Southern Medical Journal

Racial/Ethnic Disparities in the Incidence of Epithelial Ovarian Cancer in Florida by Histology, 2001–2015: Analysis of Trends

Because the population in Florida is 25.6% Hispanic, it is possible to evaluate the influence of race and ethnicity within clinically relevant subgroups of women with epithelial ovarian cancer (EOC), including histology and tumor grade. This study explores racial/ethnic disparities in the incidence of EOC in Florida by histology and tumor grade. This study is an analysis of the Florida Cancer Database System. All incidence EOC cases from 2001 through 2015 were identified. Age-adjusted incidences were calculated and trends modeled by race/ethnicity and histology using Joinpoint and Poisson regression. In total, 80% of the 21,731 women with EOC were White, followed by Hispanic (13.1%) and non-Hispanic Black (7.9%). All races/ethnicities had statistically significant declines in incidence, with non-Hispanic White and non-Hispanic Black women having the steepest declines (annual percentage change -2.5, 95% confidence interval [CI] -5.9 to -2.1 and annual percentage change -2.8, 95% CI -4.8 to -1.5, respectively). A decreased incidence trend across the time period was seen for all subgroups (relative risk 0.97 [95% CI 0.96-0.98], 0.96 [95% CI 0.96-0.99], and 0.98 [95% CI 0.96-0.99] for non-Hispanic White, non-Hispanic Black, and Hispanic). High-grade EOC incidence for all groups did not change with time. We found significant declines in the incidence of EOC for all races/ethnicities, but not for high-grade EOC. The observed incidence decline in Hispanic women differs from previous research. More research is needed to understand women the causes of overall racial/ethnic differences and the decline in EOC.

Predictors of Blood Transfusion in Patients Undergoing Cytoreductive Surgeries for Ovarian Malignancy

The aims of this study were to describe the baseline estimated blood loss (EBL) in surgery and transfusion rate in patients undergoing cytoreductive surgeries for ovarian malignancy, and identify perioperative variables associated with blood loss and transfusion. A retrospective cohort study at a single institution was performed that included patients with known or suspected ovarian malignancy undergoing cytoreductive surgery between 2016 and 2021. Among 44 patients meeting inclusion criteria, 61% received perioperative blood transfusion. There were significant differences in EBL and preoperative hemoglobin levels between patients who did and did not receive transfusion (EBL 442.6 vs 236.8 mL, Perioperative blood transfusion is common in patients undergoing cytoreductive surgery. In this study, EBL and preoperative hemoglobin levels were significantly associated with transfusion receipt. Clinicians should optimize hemoglobin levels and intraoperative blood conservation strategies to reduce the need for transfusion. The results also highlight the importance of considering racial and ethnic differences when developing strategies to reduce transfusion risk.

Role of Race, Rurality, and Age in Human Papillomavirus Vaccine Initiation among US Women

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, with a lifetime prevalence of more than 80%. HPV is associated with cervical cancer, which affects thousands of US women each year. A vaccine was introduced in 2006 to mitigate the prevalence and mortality of HPV-associated cancers. Although HPV vaccine adherence has increased over time, disparities in vaccine uptake exist among adolescents, and likely within adult communities. This study explored the impact of race/ethnicity, rural classification, and age on vaccine initiation among adult women in the United States. The final sample included N = 4666 females aged 18 to 43 years from the 2022 National Health Interview Survey. A logistic regression model explored the association of race/ethnicity, rural classification, and age with HPV vaccine initiation. Only 40.1% of our sample ever received an HPV vaccine. Urban residents were significantly more likely than rural residents to have ever gotten an HPV vaccine. Hispanic, Black, and Asian participants had significantly lower HPV vaccine initiation rates compared with their White counterparts. Finally, as age increased, HPV vaccine initiation decreased. Efforts to increase HPV vaccine uptake for future generations of women and girls in the United States should focus on rural communities, as well as Black, Hispanic, and Asian racial minorities. Because so many women within our sample had not received any HPV vaccine, we must emphasize the importance of HPV testing and cervical cancer screening, especially among aging women.

