Cervical Cancer Control Program Research Articles

Breast Health Awareness: Understanding Health-Seeking Behavior in Western Kenya.

In Kenya, patients with breast cancer predominantly present with late-stage disease and experience poor outcomes. To promote early-stage diagnosis, we implemented the Academic Model Providing Access to Healthcare (AMPATH) Breast and Cervical Cancer Control Program (ABCCCP) in Western Kenya. The aim of this study was to assess differences between patients presenting to health facilities and health fairs. This was an institutional Review and Ethics Commitee-approved retrospective cohort study of all individuals who underwent clinical breast examination (CBE) via local healthcare workers in Western Kenya. From 2017 to 2021, the program hosted health fairs, and trained healthcare providers at health facilities to complete CBEs. Results were analyzed using the Chi-square and Kruskal-Wallis tests, with an α < 0.05. Over a 5-year period, the ABCCCP completed 61,812 CBEs with 75.9% (n=46,902) performed at a health facility. Patients presenting to health fairs were older (44 vs. 38 years; p < 0.0001) and had higher risk factor rates including early menarche, family history of breast and ovarian cancer, and use of alcohol or smoking. Only 27.6% of patients with an abnormal CBE underwent core needle biopsy, and only 5.2% underwent repeat CBE over the 5-year period, of whom 90.3% presented to health facilities. Successful uptake of CBE through the ABCCCP is the first step to introduce breast health awareness (BHA). Benefits of broad advertisements for health fairs in promoting BHA may be limited to a single event. Poor rates of repeat examinations and diagnostic testing of abnormal CBEs indicate additional resources should be allocated to educating patients, including about possible treatment trajectories for breast cancer.

Women and health providers' perspectives on male support for cervical cancer screening in Gwanda district, Zimbabwe.

Several studies have shown that male involvement increases the uptake of sexual and reproductive health programmes for improved family health outcomes. The role of men in reducing the burden of cervical cancer has however not been researched in Zimbabwe. It is for this reason that this study explores male support for cervical cancer screening programmes from the perspective of women and health providers in the Gwanda district of Zimbabwe. A qualitative approach that engaged thirty-six women aged 25-50 years in focus group discussions, and twenty-five health providers with different roles in the cervical cancer screening programme in in-depth interviews was used to determine their perspectives on male support for cervical cancer screening. Data were analysed thematically using ATLAS.ti Computer Assisted Qualitative data analysis software. Key findings reflected that men lacked knowledge on cervical cancer and its risk factors and prevention. Subsequently, they engaged in sexual behaviours that increased their partners' risk of acquiring Human Papillomavirus infection, the virtually necessary cause of cervical cancer. Furthermore, men did not provide the necessary emotional and financial support for their women to access screening and treatment. Participants were optimistic that innovative awareness creation strategies and intense, sustained cervical cancer education efforts targeting men could increase male partner support. Involvement of community leaders was seen as crucial in the facilitation of male involvement for programme acceptance and improved uptake of cervical cancer screening. Male involvement is seen as an integral component of the cervical cancer prevention and control programme that has to be implemented in Gwanda district to minimise male partner-related barriers to cervical cancer screening. Further research focusing on men is required to identify specific knowledge gaps that would enable development of appropriate strategies that best involve men in cervical cancer prevention and control interventions.

Preventive Oncology International: A brief history of HPV self-collected vaginal specimens for cervical cancer screening

Since 1998, Preventive Oncology International, Inc. (POI) has been at the forefront of studying human papillomavirus (HPV) self-collection for cervical cancer screening, with a significant focus in China. Through multiple clinical trials over the past 25 years, POI has explored various aspects related to self-collection methodologies. In 2004–2006, POI established that self-collection could be equivalent to direct endocervical samples. Subsequently, a large randomized trial involving 10,000 patients in 2010 further confirmed that self-collected vaginal specimens, tested for high-risk HPV (hrHPV) using a PCR-based assay with high analytic sensitivity, could effectively replace endocervical specimens with minimal loss of sensitivity and a slight decrease in specificity. Throughout the years, POI's research has encompassed several crucial topics, including patient acceptance, the development of new cost-effective, simpler, and faster assays, exploring different collection devices, devising efficient methods of specimen transport, and implementing population-based screening systems. The findings strongly support the integration of self-collection methodologies into cervical cancer control programs worldwide, particularly in medically underserved regions. As HPV self-collection continues to evolve, ongoing research and innovations are expected to play a pivotal role in achieving the global mission of combating cervical cancer.

