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History of Violence is Prevalent in Cancer Patients: Presented at SGO

By Norra MacReady

PALM SPRINGS, C.A. -- March 28, 2006 -- Nearly half of women undergoing treatment for gynecological cancers at a university clinic reported a history of physical or sexual violence, researchers noted here at the 37^th Annual Meeting of the Society of Gynecologic Oncologists (SGO).

These patients were almost 3 times more likely than patients with no history of violence to be diagnosed at a later stage of the disease, despite similar adherence to recommended cancer-screening schedules, said Susan C. Modesitt, MD, assistant professor of gynecologic oncology, University of Kentucky, Lexington, Kentucky, United States.

Of 101 women screened for violence in the study, 26 had breast cancer and 25 each had cancer of the ovary, endometrium, and cervix. A total of 49 patients (49%) reported a history of at least 1 episode of violence during childhood or adulthood, including 27 (55%) with a history of sexual violence. Those women had a mean age of 50 years, compared to a mean of 56 years among women without a violent history (P = .031). These women were also significantly more likely to smoke, to be divorced, to have no commercial health insurance, and to be diagnosed at a later stage of the disease. The groups did not differ with regard to race, cancer type, education level, use of alcohol or drugs, mental health status, or compliance with cancer-screening methods.

On multivariate analysis, only cancer stage retained a significant association with a history of violence, with an odds ratio of 2.6 (P = .08).

There was no association between a history of violence and compliance with recommended cancer-screening guidelines, which was dishearteningly low in both groups, Dr. Modesitt said. Fifty-six percent and 55% of the women followed the recommendations for breast- and cervical-cancer screening, respectively.

The reasons for the relationship between cancer and violence are unclear. Since these women were less likely to have insurance, they may have had less access to health care. It is also possible that the stress of living in violent or chaotic circumstances may impair immune function and may allow tumor cells to flourish.

Information on the prevalence of violence is scarce, but in the National Survey of Violence Against Women, released in July 2000, nearly 25% of the women surveyed reported at least 1 incident of physical or sexual abuse, compared to 7.5% of the men surveyed. Most surprising was Dr. Modesitt's own observation that violence cuts across all races, ages, and educational and socioeconomic levels. She urged all clinicians to incorporate violence screening into patient assessments, and to offer follow-up guidance in the form of information about hot lines, shelters, and counseling for patients with a positive screen.


[Presentation title: The Adverse Impact of a History of Violence in Women Diagnosed with Breast, Cervical, Ovarian, or Endometrial Cancer. Abstract 53]

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