Trends in Premature Deaths among Women Living with HIV/AIDS and Cervical Cancer

There is a lack of updated information on premature death and years of potential life lost (YPLL) among human immunodeficiency (HIV)-positive women with cervical cancer. We hypothesize that increased access to preventive resources such as antiretroviral therapy, preexposure prophylaxis, and human papillomavirus vaccines has reduced premature mortality and YPLL in these women in the previous decades. We used data from the National Inpatient Sample database from 2003 to the third quarter of 2015, and restricted the analysis to HIV-positive women with or without cervical cancer. Joinpoint regression models were run to identify trends in the rates of HIV and cervical cancer. Overall and age-stratified YPLL were calculated for HIV-positive women with cervical cancer. Adjusted survey logistic regression models were built to determine the predictive factors of in-hospital mortality among women living with HIV. Among hospitalized women, low-income, non-Hispanic Blacks, and patients aged 40 to 59 years experienced greater frequencies of HIV/cervical cancer comorbidity. The prevalence of HIV hospitalizations increased by an average annual percentage of 0.9% (95% confidence interval 0.3-1.6). YPLL decreased in HIV-positive women living with and without cervical cancer by 4.9% and 4.3%, respectively. The trajectory for YPLL was not uniform across age groups. YPLL decreased substantially in women aged 20 to 29 years with HIV/cervical cancer comorbidity. Cervical cancer remained a significant predictor of mortality among HIV-positive women when adjusted for age, race, and insurance coverage. Within a large, national sample from 2003 to 2015, we found an overall declining trend in YPLL in women living with HIV/cervical cancer comorbidity. In-hospital mortality among HIV-positive women was associated with cervical cancer, age, race, and insurance coverage. We recommend further investigation into the quality of HIV and cervical cancer treatment and prevention services for the sociodemographic groups described.

Improving Preventive Care for Women through a Provider Reminder Tool

To determine the association of utilization of health maintenance tables (HMTs) as a provider reminder tool within the electronic medical record with the completion of women's preventive health services. Guidelines from the US Preventive Services Task Force and the Advisory Committee on Immunization Practices were used to create the HMT. The study sample consisted of female patients between 18 and 74 years of age who visited the University of Florida Internal Medicine Clinic at Medical Plaza between February 15, 2016 and June 24, 2016. We determined whether a reminder system was used for each visit and whether the following preventive health services were up to date: breast cancer screening, cervical cancer screening, and human papillomavirus vaccination. χ We divided the visits into four groups based on the type of provider reminder used: the HMT, the computer-generated reminder .HM, simple annotation, and no reminder. Compared with .HM, no reminder, and all non-HMT, HMT utilization had a statistically significant positive association with the completion of breast and cervical cancer screening and human papillomavirus vaccination. The difference between the HMT and simple annotation groups did not achieve statistical difference, however. Despite well-established, evidence-based guidelines for screening tests and immunizations effective in reducing cancer-related morbidity and mortality, significant gaps in routine preventive care remain. The HMT may be a provider-friendly and cost-effective reminder tool to enhance the preventive health care of women.

Extended Venous Thromboembolism Prophylaxis after Robotic Staging for Endometrial Cancer

Our objectives were to estimate the incidence of venous thromboembolism (VTE) after robotic staging for endometrial cancer and to compare the incidence of VTE in patients who received a single dose of preoperative prophylaxis of enoxaparin with those who received extended postoperative prophylaxis. This study is a retrospective chart review of patients who underwent robot-assisted surgical staging for endometrial cancer. Patients were categorized into two groups: preoperative prophylaxis (PP), patients who received a single dose of enoxaparin preoperatively, and extended prophylaxis (EP), patients who received 28 days of enoxaparin postoperatively. In total, 148 patients were included, with 117 patients in the PP group and 31 patients in the EP group. The overall incidence of VTE within 30 days postoperatively was 0.67%. No significant difference was found between the PP and the EP groups (0.9% and 0%, respectively; The incidence of VTE following robot-assisted surgical staging for endometrial cancer in this study was 0.67%. No significant difference was found in VTE incidence between the PP group compared with the EP group. Mechanical prophylaxis plus a single dose of preoperative pharmacologic prophylaxis may suffice for low-risk patients following robotic surgical staging for endometrial cancer.

Sentinel Lymph Node Sampling in Robot-Assisted Staging of Endometrial Cancer

Sentinel lymph node (SLN) sampling in endometrial cancer staging has become an acceptable standard. Indocyanine green dye injected into the cervix and detected by near-infrared light is technically simple and sensitive. We aimed to evaluate SLN sampling in robot-assisted surgical staging of endometrial cancer at a university-affiliated teaching hospital. A retrospective chart review, from January 2016 to December 2017, of patients who underwent robot-assisted surgical staging with cervical injection of indocyanine green dye detected by near-infrared light. The map rate, sensitivity, false negatives, and negative predictive value were calculated. A total of 105 charts were reviewed; 79 patients met inclusion criteria. The mean age was 65 (range 38-93) and the mean body mass index was 33.3 (range 16-49). Most patients (72.2%) had stage I disease and grade 1 or 2 histology (77.1%). Eight (10.1%) patients had lymph node metastasis. Seventy-two (91.1%) patients had positive mapping to at least 1 SLN. Sixty-two (78.5%) patients had bilateral mapping. Forty-four patients had concurrent pelvic ± para-aortic lymph node dissection and were included in the sensitivity analysis. Five of 44 cases had LN metastasis. The sensitivity was 80%, and the negative predictive value of SLN sampling was 97.5%. SLN mapping and sampling at a university-affiliated teaching hospital have comparable map rate, sensitivity, and negative predictive value as demonstrated in multiple trials. The technique has the potential to standardize endometrial cancer staging across different practice settings.