BACKGROUND:We aimed to review the burden and the potential impact of human papillomavirus (HPV) vaccines on HPV-related diseases in the Republic of Korea and to discuss cervical cancer prevention practices in this country.METHODS:Cancer burden statistics were retrieved from GLOBOCAN-2018 and Statistics Korea. HPV disease burden was assessed via systematic review. Vaccine types relative contribution (RC) was estimated using data from an international project using formalin-fixed paraffin-embedded specimens.RESULTS:Despite a downtrend in cervical cancer in recent years, Korean rates remain high. In contrast, oropharyngeal cancer incidence has gradually increased and other anogenital cancers remain rare. In Korea, HPV prevalence in general population is around 20%. In cervical cancer, RC of HPVs 16/18 (74.0%) increased to 92.0% when including HPVs 31/33/45/52/58. Limited information was available for other HPV-related cancer sites. Regarding prevention, since the inclusion of the HPV vaccine into the National Immunization Program, almost half (49%) of the target cohort in 2016 had received the first dose of vaccine. Further, percentage of women screened with pap has increased from 41.1%-2009 to 53.0%-2016.CONCLUSIONS:HPV-related disease burden in Korea is significant. Results suggest that the combination of effective and high coverage HPV vaccination and screening programmes could substantially impact on HPV-related disease in Korea.

Background: Morbidity and mortality from breast cancer in Europe, as well as costs associated with the disease, remain high. Patients treated according to existing guidelines have better survival. The European Commission Initiative on Breast Cancer (ECIBC) aims to improve quality of care by developing evidence-based breast cancer guidelines and supporting their implementation via a quality assurance scheme for breast cancer services. The goal of this study is to give an overview on compliance with breast cancer guidelines in Europe. Methods: Studies assessing adherence to guidelines on breast cancer screening, diagnosis, treatment and follow-up were searched via Pubmed. Studies published between 1990 and 2016 were included. Results: In total, 127 studies (mainly observational, retrospective, prospective, and cross sectional) were analysed. The number of participants varied from 56 to 72 000—with studies based on cancer registry data typically including more than 10 000 patients. Overall, adherence to guidelines was variable. Regarding treatment, (e.g. chemotherapy) adherence ranged from 70% to 96% and was approximately 50% for follow-up. Additional or 'unnecessary' procedures were cited as the main causes of non-compliance to follow-up. On the other hand, adherence with respect to radiotherapy (e.g. compliance with technical guidelines) and some safety-related aspects (e.g. cardiac monitoring during adjuvant trastuzumab therapy and prophylaxis with colony-stimulating factors) was substantially lower. Elderly patients were treated less frequently according to existing guidelines. Professionals with less experience (i.e. < 8 years) complied better with guidelines. Use of computerised decision support systems (CDSS) and implementation of a multidisciplinary breast cancer pathway led to better compliance. Conclusions: In Europe, adherence to guidelines is variable. Implementation of guidelines can help decrease variability in clinical practice, and improve treatment effectiveness and patient safety. Fortunately, adherence can be monitored through the use of quality assurance schemes (e.g., the ECIBC). Incorporating a CDSS within the clinical workflow could reduce the workload of physicians and thus increase their compliance with guidelines. Legal entity responsible for the study: European Commission, Directorate General Joint Research Centre European Commission, Directorate General Joint Research Centre. Funding: None Disclosure: All authors have declared no conflicts of interest.

