Term Ovarian Cancer Survival
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Wenzel, Lari, Osann, Kathryn, McKinney, Chelsea, Cella, David, Fulci, Giulia, Scroggins, Mary J, Lankes, Heather A, Wang, Victoria, Nephew, Kenneth P, Maxwell, George L, Mok, Samuel C, Conrads, Thomas P, Miller, Austin, Mannel, Robert S, Gray, Heidi J, Hanjani, Parviz, Huh, Warner K, Spirtos, Nick, Leitao, Mario M, Glaser, Gretchen, Sharma, Sudarshan K, Santin, Alessandro D, Sperduto, Paul, Lele, Shashikant B, Burger, Robert A, Monk, Bradley J, and Birrer, Michael
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Cancer ,Rehabilitation ,Ovarian Cancer ,Clinical Research ,Rare Diseases ,Management of diseases and conditions ,7.1 Individual care needs ,Carcinoma ,Ovarian Epithelial ,Humans ,Ovarian Neoplasms ,Prognosis ,Quality of Life ,Survivors ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
BackgroundThere is a critical need to identify patient characteristics associated with long-term ovarian cancer survival.MethodsQuality of life (QOL), measured by the Functional Assessment of Cancer Therapy-Ovarian-Trial Outcome Index (FACT-O-TOI), including physical, functional, and ovarian-specific subscales, was compared between long-term survivors (LTS) (8+ years) and short-term survivors (STS) (
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- 2021
5. Beyond Sedlis—A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis
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Levinson, Kimberly, Beavis, Anna L, Purdy, Christopher, Rositch, Anne F, Viswanathan, Akila, Wolfson, Aaron H, Kelly, Michael G, Tewari, Krishnansu S, McNally, Leah, Guntupalli, Saketh R, Ragab, Omar, Lee, Yi-Chun, Miller, David S, Huh, Warner K, Wilkinson, Kelly J, Spirtos, Nicola M, Van Le, Linda, Casablanca, Yovanni, Holman, Laura L, Waggoner, Steven E, and Fader, Amanda N
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Cancer ,Adenocarcinoma ,Adult ,Carcinoma ,Squamous Cell ,Female ,Humans ,Middle Aged ,Neoplasm Invasiveness ,Neoplasm Recurrence ,Local ,Neoplasm Staging ,Nomograms ,Proportional Hazards Models ,Randomized Controlled Trials as Topic ,Risk Factors ,Uterine Cervical Neoplasms ,Cervical cancer ,Stage I ,Adjuvant radiation ,Oncology and Carcinogenesis ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis - Abstract
PurposeThe Sedlis criteria define risk factors for recurrence warranting post-hysterectomy radiation for early-stage cervical cancer; however, these factors were defined for squamous cell carcinoma (SCC) at an estimated recurrence risk of ≥30%. Our study evaluates and compares risk factors for recurrence for cervical SCC compared with adenocarcinoma (AC) and develops histology-specific nomograms to estimate risk of recurrence and guide adjuvant treatment.MethodsWe performed an ancillary analysis of GOG 49, 92, and 141, and included stage I patients who were surgically managed and received no neoadjuvant/adjuvant therapy. Multivariable Cox proportional hazards models were used to evaluate independent risk factors for recurrence by histology and to generate prognostic histology-specific nomograms for 3-year recurrence risk.ResultsWe identified 715 patients with SCC and 105 with AC; 20% with SCC and 17% with AC recurred. For SCC, lymphvascular space invasion (LVSI: HR 1.58, CI 1.12-2.22), tumor size (TS ≥4 cm: HR 2.67, CI 1.67-4.29), and depth of invasion (DOI; middle 1/3, HR 4.31, CI 1.81-10.26; deep 1/3, HR 7.05, CI 2.99-16.64) were associated with recurrence. For AC, only TS ≥4 cm, was associated with recurrence (HR 4.69, CI 1.25-17.63). For both histologies, there was an interaction effect between TS and LVSI. For those with SCC, DOI was most associated with recurrence (16% risk); for AC, TS conferred a 15% risk with negative LVSI versus a 25% risk with positive LVSI.ConclusionsCurrent treatment standards are based on the Sedlis criteria, specifically derived from data on SCC. However, risk factors for recurrence differ for squamous cell and adenocarcinoma of the cervix. Histology-specific nomograms accurately and linearly represent risk of recurrence for both SCC and AC tumors and may provide a more contemporary and tailored tool for clinicians to base adjuvant treatment recommendations to their patients with cervical cancer.
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- 2021
6. Adjuvant chemotherapy following chemoradiotherapy as primary treatment for locally advanced cervical cancer versus chemoradiotherapy alone (OUTBACK): an international, open-label, randomised, phase 3 trial
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Mileshkin, Linda R, Moore, Kathleen N, Barnes, Elizabeth H, Gebski, Val, Narayan, Kailash, King, Madeleine T, Bradshaw, Nathan, Lee, Yeh Chen, Diamante, Katrina, Fyles, Anthony W, Small, William, Jr, Gaffney, David K, Khaw, Pearly, Brooks, Susan, Thompson, J Spencer, Huh, Warner K, Mathews, Cara A, Buck, Martin, Suder, Aneta, Lad, Thomas E, Barani, Igor J, Holschneider, Christine H, Van Dyk, Sylvia, Quinn, Michael, Rischin, Danny, Monk, Bradley J, and Stockler, Martin R
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- 2023
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7. Phase II study of axalimogene filolisbac (ADXS-HPV) for platinum-refractory cervical carcinoma: An NRG oncology/gynecologic oncology group study
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Huh, Warner K, Brady, William E, Fracasso, Paula M, Dizon, Don S, Powell, Matthew A, Monk, Bradley J, Leath, Charles A, Landrum, Lisa M, Tanner, Edward J, Crane, Erin K, Ueda, Stefanie, McHale, Michael T, and Aghajanian, Carol
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Infectious Diseases ,Vaccine Related ,Immunization ,Sexually Transmitted Infections ,Patient Safety ,Clinical Research ,Cancer ,Cervical Cancer ,Clinical Trials and Supportive Activities ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Adult ,Aged ,Cancer Vaccines ,Drug Resistance ,Neoplasm ,Female ,Humans ,Listeria monocytogenes ,Middle Aged ,Organoplatinum Compounds ,Papillomavirus E7 Proteins ,Uterine Cervical Neoplasms ,Recurrentcervicalcancer ,Metastatic ,HPV ,Listeria ,Immunotherapy ,Recurrent cervical cancer ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Reproductive medicine - Abstract
ObjectiveWomen with persistent, recurrent, and/or metastatic cervical cancer have a poor prognosis. Even with the availability of cisplatin plus paclitaxel and bevacizumab, median overall survival (OS) is only 17.0 months, with median post-progression survival of approximately seven months. We studied the therapeutic vaccine, Axalimogene filolisbac (ADXS-HPV), in women who had progressed following at least one prior line of therapy (Gynecologic Oncology Group protocol 265/NCT01266460).MethodsVolunteers ≥18 years with advanced cervical cancer and GOG performance status score of 0 or 1 were eligible for participation in this 2-stage, phase II trial. In stage 1, women received up to three doses of ADXS-HPV (1 × 109 colony-forming units in 250 mL IV over 15 min every 28 days) and were monitored for tumor progression. In stage 2, women were treated until progression, intolerable adverse events (AEs), or voluntary withdrawal of consent. Co-primary endpoints were safety and proportion of volunteers surviving ≥12 months. An estimated, combined (stages 1 + 2) 12-month OS of 35% was calculated from historical GOG cohorts to declare ADXS-HPV sufficiently active in this platinum-pre-treated population. Secondary endpoints were OS and progression-free survival (PFS).ResultsAmong 50 evaluable volunteers, the 12-month OS was 38% (n = 19). Median OS was 6.1 months (95% CI: 4.3-12.1) and median PFS was 2.8 months (95% CI: 2.6-3.0). The most common treatment-related AEs were fatigue, chills, fever, nausea, and anemia. The majority of AEs were grade 1 or 2 and resolved spontaneously or with appropriate treatment.ConclusionAt the dose and schedule studied, ADXS-HPV immunotherapy was tolerable and met the protocol-specified benchmark for activity required to warrant further investigation in volunteers with cervical carcinoma.
