Abstract
Cervical cancer is the fourth most common cancer among women worldwide. Organized cervical screening and vaccination against human papilloma virus (HPV) have been successful interventions for prevention of invasive cervical cancer (ICC). Because of cultural and religious considerations, ICC has low incidence in Iran and many other Muslim countries. There is no organized cervical screening in these countries. Therefore, ICC is usually diagnosed in advanced stages with poor prognosis in these countries. We performed a priority setting exercise and suggested priorities for prevention of ICC in this setting. We invited experts and researchers to a workshop and asked them to list important suggestions for ICC prevention in Iran. After merging similar items and removing the duplicates, we asked the experts to rank the list of suggested items. We used a strategy grid and Go-zone analysis to determine final list of priorities for ICC prevention in Iran. From 26 final items suggested as priorities for prevention of ICC, the most important priorities were developing national guidelines for cervical screening and quality control protocol for patient follow-up and management of precancerous lesions. In addition, we emphasized considering insurance coverage for cervical screening, public awareness, and research priorities, and establishment of a cervical screening registry. A comprehensive approach and implementation of organized cervical screening program is necessary for prevention of ICC in Iran and other low incidence Muslim countries. Because of high cost for vaccination and low incidence of cervical cancer, we do not recommend HPV vaccination for the time being in Iran.
Highlights
Invasive cervical cancer (ICC) is the fourth most common cancer type among females worldwide.[1]
Top priorities for invasive cervical cancer (ICC) prevention in Iran which were located in the URQ and were both important and feasible include: 1. Developing a national guideline and defining appropriate screening test, starting age and interval for regular screenings; 2
Incidence rate of ICC is relatively low in Iran and other Muslim countries; the patients are diagnosed in advanced stages and experience poor prognosis, leading to a high mortality to incidence ratio (MIR) in these countries
Summary
Invasive cervical cancer (ICC) is the fourth most common cancer type among females worldwide.[1]. Some Muslim women are reluctant to undergo cervical screening.[7,12,13,14,15] in spite of a low incidence rate, patients are usually diagnosed in advance stages and experience a poor prognosis.[16] The resources for public health interventions are always limited, especially in the LMICs and public health organizations should choose among several options available to them They face challenges to prioritize among these options and to select the interventions that may have higher impact on improving the public’s health.[17] The World Health Organization (WHO) considered the research priority setting as “the catalyst for public debate, for bringing together different stakeholders, and for creating networks.”[18] In addition, it was postulated that research priority setting leads to consensus about areas where increased research efforts including coordination, collaboration, and investment will increase the benefit to society.[19] Priority setting is not limited to research programs and it is an important concept in public health programs. The results of this study will help the policy-makers, research community, and other stakeholders to take necessary actions and improve prevention of cervical cancer in the country
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