Journal of Women's Health

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Despite the availability of several different screening tests for colorectal cancer, screening rates remain low. To raise awareness about colorectal cancer and encourage men and women aged 50 and older to speak with their physicians about being screened for colorectal cancer, the Centers for Disease Control and Prevention and the Health Care Financing Administration launched Screen for Life: A National Colorectal Cancer Action Campaign in 1999. The purpose of this paper is to outline the development of this multiyear, multimedia campaign, from conducting formative research to developing campaign messages and materials. Limited process evaluation results are presented.

We assessed the influence of hormonal (oral, injectable, or levonorgestrel [Norplant, Wyeth-Ayerst, Philadelphia, PA]) and barrier methods of contraception on the risk of cervical squamous intraepithelial lesions (SIL), while adjusting for high-risk (HR) HPV infection. Subjects were women receiving family planning services through the state health department clinics from 1995 to 1998. We selected 60 cases with high-grade cervical/SIL (HSIL) and 316 with low-grade cervical/SIL (LSIL) and controls (427 women with normal cervical cytology) and analyzed cervical DNA for HR-HPV, using Hybrid Capture I (Digene; Gaithersburg, MD). When assessing ever use, duration, recency, latency, and age at first use, neither oral contraceptives (OC), Norplant, nor injectable use was associated with an increased risk of SIL development after adjusting for age, age at first sexual intercourse, and HR-HPV positivity. Among HR-HPV-positive women, longer duration barrier method use was associated with a reduced risk of SIL. This finding has important clinical implications for SIL prevention among HR-HPV-infected women.

Postmenopausal women with coronary heart disease (CHD) who volunteered for the Heart and Estrogen/Progestin Replacement Study (HERS) randomized clinical trial had high rates of gynecological abnormalities. We examined compliance with gynecological cancer screening and factors affecting this behavior. Women who met inclusion criteria for HERS and were seen for screening by the study gynecologist were considered eligible for this study. Data were abstracted from study records, and additional information was obtained by telephone questionnaire. Adherence to mammography, breast examination, pelvic examination, and Pap smear recommendations was assessed. Provider behavior and its effect on compliance were assessed. Compliance rates were 59.1% for monthly breast self-examination (BSE), 67.2% for yearly mammography, 73% for yearly Pap smear and pelvic examination, and 75.7% for provider breast examination. Over 50% of patients had most of their screening tests done within the last year. Provider behavior was significantly related to patient screening compliance for mammography, breast examination, Pap smear, and pelvic examination. Provider gender was not significantly related to adherence. There were no significant differences in compliance rates based on the type of most recent coronary event. Compliance rates did not differ significantly between patients with and without gynecological abnormalities, except for mammography (78.3% versus 48.3%, p = 0.02). The majority of patients were compliant with gynecological screening. Among patients with gynecological abnormalities, mammography compliance was significantly lower. Provider behavior was an important factor in influencing women to obtain preventive screening. There were no significant differences in compliance based on provider gender or type of coronary event preceding HERS enrollment.

Obesity increases cancer risk, yet small-scale surveys indicate that obese women delay or avoid cancer screening even more so than do nonobese women. We sought to estimate the association between body mass index (BMI) (kg/m²) and delayed cancer screening among adult women in a population-based survey. Subjects were women classified by BMI as underweight (<18.5), desirable weight (18.5-24.9), overweight (25-29.9), obese class I (30-34.9), obese class II (35-39.9), and obese class III (≥40). Outcome measures were intervals (0 for ≤2 years versus 1 for >2 years) since most recent screening for Papanicolaou (Pap) smear, mammography, and clinical breast examination (CBE). Adjusting for age, race, smoking, and health insurance, we observed J-shaped associations between BMI and screening. Compared with desirable weight women, underweight women (odds ratios [OR] = 1.21, 95% confidence interval [95% CI] 1.09-1.34), overweight women (OR = 1.13, 95% CI 1.07-1.18), and obese women (OR range 1.22-1.69) were significantly more likely to delay Pap smear testing for >2 years. Underweight (OR = 1.32, 95% CI 1.13-1.54), obesity class I (OR = 1.12, 95% CI 1.02-1.23), and obesity class III women (OR = 1.32, 95% CI 1.10-1.54) were more likely to delay mammography, and overweight (OR = 1.10, 95% CI 1.01-1.19), obesity class I (OR = 1.18, 95% CI 1.08-1.30), and obesity class III women (OR = 1.47, 95% CI 1.23-1.75) were more likely to delay CBE. White women were more likely to delay CBE as a function of BMI than were non-white women. Weight may be an important correlate of cancer screening behavior, particularly for white women.