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- 2020
8. Human papillomavirus: The other invisible enemy
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Abel, Mary Kathryn, Huh, Warner K, and Chan, John K
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Biomedical and Clinical Sciences ,Immunology ,Vaccine Related ,Immunization ,Cancer ,Prevention of disease and conditions ,and promotion of well-being ,3.4 Vaccines ,Good Health and Well Being ,Betacoronavirus ,COVID-19 ,COVID-19 Vaccines ,Coronavirus Infections ,Female ,Humans ,Neoplasms ,Pandemics ,Papillomaviridae ,Papillomavirus Infections ,Papillomavirus Vaccines ,Pneumonia ,Viral ,SARS-CoV-2 ,Viral Vaccines ,Oncology and Carcinogenesis ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Reproductive medicine - Abstract
• The world is working with unprecedented fervor and spending billions of dollars to find a vaccine for COVID-19. • Nearly 381,500 people worldwide died from human papillomavirus-related cancers in 2018 despite a safe and effective vaccine. • With the momentum from our fight against this pandemic, we can improve vaccine implementation.
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- 2020
9. Patient-reported outcomes at discontinuation of anti-angiogenesis therapy in the randomized trial of chemotherapy with bevacizumab for advanced cervical cancer: an NRG Oncology Group study.
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Chase, Dana, Huang, Helen Q, Monk, Bradley J, Ramondetta, Lois Michelle, Penson, Richard T, Gil, Karen, Landrum, Lisa M, Leitao, Mario, Oaknin, Ana, Huh, Warner K, Pulaski, Heather L, Robison, Katina, Guntupalli, Saketh R, Richardson, Debra, Salani, Ritu, Sill, Michael W, Wenzel, Lari B, and Tewari, Krishnansu Sujata
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Humans ,Cisplatin ,Paclitaxel ,Topotecan ,Angiogenesis Inhibitors ,Antineoplastic Combined Chemotherapy Protocols ,Withholding Treatment ,Quality of Life ,Adult ,Aged ,Middle Aged ,Uterine Cervical Neoplasms ,Female ,Bevacizumab ,Patient Reported Outcome Measures ,cervical cancer ,gynecology ,quality of life (PRO)/palliative care ,Clinical Trials and Supportive Activities ,Cancer ,Clinical Research ,Pain Research ,Chronic Pain ,6.1 Pharmaceuticals ,7.1 Individual care needs ,Management of diseases and conditions ,Evaluation of treatments and therapeutic interventions ,Good Health and Well Being ,quality of life ,palliative care ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
IntroductionTo describe patient-reported outcomes and toxicities at time of treatment discontinuation secondary to progression or toxicities in advanced/recurrent cervical cancer patients receiving chemotherapy with bevacizumab.MethodsSummarize toxicity, grade, and health-related quality of life within 1 month of treatment discontinuation for women receiving chemotherapy with bevacizumab in GOG240.ResultsOf the 227 patients who received chemotherapy with bevacizumab, 148 discontinued study protocol treatment (90 for disease progression and 58 for toxicity). The median survival time from treatment discontinuation to death was 7.9 months (95% CI 5.0 to 9.0) for those who progressed versus 12.1 months (95% CI 8.9 to 23.2) for those who discontinued therapy due to toxicities. The most common grade 3 or higher toxicities included hematologic, gastrointestinal, and pain. Some 57% (84/148) of patients completed quality of life assessment within 1 month of treatment discontinuation. Those patients who discontinued treatment due to progression had a mean decline in the FACT-Cx TOI of 3.2 points versus 2.2 in patients who discontinued therapy due to toxicity. This was a 9.9 point greater decline in the FACT-Cx TOI scores than those who discontinued treatment due to progression (95% CI 2.8 to 17.0, p=0.007). The decline in quality of life was due to worsening physical and functional well-being. Those who discontinued treatment due to toxicities had worse neurotoxicity and pain.DiscussionPatients who discontinued chemotherapy with bevacizumab for toxicity experienced longer post-protocol survival but significantly greater declination in quality of life than those with progression. Future trial design should include supportive care interventions that optimize physiologic function and performance status for salvage therapies.
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- 2020
10. Challenges Associated With Cervical Cancer Screening and Management in Obese Women: A Provider Perspective.
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Clarke, Megan A, Massad, L Stewart, Khan, Michelle J, Smith, Katie M, Guido, Richard S, Mayeaux, EJ, Darragh, Teresa M, Huh, Warner K, Johnson, Amanda L, Gold, Michael A, Schiffman, Mark, and Wentzensen, Nicolas
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Health Services ,Obesity ,Prevention ,Cancer ,Cervical Cancer ,Clinical Research ,Adult ,Attitude of Health Personnel ,Colposcopy ,Early Detection of Cancer ,Female ,Health Care Surveys ,Humans ,Male ,Middle Aged ,Physicians ,Uterine Cervical Neoplasms ,cervical cancer ,obesity ,screening ,management ,cervical sampling ,colposcopy ,biopsy ,provider perspective ,survey ,disparity ,Clinical Sciences ,Obstetrics & Reproductive Medicine ,Clinical sciences - Abstract
ObjectivesObese women are at increased risk of cervical cancer, partly due to missed detection of cervical precancers during routine cervical cancer screening. We administered a clinician survey to better understand specific challenges and identify potential solutions to performing cervical cancer screening and management in obese women.Materials and methodsWe administered a web-based survey to 2,319 members of the American Society of Colposcopy and Cervical Pathology including questions related to challenges associated with cervical sampling and visualization in obese compared with normal weight women and potential strategies for improvement. We summarized providers' responses using descriptive statistics and used Fisher exact tests to evaluate associations between provider characteristics and challenges with cervical sampling, visualization, and biopsy.ResultsOf the 240 providers that completed the survey, 89% and 93% reported that cervical sampling and visualization are more challenging in obese women, respectively, whereas 80% reported that taking a biopsy was more challenging. Commonly reported barriers included vaginal prolapse, difficulty visualizing and accessing the cervix, and lack of long enough sampling devices and large enough speculums. Frequently used techniques to improve sampling and visualization included use of a condom or examination glove finger to sheath a speculum and using a tenaculum. Most providers identified training for cervical sampling and colposcopy in obese women as a learning gap, and only 8% reported receiving such training.ConclusionsCervical cancer screening and management are more challenging in obese compared with normal weight women. Major barriers to cervical sampling and visualization included lack of adequately sized equipment and lack of education and training.
