Papers by Herschel Lawson
Preventing Chronic Disease, 2005
Journal of Lower Genital Tract Disease, 2018
Journal of lower genital tract disease, Jan 19, 2016
Vaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is no... more Vaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (HPV) tests, and clinicians are faced with managing their abnormal results. Our objectives were to review the literature on vaginal cytology and high-risk HPV (hrHPV) testing and to develop guidance for the management of abnormal vaginal screening tests. An electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted. The available literature was too limited to develop evidence-bas...
Obstetrics and gynecology, 2012
In March 2012, the College of American Pathologists and American Society for Colposcopy and Cervi... more In March 2012, the College of American Pathologists and American Society for Colposcopy and Cervical Pathology, in collaboration with 35 stakeholder organizations, convened a consensus conference called the Lower Anogenital Squamous Terminology (LAST) Project. The recommendations of this project include using a uniform, two-tiered terminology to describe the histology of human papillomavirus-associated squamous disease across all anogenital tract tissues: vulva, vagina, cervix, penis, perianus, and anus. The recommended terminology is "low-grade" or "high-grade squamous intraepithelial lesion (SIL)." This terminology is familiar to clinicians, because it parallels the terminology of the Bethesda System cytologic reports. Biopsy results using SIL terminology may be further qualified using "intraepithelial neoplasia" (IN) terminology in parentheses. Laboratory p16 tissue immunostaining is recommended to better classify histopathology lesions that morpholo...
Obstetrics & Gynecology, 2004
To describe results of cervical cytology screening among low-income and uninsured women in the Na... more To describe results of cervical cytology screening among low-income and uninsured women in the National Breast and Cervical Cancer Early Detection Program. METHODS: We analyzed data from 750,591 women who received their first Papanicolaou (Pap) test in the program between July 1995 and March 2001. RESULTS: Nearly 85% of the women were aged 40 years or older. Almost half were members of racial or ethnic minority groups. Overall, the percentage of abnormal Pap test results decreased with increasing age. The rates of cervical intraepithelial neoplasia (CIN) were highest in the younger age groups but the rate of invasive cancer increased with age. White women had the highest age-adjusted percentage of abnormal Pap test results and the highest rate of biopsyconfirmed CIN 2 or worse. CONCLUSIONS: In this nationwide screening program, only 7% of all biopsy-confirmed high-grade cervical lesions (CIN 2 or worse) were invasive cancer. This underscores the success of Pap screening in identifying preinvasive disease and preventing cancer.
Gynecologic oncology, 2015
In 2011, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology,... more In 2011, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology updated screening guidelines for the early detection of cervical cancer and its precursors. Recommended screening strategies were cytology and cotesting (cytology in combination with hrHPV testing). These guidelines also addressed the use of hrHPV testing alone as a primary screening approach, which was not recommended for use at that time. There is now a growing body of evidence for screening with primary hrHPV testing, including a prospective US-based registration study. Thirteen experts including representatives from the Society of Gynecologic Oncology, American Society for Colposcopy and Cervical Pathology, American College of Obstetricians and Gynecologists, American Cancer Society, American Society of Cytopathology, College of American Pathologists, and the American Society for Clinical Pathology, convened to provide interim guidance...
Cancer Causes & Control, 2003
Background: Although clinical breast examinations (CBEs) provide important opportunities to detec... more Background: Although clinical breast examinations (CBEs) provide important opportunities to detect breast cancer, little is known about factors that affect cancer detection during CBEs performed in community settings. To evaluate several potential factors, we analyzed data from 1,056,153 cancer screening records reported to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Methods: Using case-series methods, we compared 2159
Encyclopedia of Cancer and Society
Vaccine, 2008
1. Vaccine. 2008 Mar 14;26 Suppl 1:A33-6. EUROGIN 2007 patient education conference: sharing expe... more 1. Vaccine. 2008 Mar 14;26 Suppl 1:A33-6. EUROGIN 2007 patient education conference: sharing experiences and action in cervical cancer prevention--an overview. Part 2. Pagliusi S, Lawson H, Singer A, Monsonego J. Centers for Disease Control, Atlanta, USA. ...
