Your search found 22 Results

  1. 1

    Cervical cancer screening and management of cervical pre-cancers. Training of health staff in colposcopy, LEEP and CKC. Trainees' handbook.

    World Health Organization [WHO]. Regional Office for South-East Asia

    New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 199 p.

    The Trainees’ handbook is designed to train gynaecologists and non-specialist clinicians in performing colposcopy and treatment of cervical precancerous conditions so they can provide the necessary diagnostic and therapeutic services in a cervical cancer screening programme. The Trainees’ handbook contains guidelines and information intended to be used both by trainees and facilitators while participating in the structured training programme on cervical cancer screening and treatment. The Trainees’ handbook contains different modules intended to assist trainees to develop their knowledge and learn the correct steps to perform colposcopy and treatment procedures. The modules contain checklists that serve as ready reckoners to develop skills in various procedures during clinical sessions. These checklists are also intended to be used by trainees during their post-training practice. The structure and methodology of the training have been designed to impart knowledge in the most effective manner and have taken into consideration the overall training objectives, profiles of trainees and the expected learning outcomes. (Excerpt)
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  2. 2

    Cervical cancer screening and management of cervical pre-cancers. Training of health staff in colposcopy, LEEP and CKC. Facilitators' guide.

    World Health Organization [WHO]. Regional Office for South-East Asia

    New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 118 p.

    This manual is an instruction guide for facilitators to provide competence based training to providers of colposcopy and treatment services in a cervical cancer screening programme. The training is intended to assist gynaecologists and non-specialist clinicians to learn and improve upon their skills to perform colposcopy and to treat cervical pre-cancers by excision methods. Facilitators are required to consult both the Facilitators’ guide and the Trainees’ handbook while training participants through interactive presentations, group discussions, role plays, clinical practice sessions, etc. The Facilitators’ guide contains detailed training methodologies, structure of the individual training sessions and guidelines for assessment of trainees. The Trainees’ handbook contains different modules to assist trainees with step-by-step learning of colposcopy and treatment procedures. (Excerpt)
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  3. 3

    Cervical cancer screening and management of cervical pre-cancers. Training of health staff in VIA, HPV detection test and cryotherapy -- Trainees' handbook.

    World Health Organization [WHO]. Regional Office for South-East Asia

    New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 171 p.

    The Trainees’ handbook is designed for paramedical workers, midwives, nurses and clinicians involved in cervical cancer screening to help them acquire the necessary skills to perform VIA, collect samples for HPV test and treat cervical pre-cancers by ablative methods. The publication of the World Health Organization guidance document Comprehensive cervical cancer control: A guide to essential practice, 2nd edition, 2014 has necessitated modifications in the existing training resources for cervical cancer screening and treatment. The new screening recommendations and management algorithms have been incorporated in the present Trainees’ handbook. The Trainees’ handbook contains guidelines and information intended to be used both by trainees and facilitators while participating in the structured training on cervical cancer screening and treatment. The handbook contains different modules to assist trainees to learn various screening and treatment procedures step- by-step and to comprehend their underlying principles. The modules contain checklists that serve as ready reckoners to develop skills in various procedures during clinical sessions. These checklists are also intended to be used by trainees during their post-training practice. (Excerpt)
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  4. 4

    Cervical cancer screening and management of cervical pre-cancers. Training of health staff in VIA, HPV detection test and cryotherapy -- Facilitators' guide.

    World Health Organization [WHO]. Regional Office for South-East Asia

    New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 123 p.

    This manual is an instruction guide for facilitators to provide competence based training to providers for screening (with VIA or HPV test) and ablative treatment services in a cervical cancer screening programme. The training is intended to assist midwives, paramedical workers, nurses and clinicians to learn and improve upon their skills to perform counselling, screening tests and treatment. Facilitators are required to consult both the Facilitators’ guide and the Trainees’ handbook while training through interactive presentations, group discussions, role plays, simulated learning sessions, and clinical practice sessions. The Facilitators’ guide contains detailed training methodologies, structure of the individual training sessions, simulated learning sessions and guidelines for assessment of trainees. (Excerpt)
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  5. 5
    Peer Reviewed

    Estimating the value of point-of-care HPV testing in three low- and middle-income countries: a modeling study.