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- 2020
11. Doubling down on the future of gynecologic oncology: The SGO future of the profession summit report
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Blank, Stephanie V., Huh, Warner K., Bell, Maria, Dilley, Sarah, Hardesty, Melissa, Hoskins, Ebony R., Lachance, Jason, Musa, Fernanda, Prendergast, Emily, Rimel, B.J., Shahin, Mark, and Valea, Fidel
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- 2023
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12. Contributors
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Backes, Floor J., primary, Beffa, Lindsey B., additional, Billingsley, Caroline C., additional, Birrer, Michael J., additional, Bixel, Kristin, additional, Boitano, Teresa K.L., additional, Brewster, Wendy R., additional, Chase, Dana M., additional, Bruce, Shaina, additional, Crown, Angelena, additional, Chu, Christina S., additional, Clarke-Pearson, Daniel L., additional, Ross, Robert A., additional, Crosland, Brian, additional, Cohen, Joshua G., additional, Coleman, Robert L., additional, DiSilvestro, Paul A., additional, Dorigo, Oliver, additional, Duska, Linda R., additional, Eskander, Ramez Nassef, additional, Gemignani, Mary L., additional, Gunderson, Camille Catherine, additional, Hagemann, Andrea R., additional, Herzog, Thomas J., additional, Korenaga, Travis R., additional, Huh, Warner K., additional, Kuroki, Lindsay, additional, Kurnit, Katherine, additional, Mannel, Robert S., additional, Massad, L. Stewart, additional, Mathews, Cara A., additional, Miller, David S., additional, Monk, Bradley J., additional, Mutch, David G., additional, Nikam, Rachita, additional, Pinkerton, JoAnn V., additional, Powell, Matthew, additional, Rash, Dominique L., additional, Landrum, Lisa M., additional, Ring, Kari L., additional, Renz, Malte, additional, Roane, Brandon, additional, Rubin, Stephen C., additional, Salani, Ritu, additional, Satero, Jane, additional, Sood, Anil K., additional, Soper, John T., additional, Stock, Elizabeth Christina, additional, Sung, C. James, additional, Tewari, Krishnansu Sujata, additional, Toboni, Michael D., additional, Tucker, Katherine, additional, Walker, Joan L., additional, Wall, Jaclyn A., additional, Washington, Christina, additional, Wenzel, Lari B., additional, Westin, Shannon N., additional, Yashar, Catheryn M., additional, Creasman, William T., additional, and Zuna, Rosemary E., additional
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- 2023
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13. Preinvasive disease of the cervix
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Wall, Jaclyn A., primary, Boitano, Teresa K.L., additional, Massad, L. Stewart, additional, and Huh, Warner K., additional
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- 2023
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14. Identity-related experiences of Asian American trainees in gynecologic oncology
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Dholakia, Jhalak, Lee, Yeon Woo, Lu, Karen H., Huh, Warner K., Yamada, S. Diane, Fuh, Katherine C., Kumar, Amanika S., Liang, Margaret I., Nair, Navya, and Kim, Kenneth H.
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- 2022
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15. Navigating job and cancer demands during treatment: A qualitative study of ovarian cancer patients
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Liang, Margaret I., Simons, J. Leahgrace, Herbey, Ivan I., Wall, Jaclyn A., Rucker, Lindsay R., Ivankova, Nataliya V., Huh, Warner K., and Pisu, Maria
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- 2022
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16. Moderate to severe distress in half of ovarian cancer patients undergoing treatment highlights a need for more proactive symptom and psychosocial management
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Wall, Jaclyn A., Lipking, Kelsey, Smith, Haller J., Huh, Warner K., Salter, Terri, and Liang, Margaret I.
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- 2022
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17. Increased disparities associated with black women and abnormal cervical cancer screening follow-up
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Boitano, Teresa K.L., Ketch, Peter, Maier, Julia G., Nguyen, Christine T., Huh, Warner K., Michael Straughn, J., and Scarinci, Isabel C.
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- 2022
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18. Piloting use of an out-of-pocket cost tracker among gynecologic cancer patients
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Liang, Margaret I., Summerlin, Sarah S., Boitano, Teresa K.L., Blanchard, Christina T., Huh, Warner K., Bhatia, Smita, and Pisu, Maria
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- 2022
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19. Effect of misoprostol on type 3 transformation zone of the cervix among Cameroonian women
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Manga, Simon M., Liang, Margaret I., Ye, Yuanfan, Szychowski, Jeff M., Nulah, Kathleen L., Tita, Alan T., Scarinci, Isabel, and Huh, Warner K.
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- 2022
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20. Misoprostol and estradiol to enhance visualization of the transformation zone during cervical cancer screening: An integrative review
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Manga, Simon M., Kincaid, Kaitlyn D., Boitano, Teresa K.L., Tita, Alan T., Scarinci, Isabel C., Huh, Warner K., and Liang, Margaret I.
