Radical hysterectomy compared with primary radiation for treatment of stage IB1 cervix cancer.

OBJECTIVE: We reviewed data on treatment of stage IB1 cervical cancer at our institution to compare recurrence, complications, and survival of women treated primarily by radical hysterectomy versus radiation. METHODS: Records for women treated for stage IB1 cervical cancer between January 1, 1990 and June 1, 2010 were retrospectively reviewed. Recurrence, survival outcomes, and complications were examined and compared. Demographic, clinical, and histopathologic factors were also analyzed. RESULTS: Of 198 patients with stage IB1 cervix cancer, 169 (85%) underwent radical hysterectomy, including 37 (20%) who received postoperative radiation, and 29 (15%) were treated primarily with radiotherapy±chemotherapy. Progression-free survival, overall survival, and disease-specific survival were all longer in the surgery group (89%, 95%, and 96%) versus the radiation group (70%, 70%, and 78%), respectively (P<0.001). Patients in the radiation group were older, had larger tumors, and were more likely to have medical comorbidities than patients in the surgery group. Within the surgical cohort, lymphvascular space invasion, outer third cervical stromal invasion, positive surgical margins, and lymph node metastasis were all predictive of recurrence (P<0.002), whereas histopathology, smoking, diabetes, and immunosuppression were not. Grade 3 or 4 complication rates were higher among the 29 patients who had primary radiotherapy (20.7%) and the 37 patients who had surgery followed by radiotherapy (21.6%) compared with the 132 patients who had surgery only (9.1%) (P=0.047). CONCLUSIONS: Primary treatment of stage IB1 cervix cancer with radical hysterectomy±adjuvant radiation resulted in a significantly lower rate of recurrence and an improved survival with fewer complications compared with radiotherapy with or without chemotherapy.

Preventing excessive weight gain among publicly insured pregnant women.

The purpose of this study is to develop an intervention to help women meet weight gain goals during pregnancy. From 2007 to 2008, pregnant women were recruited at a clinic in Chicago. Intervention participants received an educational pamphlet at their first prenatal visit. At follow up visits, provider counseling was encouraged via a weight gain trend graph and targeted feedback checklist. The primary outcome was the total weight gained over the course of prenatal care. We analyzed 57 intervention group participants and 109 controls. Demographic composition was similar between the groups except for parity. Patients in the intervention group and routine care group gained similar weight (24.5 + 13.5 lb vs. 25.3 + 14.0 lb, P = 0.71). After controlling for baseline weight, the intervention was associated with 4.6 pounds lower follow-up weight (P = 0.029). After controlling for baseline BMI and other covariates, participants who received the intervention were only 34% as likely to gain weight exceeding IOM guidelines (P = 0.009). This pilot prenatal care obesity prevention project was associated with lower weight gain in pregnancy. The feedback checklist, weight gain graph, and educational pamphlet on weight gain proved to be favorable components of this project and merit further examination in a larger intervention trial.

Knowledge of human papillomavirus among publicly and privately insured women.

INTRODUCTION: The purpose of this study was to identify characteristics associated with high and low levels of human papillomavirus (HPV) knowledge among women presenting for HPV vaccination. METHODS: Surveys were administered to women presenting for HPV vaccination at 2 distinct clinics: a private obstetrics and gynecology office with predominantly privately insured patients and a resident clinic with primarily Medicaid-insured patients. Nine outcome measures were collected in addition to open-ended response questions regarding motivation for vaccination. RESULTS: Forty-six women were recruited from the resident clinic, and 39 women were recruited from the private clinic. Knowledge scores differed significantly between the 2 recruitment sites: mean score of 19.7 at the resident clinic compared to a mean score of 24.9 at the private clinic (P < .0001, power = 80%). After controlling for age, zip code poverty prevalence, educational attainment, and parental educational attainment, clinical site was no longer independently associated with knowledge score. Rather, having attended at least 1 year of college was the only measured item independently associated with a higher HPV knowledge score. Reported condom use, having a regular sexual partner, history of an abnormal Papanicolaou (Pap) test, and having received a Pap test within the previous year were not independently associated with knowledge scores. Themes for motivation to vaccinate include protection from cervical cancer and prevention of HPV infection. DISCUSSION: Knowledge of HPV among women presenting for vaccination was significantly associated with educational attainment of some college. Common themes of low knowledge include the viral etiology of cervical cancer, the clinical presentation of HPV infection, and the lack of complete protection against cervical cancer with the HPV vaccine.