    Campos NG; Tsu V; Jeronimo J; Mvundura M; Kim JJ

    BMC Cancer. 2017 Nov 25; 17(1):791.

    BACKGROUND: Where resources are available, the World Health Organization recommends cervical cancer screening with human papillomavirus (HPV) DNA testing and subsequent treatment of HPV-positive women with timely cryotherapy. Newer technologies may facilitate a same-day screen-and-treat approach, but these testing systems are generally too expensive for widespread use in low-resource settings. METHODS: To assess the value of a hypothetical point-of-care HPV test, we used a mathematical simulation model of the natural history of HPV and data from the START-UP multi-site demonstration project to estimate the health benefits and costs associated with a shift from a 2-visit approach (requiring a return visit for treatment) to 1-visit HPV testing (i.e., screen-and-treat). We estimated the incremental net monetary benefit (INMB), which represents the maximum additional lifetime cost per woman that could be incurred for a new point-of-care HPV test to be cost-effective, depending on expected loss to follow-up between visits (LTFU) in a given setting. RESULTS: For screening three times in a lifetime at 100% coverage of the target population, when LTFU was 10%, the INMB of the 1-visit relative to the 2-visit approach was I$13 in India, I$36 in Nicaragua, and I$17 in Uganda. If LTFU was 30% or greater, the INMB values for the 1-visit approach in all countries was equivalent to or exceeded total lifetime costs associated with screening three times in a lifetime. At a LTFU level of 70%, the INMB of the 1-visit approach was I$127 in India, I$399 in Nicaragua, and I$121 in Uganda. CONCLUSIONS: These findings indicate that point-of-care technology for cervical cancer screening may be worthy of high investment if linkage to treatment can be assured, particularly in settings where LTFU is high.
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  6. 6

    Comprehensive cervical cancer control: A guide to essential practice. 2nd ed.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2014. [378] p.

    This publication, Comprehensive cervical cancer control: a guide to essential practice (C4GEP), gives a broad vision of what a comprehensive approach to cervical cancer prevention and control means. In particular, it outlines the complementary strategies for comprehensive cervical cancer prevention and control, and highlights the need for collaboration across programmes, organizations and partners. This new guide updates the 2006 edition and includes the recent promising developments in technologies and strategies that can address the gaps between the needs for and availability of services for cervical cancer prevention and control.
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  7. 7

    Strategic framework for the comprehensive control of cancer cervix in South-East Asia Region.

    Domercant JW; Guillaume FD; Marston BJ; Lowrance DW; World Health Organization [WHO]. Regional Office for South-East Asia

    MMWR. Morbidity and Mortality Weekly Report. 2015 Feb 20; New Delhi, India, WHO, Regional Office for South-East Asia, 2015. 64(6):137-140. [78] p.

    The overall objective of the strategic framework for comprehensive control of cancer cervix in South-East Asia is to guide and assist Member States to develop or strengthen national strategies to improve cervical cancer control activities; to reduce the burden of morbidity, disability and death from cervical cancer; and, to promote women’s health. The specific objectives of the framework are to help countries to prepare country-specific protocols to: 1. Introduce or scale up delivery of HPV vaccine to girls aged 9 to 13 years through a coordinated multisectoral approach involving national immunization, cancer control, reproductive and adolescent health programmes. 2. Implement or scale up organized cervical cancer screening programmes utilizing evidence-based, cost-effective interventions through effective service delivery strategies across the different levels of health care. 3. Strengthen health systems to ensure equitable access to cervical cancer screening services for all eligible women, with particular attention to socioeconomically disadvantaged population groups. 4. Augment management facilities for invasive cancer cervix and introduce palliative care services into the health system as part of a comprehensive cancer control programme. 5. Encourage / create convergence with related health programmes to ensure a coordinated and operationally feasible approach for cervical cancer control within the health system. 6. Initiate / augment a structured and coordinated advocacy and educational campaign so that the benefits of cervical cancer control are universally available and accessible. The framework discusses the determinants of a successful and organized screening programme, and feasible options that the countries can adopt. It recommends that cervical cancer screening services should be organized as a functional continuity across different levels of health-care delivery, from community to first-level health centres and to referral hospitals, so as to ensure high coverage of the target population and linkage between screening and treatment. Augmentation of cancer treatment services and improving palliative care are also crucial components of cervical cancer control that are discussed in the framework. (Excerpts)
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  8. 8

    WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2013. [60] p.

    These WHO guidelines provide recommendations for strategies for a cervical precancer screen-and-treat program. The guidelines build on previous documents: Use of cryotherapy for cervical intraepithelial neoplasia (published in 2011) and on the new WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and glandular adenocarcinoma in situ. The document is intended primarily for policymakers, managers, program officers, and other professionals in the health sector who have responsibility for choosing strategies for cervical cancer prevention at country, regional and district levels.
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  9. 9

    Health research: essential link to equity in development.

    Commission on Health Research for Development

    Oxford, England, Oxford University Press, 1990. xix, 136 p.

    The Commission on Health Research for Development is an independent international consortium formed in 1987 to improve the health of people in developing countries by the power of research. This book is the result of 2 years of effort: 19 commissioned papers, 8 expert meetings, 8 regional workshops, case studies of health research activities in 10 developing countries and hundreds of individual discussions. A unique global survey examined financing, locations and promotion of health research. The focus of all this work was the influence of health on development. This book has 3 sections: a review of global health inequities and why health research is needed; findings of country surveys, health research financing, selection of topics and promotion; conclusions and recommendations. Some research priorities are contraception and reproductive health, behavioral health in developing countries, applied research on essential drugs, vitamin A deficiency, substance abuse, tuberculosis. The main recommendations are: that all countries begin essential national health research (ENHR), with international partnership; that larger and sustained international funding for research be mobilized; and that larger and sustained international funding for research be mobilized; and that international mechanisms for monitoring progress be established. The book is full of graphs and contains footnotes, a complete bibliography and an index.
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  10. 10

    Smokeless tobacco control: report of a WHO Study Group.

    World Health Organization [WHO]. Study Group on Smokeless Tobacco Control


    This booklet presents the report of the Study Group on Smokeless Tobacco Control to the World Health Organization. The use of smokeless tobacco is increasing. 3 million people in the US and over 100 million people in India and Pakistan use some form of it -- snuff, chewing tobacco, or betel quid. They contain nicotiana and areca alkaloids, nitrosamines, phenols, aldehydes, and numerous other mutagenic and carcinogenic compounds. Smokeless tobacco has been associated with oral, nasal, pharyngeal, laryngeal, pancreatic and urinary cancers, as well as precancerous oral effects, such as leukoplakia. Smokeless tobacco has all the same effects on the cardiovascular system as nicotine in cigarettes, and it is equally addictive. In countries where smokeless tobacco is not yet used, its manufacture or importation should be forbidden, and in countries where it is already in use, all forms of promotion should be forbidden. Smokeless tobacco products should be highly taxed and should carry health warnings. Educational campaigns should be used to make the public, especially teenagers and young adults, aware of the danger. The greatest obstacles to the control of smokeless tobacco will be the tobacco companies, and action should be taken to keep them from gaining control in developing countries where smokeless tobacco-making is still mainly a cottage industry. The World Health Organization, member states, other UN agencies, and intergovernmental organizations should cooperate in this campaign. The Study Group recommended to the World Health Organization that promotion of smokeless tobacco should be banned, taxes on it should be raised, priority should be given to replacing tobacco by other crops, sales to minors should be prohibited, products should be required to display health warnings, smokeless tobacco use should be banned in public places, education campaigns should be directed at decision-makers and young people, smokeless tobacco should be included in the World Health Organization's program combatting tobacco, and the World Health Organization should cooperate with other international organizations to control smokeless tobacco.
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  11. 11

    Some clinical aspects of HIV infection in Africa.