Abstract 77: The Cervical Cancer Treatment Gap Among Mexican Women Without Social Security From 2006-2016 After the Introduction of Public Financing for Treatment

Abstract Purpose: Women in low-and-middle income countries face persistent barriers to cervical cancer treatment. To reduce financial barriers to cervical cancer treatment, in 2005 Mexico implemented public financing for treatment for women with Seguro Popular, a government insurance program for individuals without social security. Methods: We estimated the cervical cancer treatment gap for each year of the 11-year period following this policy change by comparing the number of cervical cancer cases with treatment financed by Seguro Popular with estimates of cervical cancer incident cases among women without social security. We used a nationwide administrative database to estimate the number of women receiving financing for treatment. To estimate the number of incident cervical cancer cases among the population without social security, we used national surveys with information on insurance affiliation and incidence estimates from the Global Burden of Disease Study. Results: From 2006, the first complete year financing for treatment was available, until 2016, the nation-wide treatment gap remained between 0.45 (95% CI 0.43, 0.48) and 0.60 (95% CI 0.59, 0.62). There was no substantial change in the years immediately following the introduction of financing and there was a minimal downward trend over the entire study period (β = -0.012 [95% CI: -.02, -0.001]). The treatment gap was higher in states with greater marginalization. Conclusions: These results suggest that substantial barriers to cervical treatment persisted after the introduction of public financing for treatment among women without social security. Cervical cancer control programs must be strengthened to reduce barriers to treatment, particularly in the most marginalized Mexican states. Citation Format: Sean McClellan, Karla Unger-Saldaña, Priscilla Espinoza-Tamez, Erick Suazo-Zepeda, Michael B. Potter, Salim Abraham Barquet-Muñoz, Leticia Torres-Ibarra, Hector Lamadrid-Figueroa, Martín Lajous. The Cervical Cancer Treatment Gap Among Mexican Women Without Social Security From 2006-2016 After the Introduction of Public Financing for Treatment [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 77.

Abstract 18: Cervical Cancer Prevention and Control in the Pacific: A Comprehensive Systems Based Approach in Yap State, Federated States of Micronesia

Abstract Purpose: The US Affiliated Pacific Islands, is composed of 3 US Territories (Guam, American Samoa, Commonwealth of the Northern Marianas) and 3 Sovereign Nations (Federated States of Micronesia (FSM), Republic of the Marshall Islands, Republic of Palau. The cervical cancer incidence in several of these island nations are amongst the highest globally. This project is designed to implement a sustainable comprehensive cervical cancer (CC) control program to eliminate CC in the island nations. Yap State, FSM an LMIC is a current project site. Planning, over 7 years, was through the Cancer Council of the Pacific Islands. Funding is primarily through a CDC Prevention and Control Capacity Building Grant, and other grant funds. To eliminate cervical cancer in Yap State, FSM through enhanced evidence based public health practices. The primary objective is to increase sustainable capacity to control cervical cancer. Methods: This non-research project is guided by the principles of community-based participatory development/engagement (CBPE), implementation science, transdisciplinary approach, and capacity building. The team is composed of 4 working cores, coordinated and led by an implementation core. The 4 cores are 1.) medical protocol and laboratory support 2.) community engagement and outreach 3.) data and informatics 4.) medical modeling and micro-costing. Capacity building through training and infrastructure development is a key component. Each core works synergistically and interfaces with the Yap Community Advisory Board, which has decision making authority. Results: Working towards cervical cancer control in a small island LMIC nation, with human resource and health infrastructure limitations, geographic challenges require flexibility and patience. The project processes involve multiple iterations, are culturally/geographically nuanced, and requires constant adjustment to national and international agency and medical regulatory bodies. Strong partnerships with health policy leaders, vaccination programs, clinicians is essential. Modelling projections to understand potential outcomes is necessary. Conclusions: Cervical Cancer Prevention and Control in Yap State, FSM an LMIC can be done with close and trusting community engagement that is participatory and capacity building. Building strong relationships with local, national, and international programs necessary. Citation Format: Neal Palafox, James Edilyong, Martina Reichhardt. Cervical Cancer Prevention and Control in the Pacific: A Comprehensive Systems Based Approach in Yap State, Federated States of Micronesia [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 18.