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- 2022
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21. Correlation between Surgeon's assessment and radiographic evaluation of residual disease in women with advanced stage ovarian cancer reported to have undergone optimal surgical cytoreduction: An NRG Oncology/Gynecologic Oncology Group study
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Eskander, Ramez N, Kauderer, James, Tewari, Krishnansu S, Mannel, Robert S, Bristow, Robert E, O'Malley, David M, Rubin, Stephen C, Glaser, Gretchen E, Hamilton, Chad A, Fujiwara, Keiichi, Huh, Warner K, Ueland, Frederick, Stephan, Jean-Marie, and Burger, Robert A
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Rare Diseases ,Cancer ,Clinical Research ,Biomedical Imaging ,Ovarian Cancer ,Clinical Trials and Supportive Activities ,Evaluation of treatments and therapeutic interventions ,6.4 Surgery ,Adult ,Aged ,Aged ,80 and over ,Antineoplastic Combined Chemotherapy Protocols ,Bevacizumab ,Carboplatin ,Carcinoma ,Ovarian Epithelial ,Cytoreduction Surgical Procedures ,Female ,Humans ,Middle Aged ,Neoplasm Grading ,Neoplasm Staging ,Neoplasm ,Residual ,Neoplasms ,Glandular and Epithelial ,Ovarian Neoplasms ,Paclitaxel ,Young Adult ,Surgeon's assessment ,Radiographic evaluation ,Ovarian cancer ,Surgical cytoreduction ,NRG ,GOG ,Oncology and Carcinogenesis ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis - Abstract
PurposeWe sought to determine the level of concordance among surgeons' assessment of residual disease (RD) and pre-treatment computed tomography (CT) findings among women who underwent optimal surgical cytoreduction for advanced stage ovarian cancer.MethodsThis is a post-trial ad hoc analysis of a phase 3 randomized clinical trial evaluating the impact of bevacizumab in primary and maintenance therapy for patients with advanced stage ovarian cancer following surgical cytoreduction. All subjects underwent imaging of the chest/abdomen/pelvis to establish a post-surgical baseline prior to the initiation of chemotherapy. Information collected on trial was utilized to compare surgeon's operative assessment of RD, to pre-treatment imaging.ResultsOf 1873 enrolled patients, surgical outcome was described as optimal (RD≤1cm) in 639 subjects. Twelve patients were excluded as they did not have a baseline, pretreatment imaging, leaving 627 participants for analysis. The average interval from surgery to baseline scan was 26days (range: 1-109). In 251 cases (40%), the post-operative scan was discordant with surgeon assessment, demonstrating RD>1cm in size. RD>1cm was most commonly identified in the right upper quadrant (28.4%), retroperitoneal para-aortic lymph nodes (RD>1.5cm; 28.2%) and the left upper quadrant (10.7%). Patients with RD>1cm on pre-treatment CT (discordant) exhibited a significantly greater risk of disease progression (HR 1.30; 95% CI 1.08-1.56; p=0.0059).ConclusionsAmong patients reported to have undergone optimal cytoreduction, 40% were found to have lesions >1cm on postoperative, pretreatment imaging. Although inflammatory changes and/or rapid tumor regrowth could account for the discordance, the impact on PFS and distribution of RD may suggest underestimation by the operating surgeon.
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- 2018
22. Identifying a molecular profile to predict the risk of recurrence in high‐intermediate risk endometrial cancer
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Rebecca C. Arend, Carly B. Scalise, Jhalak Dholakia, Maahum Z. Kamal, Haley B. Thigpen, David Crossman, Warner K. Huh, and Charles A. Leath III
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biomarker ,endometrial cancer ,high‐intermediate risk ,mutations ,recurrence ,survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Patients with high‐intermediate risk endometrial cancer (H‐IR EMCA) have an elevated risk of recurrence compared to low‐risk counterparts. Many H‐IR EMCA patients are treated with radiation or chemotherapy, but their overall survival is not significantly impacted by treatment. The objective of this study was to compare molecular profiles of H‐IR EMCA patients with disease recurrence to those without to identify characteristics that could better predict patient outcomes. Methods Tissue was acquired from H‐IR EMCA patients with disease recurrence (n=15) and without disease recurrence (n=15) who had not received adjuvant therapy and performed DNA and RNA analyses. Results In recurrent population, 5 patients had matchingrecurrent and initial tumor tissues. Of note, 5/7 (71%) African Americanpatients had disease recurrence compared to 10/23 (43%) White patients. Inaddition, several new mutations were found in individual patient’s recurrentcompared to initial tumors. Conclusions Currently the treatment ofendometrial cancer is rapidly changing with molecular profiling becoming partof the standard of care. Additionally, it and is being incorporated intoclinical trials in this group of patients. The specific gene mutations and RNAexpression signatures that were observed in our small cohort need to bevalidated in larger cohorts to determine their impact.
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- 2021
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23. Identity-related experiences of Asian American trainees in gynecologic oncology
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Jhalak Dholakia, Yeon Woo Lee, Karen H. Lu, Warner K. Huh, S. Diane Yamada, Katherine C. Fuh, Amanika S. Kumar, Margaret I. Liang, Navya Nair, and Kenneth H. Kim
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Gynecology and obstetrics ,RG1-991 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Anti-Asian violence increased during the COVID-19 pandemic. Asian American/Pacific Islanders (AAPI) represent a diverse population experiencing a long history of stereotyping and exclusionism; however, this group is often left out of diversity/inclusion conversations. In academic medicine, AAPI are under-represented in leadership. We characterized the personal/professional experiences of AAPI gynecologic oncology trainees and assessed the impact of a virtual panel discussion with leaders in the field. Methods: An anonymous survey was disseminated online to trainees in/interested in gynecologic oncology fellowship who identified as AAPI, using modified snowball sampling. A virtual session with AAPI leaders in gynecologic oncology discussed themes emerging from survey responses. Session attendees completed an anonymous follow-up survey. Results were assessed quantitatively and qualitatively. Results: 44/59 (75%) respondents participated in the pre-survey; 23 (39%) participated in the virtual session. All session participants (23/23, 100%) completed the post-session survey. Participants reported increased identity-related thoughts with the COVID-19 pandemic (88% during, 61% prior). Sixty-eight percent reported that identity-related thoughts/awareness changed during the pandemic. Presence of AAPI colleagues was associated with higher perceived identity-related support from their department. Of those without AAPI coworkers, none (0%) felt ‘moderately’ or ‘extremely well supported.’ Qualitative analysis demonstrated that the panel discussion created a sense of community and encouragement, combating previously reported isolation and self-consciousness. Participants reported more connection with their heritage and identified more personal/professional topics that might be related to their cultural backgrounds. Discussion: This intervention demonstrates the opportunity to provide a supportive network for mentorship and professional development in a culturally inclusive way.