    Harries A

    AFRICA HEALTH. 1992 Jul; 14(5):10-1.

    An update on clinical aspects of HIV in africa highlights new proposed clinical definitions of adult AIDS and of tuberculosis in HIV+ adults, and staging of adult HIV infection. The 1986 WHO clinical definition of AIDS has been widely used in Africa, but now research suggests that this definition has several limitations: the definition will pick up several unrelated diseases such as diabetes mellitus and renal failure. It does not ascertain cases of AIDS marked by nonopportunistic infections. Most persons with pulmonary tuberculosis may be wrongly diagnosed with AIDS by this definition. The study showed that the WHO clinical definition has good specificity and positive predictive value for HIV+ people, but its positive predictive value fell to 30% in identifying people with AIDS in Africa. New definitions should take into account any serious morbidity, tuberculosis, neurological disease, both endemic localized Kaposi's, and aggressive typical Kaposi's sarcoma, and HIV serological testing. Tuberculosis is a problem because few HIV+ people suspected of having pulmonary TB (sputum-negative TB) actually have it based on bronchoscopy, while HIV+ persons with TB experience high mortality, often from pyogenic bacteremia. HIV+ persons with TB suffer high rates of relapse, possibly related to insufficient drug treatment or reinfection. 1 study showed that 6 months of isoniazid significantly improved incidence of TB over 30 months of follow-up. Staging of AIDS in Africa based on degree of immunosuppression was proposed as: 1) clinically inapparent HIV infection marked by pulmonary TB, soft tissue infections, and community acquired pneumonia; 2) lymphadenopathy, oral thrush, widespread pruritic maculopapular rash, herpes zoster, enteric illness, dysentery, and Kaposi's sarcoma; and 3) HIV wasting syndrome, chronic pulmonary disease, meningitis, and fever of unknown origin.
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  12. 12
    Peer Reviewed

    The WHO Collaborative Study of Neoplasia and Steroid Contraceptives: the influence of combined oral contraceptives on risk of neoplasms in developing and developed countries.

    Thomas DB

    CONTRACEPTION. 1991 Jun; 43(6):695-710.

    A hospital-based case-control study was conducted in 8 developing and 3 developed countries to determine whether use of combined oral contraceptives (OCs) alters risks of various cancers. An observed trend of increasing risk of invasive cervical cancer with duration of use may not represent a causal relationship and is the subject of further study. Decreased risks of ovarian and endometrial carcinomas in users likely indicate a protective effect of OCs, the degree of which was similar in developing and developed countries. A small increase in risk of breast cancer in recent and current users was found to be somewhat greater in developing countries. Both causal and noncausal interpretations of this finding have been offered. No associations were found between OCs and in situ cervical, hepatocellular, cholangio, or gallbladder carcinomas, or uterine sarcomas. However, the ability of this study to detect alterations in risks for these neoplasms in longterm users was low. (author's)
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  13. 13

    Hormonal contraception.

    Kleinman RL

    London, England, International Planned Parenthood Federation, 1990. 122 p. (IPPF Medical Publications)

    This booklet intended for family planning doctors primarily in developing countries updates the previous IPPF edition, with new information on oral contraceptives, chapters on the subdermal implant Norplant, post-coital contraception, injectables, and appendices on statistical methods and post-partum contraception. Each chapter contains text with a statement by the IMAP (International Medical Advisory Panel) of the IPPF. After brief introductions on historical background and reproductive physiology, the main part of the book concerns the use of combined oral contraceptives, their actions, beneficial and adverse effects, indications and contraindications, and several aspects of use such as community-based distribution. There are chapters on progestogen-only pills and on orals in chronic disease. Post-coital contraception is discussed, considering combined pills, progestagens, IUDs, Danazol, RU-486, which all have different time limits of effectiveness. Both DMPA and NET-EN injectables, by 3-month and monthly protocols are described, with a section on the controversy regarding their distribution. The chapter on Norplant comprises mostly the IMAP statement: more information would be needed for training in this method. The book ends with remarks on the use of hormonal contraceptives to enhance safe motherhood, taking into account the fact that the pill offers no protection against STDs.
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  14. 14

    Integrated Programme for Noncommunicable Diseases Prevention and Control (NCD).