Hyperemesis gravidarum (HG) is a condition of severe, intractable nausea and vomiting during pregnancy. It has long been held that HG is a psychosomatic illness reflective of a long-term psychological trait, that is, conversion disorder. We investigated this possibility by conducting a two-phase study: (1) a comparison of women with (n = 9) and without (n = 10) HG during pregnancy and (2) a comparison of nonpregnant women who did (n = 10) and did not (n = 12) have HG during their most recent pregnancies. The pattern of findings differed between experiments 1 and 2. During pregnancy, women with HG scored significantly higher on three scales associated with conversion disorder (all p values <0.01) than did women without HG. There were no significant differences between HG subjects and controls after pregnancy. We find no support for the theory that HG is a psychosomatic condition. Rather, it appears to be a complex interaction of biological, psychological, and sociocultural factors.

Breast cancer is the most common cancer in Pacific Islander women, yet relatively little is known about their cancer risks and screening behaviors. Chamorros are indigenous people from Guam, and California is home to the largest numbers of Chamorros on the mainland United States. This study examined the breast cancer risk, knowledge, and screening behaviors in a nonprobability sample of Chamorro women age 40 years and older in Los Angeles and Orange Counties (n = 227). The proportional incidence ratio for breast cancer among Chamorro women was found to be 0.7 compared with white women in California, indicating a lower current breast cancer risk for Chamorro women compared with white women. Thirty-seven percent of respondents ever performed a breast self-examination (BSE), 93% ever had a clinical breast examination (CBE), and 77% ever had a mammogram. In terms of screening maintenance, only 27% did BSE monthly, 66% received a CBE in the past year, and 25% received yearly mammograms. Significant correlates of CBE were higher educational attainment, married status, higher income, and health insurance coverage. Women who knew of breast cancer symptoms, would undergo treatment, and would like to know if they had breast cancer were also more likely to have ever had a CBE. With regard to mammography, older age, moderate income, married status, and use of traditional healers and healing practices were associated with higher screening incidence. Implications of these findings for developing culturally tailored and appropriate cancer screening programs are discussed.

Native American women are at increased risk for HIV infection, but few studies have studied this threat. To address this gap in the literature, we assessed HIV risk behavior and explored the hypothesized psychological antecedents of risk behavior in 53 Native American women. Survey results indicated that women's HIV-related knowledge was incomplete and many women still held misconceptions about HIV. One third of the sample reported having two to five sexual partners in the past 5 years, and 30% of the women reported alcohol use prior to sexual intercourse. Women who were classified at higher risk, that is, who did not use condoms consistently, felt less vulnerable to HIV and were less ready to change their risky sexual behaviors compared with their lower-risk counterparts. These findings indicate that Native American women are at risk for HIV infection and can no longer be neglected by those seeking to prevent HIV infections. Culturally congruent and gender-specific interventions that provide information and behavioral skills to Native American women as well as increase their motivation to adopt safer sexual behaviors are needed.

Paraneoplastic cerebellar degeneration (PCD) is a type of paraneoplastic syndrome that primarily affects women with gynecological cancers. Patients typically experience pancerebellar symptoms, including gait ataxia, dysarthria, nystagmus, and truncal and appendicular ataxia. We present the case of a 50-year-old woman with PCD and presumed ovarian cancer who initially complained of ataxia and dysarthria. PCD was diagnosed on the basis of her symptoms, diagnostic imaging, and laboratory work. PCD symptoms may precede the diagnosis of malignancy by months or years. Early diagnosis and treatment of these syndromes, including rehabilitation, may result in improvements in quality of life for this population of patients.