Journal of the National Medical Association

A risk prediction model for cervical cancer in adults: A study based on the national health interview survey (NHIS) 2019–2023

Cervical cancer (CC) seriously threatens women's health. Precisely identifying its risk factors and constructing a reliable prediction model are of utmost importance for reducing the risks of both its occurrence and mortality. This study was precisely carried out based on such a need. This study aims to analyse the association between variables and cervical cancer, construct an effective risk prediction model, and evaluate its performance, thereby providing a basis for cervical cancer risk assessment and prevention. Using data from the US NHIS from 2019 to 2023, we analysed the association between 13 variables and cervical cancer, screened key classification variables using machine learning algorithms, and constructed a predictive model based on these variables. We then plotted nomograms, ROC curves, calibration curves, and decision curves to evaluate the model's performance. Four of the 13 variables were significantly correlated with CC (P < 0.001). Among the 38 categorical variables, the machine learning algorithm identified seven key variables. The nomogram constructed based on these variables demonstrated good predictive ability, with an AUC of 0.82, high accuracy in distinguishing CC patients from non-patients, calibration curves confirming its accuracy, and decision curves showing a net benefit greater than 0. In this study, key factors related to CC were screened out through machine learning, and an effective nomogram risk prediction model was constructed. It provided valuable insights for the risk assessment, prevention, and personalized intervention of CC, thus contributing to better clinical management of CC.

Cervical cancer disparities

A biochemical study of estrogen receptor beta and oxidative stress in females with ovarian cancer

The study includes the interpretation of hormonal disturbances resulting from the activation of Beta estrogen receptors, which leads to increased oxidative stress and its relationship to the development1and spread of ovarian1cancer in perimenopause women compared to healthy women. Blood samples were collected from (12) perimenopause women with ovarian cancer immediately after diagnosis to be compared with (45) healthy women. Estrogen receptor beta and some hormones were assessed using ELISA and miniVIDAS, while spectrophotometric methods were used to evaluate variables associated with oxidative stress. The results show a significant increase in the values of estrogen receptors beta for women with ovarian cancer (48.4±3.18) ng/mL compared to healthy women (36.20±2.44) ng/mL. Also, a significant increase was remark in the values of each estrogen, progesterone, DHEA-s, testosterone, AMH, and total oxidant status. In contrast, a significant1decrease in the concentrations of total antioxidant capacity. The results also show a positive1correlation between1the values of total oxidants and the hormones studied, compared to the negative correlation with total antioxidants. The significant increase in the values of beta-estrogen receptors as well as the estrogen hormone that may be derived from adipose tissue in women with ovarian cancer in the perimenopause stage has multiple effects, for example, causing disturbances in some hormones such as progesterone, DHEA-s, testosterone, and AMH. These hormonal disturbances resulting from granulosa cell tumors (GCTs) play a role in increasing the metabolic rate and thus increasing the oxidative stress of the cells.

Cervical Cancer Incidence and Mortality among Non-Hispanic African American and White Women, United States, 1999–2015

Cervical cancer, a preventable cancer, has disproportionately affected African American women. To better understand the burden of cervical cancer, we assessed incidence and mortality rates and analyzed trends among non-Hispanic (NH) African American and White women in the US from 1999 to 2015. From age-adjusted cervical cancer incidence and mortality rates, rate ratios (RR) and 95% confidence intervals (CI) were calculated for comparison between the two races. Trends were analyzed using joinpoint regression and expressed as annual percent change (APC) and average annual percent change (AAPC). Cervical cancer incidence rates were significantly higher (RR: 1.46; 95% CI: 1.44, 1.47) among NH African Americans (10.8 per 100,000 females) than NH Whites (7.4 per 100,000 females). Similarly, mortality rates were significantly higher (RR: 2.05; 95% CI: 2.01, 2.09) in NH African Americans (4.4 per 100,000 females) compared to NH Whites (2.1 per 100,000 females). From 1999 to 2015, overall incidence and mortality trends decreased significantly for both races. Mortality rates steadily increased with age for both races, and incidence rates only increased with age in NH African American women. NH African American women had significantly higher cervical cancer incidence and mortality rates than NH Whites. Even as incidence and mortality trends declined significantly, older NH African Americans had three times the rate of cervical cancer than NH Whites. Prevention and treatment programs need to be enhanced for African Americans as failure to do so may widen cancer disparities.

A Review of Cervical Cancer: Incidence and Disparities

Cervical cancer is the fourth most common cancer amongst women worldwide. In the United States, its incidence and mortality have been declining due to the wide scale implementation of cytological screening programs. However, there have been geographic disparities in cervical cancer, particularly in the US. This review will outline the overall incidence of cervical cancer and discuss the causes for disparities in its incidence and mortality rates. A literature review was performed from 1999 to 2020 of English language manuscripts on the incidence and reasons for disparities in mortality rates of cervical cancer. Racial and ethnic minorities, socioeconomically disenfranchised, and those in rural areas have disparate rates of vaccination, screening and treatment of cervical cancer, leading to worse outcomes. By addressing these disparities via increased education, access to care, and the expansion of screening and vaccination programs, reductions in cervical cancer incidence and mortality may be achieved.

“Girl, just pray …”: Factors That Influence Breast and Cervical Cancer Screening Among Black Women in Rochester, MN

Black women in Minnesota and beyond have a greater burden of death due to some cancers than their White counterparts. Delayed screening and treatment may explain these disparate statistics. The purpose of this study was to work in collaboration with a local Black faith-based organization to gain an updated understanding of Black women's knowledge, attitudes, and behaviors related to breast and cervical cancer, and determine to what extent known factors persist as barriers to accessing cancer screening among Black women in Rochester, MN. We also sought to identify unique barriers for Black women residing in a particularly health resource rich community. Using a community-based participatory research approach, two academic institutes worked in collaboration with a local Black faith-based organization to conduct focus groups. Focus groups were utilized to identify factors that may limit Black women's access to cancer screening and health care. Forty-five eligible participants attended one of eight focus group sessions. All participants self-identified as Black women and most were born in the United States. Content analysis of participant responses suggested that Black women's health-seeking behaviors related to breast and cervical cancer screening continue to be very much influenced by known factors that serve as barriers to screening services. Four primary themes pertaining to these influential factors emerged from participants' focus group discussions: 1) knowledge of cancer, risk factors, and screening options; and 2) socioeconomic factors, 3) psycho-social factors, including lack of trust of doctors specifically involved in clinical research, and 4) cultural factors, including reliance on religious practice in place of medical intervention. Black women face real and perceived barriers to cancer screening even where health resources are abundant. Results reiterate an on going need for culturally appropriate interventions to improve Black women's breast and cervical cancer screening participation by minimizing barriers and engaging entire communities - including Black women, religious leaders, and health care providers.