A retrospective analysis of clinicopathological profile and compliance of locally advanced carcinoma cervix patients in the coastal region of Andhra Pradesh, India

Cancer of the cervix is the most common genital tract malignancy in the female and is a major public health problem in developing countries. Study of the sociodemographic data, clinical profile and compliance of patients is the first step in planning preventive measures and treatment facilities.The aims of the study were to determine the sociodemographic data and clinical profile, prognostic factors, compliance to concurrent chemo radiation of cervical cancer patients and study their association with other tumor-related factors.Our study is a record-based retrospective study from a single institution. The data of sociodemographic and clinical factors of 175 cervical cancer patients visited and their compliance to treatment were analyzed over a 2-year period. Data were analyzed using descriptive statistics.The mean age at presentation in our study is 54.8 years. The patients presented with bleeding per vagina as the most common presenting complaint i.e. 42.28%.38.88% patients presented with both bleeding per vagina and white discharge per vagina and 18.85% patients presented with white discharge per vagina.21.14% presented with symptoms less than 1 month, 52 patients presented with symptoms 1to 3 months duration. 49.14% presented with symptoms &amp;#62;3months. In our study, 62.85% patients were married at age &amp;#60; 17&amp;#62; 17 years. squamous cell carcinoma is the most common histology in our study accounting for 85.71% followed by adenocarcinoma 11.42% other histoligies accounted for 2.85%.87.42% were grade 2 histologies. Stage IIB is the most common stage of presentation our study 47.4%. 86.28% patient are compliant with planned treatment (external beam radiotherapy +brachy therapy, 4.57% patients defaulted prior to the start of treatment, 3.42% patients defaulted during external beam radiotherapy, 15.71% defaulted for brachytherapy out of 151 patients who completed planned treatment, 80.79% patients received 5-6 cycles of concurrent ciplatin 40mg/m 2.11.92% were lost to follow up at the end of 1 year.Cervical cancer is a debilitating illness seen to affect mainly elderly women. Late presentation is still the norm, as majority of the patients presented with advanced disease at the time of diagnosis and were treated with radical radiotherapy, with or without chemotherapy. Compliance during treatment was good comparable to the other studies. The response and complication rates were comparable with other datasets. Further, the scope of studying socio-demographic factors is not limited to hospital services, and this information can also be utilized while making public health policies and implementation of cervical cancer control programs.

Cervical cancer prevention program in Mexico disrupted due to COVID-19 pandemic: Challenges and opportunities.

The COVID-19 pandemic disrupted the preventive services for cervical cancer (CC) control programs in Mexico, which will result in increased mortality. This study aims to assess the impact of the pandemic on the interruption of three preventive actions in the CC prevention program in Mexico. This study is a retrospective time series analysis based on administrative records for the uninsured population served by the Mexican Ministry of Health. Patient data were retrieved from the outpatient service information system and the hospital discharge database for the period 2017-2021. Data were aggregated by month, distinguishing a pre-pandemic and a pandemic period, considering April 2020 as the start date of the pandemic. A Poisson time series analysis was used to model seasonal and secular trends. Five process indicators were selected to assess the disruption of the CC program, these were analyzed as monthly data (N=39 pre-pandemic, N=21 during the pandemic). HPV vaccination indicators (number of doses and coverage) and diagnostic characteristics of CC cases were analyzed descriptively. The time elapsed between diagnosis and treatment initiation in CC cases was modeled using restricted cubic splines from robust regression. Annual HPV vaccination coverage declined dramatically after 2019 and was almost null in 2021. The number of positive Papanicolaou smears decreased by 67.8% (90%CI: -72.3, -61.7) in April-December 2020, compared to their expected values without the pandemic. The immediate pandemic shock (April 2020) in the number of first-time and recurrent colposcopies was -80.5% (95%CI:-83.5, -77.0) and -77.9% (95%CI: -81.0, -74.4), respectively. An increasing trend was observed in the proportion of advanced stage and metastatic CC cases. The fraction of CC cases that did not receive medical treatment or surgery increased, as well as CC cases that received late treatment after diagnosis. Our analyses show significant impact of the COVID-19 pandemic with declines at all levels of CC prevention and increasing inequalities. The restarting of the preventive programs against CC in Mexico offers an opportunity to put in place actions to reduce the disparities in the burden of disease between socioeconomic levels.

