Talk:Cervical cancer

"Weak evidence"

Wow, no one's read this discussion page since 2008. Well, I was noticing the sub-section about vitamin A and saying that there's "weak evidence" supporting that vitamin A prevents CIN 1. If the evidence is "weak", then why is it there at all? Those seem to be pretty subjective terms. ForestAngel (talk) 03:02, 25 September 2009 (UTC)

External Review Comments

The following comments are from an external reviewer BSWSJR as part of the new joint Wikipedia talk:WikiProject Medicine/Google Project. I would like to introduce myself as a new editor for this project. This will be my first revision. My aim is to shore up the references and provide the most current information about cervical cancer. I also would like to revise the article to address a putative audience who would like to get information about diagnosis and prevention of cervical cancer. —Preceding unsigned comment added by BSWSJR (talk • contribs) 22:33, 20 May 2010 (UTC)

Introductory paragraph

I would suggest that the citation needed for the sentence ending with "has reduced the incidence of invasive cervical cancer by 50% or more." be American Cancer Society. Cervical Cancer: Prevention and Early Detection. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Cervical_Cancer_Prevention_and_Early_Detection_8.asp. Also, change the first part of the sentence to "In the United States,". BSWSJR (talk) 04:22, 8 May 2010 (UTC)

This paragraph should include a reference to a basic diagram of the female reproductive system. I suggest an image like this one from the CDC website http://www.cdc.gov/cancer/cervical/. I would add--"The cervix is located at the lower end of the uterus (also known as the birth canal). The cervix connects the uterus to the vagina (for more details see http://en.wikipedia.org/wiki/Cervix). Most cervical cancers can initiate in cells that line the cervix. There are two main types of cells that cover the cervix: the squamous cells that lie closer to the vagina and the glandular cells that lie closest to the uterus. About 80-90% of cervical cancer originates from the squamous cells (squamous cell carcinoma) and the rest initiate from the glandular cells (adenocarcinoma). Cervical cancer is diagnosed by taking a sample from the cervix (pap smear) and looking at the type of cells under a microscope. Based on this type of analysis cervical cancer is classified." BSWSJR (talk) 19:30, 19 May 2010 (UTC)

Do you have sources for that? "About 80-90% of cervical cancer originates from the squamous cells (squamous cell carcinoma)". Please add new comments in the end of the talk page.---Nutriveg (talk) 19:45, 19 May 2010 (UTC)

Yes http://www.cancer.org/docroot/cri/content/cri_2_4_1x_what_is_cervical_cancer_8.asp from the ACS: What is Cervical Cancer webpage. BSWSJR (talk) 20:49, 19 May 2010 (UTC)

I don't think that source as a US public guide is a good source by Wikipedia standards.

(Rohan, 2004) says 75% (by 1998) and growing incidence of adenocarcinomas, it also cites "mixed adenosquamous tumors" beyond adenocarcinomas

Thomas E. Rohan, ed. (2004). Cervical Cancer: From Etiology to Prevention. Springer. ISBN 978-1402014109.

--Nutriveg (talk) 21:30, 19 May 2010 (UTC)

I will give you a second web reference from the National Cancer Institute (NCI) which is part of the National Institute of Health (NIH) under their health profession reviewed page http://www.cancer.gov/cancertopics/pdq/treatment/cervical/HealthProfessional/page3 where they say that 90% is squamous cell carcinoma. I also want to point out that on this page of the NCI site http://www.cancer.gov/cancertopics/pdq/treatment/cervical/HealthProfessional/page2 where they have a general overview of cervical cancer their first reference for statistics is from the ACS website. It does seem that ACS compiled data is comparable to WHO and other accepted sources. BSWSJR (talk) 18:53, 20 May 2010 (UTC)

I see a problem because those sources don't cite their references for checking, they also seem to be very lay and country specific.--Nutriveg (talk) 19:21, 20 May 2010 (UTC)

Please look at references #10, #34, #46 and even #23(webMD) that all refer directly to ACS sites and statistics. References #5 and #13 are from the NCI site. Taking cues from these previous references I believe my recommended sources are also valid. The "lay" aspect you mention is mirrored in the references I mentioned in the previous sentence. This is what I mean by counterproductive. This will be the last time I directly rebut your points. BSWSJR (talk) 20:09, 20 May 2010 (UTC)