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- 2022
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24. An Open-lung Approach Protects the Acid-injured Lung From Ventilator-induced Lung Injury and Alveolar Instability
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Kaye, E., primary, Sosa, A.M., additional, Warner, K., additional, Sottile, P.D., additional, Albers, D.J., additional, and Smith, B.J., additional
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- 2024
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25. Experimentally Induced Mild Flow Limited Dyssynchrony Protectsthe Injured Lung From Ventilator-Induced Lung Injury
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Smith, B.J., primary, Kaye, E., additional, Sosa, A.M., additional, Warner, K., additional, Colson, A., additional, Albers, D., additional, and Sottile, P.D., additional
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- 2024
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26. Comparing self-reported surgical readiness of Ob/Gyn resident trainees in the united states and canada
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Lin, E, primary, Warshafsky, C, additional, Su, J, additional, Chen, I, additional, Warner, K, additional, Fajardo, O, additional, Pruszynski, J, additional, and Kho, K, additional
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- 2024
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27. Risk factors for postpartum urinary retention: a case-control study
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Warner, K, primary, Avery, GA, additional, Battula, S, additional, Esparza, A, additional, Pinto, A, additional, and Heisler, CA, additional
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- 2024
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28. Increased disparities associated with black women and abnormal cervical cancer screening follow-up
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Teresa K.L. Boitano, Peter Ketch, Julia G. Maier, Christine T. Nguyen, Warner K. Huh, J. Michael Straughn, and Isabel C. Scarinci
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Cervical cancer screening ,Abnormal screening follow-up ,Racial disparities ,HPV testing, lost to follow-up ,Gynecology and obstetrics ,RG1-991 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: To determine whether race and ethnicity impacts patient adherence to follow-up for colposcopy after abnormal cervical cancer screening. Methods: This retrospective chart review included women that were randomly selected from patients presenting to our colposcopy clinic from 1/2019 to 12/2019. Inclusion criteria were females age ≥21 years-old and appropriate referral for colposcopy. Patients were grouped into three categories: (1) ADHERENT to follow-up if they came to their first scheduled appointment; (2) DELAYED if they presented more than three months from their original referral (usually missing 1–3 appointments); and (3) NOT ADHERENT if they did not show for their appointment after referral. Analysis was performed using SPSS v.26. Results: 284 women met inclusion criteria for the study. The majority of women were Black (65.2 %) followed by non-Hispanic Whites (20.0 %) and Latinx (14.8 %). Overall, 39.1 % were ADHERENT, 18.6 % were DELAYED, and 42.3 % were NOT ADHERENT. When compared with non-Hispanic White women, there was a significant difference between race/ethnicity and timing of follow-up (p = 0.03). Blacks were more likely to be NOT ADHERENT (45.9 %; p = 0.03), and Latinx and Blacks were the most likely to be DELAYED (35.7 % and 21.1 %; p = 0.03). Private insurance patients were more likely to be ADHERENT for care compared with un-/underinsured patients (78.9 vs 27.8 %, p = 0.0001). Conclusion: There is inadequate follow-up after abnormal cervical cancer screening across all races/ethnicities; however, lack of adherence is higher in Black patients. Moreover, 25% of Hispanic and Black women present in a delayed fashion. Culturally relevant assessments and interventions are needed to understand and address these gaps.
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- 2022
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29. A population study of screening history and diagnostic outcomes of women with invasive cervical cancer
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Vicki B. Benard, J. Elizabeth Jackson, April Greek, Virginia Senkomago, Warner K. Huh, Cheryll C. Thomas, and Lisa C. Richardson
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cancer registries ,cervical cancer screening ,cervical cancer survivors ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Despite advances to prevent and detect cervical cancer, national targets for screening have not been met in the United States. Previous studies suggested that approximately half of women who developed cervical cancer were not adequately screened. This study aimed to provide an updated examination of women's screening and diagnostic practices five years prior to an invasive cervical cancer diagnosis. Methods The study included women age 21 years and older diagnosed with invasive cervical cancer in 2013–2016 from three population‐based state cancer registries in the United States. Medical records abstraction identified screening history and diagnostic follow‐up. A mailed survey provided sociodemographic data. Screening was a Pap or human papillomavirus (HPV) test between 6 months and 5 years before diagnosis. Adequate follow‐up was defined per management guidelines. Results Of the 376 women, 60% (n = 228) had not been screened. Among women who received an abnormal screening result (n = 122), 67% (n = 82) had adequate follow‐up. Predictors of: (a) being screened were younger age, having a higher income, and having insurance; (b) adequate follow‐up were having a higher income, and (c) stage 1 cervical cancer were being screened and younger age. Conclusion Unlike other cancer patterns of care studies, this study uses data obtained from medical records supplemented with self‐report information to understand a woman's path to diagnosis, her follow‐up care, and the stage of her cervical cancer diagnosis. This study provides findings that could be used to reach more unscreened or under screened women and to continue lowering cervical cancer incidence in the United States.
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- 2021
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30. The financial burden of PARP inhibitors on patients, payors, and financial assistance programs: Who bears the cost?
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Goldsberry, Whitney N., Summerlin, Sarah S., Guyton, Allison, Caddell, Brittani, Huh, Warner K., Kim, Kenneth H., and Liang, Margaret I.
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- 2021
- Full Text
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31. Total and out-of-pocket costs for PARP inhibitors among insured ovarian cancer patients
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Liang, Margaret I., Chen, Ling, Hershman, Dawn L., Hillyer, Grace C., Huh, Warner K., Guyton, Allison, and Wright, Jason D.
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- 2021
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32. Fluorescence Imaging of the Ureter in Minimally Invasive Pelvic Surgery
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Huh, Warner K., Johnson, John L., Elliott, Emily, Boone, Jonathan D., Leath, Charles A., III, Kovar, Joy L., and Kim, Kenneth H.
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- 2021
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33. ASCCP Colposcopy Standards
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Khan, Michelle J, Werner, Claudia L, Darragh, Teresa M, Guido, Richard S, Mathews, Cara, Moscicki, Anna-Barbara, Mitchell, Martha M, Schiffman, Mark, Wentzensen, Nicolas, Massad, L Stewart, Mayeaux, EJ, Waxman, Alan G, Conageski, Christine, Einstein, Mark H, and Huh, Warner K
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Cancer ,Cervical Cancer ,Patient Safety ,Biopsy ,Colposcopy ,Early Detection of Cancer ,Female ,Humans ,Terminology as Topic ,United States ,Uterine Cervical Neoplasms ,role of colposcopy ,benefits ,potential harms ,terminology ,Clinical Sciences ,Obstetrics & Reproductive Medicine ,Clinical sciences - Abstract
ObjectivesThe American Society for Colposcopy and Cervical Pathology Colposcopy Standards address the role of and approach to colposcopy and biopsy for cervical cancer prevention in the United States. Working Group 1 was tasked with defining the role of colposcopy, describing benefits and potential harms, and developing an official terminology.MethodsA systematic literature review was performed. A national survey of American Society for Colposcopy and Cervical Pathology members provided input on current terminology use. The 2011 International Federation for Cervical Pathology and Colposcopy terminology was used as a template and modified to fit colposcopic practice in the United States. For areas without data, expert consensus guided the recommendation. Draft recommendations were posted online for public comment and presented at an open session of the 2017 International Federation for Cervical Pathology and Colposcopy World Congress for further comment. All comments were considered for the final version.ResultsColposcopy is used in the evaluation of abnormal or inconclusive cervical cancer screening tests. Colposcopy aids the identification of cervical precancers that can be treated, and it allows for conservative management of abnormalities unlikely to progress. The potential harms of colposcopy include pain, psychological distress, and adverse effects of the procedure. A comprehensive colposcopy examination should include documentation of cervix visibility, squamocolumnar junction visibility, presence of acetowhitening, presence of a lesion(s), lesion(s) visibility, size and location of lesions, vascular changes, other features of lesion(s), and colposcopic impression. Minimum criteria for reporting include squamocolumnar junction visibility, presence of acetowhitening, presence of a lesion(s), and colposcopic impression.ConclusionsA recommended terminology for use in US colposcopic practice was developed, with comprehensive and minimal criteria for reporting.