The trend of change in cervical tumor size and time to death of hospitalized patients in northwestern Ethiopia during 2018-2022: Retrospective study design.

Cervical cancer is the fourthmost common cause of cancer-related death in the world. The objective of this study was to determine factors that affect the longitudinal change of tumor size and the time to death of outpat. A retrospective follow-up study was carried out among 322 randomly selected patients with cervical cancer at the University of Gondar Referral Hospital from May 15,2018 to May 15,2022. Data were extracted from the patient's chart from all patients' data records. Kaplan-Meier estimator, log-rank test, the Cox proportional-hazard model, and the joint model for the two response variables simultaneously were used. Among 322 outpatients with cervical cancer, 148 (46%) of them were human immunodeficiency virus(HIV) positive and 107 (33.3%) of them died. The results of joint and separate models showthat there is an association between survival and the longitudinal data in the analysis; it indicates that there is a dependency between longitudinal terms of cervical tumor size and time-to-death events. A unit centimeter square rise in tumor size, corresponding to an exp(0.8502) = 2.34 times, significantly raised the mortality risk. The study showed that HIV, stage of cancer, treatment, weight, history of abortion, oral contraceptive use, smoking status, and visit time were statistically significant factors for the two outcomes jointly. As a result, adequate health services and adequate resource allocations are critical for cervical cancer control and prevention programs. Therefore, the government should provide adequate funding and well-trained health professionals to hospitals to sustainscreening programs with appropriate coverage of cervical cancer patient treatments.

Human papillomavirus genotype distribution among women with and without cervical cancer: Implication for vaccination and screening in Ghana.

Determining the high-risk human papillomavirus (HR-HPV) genotypes burden in women with and without cervical cancer afford a direct comparison of their relative distributions. This quest is fundamental to implementing a future population-based cervical cancer prevention strategy in Ghana. We estimated the cervical cancer risk by HPV genotypes, and the HPV vaccine-preventable proportion of cervical cancer diagnosed in Ghana. An unmatched case-control study was conducted at the two largest cervical cancer treatment centres in Ghana from 1st October 2014 to 31st May 2015. Cases were women diagnosed with cervical cancer and controls were women without cervical cancer who were seeking care at the two hospitals. Nested multiplex polymerase chain reaction (NM-PCR) was used to detect HPV infection in cervical samples. Logistic regression was used to determine the association between the risk of cervical cancer and identified HPV infection. P ≤0.05 was considered statistically significant. HPV deoxyribonucleic acid (DNA) data were analysed for 177 women with cervical cancer (cases) and 201 without cancer (controls). Cervical cancer was diagnosed at older ages compared to the age at which controls were recruited (median ages, 57 years vs 34 years; p < 0.001). Most women with cervical cancer were more likely to be single with no formal education, unemployed and less likely to live in metropolitan areas compared to women without cervical cancer (all p-value <0.001). HPV DNA was detected in more women with cervical cancer compared to those without cervical cancer (84.8% vs 45.8%). HR-HPV genotypes 16, 18, 45, 35 and 52 were the most common among women with cervical cancer, while 66, 52, 35, 43 and 31 were frequently detected in those without cancer. HPV 66 and 35 were the most dominant non-vaccine genotypes; HPV 66 was more prevalent among women with cervical cancer and HPV 35 in those without cervical cancer. Cervical cancer risk was associated with a positive HPV test (Adjusted OR (AOR): 5.78; 95% CI: 2.92-11.42), infection with any of the HR-HPV genotypes (AOR: 5.56; 95% CI: 3.27-13.16) or multiple HPV infections (AOR: 9.57 95% CI 4.06-22.56). Women with cervical cancer in Ghana have HPV infection with multiple genotypes, including some non-vaccine genotypes, with an estimated cervical cancer risk of about six- to ten-fold in the presence of a positive HPV test. HPV DNA tests and multivalent vaccine targeted at HPV 16, 18, 45 and 35 genotypes will be essential in Ghana's cervical cancer control programme. Large population-based studies are required in countries where cervical cancer is most prevalent to determine non-vaccine HPV genotypes which should be considered for the next-generation HPV vaccines.