We are grateful to Drs Bahcivan and Altundag [ [1] Bahcivan O. Altundag K. Considerations to include while setting policy and standards for psycho oncological care in breast cancer services in Europe. Breast. 2017; https://doi.org/10.1016/j.breast.2017.02.007 Abstract Full Text Full Text PDF Scopus (1) Google Scholar ] for providing valuable complementary information to our paper [ [2] Neamtiu L. Deandrea S. Pylkkanen L. et al. Psycho-oncological support for breast cancer patients: a brief overview of breast cancer services certification schemes and national health policies in Europe. Breast. 2016; 29: 178-180 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ]. We agree that there is a need for harmonisation as training in psycho-oncologyvaries greatly across Europe. However, we propose to look at psycho-oncology as part of comprehensive cancer care rather than merely as a sub-discipline of psychology [ [1] Bahcivan O. Altundag K. Considerations to include while setting policy and standards for psycho oncological care in breast cancer services in Europe. Breast. 2017; https://doi.org/10.1016/j.breast.2017.02.007 Abstract Full Text Full Text PDF Scopus (1) Google Scholar ]. Looking at the cancer care pathway, psycho-oncology addresses the psychological responses to cancer and the psychological, behavioural and social factors that may influence the disease process [ [4] Holland J.C. Psycho-oncology: overview, obstacles and opportunities. Psyco-Oncology. 1992; 1: 1-13 Crossref Scopus (37) Google Scholar ]; in this context other disciplines may also play a significant role. Furthermore, a guide developed within the EU Joint Action CANCON [ [3] Albreht T. Kiasuwa R. Van den Bulcke M. European guide on quality improvement in comprehensive cancer control. Ljubljana: national institute of public health. Scientific Institute of Public Health, Brussels2017 Google Scholar ] recognises the need for psycho-oncology within comprehensive cancer care, recommends psychosocial support as a standard of care, and recommends investing in psycho-oncology training and communication skills for primary oncology staff [ [3] Albreht T. Kiasuwa R. Van den Bulcke M. European guide on quality improvement in comprehensive cancer control. Ljubljana: national institute of public health. Scientific Institute of Public Health, Brussels2017 Google Scholar ]. Finally, as the scope of our paper [ [2] Neamtiu L. Deandrea S. Pylkkanen L. et al. Psycho-oncological support for breast cancer patients: a brief overview of breast cancer services certification schemes and national health policies in Europe. Breast. 2016; 29: 178-180 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ] was to evaluate how psycho-oncology is recognised in European national cancer plans and certification schemes, professional societies were not included in the analysis. We once again thank Drs Bahcivan and Altundag [ [1] Bahcivan O. Altundag K. Considerations to include while setting policy and standards for psycho oncological care in breast cancer services in Europe. Breast. 2017; https://doi.org/10.1016/j.breast.2017.02.007 Abstract Full Text Full Text PDF Scopus (1) Google Scholar ] for having highlighted the role of societies and stakeholders in ensuring that psycho-oncology shall become commonly applied practice. Psycho-oncological support for breast cancer patients: A brief overview of breast cancer services certification schemes and national health policies in EuropeThe BreastVol. 29PreviewPsycho-oncology addresses the psychological, social, behavioural, and ethical aspects of cancer. Identification and proper management of the patients' psychosocial needs, as well as the needs of their caregivers and family are essential for a person-centred concept of breast cancer care. The aim of this overview is to describe how psychosocial support in breast cancer is incorporated in cancer-related policy documents, such as national cancer plans and breast cancer care certification schemes. Full-Text PDF Considerations to include while setting policy and standards for psycho-oncological care in breast cancer services in EuropeThe BreastVol. 33PreviewFirst of all, I would like to congratulate Neamtiu and colleagues for their study [1] in which they observed 32 European countries' national health policies and psycho-oncological support service inclusions in breast cancer services. They concluded that, psycho-oncologists in Europe perceived as having a key role in the care of breast cancer patients. Therefore, including a set of requirements specific to role of psycho-oncologist is vital within the European breast cancer care related policy documents, and assessed through quality assurance measures. Full-Text PDF

Psycho-oncology addresses the psychological, social, behavioural, and ethical aspects of cancer. Identification and proper management of the patients' psychosocial needs, as well as the needs of their caregivers and family are essential for a person-centred concept of breast cancer care. The aim of this overview is to describe how psychosocial support in breast cancer is incorporated in cancer-related policy documents, such as national cancer plans and breast cancer care certification schemes.

