Clinical and sociodemographic factors associated with late stage cervical cancer diagnosis in Botswana

Abstract Background Cervical cancer is the leading cause of female cancer mortality in Botswana with the majority of cervical cancer patients presenting with late-stage disease. The identification of factors associated with late-stage disease could reduce the cervical cancer burden. This study aims to identify potential patient level clinical and sociodemographic factors associated with a late-stage diagnosis of cervical cancer in Botswana in order to help inform future interventions at the community and individual levels to decrease cervical cancer morbidity and mortality. Results There were 984 women diagnosed with cervical cancer from January 2015 to March 2020 at two tertiary hospitals in Gaborone, Botswana. Four hundred forty women (44.7%) presented with late-stage cervical cancer, and 674 women (69.7%) were living with HIV. The mean age at diagnosis was 50.5 years. The association between late-stage (III/IV) cervical cancer at diagnosis and patient clinical and sociodemographic factors was evaluated using multivariable logistic regression with multiple imputation. Women who reported undergoing cervical cancer screening had lower odds of late-stage disease at diagnosis (OR: 0.63, 95% CI 0.47–0.84) compared to those who did not report screening. Women who had never been married had increased odds of late-stage disease at diagnosis (OR: 1.35, 95% CI 1.02–1.86) compared to women who had been married. Women with abnormal vaginal bleeding had higher odds of late-stage disease at diagnosis (OR: 2.32, 95% CI 1.70–3.16) compared to those without abnormal vaginal bleeding. HIV was not associated with a diagnosis of late-stage cervical cancer. Rural women who consulted a traditional healer had increased odds of late-stage disease at diagnosis compared to rural women who had never consulted a traditional healer (OR: 1.61, 95% CI 1.02–2.55). Conclusion Increasing education and awareness among women, regardless of their HIV status, and among providers, including traditional healers, about the benefits of cervical cancer screening and about the importance of seeking prompt medical care for abnormal vaginal bleeding, while also developing support systems for unmarried women, may help reduce cervical cancer morbidity and mortality in Botswana.

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Socio-demographic, reproductive and clinical profile of women diagnosed with cervical cancer in a tertiary care center in middle Kerala

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20172186 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2112

Author(s):

Neha E. L. ◽

Nishi Roshini Kondakasseril

Keyword(s):

Health Care ◽

Cervical Cancer ◽

Health Education ◽

Late Stage ◽

Rural Population ◽

Clinical Presentation ◽

Tertiary Care ◽

Advanced Stage ◽

Stage Disease ◽

Late Stage Disease

Background: Cervical cancer is a major health problem in rural India. Barriers to cervical cancer control in our country include a lack of awareness of the disease because of illiteracy, poverty, lack of health education and screening programme. The aim of the study was the clinical profile of women diagnosed with cervical carcinoma in a tertiary care centre in the middle part of Kerala in South India.Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, Government medical college Thrissur for a period of two years from January 2014 to December 2016. The characteristics of patient (age, age at menarche and at marriage, parity, reproductive history, place of residence, income, education status, contraception, screening details, clinical presentation and tumor histopathology and stage were obtained. Data was entered in Excel and analysed.Results: Among7224 new patients seeking care from the department, 104 new cases of carcinoma of uterine cervix were identified (0.71%). Mean age was 58.3±8.4 years. 79% women were from rural area. 73% were illiterate, 88.5% belonged to below poverty line (BPL). Post-menopausal bleeding was the commonest clinical presentation (78.8%). Squamous cell carcinoma was the commonest histologic type (88.5%). 50% had first coitus before age of twenty. 94.3% were not aware of any screening procedures and its importance. 67.31% of cases presented in the advanced stage (stage 2B-1V). 75.81% of late stage disease patients were rural population. 96.77% of late stage disease patients were from below poverty line.Conclusions: Carcinoma cervix is more in the low socioeconomic class and rural elderly presented at an advanced stage. Ignorance about the disease and the lack of awareness of the risk factors, need and availability of screening programmes at low cost in Government health care systems was noteworthy. Government health care policies, health education, effective cancer prevention strategies and early cancer detection programmes are yet to reach the outskirts of rural population in Kerala.