    Shigan EN


    Because declining mortality from infectious diseases is accompanied by increasing mortality from noncommunicable diseases in both developed and developing countries, the World Health Organization (WHO) has initiated the Integrated Program for Community Health in Noncommunicable Diseases (Interhealth). Interhealth is based on the concepts that 1) noncommunicable diseases are related to a set of risk factors some of which can be controlled; 2) the entire community must be involved; 3) health promotion intervention strategies, such as population control, risk identification, screening and prevention strategies, must be integrated; 4) different categories of intervention (e.g., lifestyle changes, health care reorganization) must be coordinated; 5) social and environmental changes will be necessary; and 6) noncommunicable disease prevention and control strategies will be implemented through existing primary health care systems. The core program of Interhealth addresses heart diseases, stroke, diabetes, cancer, and respiratory diseases from the point of view of their common risk factors: diet, tobacco, physical activity, environment, oral hygiene, blood pressure, lipids, and glucose. The Interhealth program is being developed as a dynamic system, consisting of 4 main activities: experimental testing by means of demonstration projects (of which there are currently 18 in 15 countries); mathematical modeling of disease/risk factor interrelations; training; and research activities. These activities will be supported by organizational, financial and information activities at WHO headquarters and in the WHO Regional Offices.
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  15. 15

    Injectable contraceptives: how safe is safe?

    Sathyamala C; Nalini

    ECONOMIC AND POLITICAL WEEKLY. 1986 Jun 14; 21(24):1079-80.

    NET-EN was marketed initially in 1967 and almost 15 years following its use the Twelfth Annual Report of the World Health Organization (WHO), published in 1983, states that questions exist regarding the effectiveness and safety of DMPA and NET-EN that call for more research. Yet, in 1982, the Toxicology Review Panel of WHO had found NET-EN to be a safe contraceptive and had recommended its use in family planning programs. According to Iris Kapil, studies by WHO have failed thus far to identify any health risk associated with the use of Depo Provera and have shown no adverse effect on the composition or yield of breast milk. In 1983, however, the Federal Health Office of West Germany, where the parent company manufacturing NET-EN is based, revised its ruling with specific reference to the use of NET-EN and DMPA during lactation. If Kapil would not be so awed by the WHO and the ICMR and would take the time to identify their own admissions, she too would question the basis on which the injectables are being declared safe. Factors governing the rate of metabolism of contraceptive hormones are not well understood. The rate of decline of circulating norethisterone in patients having multiple injection was significantly slower, suggesting a decrease in the metabolism of the steroid. In the WHO multicenter trial of 1977 no systematic differences in factors could be identified to account for the high failure rate. Little is known about the basic mechanisms of bleeding disturbances especially those related to steroidal contraceptions. A satisfactory approach to the management of prolonged or heavy bleeding due to the injectable contraceptive has not been developed as yet. Nothing is known about whether synthetic progestogens have any effects on normal hormonal changes in the early infant which may in turn affect the latter's sexual development. Little information from human studies is available on long acting injectable contraceptives and the risk of neoplasia. Other important aspects such as immuno-supressive effect of the injectable on the woman and her breastfed infant, the possibility of irreversible pituitary ovarian and endometrial atrophy have not been studied. Kapil cities a "well-reported" project from South India to support her case. What is apparent is that the list of disadvantages identified appear to be written from the perspective of how it would affect continuation rates. Nowhere does it appear to stem from a concern for the health of the women involved.
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  16. 16
    Peer Reviewed

    Depot-medroxyprogesterone acetate (DMPA) and cancer: memorandum from a WHO meeting.