Cervical Cancer in SAARC Countries.

Purvish M. ParikhIn the year 2020, a total of 342 000 women were estimated to die of cervical cancer, of which 90%) were expected amongst low- and middle-income countries (LMIC). Globally incidence of cervical cancer has reduced as a result of improved personal hygiene, better living conditions and higher application of opportunistic screening programs. Yet GLOBOCAN shows that absolute number of cases are still increasing. We therefore conducted a 21 question multiple choice questionnaire online survey in Jan 2023 amongst 9 SAARC countries. A total of 367 replies were received and the representative answers for each country are being reported in this manuscript. A good possibility of achieving World Health Assembly target (Nov 17, 2020) was felt only by Bhutan and Nepal. For screening, most countries (Bhutan, India, Myanmar, Nepal, Pakistan and Sri Lanka) recommend for all asymptomatic eligible patients. Public health experts have suggested VIA / VILI as the best solution for LMICs. However, a dual screening strategy (HPV DNA plus) cytology was preferred by doctors in Afghanistan, Bhutan, India, Myanmar, Pakistan and Sri Lanka. Screening, triage and then treatment was the preferred by Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka. HPV vaccination was recommended in all girls between ages 10 to 26 years in Bangladesh, India, Myanmar, Nepal, Pakistan and Sri Lanka. All the 9 countries would use HPV vaccination to all eligible patients if the cost of the vaccine was reasonably low. Our survey clearly outlines challenges faced in tackling cervical cancer in SAARC countries. We also provide consensus regarding several potential solutions that can be used in both public and private cervical cancer control programs.

The associations of tobacco use, sexually transmitted infections, HPV vaccination, and screening with the global incidence of cervical cancer: an ecological time series modeling study.

We aimed to quantify the temporal associations between cervical cancer incidence and cervical cancer-related factors and to predict the number of new cervical cancer cases averted under counterfactual scenarios compared to the status quo scenario. We described temporal trends in cervical cancer and associated factors globally from 1990 to 2019. We then used generalized linear mixed models to explore the impact of tobacco use, sexually transmitted infections (STIs), human papillomavirus (HPV) vaccination, and cervical screening on cervical cancer incidence. A counterfactual analysis was performed to simulate the most effective scenario for reducing cervical cancer incidence. The worldwide incidence of cervical cancer showed a downward trend over the past 3 decades (estimated annual percentage change, -0.72%), although the incidence remained high (>30 cases per 100,000 persons) in sub-Saharan Africa, Latin America, and the Caribbean. Higher smoking and STI prevalence showed significant direct associations with the incidence of cervical cancer, whereas HPV vaccination and screening coverage showed significant inverse associations. If the strategic goals for accelerating the elimination of cervical cancer and tobacco control programs had been achieved in 2019, the largest decrease in the number of new cervical cancer cases would have been observed, with 54,169 fewer new cases of cervical cancer in 2019. Our counterfactual analysis found that a comprehensive intervention program emphasizing scaled-up cervical screening coverage (70%), HPV vaccination coverage (90%), and tobacco control (30% relative reduction) would be the most effective program for reducing cervical cancer incidence.

Mobilizing stakeholders to drive the cervical cancer elimination agenda in Kenya: The national cervical cancer stakeholders' forum 2022.

Kenya is among the nineteen countries in Sub-Saharan Africa with the highest burden of cervical cancer globally. The high burden of cervical cancer in developing countries reflects the absence of effective cervical cancer prevention programs with limited resources invested to provide comprehensive services. We aimed to engage stakeholders in a structured consultative forum, to gain insights and forge effective partnerships to drive the cervical cancer elimination agenda in Kenya. The National Cervical Cancer Stakeholders Consultative Forum was organized as a part of activities to commemorate the National Cervical Cancer Awareness Month on 19th January 2022 in Nairobi, Kenya. The overall goal of the meeting was to provide a forum to sensitize stakeholders on the National Cervical Cancer Prevention and Control Program (NCCP) with a view to strengthen partnerships, increase coordination for improved service delivery and to provide a forum for resource mobilisation and alignment of key stakeholders towards elimination of cervical cancer in Kenya. Nominal group technique was adopted for structured discussions, and the findings analysed to derive key themes. Key challenges to primary and secondary prevention of cervical cancer were identified as low awareness, stigma and misinformation, high unmet need for treatment of early lesions, few health care providers with capacity to screen and treat, inadequate supplies, inefficient health information systems and poor referral pathways. Championing integration of cervical cancer screening and treatment services into routine health programs, strengthening policy implementation and robust monitoring and evaluation were identified as critical interventions. The National Cervical Cancer Stakeholders Forum 2022 provided insights for enabling Kenya to progress on the 2030 elimination targets. Such forums can be useful in bringing all actors together to evaluate achievements and identify opportunities for more effective national cervical cancer prevention and control programs.