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Resistance to antibody neutralization in HIV-2 infection occurs in late stage disease and is associated with X4 tropism

AIDS ◽

10.1097/qad.0b013e328359a89d ◽

2012 ◽

Vol 26 (18) ◽

pp. 2275-2284 ◽

Cited By ~ 12

Author(s):

José M. Marcelino ◽

Pedro Borrego ◽

Charlotta Nilsson ◽

Carlos Família ◽

Helena Barroso ◽

...

Keyword(s):

Late Stage ◽

Antibody Neutralization ◽

Stage Disease ◽

Late Stage Disease

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Receipt of Screening Mammography by Insured Women Diagnosed With Breast Cancer and Impact on Outcomes

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7801 ◽

2021 ◽

Author(s):

Marissa B. Lawson ◽

Christoph I. Lee ◽

Daniel S. Hippe ◽

Shasank Chennupati ◽

Catherine R. Fedorenko ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Late Stage ◽

Breast Cancer Diagnosis ◽

Screening Mammography ◽

Socioeconomic Deprivation ◽

Tumor Characteristics ◽

Stage Disease ◽

Increased Risk ◽

Late Stage Disease

Background: The purpose of this study was to determine factors associated with receipt of screening mammography by insured women before breast cancer diagnosis, and subsequent outcomes. Patients and Methods: Using claims data from commercial and federal payers linked to a regional SEER registry, we identified women diagnosed with breast cancer from 2007 to 2017 and determined receipt of screening mammography within 1 year before diagnosis. We obtained patient and tumor characteristics from the SEER registry and assigned each woman a socioeconomic deprivation score based on residential address. Multivariable logistic regression models were used to evaluate associations of patient and tumor characteristics with late-stage disease and nonreceipt of mammography. We used multivariable Cox proportional hazards models to identify predictors of subsequent mortality. Results: Among 7,047 women, 69% (n=4,853) received screening mammography before breast cancer diagnosis. Compared with women who received mammography, those with no mammography had a higher proportion of late-stage disease (34% vs 10%) and higher 5-year mortality (18% vs 6%). In multivariable modeling, late-stage disease was most associated with nonreceipt of mammography (odds ratio [OR], 4.35; 95% CI, 3.80–4.98). The Cox model indicated that nonreceipt of mammography predicted increased risk of mortality (hazard ratio [HR], 2.00; 95% CI, 1.64–2.43), independent of late-stage disease at diagnosis (HR, 5.00; 95% CI, 4.10–6.10), Charlson comorbidity index score ≥1 (HR, 2.75; 95% CI, 2.26–3.34), and negative estrogen receptor/progesterone receptor status (HR, 2.09; 95% CI, 1.67–2.61). Nonreceipt of mammography was associated with younger age (40–49 vs 50–59 years; OR, 1.69; 95% CI, 1.45–1.96) and increased socioeconomic deprivation (OR, 1.05 per decile increase; 95% CI, 1.03–1.07). Conclusions: In a cohort of insured women diagnosed with breast cancer, nonreceipt of screening mammography was significantly associated with late-stage disease and mortality, suggesting that interventions to further increase uptake of screening mammography may improve breast cancer outcomes.

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Oxidative stress in chronic hepatitis C: not just a feature of late stage disease

Journal of Hepatology ◽

10.1016/s0168-8278(02)00060-0 ◽

2002 ◽

Vol 36 (6) ◽

pp. 805-811 ◽

Cited By ~ 131

Author(s):

Sanjiv K. Jain ◽

Philip W. Pemberton ◽

Alexander Smith ◽

Raymond F.T. McMahon ◽

Peter C. Burrows ◽

...