    Chutivongse S; Gray R; Hill C; Hulka B; Kenya P; Odlind V; Pardthaisong T; Petitti D; Rubin G; Shapiro S


    This memorandum from a World Health Organization (WHO) meeting held in 1985 summarizes available epidemiologic data from human studies, including the WHO Collaborative Study of Neoplasia and Steroid Contraceptives, on the association between depot-medroxyprogesterone acetate (DMPA) use and neoplasia. The WHO Collaborative Study is collecting data on cases and controls from 14 collaborating centers in 11 countries. Analysis of preliminary findings regarding cancers of the endometrium, ovary, liver, and breast suggest that there is no increased risk in DMPA users. The relative risk estimates for these sites are 0.3 for endometrial cancer, 0.7 for ovarian cancer, 1.0 for liver cancer, and 1.0 for breast cancer. The issue of a causal association between DMPA use and cervical cancer is less clear. The adjusted relative risk for cervical cancer was a nonsignificant 1.2; however, somewhat higher risks were noted in subgroups of longterm (over 4 years) users. Although the WHO study is the 1st to provide reliable data on DMPA and neoplasia, its findings must be regarded as tentative. At this point the data are insufficient to assess the influence of DMPA on risk among longterm users or risk long after initial exposure.
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  17. 17

    Invasive cervical cancer and combined oral contraceptives [letter]

    Fortney JA; Potts M; Bonhomme M

    BMJ. British Medical Journal. 1985 May 25; 290(6481):1587.

    The recent World Health Organization (WHO) report on oral contraceptives (OCs) and cervical cancer suggests a relative risk of contracting cervical cancer among users and former users of OCs ranging from 1.1-1.7 depending on which variables are controlled. For women who had used OCs for 2-5 years the relative risk was 1.46 (not controlling for other risk factors). OC use carries both risks and benefits and these need to be kept in perspective. It is important to remember that the risk attributable to OC use is small even for those diseases which have been associated with OC use. Life expectancy was calculated using mortality rates that have been modified to incorporate all known risks and benefits of OC use. To illustrate the effect of an increased risk of cervical cancer life expectancy was calculated with no increased risk of cervical cancer (relative risk = 1) and again with a relative risk of 1.46 (the relative risk reported by WHO for women with 2-5 years of OC use). Relative risks for other diseases were kept constant. The risks for women taking OCs were calculated when the women were 20-24 and for women taking pills when they were 30-34. The expectation of life for American women never taking OCs is 77.34 years. A table shows the expectation of life for OC users. Young women using OCs benefit very slightly in terms of life expectancy, and older women taking pills lose very slightly. That part of the difference which is contributed by cervical cancer is also extremely small. The maximum change in life expectancy that could be attributed to an increased risk of cervical cancer is 0.03 years or 11 days. By contrast, a women who smokes 1-10 cigarettes a day during her 30s reduces her life expectancy by about 4 years.
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  18. 18

    Invasive cervical cancer and combined oral contraceptives. WHO Collaborative Study of Neoplasia and Steroid Contraceptives.

    Thomas DB; Whitehead A; Roseman D

    BMJ. British Medical Journal. 1985 Mar 30; 290(6473):961-5.

    This paper presents the preliminary results of a multicenter case-control study conducted under the auspices of the World Health Organzation to determine whether combined oral contraceptives (OCs) increase the risk of malignant neoplasms of the breast, cervix, endometrium, ovary, and liver. Initial results on the relationship between combined OCs and invasive cervical carcinoma in 726 cases and 5246 controls indicate a relative risk of 1.19 (95% confidence interval, 0.99-1.44) in women who had ever used OCs. The risk increased to 1.53 after 5 years of OC use. The analysis made adjustments for various potentially confounding variables, including age, center, number of pregnancies, age at 1st intercourse, number of sexual relations, and history of vaginal discharge. The relative risk obtained in this study, of borderline significance, could be explained on the basis of incomplete control for the confounding effect wf sexual variables. In addition, the implications of these findings for women who are currently using combined OCs are uncertain; most wf the women in this study were exposed to preparations containing higher doses of estrogen and progestogens than products now in use. Future analyses of data from this investigation, bases on lager numbers of patents, will include controls for smoking and infection by sexually transmitted agents.
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  19. 19

    Breast cancer, cervical cancer, and depot medroxyprogesterone acetate. [WHO Collaborative Study of Neoplasia and Steroid Contraceptives] [letter].

