Trends in Precancerous Cervical Lesions by Area-Based Measures of Poverty, Race, and Ethnicity, Connecticut, 2008-2018.

OBJECTIVES: Trends in the incidence of precancerous cervical lesions can be monitored to evaluate the impact of human papillomavirus (HPV) vaccination. The objective of this analysis was to determine whether declines in precancerous cervical lesions varied by area-based measures of poverty, race, and ethnicity. METHODS: We analyzed 11 years of incidence data (2008-2018) from a statewide active surveillance system of precancerous cervical lesions in Connecticut. We divided area-based measures of poverty, race, and ethnicity (percentage of the population in a census tract who were living below the federal poverty level, who were Black, and who were Hispanic) at the census-tract level into 4 groups (<5.0%, 5.0%-9.9%, 10.0%-19.9%, ≥20.0%) using recommended cut points from the Public Health Disparities Geocoding Project. We estimated incidence rates and average annual percentage changes (AAPCs) stratified by age and each area-based measure using Joinpoint regression software. We used total population and estimated screened population as denominators for each age group to calculate rates and AAPCs. RESULTS: During 2008-2018 in Connecticut, 18 878 women aged 21-39 were diagnosed with precancerous cervical lesions. After adjusting for screening, the largest declines occurred among women aged 21-24 (AAPC = -11.5%; 95% CI, -13.6% to -9.4%). We found significant and similar annual declines (~10%-12%) in this age group across all 4 levels of poverty, race, and ethnicity. CONCLUSIONS: This analysis adds to the growing body of evidence demonstrating the positive impact of population-level HPV vaccination among young women that appears similar across area-based measures of sociodemographic characteristics. Monitoring is necessary to ensure the continuation of this progress in all communities.

Cervical adenocarcinoma in situ: Human papillomavirus types and incidence trends in five states, 2008-2015.

Primary prevention through the use of human papillomavirus (HPV) vaccination is expected to impact both cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS). While CIN is well described, less is known about the epidemiology of AIS, a rare cervical precancer. We identified AIS and CIN grade 3 (CIN3) cases through population-based surveillance, and analyzed data on HPV types and incidence trends overall, and among women screened for cervical cancer. From 2008 to 2015, 470 AIS and 6,587 CIN3 cases were identified. The median age of women with AIS was older than those with CIN3 (35 vs. 31 years; p < 0.01). HPV16 was the most frequently detected type in both AIS and CIN3 (57% in AIS; 58% in CIN3), whereas HPV18 was the second most common type in AIS and less common in CIN3 (38% vs. 5%; p < 0.01). AIS lesions were more likely than CIN3 lesions to be positive for high-risk types targeted by the bivalent and quadrivalent vaccines (HPV16/18, 92% vs. 63%; p < 0.01), and 9-valent vaccine (HPV16/18/31/33/45/52/58, 95% vs. 87%; p < 0.01). AIS incidence rates decreased significantly in the 21-24 year age group (annual percent change [APC] overall: -22.1%, 95% CI: -33.9 to -8.2; APC among screened: -16.1%, 95% CI: -28.8 to -1.2), but did not decrease significantly in any older age group. This report on the largest number of genotyped AIS cases to date suggests an important opportunity for vaccine prevention of AIS, and is the first to document a decline in AIS incidence rates among young women during the vaccine era.

Association of Interim FDG-PET Imaging During Chemoradiation for Squamous Anal Canal Carcinoma With Recurrence.

PURPOSE: Imaging parameters from 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) before and after chemoradiation therapy (CRT) for anal canal cancer correlate with clinical outcomes. This prospective, hypothesis-generating pilot study investigates the relationship between interim PET imaging during CRT for anal canal cancer and clinical outcome. METHODS AND MATERIALS: From June 2012 to August 2015, 30 patients with anal canal cancer were enrolled in a prospective clinical study of PET prior to and during CRT after ∼30 Gy. PET parameters of the primary site included maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). MTV and TLG were calculated based on 40% SUVmax (MTV40, TLG40) or SUV 2.5 (MTV2.5, TLG2.5) thresholds for pretreatment and interim images. Absolute and change in PET parameters were assessed for association with freedom from local and regional recurrence (FFLR) using single-predictor Cox regression models. Local and regional recurrence were primary and nodal (in-field) recurrences, respectively. RESULTS: Twenty-three patients were eligible for analysis. Patients were excluded with nonsquamous cell histology, recurrent anal cancer, and incomplete studies due to treatment toxicity or patient choice. Median follow-up was 2.5 years. Pretreatment MTV40 (HR 1.4 [95% CI 1.02-2.05]), interim MTV2.5 (1.4 [1.04-1.89]), and interim TLG2.5 (1.1 [1.01-1.21]) were associated with FFLR. CONCLUSIONS: In this prospective pilot study, interim PET parameters were associated with FFLR. These results warrant further investigation assessing the value of interim PET as a biomarker of response in the treatment of patients with anal cancer.

Parental stress, family quality of life, and family-teacher partnerships: Families of children with autism spectrum disorder.

BACKGROUND: Reducing parental stress and improving family quality of Life (FQOL) are continuing concerns for families of children with autism spectrum disorder (ASD). Family-teacher partnerships have been identified as a positive factor to help parents reduce their stress and improve their FQOL. However, the interrelations among parental stress, FQOL, and family-teacher partnerships need to be further examined so as to identify the possible paths to help parents reduce their stress and improve their FQOL. The purpose of this study was to examine the interrelations among these three variables. METHOD: A total of 236 parents of school children with ASD completed questionnaires, which included three measures: (a) the Beach Center Family Quality of Life Scale, (b) the Parental Stress Scale, and (c) the Beach Center Family-Professional Partnerships Scale. The structural equation modeling was used to analyze the interrelations among these three variables. RESULTS: Perceived parental stress had a direct effect on parental satisfaction concerning FQOL and vice versa. Perceived family-teacher partnerships had a direct effect on FQOL, but did not have a direct effect on parental stress. However, family-teacher partnerships had an indirect effect on parental stress through FQOL. CONCLUSIONS AND IMPLICATIONS: Reducing parental stress could improve FQOL for families of children with ASD and vice versa. Strong family-teacher partnerships could help parents of children with ASD improve their FQOL and indirectly reduce their stress.

An improved method for calibrating the gantry angles of linear accelerators.

Linear particle accelerators (linacs) are widely used in radiotherapy procedures; therefore, accurate calibrations of gantry angles must be performed to prevent the exposure of healthy tissue to excessive radiation. One of the common methods for calibrating these angles is the spirit level method. In this study, a new technique for calibrating the gantry angle of a linear accelerator was examined. A cubic phantom was constructed of Styrofoam with small lead balls, embedded at specific locations in this foam block. Several x-ray images were taken of this phantom at various gantry angles using an electronic portal imaging device on the linac. The deviation of the gantry angles were determined by analyzing the images using a customized computer program written in ImageJ (National Institutes of Health). Gantry angles of 0, 90, 180, and 270 degrees were chosen and the results of both calibration methods were compared for each of these angles. The results revealed that the image method was more precise than the spirit level method. For the image method, the average of the measured values for the selected angles of 0, 90, 180, and 270 degrees were found to be -0.086 ± 0.011, 90.018 ± 0.011, 180.178 ± 0.015, and 269.972 ± 0.006 degrees, respectively. The corresponding average values using the spirit level method were 0.2 ± 0.03, 90.2 ± 0.04, 180.1 ± 0.01, and 269.9 ± 0.05 degrees, respectively. Based on these findings, the new method was shown to be a reliable technique for calibrating the gantry angle.