Cancer
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2-Fluoro-2-deoxy-D-glucose (FDG) imaging is highly accurate for assessing solitary pulmonary nodules (SPNs) in patients without known malignancy. In the current study, the authors evaluated FDG-positron emission tomography/computed tomography (PET/CT) for the characterization of SPN in cancer patients. ⋯ FDG imaging was highly accurate for the diagnosis of malignant SPNs in patients with cancer, similar to the general population. The presence of any FDG avidity had significantly greater sensitivity than semiquantitative analysis. The current results indicated that lower than mediastinal uptake should be explored cautiously, particularly for second primary tumors, whereas no FDG avidity was a better predictor of SPN benignity than very low uptake.
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Acute palliative care units (APCUs) are gaining popularity in tertiary care centers. In this study, the authors examined the impact of opening an APCU on administrative outcomes for a general oncology ward (GOW) at a comprehensive cancer center. ⋯ After the opening of an APCU at the authors' cancer center, the GOW experienced a decrease in administrative endpoints related to palliative and end-of-life care and an increase in endpoints related to cancer-directed interventions. Prospective studies with clinical endpoints will be required to determine whether this specialization of inpatient care improves quality of life, quality of death, and psychosocial well being.
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Three federal programs with the potential to reduce cervical cancer incidence, morbidity, and mortality, especially among underserved populations, are administered by the Centers for Disease Control and Prevention (CDC): the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the Vaccines for Children (VFC) Program, and the Section 317 immunization grant program. The NBCCEDP provides breast and cervical cancer screening and diagnostic services to uninsured and underinsured women. ⋯ Potential long-term reduction in healthcare costs resulting from HPV vaccination is also discussed. As an example of an initiative to vaccinate uninsured women aged 19-26 years through a cancer services program, a state-based effort that was recently launched in New York, is highlighted.
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Review
A review of prophylactic human papillomavirus vaccines: recommendations and monitoring in the US.
It has been estimated that genital human papillomavirus (HPV) is the most common sexually transmitted infection in the US. Nononcogenic types, such as HPV type 6 (HPV-6) and HPV-11, can cause benign or low-grade cervical cell changes, genital warts, and recurrent respiratory papillomatosis. Oncogenic types can cause cervical and other anogenital cancers; oncogenic HPV types are detected in 99% of cervical cancers worldwide. ⋯ Currently in the US, the quadrivalent HPV vaccine is recommended for routine immunization of girls aged 11 and 12 years, and catch-up immunization is recommended through age 26 years. Monitoring the impact of prophylactic HPV vaccines will be useful for understanding the population level impact of vaccination. In this report, the authors provide a brief review of the epidemiology of HPV infection and an overview of prophylactic HPV vaccines and postvaccine licensure monitoring.
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Up to 17% of men with a prostate-specific antigen (PSA) level below the accepted prostate biopsy cutoff of 2.5 ng/mL may have prostate cancer. Because identification of these patients represents a difficult task, we assessed the ability of percent free PSA to discriminate between benign and malignant prostate biopsy outcomes in men with PSA < or =2.5 ng/mL. ⋯ The risk of prostate cancer is clearly non-negligible in patients with PSA < or =2.5 ng/mL. The percent free PSA can accurately predict the prevalence of prostate cancer at prostate biopsy in these individuals.