INTRODUCTION Certain types of smokeless tobacco (ST) are popular among some people of South Asian origin in England; however, little is known about the contextual factors surrounding use in this population. This systematic review explores the factors associated with ST use among people of South Asian origin in England. METHODS An iterative search strategy in targeted databases and grey literature sources was conducted in the summer of 2011. Data extractions and quality assessments were completed and verified by two reviewers, and results were presented as a narrative. RESULTS A total of 2,968 references were screened by two reviewers who agreed on the inclusion of 14 studies. ST use is more prevalent among older participants who may have started chewing in India; however, the evidence suggests that some younger English-born South Asians are using ST as well. Reasons for chewing included the use of these products in times of stress, boredom or simply to relax. Traditional health messages and prior held beliefs may lead them to chew these products because of misconceptions about their health benefits, since very few people were aware of the health risks. Many expressed a desire to quit, however found it difficult to go without ST. CONCLUSION This review examines the complex factors that underpin and influence ST use among South Asians in England with the potential of informing targeted interventions and health policy.

Objective Randomized trials provide evidence that intensive lifestyle interventions leading to dietary and physical activity change can delay or prevent Type 2 diabetes. Translational studies have assessed the impact of interventions based on, but less intensive than, trial protocols delivered in community settings with high-risk populations. The aim of this review was to synthesize evidence from translational studies of any design to assess the impact of interventions delivered outside large randomized trials. Methods Medical and scientific databases were searched using specified inclusion and exclusion criteria. Studies were included that used a tested diabetes preventive study protocol with an adult population at risk from Type 2 diabetes. Included papers were quality assessed and data extracted using recommended methods. Results From an initial 793 papers, 19 papers reporting 17 studies were included. Translational studies from a range of settings utilized a variety of methods. All were based on the US Diabetes Prevention Programme protocol or the Finnish Diabetes Prevention Study, with modifications that increased feasibility and access. The main outcome that was reported in all studies was weight change. Weight loss, which occurred in all but one study, was greater in intervention arms than in control subjects. No consistent differences were found in blood glucose or waist circumference. Conclusions Translational studies based on the intensive diabetes prevention programmes showed that there is potential for less intensive interventions both to be feasible and to have an impact on future progression to diabetes in at-risk individuals. Diabet. Med. 30, 3-15 (2013)

Abstract The IARC Monographs have been published continuously since 1971. For the 100th Vol. of the programme the evidence on all human carcinogens that have been identified to date has been updated. 147 experts from 28 countries contributed to the Vol. 100 series which was developed in six meetings from Oct 2008 to Oct 2009 (A. Pharmaceuticals, 23 agents; B. Biological agents, 11 agents; C. Metals, particles and fibres, 14 agents; D. Radiation, 14 agents; E. Lifestyle factors, 11 agents; F. Chemicals and related occupations, 34 agents). For each agent evaluations of the evidence in humans and in experimental animals and an overall evaluation of the human carcinogenicity have been developed and tumour sites with sufficient evidence of carcinogenicity as well as tumour sites that are strongly suspected and plausible mechanisms have been identified. All Group 1 carcinogens have been re-affirmed, several new Group 1 carcinogens and additional tumour sites for Group 1 carcinogens have been identified. Cancers of the colon, rectum and ovaries (mucinous type) have been added to the long list of tobacco smoking-related cancers, and parental smoking causes hepatoblastoma in the offspring and probably childhood leukemia. Acetaldehyde associated with alcohol consumption is carcinogenic to humans and causes cancers of the oesophagus, and head and neck. Based on sufficient evidence in humans for cutaneous and ocular melanoma, use of UV emitting tanning devices is now classified as “carcinogenic to humans”. In addition to lung cancer and mesothelioma, asbestos has now been linked with cancers of the larynx and ovaries, and leather dust has been identified as causing cancers of the nasal cavity and paranasal sinuses. There is now sufficient epidemiological evidence for TCDD exposure and all cancers combined, making TCDD the first agent classified initially in Group 1 based on sufficient animal data and mechanisms, to be later confirmed by increased cancer incidence in humans. Like TCDD, 2,3,4,7,8-pentachlordibenzofuran and 3,3’,4,4’, 5-pentachlorobiphenyl are complete carcinogens in experimental animals, and there is extensive evidence that they act through the same AhR-mediated mechanism. The Working Group classified these two chemicals in Group 1. The Working Group unanimously reaffirmed the classification of formaldehyde in Group 1, based on sufficient evidence in humans of nasopharyngeal cancer and concluded that, overall, there is sufficient evidence for leukaemia, particularly myeloid leukaemia. The re-affirmation of all group 1 carcinogens underlines the robust procedures and criteria for human carcinogen identification employed in the IARC Monographs Programme. Two additional Working Groups will be convened to develop scientific publications that build on the data that have been summarized in Volume 100: 1) Tumour-site concordance between humans and experimental animals; 2) Mechanisms involved in human carcinogenesis. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 869.