    World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction

    Lancet. 1984 Nov 24; 2(8413):1207-8.

    This letter presents the preliminary findings of a collaborative, multinational, hospital-based, case-control study being conducted under the auspices of the World Health Organization to assess the influence of depot medroxyprogesterone acetate (DMPA) on risks of mammary, gynecological, and hepatobiliary malignancies. The frequency of ever-use of DMPA was greater in breast cancer cases (15/246, or 6,0%) than in controls (381/4162, or 9.2%). When adjusted for age, center, age of birth of 1st child, and nulliparity, the relative risk in women who had ever used DMPA was 0.7. The lowest risk was noted in women who had used DMPA for 3 or more years, but no decreasing trend in risk with duration of use was evident. The reducton in risk of breast cancer in DMPA users was largely confined to women with 1st exposure after age 30 years. In terms of cervical cancer, a history of DMPA use was reported by slightly more cases (67/469, or 14.3%) than controls (269/2704, or 9.9%). Use of oral contraceptives, number of cervical smears, and number of pregnancies were the variables most strongly related to cervical or having the greatest influence on relative risk estimates for users of DMPA. When controlled for these 4 factors and age and center, the relative risk in DMPA was 1.13. The highest relative risk was found in longterm users, although there was no clear trend of increasing risk with duration of DMPA use. These preliminary findings provide no evidence that DMPA increases the risk of breast cancer. The relative risk for cervical cancer for DMPA users obtained in this study could be due to chance or to incomplete control for the confounding effect of sexual variables. Although the absence of a trend of increasing risk with duration of use tends to rule out a causal connection between DMPA use and cervical cancer, the doubling of risk in women who used DMPA for 5 years or more is of potential concern.
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  20. 20

    The pill and cancer--IPPF response.

    Ippf Medical Bulletin. 1983 Dec; 17(6):1-2.

    The response of the International Medical Advisory Panel (IMAP) of the International Planned Parenthood Federation to 2 recent papers suggesting a link between cancer and oral contraceptive (OC) use is reported. The 1st paper by Pike et al. suggested an increased risk of breast cancer in women who use OCs containing high potency progestogens before age 25 for at least 4 years. It is noted that several methodological problems with the study design could have introduced a degree of selection of ascertainment bias. These issues include the procedures used for age matching between cases and controls, the 1/3 loss to follow-up among cancer cases, and the use of telephone interviews to ascertain OC use history. Moreover, data from other studies suggest that ever-users of OCs who develop breast cancer may be more likely to survive than women with breast cancer who have never used OCs, leading to the overrepresentation of women in the former group among surviving cases. The ranking of OCs by progestogen potency does not take the estrogen content into consideration. In addition, assessment of progestogen potency by use of a delay of menses test may not correlate with the degree of effect on the breast and has produced conflicting results when used by different researchers. Finally, the numbers of women using some OC brands were too small and the possibility that women may have changed OC brand over the study period was not considered. Largescale studies such as the UK Oxford-Family Planning Association contraceptive study and the Centers for Disease Control Cancer and Steroidal Hormone Study are curently being reanalyzed, controlling for type and amount of progestogen in the OCs. Until new data become available, IMAP believes there is insufficient evidence to recommend modification of existing practice. The 2nd study by Vessey et al. suggested a higher incidence of cervical cancer in OC users as compared to IUD users. However, several key modifying factors on the risk of cervical cancer, including age at 1st sexual intercourse and number of partners, could not be controlled for. Moreover, a high proportion of OC use involved preparations containing 50 mcg or more of estrogen. Although regular cervical smears are recommended for OC users, the IMAP again does not recommend any change in current practice. The IMAP noted that the possible cancer-related risks of OCs must be weighed against the protective effects of OCs against cancers of the endometrium and ovary, pelvic inflammatory disease, and unwanted pregnancies.
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  21. 21

    WHO seeks global program against viral hepatitis.