Diagnosis

The staging section should have a reference. I suggest http://www.bgcs.org.uk/media/7f4b5fd0dd26474db0ae97073639d15b.pdf. BSWSJR (talk) 05:45, 21 May 2010 (UTC) Under pathologic types the reference for squamous cell carcinoma percentage should be ttp://www.cancer.gov/cancertopics/pdq/treatment/cervical/HealthProfessional/page3 where they say that 90% is squamous cell carcinoma. 99.161.157.28 (talk) 06:01, 21 May 2010 (UTC)

Prevention

I would recommend moving the whole section entitled Screening to be the first part of the section entitled Diagnosis. BSWSJR (talk) 20:42, 19 May 2010 (UTC) I also think it is misleading to have VIA as the main source of diagnosis when it is used as an alternative to Pap test in developing countries. BSWSJR (talk) 22:21, 20 May 2010 (UTC)

From my understanding that section id about "premalignant changes in the cervix" and "hpv infection (by specific types)" which is a different thing than "Cervical Cancer", so they belong to "Prevention" in my opinion.--Nutriveg (talk) 20:51, 19 May 2010 (UTC)

I disagree because a Pap smear and subsequent HPV detection are methods that allow for a diagnosis of pre-malignant changes in the cervix. I would also remove the statement that says the Pap test is a method to prevent cancer. If you look at the other sections in Prevention they specifically address procedures (e.g. vaccination, lower susceptibility behaviors, and diet that could lead to prevention. BSWSJR (talk) 21:02, 19 May 2010 (UTC)

The article intro defines "Cervical cancer is malignant neoplasm", so "premalignant changes in the cervix" and "hpv infection (by specific types)" are not cervical cancer. Cervical cancer can be prevented if those previous alterations are treated.--Nutriveg (talk) 21:35, 19 May 2010 (UTC)

Merck also puts pap test as prevention.---Nutriveg (talk) 21:41, 19 May 2010 (UTC)

I've separated the prevention section by David S. Alberts, ed. (2008). Fundamentals of Cancer Prevention. Springer. ISBN 978-3540689850.--Nutriveg (talk) 22:07, 19 May 2010 (UTC)

Again the PAP test in your Merck reference is first described in the Diagnosis section. Also, there is a statement that the PAP test combined with treatment is preventative. I want to say I think this is counterproductive to the editing process. I am striving to find the most recent and relevant information. BSWSJR (talk) 18:53, 20 May 2010 (UTC)

Merck "also" uses, it's not the same as "moving the whole section" which as in Merck remains mainly in the prevention section. Exactly what is is counterproductive?--Nutriveg (talk) 19:17, 20 May 2010 (UTC)

Let me be clear the PAP test needs to be mentioned at the beginning of the Diagnosis section along with information about following up a PAP test result with an HPV DNA test. Information about how often and at what age the PAP test should be administered should stay in the prevention section. BSWSJR (talk) 20:09, 20 May 2010 (UTC)

Under the Nutrition subsection the reference needed Coenzyme Q10 should be Palan PR, Mikhail MS, et al. Plasma concentrations of coenzyme Q10 and tocopherols in cervical intraepithelial neoplasia and cervical cancer. Eur J Cancer Prev . 2003 Aug;12(4):321–6. 99.161.157.28 (talk) 06:30, 21 May 2010 (UTC)

As I understand it the majority of cases of cervical cancer are due to an STD correct? That being the case shouldn't prevention include discouraging sleeping around? Seems pretty obvious so I'm surprised it's not been mentioned, especially since the article uses very qualified language (may protect etc) in relation to condoms. Prevention is better than cure, which is why Gardasil is viewed so favourably, except that's not a preventative it's an immunisation.