Objective. To determine whether patient race, ethnicity, or insurance status was associated with access to cervical cancer screening with liquid-based cytology (LBC) and with human papillomavirus (HPV) DNA testing and with access to on-site colposcopy at the provider's principal practice site.Materials and Methods. We conducted a nationally representative survey of clinicians in specialties that provide cervical cancer screening. Adjusted odds ratios (OR) were estimated for the associations between race, ethnicity, and insurance status of patients and provider use of LBC, HPV DNA testing, and on-site colposcopy.Results. Providers who cared for >= 20% Hispanic patients were less likely to use LBC (OR 0.60, 95% CI = 0.42-0.84). Providers who cared for >= 25% black women (OR 0.71, 95% CI = 0.51-0.98) and providers who cared for <75% privately insured patients (OR 0.66, 95% Cl = 0.46-0.95) were less likely to use HPV DNA testing. Providers who cared for <75% privately insured patients were less likely to have on-site colposcopy (OR 0.57, 95% CI = 0.37-0.89), but those who cared for >= 20% Medicaid patients were more likely to have on-site colposcopy (OR 1,86, 95% CI = 1.26-2.73).Conclusions. Given the high rates of cervical cancer in minority women, access to cervical cancer screening and diagnostic follow-up must be ensured. It may also be beneficial to ensure affordable access to technologies such HPV DNA testing that increases the sensitivity of disease detection and to on-site colposcopy that facilitates follow-up of abnormal cytology.

In June 2009, 20 scientists from nine countries met at the International Agency for Research on Cancer (IARC) to reassess the carcinogenicity of the types of radiation previously classified as “carcinogenic to humans” (Group 1) and to identify additional tumour sites and mechanisms of carcinogenesis (table and panel). These assessments will be published as part D of Volume 100 of the IARC Monographs.1Grosse Y Baan R Straif K et al.A review of human carcinogens—part A: pharmaceuticals.Lancet Oncol. 2009; 10: 13-14Summary Full Text Full Text PDF PubMed Google ScholarTableRadiation exposures with sufficient evidence in humansRadiation typeMajor study populationsTumour sites (and types) on which sufficient evidence is basedAlpha-particle and beta-particle emittersRadon-222 and decay productsGeneral population (residential exposure), underground minersLungRadium-224 and decay productsMedical patientsBoneRadium-226, radium-228, and decay productsRadium-dial paintersBone, paranasal sinus and mastoid process (radium-226 only)Thorium-232 and decay productsMedical patientsLiver, extrahepatic bile ducts, gall bladder, leukaemia (excluding CLL)PlutoniumPlutonium-production workersLung, liver, bonePhosphorus-32Medical patientsAcute leukaemiaFission products, including strontium-90General population, following nuclear reactor accidentSolid cancers, leukaemiaRadioiodines, including iodine-131Children and adolescents, following nuclear reactor accidentThyroidX-radiation or gamma-radiationAtomic-bomb survivors, medical patients; in-utero exposure (offspring of pregnant medical patients and of atomic-bomb survivors)Salivary gland, oesophagus, stomach, colon, lung, bone, skin (BCC), female breast, urinary bladder, brain and CNS, leukaemia (excluding CLL), thyroid, kidney (atomic-bomb survivors, medical patients); multiple sites (in-utero exposure)Solar radiationGeneral populationSkin (BCC, SCC, melanoma)UV-emitting tanning devicesGeneral populationSkin (melanoma), eye (melanoma, particularly choroid and ciliary body)CLL=chronic lymphocytic leukaemia. BCC=basal-cell carcinoma. SCC=squamous-cell carcinoma. Open table in a new tab PanelTypes of radiation classified in Group 1 •Ionising radiation •Alpha-particle emitters•Beta-particle emitters•X-rays and gamma-rays•Neutron radiation•Solar radiation•Ultraviolet radiation (wavelengths 100–400 nm, encompassing UVA, UVB, and UVC) CLL=chronic lymphocytic leukaemia. BCC=basal-cell carcinoma. SCC=squamous-cell carcinoma. •Ionising radiation •Alpha-particle emitters•Beta-particle emitters•X-rays and gamma-rays•Neutron radiation•Solar radiation•Ultraviolet radiation (wavelengths 100–400 nm, encompassing UVA, UVB, and UVC) Alpha particles, consisting of two protons and two neutrons, are a densely ionising type of radiation with low capacity to penetrate living tissue (less than 0·1 mm). Beta particles