Keyword(s):

Oxidative Stress ◽

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Late Stage ◽

Stage Disease ◽

Late Stage Disease

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Natural alteration of HIV-1 co-receptor tropism by contemporaneous HIV-2 infection

10.1101/410456 ◽

2018 ◽

Author(s):

Joakim Esbjörnsson ◽

Fredrik Månsson ◽

Hans Norrgren ◽

Sarah L. Rowland-Jones

Keyword(s):

Late Stage ◽

Stage Disease ◽

Late Stage Disease ◽

Underlying Mechanisms ◽

Disease Understanding ◽

Hiv 1 ◽

The Way

In this study, we show that the pathogenic HIV-1 CXCR4-tropism is more common in HIV-1 single (79%) than in HIV-1 and HIV-2 dual-infected individuals (35%), suggesting that contemporaneous HIV-2 infection can affect HIV-1 co-receptor tropism in late-stage disease. Understanding the underlying mechanisms responsible for this natural alteration by HIV-2 could pave the way towards a deeper understanding of the AIDS pathogenesis.

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Prognostic and Predictive Value of Circulating and Disseminated Tumor Cells in Breast Cancer: A National Cancer Database (NCDB) Analysis

Technology in Cancer Research & Treatment ◽

10.1177/1533033820980107 ◽

2020 ◽

Vol 19 ◽

pp. 153303382098010

Author(s):

Nadeem Bilani ◽

Leah Elson ◽

Hong Liang ◽

Elizabeth Blessing Elimimian ◽

Rafael Arteta-Bulos ◽

...

Keyword(s):

Breast Cancer ◽

Tumor Cells ◽

Late Stage ◽

Early Stage ◽

Disseminated Tumor Cells ◽

Her2 Status ◽

National Cancer Database ◽

Factors Associated ◽

Stage Disease ◽

Chemotherapy Efficacy

Importance: Our understanding of the utility of circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) as clinical biomarkers continues to evolve. Objective: This study evaluated (1) clinicopathologic factors associated with the presence of CTCs or DTCs, (2) the prognostic value of CTCs or DTCs by disease stage, 3), the value of these biomarkers in predicting the benefit of chemotherapy. Design: This is a retrospective analysis of patients with breast cancer (BC) diagnosed between 2004 and 2016 using the National Cancer Database (NCDB). To evaluate variables associated with the presence of CTCs or DTCs at the univariate level, we used chi-squared and Wilcoxon rank-sum tests. Multivariate logistic regression models were then constructed using significant variables. Consequently, we included CTC or DTC status (i.e. positive or negative) in multivariate, stage-by-stage Cox regression analyses for overall survival (OS). After stratifying by receptor status and staging, we used the Kaplan-Meier method to explore chemotherapy efficacy in CTC- or DTC-positive vs. CTC- or DTC-negative subsets. Results: Factors significantly associated with CTCs were race, progesterone receptor status, HER2 status, histology and AJCC N- and M-staging. Factors associated with DTCs were race, HER2 status, histology and AJCC N-staging. CTCs were associated with poor OS in late-stage (III and IV) but not early-stage (0-II) BC. DTCs were not significantly associated with OS in either context. In hormone receptor (HR)-positive disease, chemotherapy was associated with better OS when CTC status was positive, both in early-stage and late-stage disease. In a subset of patients without CTCs, however, chemotherapy conferred no survival benefit. DTC status was not a significant predictor of chemotherapy efficacy in early or late-stage, HR+ disease. Conclusions: This study suggests that CTC-status is a significant prognostic factor at later stages of BC; yet it can also help guide management of early-stage disease as it appears predictive for chemotherapy benefit.

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Timing of Antiretroviral Therapy and Systemic Inflammation in Sub-Saharan Africa: Results From the META Longitudinal Cohort Study

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz259 ◽

2019 ◽

Vol 220 (7) ◽

pp. 1172-1177 ◽

Cited By ~ 6

Author(s):

Mark J Siedner ◽

Mwebesa Bosco Bwana ◽

Stephen Asiimwe ◽

Gideon Amanyire ◽

Nicholas Musinguzi ◽

...