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- 2017
34. Evidence-Based Consensus Recommendations for Colposcopy Practice for Cervical Cancer Prevention in the United States
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Wentzensen, Nicolas, Massad, L Stewart, Mayeaux, Edward J, Khan, Michelle J, Waxman, Alan G, Einstein, Mark H, Conageski, Christine, Schiffman, Mark H, Gold, Michael A, Apgar, Barbara S, Chelmow, David, Choma, Kim K, Darragh, Teresa M, Gage, Julia C, Garcia, Francisco AR, Guido, Richard S, Jeronimo, Jose A, Liu, Angela, Mathews, Cara A, Mitchell, Martha M, Moscicki, Anna-Barbara, Novetsky, Akiva P, Papasozomenos, Theognosia, Perkins, Rebecca B, Silver, Michelle I, Smith, Katie M, Stier, Elizabeth A, Tedeschi, Candice A, Werner, Claudia L, and Huh, Warner K
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Cervical Cancer ,Cancer ,Prevention ,Colposcopy ,Early Detection of Cancer ,Female ,Humans ,United States ,Uterine Cervical Neoplasms ,colposcopy ,biopsy ,recommendations ,cervical cancer ,screening ,evidence based ,Clinical Sciences ,Obstetrics & Reproductive Medicine - Abstract
The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of colposcopy and directed biopsy for cervical cancer prevention in the United States (US). The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. An extensive literature review was conducted and supplemented by a systematic review and meta-analysis of unpublished data. In addition, a survey of practicing colposcopists was conducted to assess current colposcopy practice in the US. Recommendations were approved by the working group members, and the final revisions were made based on comments received from the public. The recommendations cover terminology, risk-based colposcopy, colposcopy procedures, and colposcopy adjuncts. The ASCCP Colposcopy Standards recommendations are an important step toward raising the standard of colposcopy services delivered to women in the US. Because cervical cancer screening programs are currently undergoing important changes that may affect colposcopy performance, updates to some of the current recommendations may be necessary in the future.
- Published
- 2017
35. ASCCP Colposcopy Standards: Role of Colposcopy, Benefits, Potential Harms, and Terminology for Colposcopic Practice.
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Khan, Michelle J, Werner, Claudia L, Darragh, Teresa M, Guido, Richard S, Mathews, Cara, Moscicki, Anna-Barbara, Mitchell, Martha M, Schiffman, Mark, Wentzensen, Nicolas, Massad, L Stewart, Mayeaux, EJ, Waxman, Alan G, Conageski, Christine, Einstein, Mark H, and Huh, Warner K
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Humans ,Colposcopy ,Biopsy ,United States ,Uterine Cervical Neoplasms ,Female ,Terminology as Topic ,Early Detection of Cancer ,role of colposcopy ,benefits ,potential harms ,terminology ,Obstetrics & Reproductive Medicine ,Clinical Sciences - Abstract
ObjectivesThe American Society for Colposcopy and Cervical Pathology Colposcopy Standards address the role of and approach to colposcopy and biopsy for cervical cancer prevention in the United States. Working Group 1 was tasked with defining the role of colposcopy, describing benefits and potential harms, and developing an official terminology.MethodsA systematic literature review was performed. A national survey of American Society for Colposcopy and Cervical Pathology members provided input on current terminology use. The 2011 International Federation for Cervical Pathology and Colposcopy terminology was used as a template and modified to fit colposcopic practice in the United States. For areas without data, expert consensus guided the recommendation. Draft recommendations were posted online for public comment and presented at an open session of the 2017 International Federation for Cervical Pathology and Colposcopy World Congress for further comment. All comments were considered for the final version.ResultsColposcopy is used in the evaluation of abnormal or inconclusive cervical cancer screening tests. Colposcopy aids the identification of cervical precancers that can be treated, and it allows for conservative management of abnormalities unlikely to progress. The potential harms of colposcopy include pain, psychological distress, and adverse effects of the procedure. A comprehensive colposcopy examination should include documentation of cervix visibility, squamocolumnar junction visibility, presence of acetowhitening, presence of a lesion(s), lesion(s) visibility, size and location of lesions, vascular changes, other features of lesion(s), and colposcopic impression. Minimum criteria for reporting include squamocolumnar junction visibility, presence of acetowhitening, presence of a lesion(s), and colposcopic impression.ConclusionsA recommended terminology for use in US colposcopic practice was developed, with comprehensive and minimal criteria for reporting.
- Published
- 2017
36. Piloting use of an out-of-pocket cost tracker among gynecologic cancer patients
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Margaret I. Liang, Sarah S. Summerlin, Teresa K.L. Boitano, Christina T. Blanchard, Warner K. Huh, Smita Bhatia, and Maria Pisu
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Out-of-pocket costs ,Costs of care ,Healthcare expenditures ,Cancer ,Financial toxicity ,Gynecology and obstetrics ,RG1-991 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Objective: Our objective was to evaluate uptake and satisfaction with an out-of-pocket (OOP) cost tracker as a means for cancer patients to manage their personalized costs of care and to identify characteristics associated with usage. Methods: Within a longitudinal survey evaluating financial toxicity among gynecologic cancer patients on active systemic therapy over a 6-month period, we provided paper worksheets for participants to voluntarily track expenses. We assessed usage and satisfaction at 3 and 6 months using frequency and percentage. We used Fisher’s exact test and Wilcoxon rank sum analysis to evaluate patient characteristics based upon usage. Participants were encouraged to submit their completed cost tracker worksheets. Results: Fifty-three of 121 (44%) participants reported ever using the OOP cost tracker. Most users reported it was easy to use (97%, 100%) and helpful (86%, 72%); however, fewer users rated it as useful for budgeting (42%, 26%) at 3 and 6 months, respectively. More patients who knew their insurance premium were users compared to non-users (74.4% vs. 54.4%, p = 0.04). Among thirteen users who submitted their completed cost tracker worksheets, non-medical costs (i.e., transportation) had the highest monthly out of pocket costs (mean $213, range $0–587). User feedback included suggestions to enhance the cost tracker with educational tutorials or a reminder system. Conclusions: Future studies should explore if cost tracker uptake and satisfaction are enhanced with the addition of reminders and whether usage decreases financial toxicity or increases patient self-efficacy in managing the costs of cancer care.
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- 2022
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37. Noncanonical effector functions of the T-memory–like T-PLL cell are shaped by cooperative TCL1A and TCR signaling
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Oberbeck, S., Schrader, A., Warner, K., Jungherz, D., Crispatzu, G., von Jan, J., Chmielewski, M., Ianevski, A., Diebner, H.H., Mayer, P., Kondo Ados, A., Wahnschaffe, L., Braun, T., Müller, T.A., Wagle, P., Bouska, A., Neumann, T., Pützer, S., Varghese, L., Pflug, N., Thelen, M., Makalowski, J., Riet, N., Göx, H.J.M., Rappl, G., Altmüller, J., Kotrová, M., Persigehl, T., Hopfinger, G., Hansmann, M.L., Schlößer, H., Stilgenbauer, S., Dürig, J., Mougiakakos, D., von Bergwelt-Baildon, M., Roeder, I., Hartmann, S., Hallek, M., Moriggl, R., Brüggemann, M., Aittokallio, T., Iqbal, J., Newrzela, S., Abken, H., and Herling, M.