are electrons or positrons that are less ionising, but more penetrating (up to a few milimetres). The health hazards resulting from radionuclides that emit these particles largely occur after internal deposition. Epidemiological evidence shows a number of radionuclides that emit alpha or beta particles increase cancer risks at several anatomical sites (table). The Working Group reaffirmed the carcinogenicity of internally deposited radionuclides that emit alpha or beta particles (Group 1). After the Chernobyl accident, a sharp increase in the risk of thyroid cancer was found with exposure to radioiodines, particularly iodine-131, during childhood and adolescence.2UN Chernobyl Forum expert group “Health” (EGH)Health effects of the Chernobyl accident and special health care programmes. Geneva.http://whqlibdoc.who.int/publications/2006/9241594179_eng.pdfDate: 2006Google Scholar, 3Cardis E Howe G Ron E et al.Cancer consequences of the Chernobyl accident: 20 years on.J Radiol Prot. 2006; 26: 127-140Crossref PubMed Scopus (209) Google Scholar This increased risk might be due to higher milk intake per unit of body weight among children; a higher thyroid dose per unit of iodine-131 intake from milk; a higher susceptibility per unit of thyroid dose; or a combination of these. Radon exposure occurs mainly through contamination of indoor air by radon released from soil and building materials. Combined analyses of case–control studies now estimate that residential exposure to radon gas is the leading cause of lung cancer after tobacco smoke (8–15% attributable risk in Europe and North America).4Darby S Hill D Auvinen A et al.Radon in homes and risk of lung cancer: collaborative analysis of individual data from 13 European case–control studies.BMJ. 2005; 330: 223Crossref PubMed Scopus (1315) Google Scholar, 5National Research Council, Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board on Radiation Effects, and Research Division on Earth and Life StudiesHealth effects of exposure to radon: BEIR VI. National Academies Press, Washington1999Google Scholar X-rays and gamma-rays are sparsely ionising electromagnetic radiation that penetrate living tissue, typically producing fast electrons that deposit energy, resulting in tissue damage. Extensive study of atomic-bomb survivors shows increased cancer risks at multiple anatomical sites.6National Research Council, Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board on Radiation Effects, and Research Division on Earth and Life StudiesHealth risks from exposure to low levels of ionizing radiation: BEIR VII, Phase 2. National Academies Press, Washington2006Google Scholar Current evidence adds to the list of tumours caused by x-rays and gamma-rays (table), and also establishes that in-utero exposure increases the risk of cancer at multiple sites.7Wakeford R Little MP Risk coefficients for childhood cancer after intrauterine irradiation: a review.Int J Radiat Biol. 2003; 79: 293-309Crossref PubMed Scopus (174) Google Scholar, 8Preston DL Cullings H Suyama A et al.Solid cancer incidence in atomic bomb survivors exposed in utero or as young children.J Natl Cancer Inst. 2008; 100: 428-436Crossref PubMed Scopus (274) Google Scholar The Working Group reaffirmed the carcinogenicity of x-radiation and gamma-radiation (Group 1). Neutrons are produced by nuclear reactions and are a main component of cosmic radiation. They are highly penetrating and interact with the traversed tissue, producing protons, other charged particles, and gamma-radiation. Epidemiological evidence is inadequate to assess the carcinogenicity of neutrons, because of co-exposures to other types of radiation. However, the evidence of cancer in experimental animals is sufficient, and mechanistic data show that neutrons transfer their energy in clusters of ionising events—resulting in similar, but more severe, local damage than that induced by x-rays or gamma-rays. On the basis of this evidence, the Working Group reaffirmed the carcinogenicity of neutron radiation (Group 1). Each type of ionising radiation (panel) transfers energy in the form of highly structured tracks of ionisation and excitation events that can produce a variety of molecular lesions and clustered, complex DNA damage.9Goodhead DT Initial events in the cellular effects of ionizing radiations: clustered damage in DNA.Int J Radiat Biol. 1994; 65: 7-17Crossref PubMed Scopus (1014) Google