Keyword(s):

T Cell ◽

Antiretroviral Therapy ◽

Cell Count ◽

Late Stage ◽

Sub Saharan Africa ◽

Cd4 T Cell ◽

Disease Stage ◽

Stage Disease ◽

Late Stage Disease ◽

Cd4 T Cell Count

Abstract Chronic inflammation predicts complications in persons with human immunodeficiency virus infection. We compared D-dimer, soluble CD14, and interleukin 6 levels before and 12 months after antiretroviral therapy (ART) initiation, among individuals starting ART during earlier-stage (CD4 T-cell count >350/µL) or late-stage disease (CD4 T-cell count <200/µL). Female sex, older age, viral load, and late-stage disease were associated with pre-ART biomarkers (n = 661; P < .05). However, there were no differences in biomarkers by disease stage after 12 months of ART (n = 438; P > .05), owing to loss from observation and greater declines in biomarkers in late-stage initiators (P < .001). Earlier initiation of ART is associated with decreased inflammation, but levels seem to converge between earlier and later initiators surviving to 12 months.

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Complete remission of cancer in late-stage disease by radiation and transfer of allogeneic MHC-matched immune T cells: lessons from GvL studies in animals

Cancer Immunology Immunotherapy ◽

10.1007/s00262-014-1530-2 ◽

2014 ◽

Vol 63 (6) ◽

pp. 535-543 ◽

Cited By ~ 6

Author(s):

Volker Schirrmacher

Keyword(s):

T Cells ◽

Complete Remission ◽

Late Stage ◽

Stage Disease ◽

Late Stage Disease

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The management of sinogenic orbital complications

The Journal of Laryngology & Otology ◽

10.1017/s0022215100129974 ◽

1995 ◽

Vol 109 (4) ◽

pp. 300-303 ◽

Cited By ~ 15

Author(s):

Bharath Singh

Keyword(s):

Conservative Treatment ◽

Eye Movement ◽

Late Stage ◽

Stage Disease ◽

Intravenous Antibiotics ◽

Late Stage Disease ◽

Group 3 ◽

Group 2 ◽

Orbital Complications ◽

Group 1

AbstractThe place of conservative treatment in sinogenic orbital complications has not been fully explained in the literature. The question that remains unresolved is – at which stage of the disease is surgery indicated?A study was undertaken in 240 patients with sinogenic orbital complications, to determine this. The patients were divided into three groups according to the stage of the disease as determined clinically: Group 1 (52 patients) with early stage disease, as detected by cellulitis only; Group 2 (76 patients) with intermediate stage, as detected by periorbital cellulitis and proptosis, but with full range of eye movement and unaltered vision: Group 3 (122 patients) with late stage disease, as detected by periorbital cellulitis and gross proptosis. with limitation of eye movement and altered vision.Group I and Group 2 patients were treated conservatively, with intravenous antibiotics and antral lavage. Group 3 patients were treated with intravenous antibiotics and surgery. External frontoethmoidectomy was performed in 31 (bilateral in two), ethmoidectomy in 91 (bilateral in five), sphenoidectomy in 15 and bilateral antral washout in all (122 patients). There was 100 per cent success with conservative treatment in Group 1 patients, whilst in Group 2 there was 98.6 per cent failure. The 75 patients in whom conservative treatment failed were successfully treated with surgery: frontoethmoidectomy was performed in 66 and ethmoidectomy in nine. In Group 3 patients, 100 per cent success was achieved with intravenous antibiotics and surgery.Sinogenic orbital complications can be treated conservatively and surgically, depending on the stage of the disease on presentation. Conservative treatment is only suitable for early complications, i.e. patients with periorbital cellulitis only. For disease beyond this stage i.e. intermediate and late stage disease, surgery is the treatment of choice.

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