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- 2020
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38. Effect of misoprostol on type 3 transformation zone of the cervix among Cameroonian women
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Simon M. Manga, Margaret I. Liang, Yuanfan Ye, Jeff M. Szychowski, Kathleen L. Nulah, Alan T. Tita, Isabel Scarinci, and Warner K. Huh
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Cervix uteri ,Cameroon ,Misoprostol ,Precancerous conditions ,Gynecology and obstetrics ,RG1-991 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Type 3 transformation zone (TZ) of the cervix has been shown to be associated with a four to five-fold increased risk of missed precancerous/cancerous lesions. The aim of this study was to evaluate the effect of intravaginal misoprostol on the TZ among women with Type 3 TZ in Cameroon. Materials and methods: A single dose of vaginal misoprostol (400 mcg or 600 mcg) was administered as part of the plan of care for women with Type 3 TZ during cervical cancer screening. The primary outcome was successful conversion from Type 3 TZ to Types 1 or 2 TZ. Descriptive analysis was performed using chi-square and Fisher’s exact tests. Results: Among the 90 of 107 (84.2%) women who returned for re-evaluation of the cervix, 43 (47.8%, 95% CI: 0.36%-0.60%) had conversion of Type 3 TZ to Types 1 or 2. Women who received misoprostol 600 mcg were more likely to have their Type 3 TZs converted to Types 1 or 2 than women receiving 400 mcg (p = 0.037). Conclusion: Misoprostol converted approximately 50% of Type 3 TZ to Types 1 or 2 in Cameroon. Misoprostol is feasible in converting Type 3 TZ to Types 1 or 2 among Cameroonian women.
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- 2022
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39. Risk of second primary cancers among survivors of gynecological cancers
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Adjei Boakye, Eric, Grubb, Logan, Peterson, Caryn E., Osazuwa-Peters, Nosayaba, Grabosch, Shannon, Ladage, Heather D., and Huh, Warner K.
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- 2020
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40. When to Operate, Hesitate and Reintegrate: Society of Gynecologic Oncology Surgical Considerations during the COVID-19 Pandemic
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Fader, Amanda N., Huh, Warner K., Kesterson, Joshua, Pothuri, Bhavana, Wethington, Stephanie, Wright, Jason D., Bakkum-Gamez, Jamie N., Soliman, Pamela T., Sinno, Abdulrahman K., Leitao, Mario, Martino, Martin A., Karam, Amer, Rossi, Emma, Brown, Jubilee, Blank, Stephanie, Burke, William, Goff, Barbara, Yamada, S. Diane, Uppal, Shitanshu, and Dowdy, Sean C.
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- 2020
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41. Risk of subsequent malignant neoplasms after an index potentially-human papillomavirus (HPV)-associated cancers
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Wang, Maggie, Sharma, Arun, Osazuwa-Peters, Nosayaba, Simpson, Matthew C., Schootman, Mario, Piccirillo, Jay F., Huh, Warner K., and Adjei Boakye, Eric
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- 2020
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42. Extensive financial hardship among gynecologic cancer patients starting a new line of therapy
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Liang, Margaret I., Pisu, Maria, Summerlin, Sarah S., Boitano, Teresa K.L., Blanchard, Christina T., Bhatia, Smita, and Huh, Warner K.
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- 2020
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43. Human papillomavirus vaccination: Ongoing challenges and future directions
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Dilley, Sarah, Miller, Kathryn M., and Huh, Warner K.
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- 2020
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44. A common clinical dilemma: Management of abnormal vaginal cytology and human papillomavirus test results
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Khan, Michelle J, Massad, L Stewart, Kinney, Walter, Gold, Michael A, Mayeaux, EJ, Darragh, Teresa M, Castle, Philip E, Chelmow, David, Lawson, Herschel W, and Huh, Warner K
- Subjects
Reproductive Medicine ,Biomedical and Clinical Sciences ,Cervical Cancer ,Prevention ,Sexually Transmitted Infections ,Clinical Research ,Health Services ,Cancer ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Female ,Humans ,Papillomavirus Infections ,Precancerous Conditions ,Vagina ,Vaginal Neoplasms ,Vaginal Smears ,Vaginal cytology ,HPV ,Vaginal cancer ,VaIN ,Oncology and Carcinogenesis ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Reproductive medicine - Abstract
ObjectiveVaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (hrHPV) tests, and clinicians are faced with managing their abnormal results. Our objective is to review the literature on vaginal cytology and hrHPV testing and to develop guidance for the management of abnormal vaginal screening tests.MethodsAn electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted.ResultsThe available literature was too limited to develop evidence-based recommendations for managing abnormal vaginal cytology and hrHPV screening tests. However, the data did show that 1) the risk of vaginal cancer in women after hysterectomy is extremely low, justifying the recommendation against routine screening, and 2) in women for whom surveillance is recommended, e.g. women post-treatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors.ConclusionVaginal cancer is rare, and asymptomatic low-risk women should not be screened. An algorithm based on expert opinion is proposed for managing women with abnormal vaginal test results.
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- 2016
45. A Common Clinical Dilemma
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Khan, Michelle J, Massad, L Stewart, Kinney, Walter, Gold, Michael A, Mayeaux, EJ, Darragh, Teresa M, Castle, Philip E, Chelmow, David, Lawson, Herschel W, and Huh, Warner K
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Prevention ,Clinical Research ,Infectious Diseases ,Health Services ,Cervical Cancer ,Sexually Transmitted Infections ,Cancer ,Detection ,screening and diagnosis ,4.4 Population screening ,4.2 Evaluation of markers and technologies ,Algorithms ,Case Management ,Female ,Human Papillomavirus DNA Tests ,Humans ,Papanicolaou Test ,Papillomavirus Infections ,Vaginal Neoplasms ,HPV ,vaginal cancer ,vaginal cytology ,VaIN ,Clinical Sciences ,Obstetrics & Reproductive Medicine ,Clinical sciences - Abstract
ObjectiveVaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (HPV) tests, and clinicians are faced with managing their abnormal results. Our objectives were to review the literature on vaginal cytology and high-risk HPV (hrHPV) testing and to develop guidance for the management of abnormal vaginal screening tests.Materials and methodsAn electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted.ResultsThe available literature was too limited to develop evidence-based recommendations for managing abnormal vaginal cytology and hrHPV screening tests. However, the data did show that (1) the risk of vaginal cancer in women after hysterectomy is extremely low, justifying the recommendation against routine screening, and (2) in women for whom surveillance is recommended, e.g., women posttreatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors.ConclusionsVaginal cancer is rare, and asymptomatic low-risk women should not be screened. An algorithm based on expert opinion is proposed for managing women with abnormal vaginal test results.