Obstetrics & Gynecology, 2005
Obstetrics & Gynecology, 1998
T hiS publication, Native Outreach: A Rep011 to American Indian, Alaska Native, and Native Hawaii... more T hiS publication, Native Outreach: A Rep011 to American Indian, Alaska Native, and Native Hawaiian Communities, is significant as it provides needed information on program imple mentation and data to our Native people. Cancer is rapidly becoming a serious threat in our communi ties. It is necessary to become more familiar with this threat and its causes, consequences, and treat ment in order for us to successfully combat this dis ease. This publication contains information not only on the morbidity and mortality of cancers in Native communities but also on projects that are successful and culturally relevant to our communities. This is an important and valuable contribution to our Native people, as it provides information and models that can be referenced and replicated. This is a necessary step in addressing the health of our communities and in helping us set up our own programs. This manuscript is the first of its kind. It is designed to provide essential information to the Native population regarding the problem of cancer in our communities and the identification of what works in cancer prevention and control. Thanks to each of the researchers involved in these projects for their dedication and hard work in cancer control efforts in our American Indian, Alaska Native, and Native Hawaiian communities.
Obstetrics & Gynecology, 2009
To quantify repeat Pap testing and colposcopic biopsies among women in the National Breast and Ce... more To quantify repeat Pap testing and colposcopic biopsies among women in the National Breast and Cervical Cancer Early Detection Program between 2003 and 2006 (N‫.)494,559؍‬ METHODS: Rates of repeat Pap testing (two tests within 9 months) and colposcopic biopsies were estimated along with 95% confidence intervals (CIs). Odds ratios and 95% CIs for receipt of colposcopic biopsy compared with repeat Pap testing were estimated from multivariable logistic regression models. Finally, we estimated positive predictive values and 95% CIs of cervical intraepithelial neoplasia (CIN) 2 or worse (CIN 3, carcinoma in situ, invasive cancer) for two strategies: 1) repeat Pap testing followed by colposcopic biopsy and 2) colposcopic biopsy alone. RESULTS: There were 39,583 and 53,880 women with repeat Pap testing and colposcopic biopsy, respectively, from 2003 to 2006. Overall, age-standardized rates of repeat Pap testing and colposcopic biopsies were 37.2 per 1,000 women and 39.3 per 1,000 women, respectively. Younger women, Hispanic women, and African-American women were more likely to receive colposcopic biopsies compared with repeat Pap tests. Positive predictive values of colposcopic biopsy were highest after abnormal Pap test results (27% after a result of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, 70% after a result of high-grade squamous intraepithelial lesion/ squamous cell cancer). CONCLUSION: Colposcopic biopsies are common among young women after being screened for cervical cancer and, except among those with the most severe Pap test results, may not be efficient in detecting serious disease. These results conflict with current recommendations for less aggressive follow-up for most young women.