Scholar Subsequent processing of this damage induces many responses (eg, cell killing, chromosomal aberrations, mutations, genomic instability, cell transformation, and bystander effects) that contribute to carcinogenesis. Based on these mechanistic considerations, all types of ionising radiation were classified by the Working Group as “carcinogenic to humans” (Group 1). Solar radiation is the main source of human exposure to ultraviolet (UV) radiation, which is further subdivided into UVA, UVB, and UVC. The ultraviolet component that reaches the earth's surface comprises around 95% UVA and 5% UVB; UVC is blocked by stratospheric ozone. Epidemiological studies have established a causal association between exposure to solar radiation and all major types of skin cancer (table). The Working Group reaffirmed the carcinogenicity of solar radiation (Group 1). Exposure to solar radiation causes a specific mutation fingerprint (cytidine to thymidine transition), as a result of cyclobutane pyrimidine dimers in DNA. This pattern had long been attributed to UVB.10Runger TM Kappes UP Mechanisms of mutation formation with long-wave ultraviolet light (UVA).Photodermatol Photoimmunol Photomed. 2008; 24: 2-10Crossref PubMed Scopus (130) Google Scholar However, this same cytidine to thymidine transition has been detected in the skin of UVA-treated mice11Ikehata H Kawai K Komura J et al.UVA1 genotoxicity is mediated not by oxidative damage but by cyclobutane pyrimidine dimers in normal mouse skin.J Invest Dermatol. 2008; 128: 2289-2296Crossref PubMed Scopus (67) Google Scholar and in the Tp53 gene of UVA-induced or UVB-induced skin tumours in hairless mice.10Runger TM Kappes UP Mechanisms of mutation formation with long-wave ultraviolet light (UVA).Photodermatol Photoimmunol Photomed. 2008; 24: 2-10Crossref PubMed Scopus (130) Google Scholar In humans, this transition has been seen in TP53 in premalignant solar keratosis and in malignant skin tumours.12Agar NS Halliday GM Barnetson RS Ananthaswamy HN Wheeler M Jones AM The basal layer in human squamous tumors harbors more UVA than UVB fingerprint mutations: a role for UVA in human skin carcinogenesis.Proc Natl Acad Sci USA. 2004; 101: 4954-4959Crossref PubMed Scopus (463) Google Scholar Based on these mechanistic data, the Working Group classified UV radiation as “carcinogenic to humans” (Group 1). The use of UV-emitting tanning devices is widespread in many developed countries, especially among young women. A comprehensive meta-analysis concluded that the risk of cutaneous melanoma is increased by 75% when use of tanning devices starts before 30 years of age.13IARC Working GroupThe association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review.Int J Cancer. 2006; 120: 1116-1122Crossref Scopus (484) Google Scholar Additionally, several case–control studies provide consistent evidence of a positive association between the use of UV-emitting tanning devices and ocular melanoma.14Seddon JM Gragoudas ES Glynn RJ Egan KM Albert DM Blitzer PH Host factors, UV radiation, and risk of uveal melanoma: a case-control study.Arch Ophthalmol. 1990; 108: 1274-1280Crossref PubMed Scopus (153) Google Scholar, 15Vajdic CM Kricker A Giblin M et al.Artificial ultraviolet radiation and ocular melanoma in Australia.Int J Cancer. 2004; 112: 896-900Crossref PubMed Scopus (43) Google Scholar Therefore, the Working Group raised the classification of the use of UV-emitting tanning devices to Group 1, “carcinogenic to humans”. While reviewing the studies of occupational UV exposure, the Working Group concluded that there is “sufficient evidence” for ocular melanoma in welders.16Lutz JM Cree I Sabroe S et al.Occupational risks for uveal melanoma results from a case-control study in nine European countries.Cancer Causes Control. 2005; 16: 437-447Crossref PubMed Scopus (38) Google Scholar, 17Shah CP Weis E Lajous M Shields JA Shields CL Intermittent and chronic ultraviolet light exposure and uveal melanoma: a meta-analysis.Ophthalmology. 