Emotional response to testing positive for human papillomavirus at cervical cancer screening: a mixed method systematic review with meta-analysis, Health Psychology Review,

Summary Phospholipid metabolism of human breast cancer was studied by 31p magnetic resonance spectroscopy (MRS). In vivo localised 31p MR spectra were obtained from the tumour alone using phase modulated rotating frame imaging. For 31 tumours, median (range) phosphomonoester (PME) to ATP ratio was 1.48 (0.57-3.78) and phosphodiester (PDE) to ATP ratio was 1.65 (0.44-3.89). DNA index and S phase fraction (SPF) were measured by flow cytometry of paraffin embedded tissue. Twelve (39%) tumours were diploid and 19 aneuploid. Median (range) SPF for 29 assessable tumours was 5.3% (0.6-28%), with significantly greater median SPF for aneuploid tumours (9.3%) than diploid (3.8%, P = 0.007). There was a significant association between PME/ATP and SPF (P= 0.03) due to a significant correlation for aneuploid tumours (P= 0.01). High resolution 31P MRS of extracts from 18 tumours (including seven studied in vivo) demonstrated that the PME peak consists predominantly of phosphoethanolamine (PE) with a smaller contribution from phosphocholine (PC) (median (range) PE/PC: 3.02 (1.13-5.09)). Changes in PME/ATP were observed for two tumours where tamoxifen stablised disease and may be consistent with the cytostatic effects of this drug.Breast cancer is the commonest cancer in women with an annual mortality rate in the United Kingdom of over 14,000 (OPCS Monitor, 1992), and its incidence appears to be rising in the western hemisphere (Glass & Hoover, 1990). Reduction in mortality has been reported for mammographic screening (Shapiro et al., 1982;Tabar et al., 1985) and adjuvant chemotherapy (Early Breast Cancer Trialists' Collaborative Group, 1992a,b (Glaholm et al., 1989). In another report of three patients with locally advanced breast tumours, PME/ATP decreased in response to therapy (Ng et al., 1989). PC and PE are intermediates in membrane phospholipid biosynthesis and can also be generated by growth factor signalling (Fisher et al., 1991). The concentration of PME may reflect the rate of cell membrane synthesis and therefore cellular proliferation . This is consistent with the observation of high concentration of the phosphomonoester, PE in the developing infant brain (Hope et al., 1984;Younkin et al., 1984) and liver (Moorcroft et al., 1991), and is further supported by the increase in PME to ATP ratio during liver regeneration in the rat following 70% resection (Murphy et al., 1992). However, alteration in PME associated with therapy could also be explained by a change in cellular number, particularly as in most cases there was an associated change in tumour size. The biochemical basis for therapy induced changes in PME in human breast cancer detected by 31p MRS is not clear.The aim of this study was to assess the relationship between the level of PME measured by 31P MRS in vivo and proliferation in untreated, primary human breast cancer. Patients were studied the day before surgery using 31P MRS and where possible, PME composition of extracts of tumour were studied by high resolution 31P MRS to aid interpretation of the in...

Primary screening for cervical cancer is transitioning from the longstanding Pap smear towards implementation of an HPV-DNA test, which is more sensitive than Pap cytology in detecting high-risk lesions and offers greater protection against invasive cervical carcinomas. Based on these results, many countries are recommending and implementing HPV testing-based screening programs. Understanding what factors (e.g., knowledge, attitudes) will impact on HPV test acceptability by women is crucial for ensuring adequate public health practices to optimize cervical screening uptake. We used mixed methods research synthesis to provide a categorization of the relevant factors related to HPV primary screening for cervical cancer and describe their influence on women's acceptability of HPV testing. We searched Medline, Embase, PsycINFO, CINAHL, Global Health and Web of Science for journal articles between January 1, 1980 and October 31, 2017 and retained 22 empirical articles. Our results show that while most factors associated with HPV test acceptability are included in the Health Belief Model and/or Theory of Planned Behavior (e.g., attitudes, knowledge), other important factors are not encompassed by these theoretical frameworks (e.g., health behaviors, negative emotional reactions related to HPV testing). The direction of influence of psychosocial factors on HPV test acceptability was synthesized based on 14 quantitative studies as: facilitators (e.g., high perceived HPV test benefits), barriers (e.g., negative attitudes towards increased screening intervals), contradictory evidence (e.g., sexual history) and no impact (e.g., high perceived severity of HPV infection). Further population-based studies are needed to confirm the impact of these factors on HPV-based screening acceptability.

Background: Achieving optimal human papillomavirus (HPV) vaccine uptake can be delayed by parents' HPV vaccine hesitancy, which is as a multi-stage intention process rather than a dichotomous (vaccinated/not vaccinated) outcome. Our objective was to longitudinally explore HPV related attitudes, beliefs and knowledge and to estimate the effect of psychosocial factors on HPV vaccine acceptability in HPV vaccine hesitant parents of boys and girls. Methods: We used an online survey to collect data from a nationally representative sample of Canadian parents of 9-16 years old boys and girls in September 2016 and July 2017. Informed by the Precaution Adoption Process Model, we categorized HPV vaccine hesitant parents into unengaged/undecided and decided not. Measures included sociodemographics, health behaviors and validated scales for HPV and HPV vaccine related attitudes, beliefs and knowledge. Predictors of HPV vaccine acceptability were assessed with binomial logistic regression. Results: Parents of boys and girls categorized as "flexible" hesitant (i.e., unengaged/undecided) changed over time their HPV related attitudes, behaviors, knowledge and intentions to vaccinate compared to "rigid" hesitant (i.e., decided not) who remained largely unchanged. In "flexible" hesitant, greater social influence to vaccinate (e.g., from family), increased HPV knowledge, higher family income, white ethnicity and lower perception of harms (e.g., vaccine safety), were associated with higher HPV vaccine acceptability. Conclusions: HPV vaccine hesitant parents are not a homogenous group. We have identified significant predictors of HPV vaccine acceptability in "flexible" hesitant parents. Further research is needed to estimate associations between psychosocial factors and vaccine acceptability in "rigid" hesitant parents.