Causes

The first sentence under the HPV section should have a reference. I suggest this one for a new study relating HPV infection with adenocarcinoma Prospective study of human papillomavirus and risk of cervical adenocarcinoma.Dahlström LA, Ylitalo N, Sundström K, Palmgren J, Ploner A, Eloranta S, Sanjeevi CB, Andersson S, Rohan T, Dillner J, Adami HO, Sparén P Int J Cancer. 2010 Apr 19. BSWSJR (talk) 23:29, 20 May 2010 (UTC) I also suggest this older reference about a prospective study correlating HPV 16 and 18 with squamous cell cervical cancer Prospective seroepidemiologic study of human papillomavirus infection as a risk factor for invasive cervical cancer.Dillner J, Lehtinen M, Björge T, Luostarinen T, Youngman L, Jellum E, Koskela P, Gislefoss RE, Hallmans G, Paavonen J, Sapp M, Schiller JT, Hakulinen T, Thoresen S, Hakama M. J Natl Cancer Inst. 1997 Sep 3;89(17):1293-9. BSWSJR (talk) 23:48, 20 May 2010 (UTC) Finally, an older study establishing the general link between HPV and cervical neoplasia is: Schiffman MH, Bauer HM, Hoover RN, et al.: Epidemiologic evidence showing that human papillomavirus infection causes most cervical intraepithelial neoplasia. J Natl Cancer Inst 85 (12): 958-64, 1993. 99.161.157.28 (talk) 05:57, 21 May 2010 (UTC)

Cofactors

I think a proper reference for the HLA-B7 is Selected class I and class II HLA alleles and haplotypes and risk of high-grade cervical intraepithelial neoplasia. Ades S, Koushik A, Duarte-Franco E, Mansour N, Arseneau J, Provencher D, Gilbert L, Gotlieb W, Ferenczy A, Coutlée F, Roger M, Franco EL; Biomarkers of Cervical Cancer Risk (BCCR) Study Team Int J Cancer. 2008 Jun 15;122(12):2820-6. BSWSJR (talk) 23:12, 20 May 2010 (UTC)

Cause unknown

The cause of cervical cancer is unknown. This claim may be referenced to a number of reliable sources:

• Stuart Campbell; Ash Monga (2006). Gynaecology by Ten Teachers (18 ed.). Hodder Education. ISBN 0340816637.
• http://www.oncologychannel.com/femalecancers/index.shtml
• http://www.gyncancer.com/cervix.html
• http://www.cancer.org.au/aboutcancer/cancertypes/cervicalcancer.htm
• ... ([1]

The majority of women infected by HPV never get cancer. --Eleassar ^{my talk} 10:14, 21 September 2010 (UTC)

To say that "The cause is unknown" is misleading. It implies that there is a single cause (which there need not be; in this case there is no reason to expect a single cause). If that is the issue, please provide WP:MEDRS that back up the claim that there is a single cause (i.e. that saying "the cause" makes sense).

We do know some of the causes of cervical cancer. To say that the cause is unknown and then to say we know a necessary cause (HPV infection) is contradictory and confusing.

I modified it to. "Not all of the causes of cervical cancer are known." Does that get more at the meaning you are thinking of?

If not - what sort of cause are you concerned with not being known? (i.e. please explain the concern in more detail). 02:22, 22 September 2010 (UTC)

The proposed phrasing is ok. --Eleassar ^{my talk} 19:08, 22 September 2010 (UTC)

I do not know any cancer where the "cause is known". Carcinogenesis is a complex process, it would be more appropriate to say something along the lines "while some causes are suspected and epidemiologically substantiated the conditions and the process of carcinogenesis are far from being completely understood". Richiez (talk) 09:38, 23 September 2010 (UTC)

As far as I know, Cervical cancer is somewhat atypical in that there is a known, widely accepted necessary cause that applies to virtually all cases. "The presence of HPV in virtually all cervical cancers implies the highest worldwide attributable fraction so far reported for a specific cause of any major human cancer." (Walboomers 1999) (i.e., it comes closest at that time to having "A cause," that cause being HR HPV infection).

How about shortening Richiez's suggestion to something like "While some causes are known, the conditions and the process of carcinogenesis is not completely understood." Zodon (talk) 19:42, 25 September 2010 (UTC)

Prognosis - should add for Pap results

Since many women assume that if they have an abnormal Pap result that means they have cancer, it might be well to add brief coverage of the prognosis for various abnormal Pap results. (e.g. if have LSIL or HSIL result what are the chances that have Cancer/likelyhood to develop.) Castle would probably be a good reference for this. (Have to look up the rest of the citation.) Zodon (talk) 09:14, 5 October 2010 (UTC)