2005; 112: 1599-1607Summary Full Text Full Text PDF PubMed Scopus (151) Google Scholar However, because welders are also exposed to other harmful agents, this association could not be attributed specifically to UV radiation. A full review of the carcinogenic hazards of welding will be undertaken by IARC with high priority. The IARC authors declared no conflicts of interest. Upcoming meetingsSept 29–Oct 6, 2009Lifestyle FactorsOct 20–27, 2009Chemical Agents and Related Occupationshttp://monographs.iarc.fr/ Upcoming meetings Sept 29–Oct 6, 2009 Lifestyle Factors Oct 20–27, 2009 Chemical Agents and Related Occupations http://monographs.iarc.fr/ Monograph Working GroupMembersB Armstrong–Co-Chair (Australia), E Cardis–Co-Chair (Spain); A Green (Australia); D Krewski, R Mitchel, N Priest (Canada); L Tomašek (Czech Republic); K Baverstock (Finland); J-F Doré, J Hall, L Sabatier (France); M Sokolnikov (Russian Federation); M Hill, M Little, M Marshall, C Muirhead, A Riddell (UK); D Brenner [unable to attend], R Guilmette, D Hoel, D Richardson, R Ullrich (USA)Conflicts of interestNP works for, and RM is a consultant to, Atomic Energy of Canada Ltd. CM receives funding from the UK Ministry of Defence. JH receives funding from Electricité de France. AG receives funding from L'Oreal Recherche.Invited SpecialistsNone Monograph Working Group Members B Armstrong–Co-Chair (Australia), E Cardis–Co-Chair (Spain); A Green (Australia); D Krewski, R Mitchel, N Priest (Canada); L Tomašek (Czech Republic); K Baverstock (Finland); J-F Doré, J Hall, L Sabatier (France); M Sokolnikov (Russian Federation); M Hill, M Little, M Marshall, C Muirhead, A Riddell (UK); D Brenner [unable to attend], R Guilmette, D Hoel, D Richardson, R Ullrich (USA) Conflicts of interest NP works for, and RM is a consultant to, Atomic Energy of Canada Ltd. CM receives funding from the UK Ministry of Defence. JH receives funding from Electricité de France. AG receives funding from L'Oreal Recherche. Invited Specialists None

In October, 2008, 21 scientists from nine countries met at the International Agency for Research on Cancer (IARC) and reaffirmed the Group 1 classification “carcinogenic to humans” of 20 pharmaceutical agents (tables 1 and 2).

Since 1999, human papillomavirus ( HPV) DNA tests have been approved only for abnormal cervical cytology management and as an adjunct to cervical cytology screening. To assess HPV DNA testing practices, we mailed surveys to 6906 randomly selected clinicians in mid-2004. Awareness ( 87%) and ever use ( 67%) of HPV DNA tests was high. Test users were more likely than nonusers to be obstetricians/gynecologists or midwives, to be female, and to serve mainly privately insured patients. Respondents reported ever using HPV DNA tests for both approved and nonapproved indications, which included testing for HPV infection in women with anogenital warts or other sexually transmitted diseases, in their sex partners, and in men. Interventions are needed to discourage HPV DNA test use for nonapproved indications.

OBJECTIVES:To examine messages US clinicians use when counseling patients diagnosed with anogenital warts. STUDY DESIGN:In mid-2004, we conducted a confidential mail survey of nationally representative samples of physicians practicing internal and adolescent medicine, family/general practice, obstetrics/gynecology, urology, or dermatology; nurse midwives; physician assistants; and nurse practitioners. The survey assessed knowledge and counseling practices of clinicians who had diagnosed anogenital warts. RESULTS:After adjusting for survey eligibility, 81% responded. Most (89%) were aware that human papillomavirus (HPV) causes anogenital warts, but only 48% were aware that oncogenic and wart-related HPV genotypes usually differ. Most (>95%) clinicians reported telling patients with warts that warts are an STD, are caused by a virus, or that their sex partners may have or may acquire warts. Many clinicians (>/=85%) also reported discussing STD prevention or assessing STD risk with such patients. Most reported addressing ways to prevent HPV (89%), including using condoms; limiting sex partners or practicing monogamy; or abstinence. Many also reported recommending prompt (82%) or more frequent (52%) Pap testing to female patients with anogenital warts. Potential barriers to counseling included providing definitive answers on how HPV infection was acquired, dealing with patients' psychosocial issues, and inadequate reimbursement. CONCLUSIONS:Most surveyed clinicians appropriately counseled patients about the cause and prevention of anogenital warts. However, many clinicians were unaware that oncogenic and wart-related HPV types usually differ, and this may explain why many reported recommending more aggressive cervical cancer screening for female patients with warts.

