Rui Manuel Vieira Reis

Randomized experimental population-based study to evaluate the acceptance and completion of and preferences for cervical cancer screening

Cervical cancer has high incidence and mortality rates, especially in less-developed countries. Prevention methods are well established, but there are still barriers preventing some Brazilian women from undergoing a Pap sample. The objective of the study was to evaluate the acceptance, preferences and completion of four screening methods. This has an experimental design (community trial). A total of 164 participants who had never had a Pap sample or had not had one for more than three years were included. The city’s urban area was stratified by census tracts and divided according to income and education levels. Women belonging to the lower-income strata were considered in the study. Random blocks were numbered into five intervention groups (Group 1- Pap sample at the hospital; Group 2- Pap sample in the mobile unit; Group 3- urine self-collection; Group 4- vaginal self-collection; Group 5- woman’s choice). Only 164 women met all of the eligibility criteria (15.3%). Most of them accepted the assigned method (92%), but only 84% of the women completed the collection step. The acceptance rates were as follows: Group 1 (100%), Group 2 (64.5%), Group 3 (100%) and Group 4 (91.4%). In Group 5, the women’s preferences were distributed as follows: examination performed at the hospital, 13 women (33.3%); examination performed at the mobile unit, 11 women (28.2%); urine self-collection, 11 women (28.2%); and vaginal self-collection, 4 women (10.3%). This study suggests that methods that allow cervical sampling collected near the women’s domicile might improve the acceptance and completion of preventive tests. This finding is relevant for the development of new cervical cancer screening strategies.

Bioprospecting of Natural Compounds from Brazilian Cerrado Biome Plants in Human Cervical Cancer Cell Lines

Cervical cancer is the third most common in Brazilian women. The chemotherapy used for the treatment of this disease can cause many side effects; then, to overcome this problem, new treatment options are necessary. Natural compounds represent one of the most promising sources for the development of new drugs. In this study, 13 different species of 6 families from the Brazilian Cerrado vegetation biome were screened against human cervical cancer cell lines (CCC). Some of these species were also evaluated in one normal keratinocyte cell line (HaCaT). The effect of crude extracts on cell viability was evaluated by a colorimetric method (MTS assay). Extracts from Annona crassiflora, Miconia albicans, Miconia chamissois, Stryphnodendron adstringens, Tapirira guianensis, Xylopia aromatica, and Achyrocline alata showed half-maximal inhibitory concentration (IC50) values < 30 μg/mL for at least one CCC. A. crassiflora and S. adstringens extracts were selective for CCC. Mass spectrometry (Electrospray Ionization Fourier Transform Ion Cyclotron Resonance Mass Spectrometer (ESI FT-ICR MS)) of A. crassiflora identified fatty acids and flavonols as secondary compounds. One of the A. crassiflora fractions, 7C24 (from chloroform partition), increased H2AX phosphorylation (suggesting DNA damage), PARP cleavage, and cell cycle arrest in CCC. Kaempferol-3-O-rhamnoside and oleic acid were bioactive molecules identified in 7C24 fraction. These findings emphasize the importance of investigating bioactive molecules from natural sources for developing new anti-cancer drugs.

A Systematic Review of MicroRNAs Involved in Cervical Cancer Progression

To obtain a better understanding on the role of microRNAs in the progression of cervical cancer, a systematic review was performed to analyze cervical cancer microRNA studies. We provide an overview of the studies investigating microRNA expression in relation to cervical cancer (CC) progression, highlighting their common outcomes and target gene interactions according to the regulatory pathways. To achieve this, we systematically searched through PubMed MEDLINE, EMBASE, and Google Scholar for all articles between April 2010 and April 2020, in accordance with the PICO acronym (participants, interventions, comparisons, outcomes). From 27 published reports, totaling 1721 cases and 1361 noncancerous control tissue samples, 26 differentially expressed microRNAs (DEmiRNAs) were identified in different International Federation of Gynecology and Obstetrics (FIGO) stages of cervical cancer development. It was identified that some of the dysregulated microRNAs were associated with specific stages of cervical cancer development. The results indicated that DEmiRNAs in different stages of cervical cancer were functionally involved in several key hallmarks of cancer, such as evading growth suppressors, enabling replicative immortality, activation of invasion and metastasis, resisting cell death, and sustained proliferative signaling. These dysregulated microRNAs could play an important role in cervical cancer’s development. Some of the stage-specific microRNAs can also be used as biomarkers for cancer classification and monitoring the progression of cervical cancer.

Rare intra-tumoral colonization of Fusobacterium nucleatum in endometrial cancer

The presence of Fusobacterium nucleatum has been associated with gynecological disorders, namely endometriosis and pregnancy complications; however, its role in endometrial cancer remains unexplored. This study aimed to assess the presence of intra-tumoral F nucleatum in endometrial carcinoma tissues and its association with patients' clinicopathological and molecular features. A total of 260 patients were included, and a droplet digital polymerase chain reaction assay was employed to detect F nucleatum in formalin-fixed paraffin-embedded tumor tissues. F nucleatum was detected in only 3 cases (1.2%), and none exhibited high bacterial levels, even within the 79 microsatellite instability-high molecular subgroup. These findings suggest that intra-tumoral F nucleatum does not play an oncogenic role in endometrial cancer.

Patient-reported outcomes and experiences following robotic, laparoscopic, and open surgery for endometrial cancer

Endometrial cancer is the most common gynecologic malignancy in developed countries, and minimally invasive surgery is increasingly used. However, comparisons among surgical approaches regarding patient-centered outcomes remain scarce. In this study, we aimed to compare patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) between minimally invasive (robotic and laparoscopic) and open surgeries for endometrial cancer staging, and to assess functional, physical, and emotional domains. This cross-sectional study was conducted at Barretos Cancer Hospital (Brazil) with retrospective clinical data and prospective collection of PROMs and PREMs. A total of 182 women with histologically confirmed endometrial cancer underwent robotic (n = 29), laparoscopic (n = 91), or open surgery (n = 62) between January 2020 and December 2023. Statistical analyses were descriptive and univariate to explore associations between surgical approach and outcomes. Overall, PROMs were highest in the robotic group (72.2 ± 6.6), followed by laparoscopic (70.8 ± 6.4) and open (70.2 ± 7.4). PREMs showed a similar pattern-robotic (98.8 ± 4.1), open (97.5 ± 3.9), and laparoscopic (97.0 ± 6.1). Robotic surgery achieved higher satisfaction (99.7 ± 7.2), sexual function (78.1 ± 23.9), and quality of life (86.6 ± 12.6). Laparoscopy favored mobility (88.6 ± 18.8) and daily activities (89.4 ± 21.7), while open surgery had higher emotional wellbeing (80.8 ± 21.6) but more gastrointestinal symptoms. Robotic surgery yielded better satisfaction, quality of life, and sexual function; laparoscopy improved mobility and daily activities; and open surgery enhanced emotional wellbeing. PROMs and PREMs proved feasible for evaluating patient-centered outcomes and revealed meaningful differences supporting personalized surgical decisions.