New England Journal of Medicine, 2000
Background Previous studies have suggested that women with acute myocardial infarction receive le... more Background Previous studies have suggested that women with acute myocardial infarction receive less aggressive therapy than men. We used data from the Cooperative Cardiovascular Project to determine whether women and men who were ideal candidates for therapy after acute myocardial infarction were treated differently. Methods Information was abstracted from the charts of 138,956 Medicare beneficiaries (49 percent of them women) who had an acute myocardial infarction in 1994 or 1995. Multivariate analysis was used to assess differences between women and men in the medications administered, the procedures used, the assignment of do-not-resuscitate status, and 30day mortality. Results Among ideal candidates for therapy, women in all age groups were less likely to undergo diagnostic catheterization than men. The difference was especially pronounced among older women; for a woman 85 years of age or older, the adjusted relative risk was 0.75 (95 percent confidence interval, 0.68 to 0.83). Women were somewhat less likely than men to receive thrombolytic therapy within 60 minutes (adjusted relative risk, 0.93; 95 percent confidence interval, 0.90 to 0.96) or to receive aspirin within 24 hours after arrival at the hospital (adjusted relative risk, 0.96; 95 percent confidence interval, 0.95 to 0.97), but they were equally likely to receive beta-blockers (adjusted relative risk, 0.99; 95 percent confidence interval, 0.95 to 1.03) and somewhat more likely to receive angiotensin-converting-enzyme inhibitors (adjusted relative risk, 1.05; 95 percent confidence interval, 1.02 to 1.08). Women were more likely than men to have a do-not-resuscitate order in their records (adjusted relative risk, 1.26; 95 percent confidence interval, 1.22 to 1.29). After adjustment, women and men had similar 30-day mortality rates (hazard ratio, 1.02; 95 percent confidence interval, 0.99 to 1.04). Conclusions As compared with men, women receive somewhat less aggressive treatment during the early management of acute myocardial infarction. However, many of these differences are small, and there is no apparent effect on early mortality. (N Engl
New England Journal of Medicine, 2003
Although contemporary guidelines suggest that the intervals between Papanicolaou tests can be ext... more Although contemporary guidelines suggest that the intervals between Papanicolaou tests can be extended to three years among low-risk women with previous negative tests, the excess risk of cervical cancer associated with less frequent than annual screening is uncertain. methods
Journal of Women's Health, 2005
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), administered by the Ce... more The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), administered by the Centers for Disease Control and Prevention (CDC), provides breast and cervical cancer screening to low-income women who are uninsured or underinsured. For women with three consecutive annual Pap tests with normal findings, the NBCCEDP supports extending the screening interval to every 3 years. Thirteen telephone focus groups were conducted with physician providers in 17 states and the District of Columbia to investigate familiarity with NBCCEDP's triennial Pap test policy, the Pap test intervals actually used, and the factors influencing screening interval selection. No participants were familiar with NBCCEDP's triennial Pap test policy, and none reported routinely extending the screening interval after three consecutive annual Pap tests with normal findings. Two patterns of screening interval use were reported: annual screeners continued performing yearly Pap tests, and selective extended screeners offered an extended interval to select patients. Annual and selective extended screeners reported that both unique and common factors influenced the screening intervals they used. The NBCCEDP has established its cancer screening priorities to focus limited resources on the goal of providing services to eligible women who have rarely or never been screened. Increased efforts are needed to educate physicians about the science supporting an extended Pap screening interval and overcome the barriers associated with its adoption.
Journal of Lower Genital Tract Disease, 2014
Vulvodynia is a complex disorder that can be difficult to treat. Most patients describe it as bur... more Vulvodynia is a complex disorder that can be difficult to treat. Most patients describe it as burning, stinging, irritation, or rawness. Vulvodynia is a costly disease both economically and on its negative impact on patient quality of life. Although many treatment options are available, no one treatment is effective for all patients, thus the need to individualize management. Measures such as gentle vulvar care, medication, biofeedback training, physical therapy, sexual counseling and surgery, as well as complementary and alternative therapies are available to treat the condition with varying success. h
Journal of Lower Genital Tract Disease, 2006
To study the tolerability and efficacy of 5% imiquimod cream applied continuously in the primary ... more To study the tolerability and efficacy of 5% imiquimod cream applied continuously in the primary treatment of vulva intraepithelial neoplasia (VIN) grade 2/3. Materials and Methods: VIN grade 2/3 patients were recruited from regional colposcopy units after biopsy confirmation. Imiquimod cream was applied over the abnormal areas by the patient using an escalating-dose regimen of once per week for 2 weeks followed by twice per week for 2 weeks followed by thrice per week for a treatment duration of 16 weeks. Patients were assessed every 2 weeks for examination and support. Colpophotographs of the target areas were obtained at each visit. At the end of the study, repeat colposcopy and biopsy of the target lesion were performed to assess for histological response. Descriptive and W 2 statistics were used as appropriate to describe demographic variables and test for significant association between categorical variables. The Kaplan-Meier method was used to estimate the median time to response. Target accrual was 40 patients using a Simon 2-stage phase 2 design. Results: Twenty-seven patients have been recruited to date. Twenty-three (85%) patients had VIN-3. Eleven (41%) patients had multifocal disease on colposcopy. Therapy was well tolerated, with the most commonly observed side effects being irritation at the application site. Complete histological responses were observed in 10 patients, with partial colposcopic responses in another 13 (relative risk = 85%). The median time to response was 7 weeks. No progression of disease was observed. The need for dose reduction due to side effects was significantly associated with histological response. One patient had a recurrence of her VIN-3 lesion at 6 months' follow-up. No invasive cancer was diagnosed. Recruitment is ongoing, and the results will be presented at the meeting. Conclusions: Imiquimod cream can induce histological regression in most high-grade VIN lesions. This therapy was well tolerated using a slow continuous dose-escalating regimen.