    Bulletin of the Pan American Health Organization. 1983; 17(3):323.

    A World Health Organization (WHO) Consultative Group on Hepatitis met during July 1983 to draft a global program for viral hepatitis control. At this time, hepatitis viruses infects tens of millions of people every year. These viruses can be transmitted by the fecal-oral route, in blood or certain blood products, and through intimate personal contact. Of the various forms (heptitis A, hepatitis B, and hepatitis non-A, non-B) hepatitis B arouses particular concern because it can produce chronic liver disease and premature death. Currently, there are over 200 million persistent carriers of this virus, many of whom will die of chronic liver damage. Firm evidence recently shows a clear cause and effect relationship between infection with hepatitis B virus and primary liver cancer, a common cancer that claims hundreds of thousands of lives a year. The July meeting made recommendations to improve the situation. One of the most important recommendations was to strengthen national capabilities to control viral hepatitis. The group also reviewed available diagnosis and control methods and suggested areas where action by the WHO would be most effective. The group agreed that the availability of safe and effective vaccines against hepatitis B provides a unique opportunity to break the chain of transmission and to prevent acute and chronic liver disease, including primary liver cancer. There has been concern that the plasma-derived hepatitis B vaccines could contain transmissible agents that might be implicated in the acquired immune deficiency syndrome (AIDS). It was felt that much care needs to be taken in selecting plasma donors and in purifying the immunizing component of the vaccine, known as hepatitis B surface antigen, so as to ensure a very high degree of purity and freedom from all infectious agencts. No evidence exists at this time of AIDS transmission by any hepatitis B vaccine.
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  22. 22

    Possible prevention of liver cancer by vaccination.

    Bulletin of the Pan American Health Organization. 1983; 17(2):212.

    A World Health Organization (WHO) sponsored scientific meeting concludes that hepatitis B vaccine presents unique opportunities for preventing a common type of human cancer by vaccination. Should these prospects be realized, it would be the 1st time an important human cancer has been prevented in this way. The 5-day meeting, held in February 1983, brought together specialists in biostatistics, epidemiology, molecular biology, pathology, virology, and vaccine development and production from 16 countries. The topic at the meeting was liver cancer, one of the 10 most common cancers in the world and one of the most prevalent cancers in developing countries. The evidence for the implication of hepatitis B virus in the etiology of primary liver cancer is based upon epidemiologic and geographic observations of a strong association between hepatitis B infection and this form of cancer and also upon recent results of molecular biology studies showing integration of hepatitis B viral DNA into the host's genetic material. About 80% of all liver cancers are thought to occur as a result of infection with hepatitis B virus. Actual development of such cancers is believed to proceed through a series of intermediate stages, including establishment of a persistent infection with the virus, the hepatitis B carrier stage, and integration of the virus into the host genome. Worldwide, survival, and persistence of the hepatitis B virus depends on a huge reservoir of human carriers, estimated conservatively to number over 200 million. Prolonged "shedding" of the virus by a portion of these carriers and its transmission to others by various routes helps to account for the high incidence of the disease. In many parts of the world perinatal infection and infection in early life play a very important role in transmission and often lead to continuing infection. Feasibility studies conducted in recent years in several countries with 2 newly developed hepatitis B vaccines demonstrated that immunization of babies can prevent natural infection with hepatitis B virus and also can prevent development of a persistent hepatitis B infection. It seems an appropriate time to take international action to plan and initiate a number of field intervention trials with the new vaccines among populations known to have high prevalence of hepatitis B infection, the hepatitis C carrier state, and liver cancer.
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