- Published
- 2016
46. Cervical and oral human papillomavirus infection in women living with human immunodeficiency virus (HIV) and matched HIV-negative controls in Brazil
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Tamy Taianne Suehiro, Gabrielle Marconi Zago Ferreira Damke, Edilson Damke, Paloma Luana Rodrigues de Azevedo Ramos, Marcela de Andrade Pereira Silva, Sandra Marisa Pelloso, Warner K. Huh, Ricardo Argemiro Fonseca Franco, Vânia Ramos Sela da Silva, Isabel Cristina Scarinci, and Marcia Edilaine Lopes Consolaro
- Subjects
HPV ,HIV ,Oral ,Cervical ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Despite the demonstrated role of human Papillomavirus (HPV) in the etiology of cervical cancer and the strong evidence suggesting the importance of HPV in the development of oropharyngeal cancer, several aspects of the interrelationship between HPV infection in both body sites remain unknown, specifically in female human immunodeficiency virus (HIV)-positive (HIV+) patients. We aimed to assess the prevalence, distribution, and concordance of cervical and oral HPV in HIV+ women and matched HIV-negative (HIV-) controls in Brazil. Material and methods Cervical and endocervical samples for cytological screening and HPV detection and oral samples were collected from 115 HIV+ women using highly active antiretroviral therapy (HAART) and 139 HIV-matched controls (HIV-) in Maringá City, Brazil. Risk factors were assessed using a standardized questionnaire, and the data regarding HIV infection were obtained from the patients’ medical records. HPV detection and typing were performed using the Kit Multiplex XGEN Multi HPV Chip HS12. Results HIV infection was well controlled in this cohort, but women who exhibited detectable HIV loads were significantly associated with HPV-positive status overall (P = 0.03) and in cervical mucosa (P = 0.01). HIV+ women had significantly more abnormal cytological findings (P = 0.04) than HIV- women. Of the 115 HIV+ women, 48.7% were positive for cervical and/or oral HPV DNA; of the 139 HIV- women, 41% were positive for cervical and/or oral HPV (P = 0.25). Both HIV+ and HIV- women had a statistically higher prevalence of cervical HPV infection than oral infection. The concurrent HPV infection in two anatomical sites was similar in HIV+ and HIV- women; however, HPV type concordance was not observed. HPV type distribution was different between the anatomical sites in both groups, and HIV+ women presented less common types, mainly in oral mucosa. Conclusion Our data support the importance of testing HPV infection in HIV+ women, even when the HIV infection is well controlled. Prospective studies are required to better understand the natural history of HPV infection in both anatomical sites, specifically in HIV+ women.
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- 2020
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47. Cauda equina syndrome in an ovarian malignant‐mixed müllerian tumor with leptomeningeal spread
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Joshua D. Bernstock, Stuart Ostby, Brandon Fox, Houman Sotoudeh, Andrew Janssen, Yun Jee Kang, Jason Chen, Veeranjaneyulu Prattipati, Galal Elsayed, Gustavo Chagoya, Daisuke Yamashita, Gregory K. Friedman, Burt Nabors, Warner K. Huh, and Mina Lobbous
- Subjects
cauda equina syndrome ,leptomeningeal carcinomatosis ,metastasis ,ovarian carcinosarcoma ,ovarian malignant‐mixed müllerian tumor ,Medicine ,Medicine (General) ,R5-920 - Abstract
Abstract Leptomeningeal metastasis is extremely rare in patients with ovarian cancer, but should be considered in patients presenting with neurologic deficits such as cauda equine syndrome. Given its poor prognosis and lack of data currently on management, additional studies are needed to optimize treatment regimens and improve outcomes.
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- 2019
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48. Meeting the looming policy challenge of sea-level change and human migration
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Wrathall, D. J., Mueller, V., Clark, P. U., Bell, A., Oppenheimer, M., Hauer, M., Kulp, S., Gilmore, E., Adams, H., Kopp, R., Abel, K., Call, M., Chen, J., deSherbinin, A., Fussell, E., Hay, C., Jones, B., Magliocca, N., Marino, E., Slangen, A., and Warner, K.
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- 2019
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49. Pathology findings among women with alterations in uterine bleeding patterns in cameroon
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Simon M. Manga, Yuanfan Ye, Jeff M. Szychowski, Kathleen L. Nulah, Calvin Ngalla, Kaitlyn Kincaid, Teresa K.L. Boitano, Alan T. Tita, Isabel Scarinci, Warner K. Huh, Zacharie Sando, and Margaret I. Liang
- Subjects
Cameroon ,Endometrial hyperplasia ,Endometrial cancer ,Gynecology and obstetrics ,RG1-991 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Purpose: Endometrial cancer is on the rise in high-income countries but it has not been adequately studied in low-and-middle income countries especially in sub-Saharan Africa (SSA), likely due to scarce pathology facilities. The purpose of this study was to characterize and quantify the prevalence of endometrial hyperplasia or cancer in a cohort of women with abnormal uterine bleeding (AUB) who underwent endometrial biopsy in Cameroon. Methods: We designed a cross-sectional study using medical records to characterize women who underwent endometrial biopsy in the Cameroon Baptist Convention Health Services (CBCHS) from 2008 to 2019. Pathologic diagnoses were classified as either endometrial hyperplasia, endometrial cancer, or no endometrial hyperplasia/cancer. We reported the overall prevalence of endometrial hyperplasia or cancer. Bivariate analyses compared patient characteristics between women with endometrial cancer, endometrial hyperplasia, and neither. Results: The average age was 46.2 years and women had an average of 5.1 parity. We found that, 61 [(36.7% of 166 women; 95% CI (27.6–47.0%)] had endometrial hyperplasia or cancer. There were no cases of hyperplasia with atypia and 13 women had endometrial cancer. The remainder were comprised of benign or infectious pathologic findings. In bivariate analysis, mean ages were statistically different among the three groups (hyperplasia, cancer, and no hyperplasia/cancer), p
- Published
- 2021
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50. Adjuvant chemotherapy following chemoradiotherapy as primary treatment for locally advanced cervical cancer versus chemoradiotherapy alone (OUTBACK): an international, open-label, randomised, phase 3 trial
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Linda R Mileshkin, Kathleen N Moore, Elizabeth H Barnes, Val Gebski, Kailash Narayan, Madeleine T King, Nathan Bradshaw, Yeh Chen Lee, Katrina Diamante, Anthony W Fyles, William Small, David K Gaffney, Pearly Khaw, Susan Brooks, J Spencer Thompson, Warner K Huh, Cara A Mathews, Martin Buck, Aneta Suder, Thomas E Lad, Igor J Barani, Christine H Holschneider, Sylvia Van Dyk, Michael Quinn, Danny Rischin, Bradley J Monk, and Martin R Stockler
- Subjects
Oncology - Published
- 2023
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