Journal of Lower Genital Tract Disease, 2006
To study the tolerability and efficacy of 5% imiquimod cream applied continuously in the primary ... more To study the tolerability and efficacy of 5% imiquimod cream applied continuously in the primary treatment of vulva intraepithelial neoplasia (VIN) grade 2/3. Materials and Methods: VIN grade 2/3 patients were recruited from regional colposcopy units after biopsy confirmation. Imiquimod cream was applied over the abnormal areas by the patient using an escalating-dose regimen of once per week for 2 weeks followed by twice per week for 2 weeks followed by thrice per week for a treatment duration of 16 weeks. Patients were assessed every 2 weeks for examination and support. Colpophotographs of the target areas were obtained at each visit. At the end of the study, repeat colposcopy and biopsy of the target lesion were performed to assess for histological response. Descriptive and W 2 statistics were used as appropriate to describe demographic variables and test for significant association between categorical variables. The Kaplan-Meier method was used to estimate the median time to response. Target accrual was 40 patients using a Simon 2-stage phase 2 design. Results: Twenty-seven patients have been recruited to date. Twenty-three (85%) patients had VIN-3. Eleven (41%) patients had multifocal disease on colposcopy. Therapy was well tolerated, with the most commonly observed side effects being irritation at the application site. Complete histological responses were observed in 10 patients, with partial colposcopic responses in another 13 (relative risk = 85%). The median time to response was 7 weeks. No progression of disease was observed. The need for dose reduction due to side effects was significantly associated with histological response. One patient had a recurrence of her VIN-3 lesion at 6 months' follow-up. No invasive cancer was diagnosed. Recruitment is ongoing, and the results will be presented at the meeting. Conclusions: Imiquimod cream can induce histological regression in most high-grade VIN lesions. This therapy was well tolerated using a slow continuous dose-escalating regimen.
Journal of Lower Genital Tract Disease, 2008
To assess the management of women in the National Breast and Cervical Cancer Early Detection Prog... more To assess the management of women in the National Breast and Cervical Cancer Early Detection Program with low-grade squamous intraepithelial lesions (LSIL) before and after the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for management of abnormal cytology were published in 2002. We examined the follow-up for 22,342 women with LSIL during 2 periods: 2000-2002 and 2003-2005. The percentage of providers who followed the recommended guidelines with colposcopy for an LSIL Pap test result increased by 9% from the pre-ASCCP to the post-ASCCP period. An increase was seen in every age and racial/ethnic group. Younger women (<30 years) and white women were more likely than comparison groups to be followed by colposcopy rather than a repeat Pap test. The increase in percentage of women having colposcopy in 2003, 1 year after the new guidelines were published, suggests a change in provider practices consistent with those guidelines.
Journal of Lower Genital Tract Disease, 2013
A group of 47 experts representing 23 professional societies, national and international health o... more A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14Y15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group's goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirusYnegative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21Y24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up. h B y 2001, revised Bethesda system terminology for reporting cervical cytology results and the availability of findings from a recent randomized trial of strategies for managing minor cervical cytologic abnormalities had created the need for a standard approach to managing women with abnormal cervical cytology and cervical cancer precursors (1Y3). In response, the American Society for Colposcopy and Cervical Pathology (ASCCP) initiated These guidelines are being published simultaneously in Obstetrics & Gynecology and the
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Papers by Herschel Lawson