BACKGROUND AND OBJECTIVES:Information about human papillomavirus (HPV) has evolved rapidly and HPV DNA tests are now available. Little is known about family physicians' knowledge about HPV and how it relates to HPV test use and counseling practices.METHODS:In mid-2004, confidential surveys were mailed to a nationally representative sample of 760 family physicians. We assessed and analyzed relationships between knowledge about HPV, HPV test use, and counseling messages provided when collecting cervical cytology and managing anogenital warts.RESULTS:The adjusted response rate was 68% (n=368). Ninety-one percent provided cervical cancer screening, and 90% had managed genital warts. Responses indicated that more than 90% had up-to-date knowledge about several issues: HPV infection is common, persistent infection increases risk of cervical neoplasia, and treatment does not eliminate the causative infection. However, fewer than 50% were aware that HPV infections may clear spontaneously and that the HPV types associated with warts and cervical neoplasia differ. Only 57% had ever used HPV tests. Some HPV knowledge varied by clinician characteristics, and knowledge was associated with HPV test use but not counseling messages.CONCLUSIONS:Most physicians were aware of new information about HPV infection, but some were unaware of important information relevant for patient counseling. These topics have been highlighted in new clinical training and patient education materials.

OBJECTIVE:We assessed clinician knowledge and practices since the marketing of tests for sexually transmitted human papillomavirus (HPV) and the release of HPV testing guidelines for two indications: 1) as an adjunct to cytologic screening and 2) to guide colposcopic triage of patients with atypical squamous cells of undetermined significance (ASC-US) cytology results. METHODS:In mid-2004, we surveyed nationally representative, random samples of clinicians practicing specialties that provide cytologic screening. Mail surveys addressed HPV-related knowledge, screening, abnormal cytology management, HPV testing, and counseling practices. RESULTS:The overall adjusted response rate was 82%. Of the 2,980 (89%) clinicians providing cytologic screening, 99% knew that HPV infection increases cervical cancer risk, and 91% were aware of HPV tests. Of the 21% who reported ever using HPV tests as an adjunct to cytology, more reported usually testing patients aged less than 30 years (which guidelines do not recommend) than older patients (which guidelines do recommend). Of the 63% of clinicians who ever ordered HPV tests for abnormal cytology results, 84% usually ordered tests for ASC-US results and preferentially advised colposcopy if HPV tests were positive, as guidelines recommend. However, more than 60% usually ordered HPV tests for higher-grade abnormalities, which is not recommended for colposcopy triage. Although few sought HPV test consent, most discussed sexually transmitted HPV with patients with abnormal cytology or positive HPV tests despite potentially negative psychosocial consequences. CONCLUSION:New HPV tests and testing guidelines have transformed screening, abnormal cytology management, and counseling practices. Although many U.S. clinicians reported using HPV tests according to guidelines, many also reported inappropriate use.

Two Workshops were organised in order to inform and involve stakeholders about the task the JRC has been given of updating existing European Guidelines on Quality Assurance in Breast Cancer Screening and Diagnosis and, in parallel, to develop a quality assurance scheme for breast cancer services. Participants at both workshops, coming from different areas of competence and of interest (e.g. clinical experts, patients' associations, guidelines methodologists, policy makers, screening programme managers, etc), were asked to contribute with their own experience and knowledge and to provide input on project pillars and modalities to coordinated and optimise the direction of the project. This report not only includes the narration of the events, but also the main conclusions derived from a thorough discussion on the main aspects of the project and their impact on the planning of activities for meeting the requirements of the two tasks.