Cervical cancer in Nepal: Current screening strategies and challenges.

Nepal has a high burden of cervical cancer primarily due to a limited screening program. Most present with advanced cervical disease. Despite no national cervical cancer control program, Nepal's Ministry of Health and Population has taken many initiatives with various international collaborations in screening, vaccination, and treating pre-invasive and invasive cancer. However, the existing prevention and treatment modalities are dismally inadequate to meet the targets of WHO's cervical cancer eliminative initiative by 2030. We provide an overview of the Ministry of Health and Population, Nepal's efforts to tackle the growing cervical cancer burden in the country. We discuss the challenges and potential solutions that could be practical and augment screening uptakes, such as single-dose vaccination and HPV DNA tests. The screen-and-treat approach on the same day could potentially address treatment delays and follow-up loss after testing positive. Our narrative summary highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.

Comprehensive approach to costing cervical cancer prevention and control: a case study in the United Republic of Tanzania using the Cervical Cancer Prevention and Control Costing (C4P) tool

BackgroundThe World Health Organization (WHO) has developed a costing tool, the Cervical Cancer Prevention and Control Costing (C4P) tool, to estimate the comprehensive cost of cervical cancer primary, secondary and tertiary prevention in low- and middle-income countries. The tool was piloted in the United Republic of Tanzania, a country with a high incidence of cervical cancer with 62.5 cases per 100,000 women in 2020. This paper presents the costing tool methods as well as the results from the pilot in Tanzania.MethodsThe C4P tool estimates the incremental costs of cervical cancer prevention and control programmes. It estimates the financial (monetary costs to the government) and economic costs (opportunity costs). For the pilot, the study team collected data on costs and programme assumptions for human papillomavirus (HPV) vaccination of 14-year-old girls and scaling up of cervical cancer screening (visual inspection with acetic acid and HPV-DNA testing) and treatment for women for 2020–2024. Assumptions were made on how vaccination coverage would increase over the 5 years as well as developing additional screening and treatment capacity through health personnel training and infrastructure strengthening.ResultsThe total financial and economic costs of the comprehensive programme during 2020–2024 are projected to be US$68 million and US$124 million, respectively. The financial and economic costs of a fully immunized girl with HPV vaccine are estimated to be US$6.68 and US$17.31, respectively, while the costs per woman screened for cervical cancer are, on average, US$4.02 and US$5.83, respectively; US$6.44 and US$9.37 for pre-cancer treatment, respectively; and US$101 and US$107 for diagnosis of invasive cancer, respectively. The cost of treating and managing invasive cancer range from US$7.05 and US$7.83 for outpatient palliative care to US$800.21 and US$893.80 for radiotherapy, respectively.ConclusionsThe C4P costing tool can assist national cervical cancer programmes to estimate monetary resources needed as well as opportunity costs of reducing national cervical cancer incidence through primary, secondary and tertiary prevention.

Cervical cancer programme, Kenya, 2011-2020: lessons to guide elimination as a public health problem.

BackgroundCervical cancer is the leading cause of cancer mortality in Kenya, with an estimated 3,200 deaths in 2020. Kenya has implemented cervical cancer interventions for more than a decade. We describe the evolution of the cervical cancer programme over the last 20 years and assess its performance.MethodsWe searched the Ministry of Health’s archives and website (2000–2021) for screening policy documents and assessed them using seven items: situational analysis, objectives, key result areas, implementation framework, resource considerations, monitoring and evaluation and definition of roles/responsibilities. In addition, a trend analysis was performed targeting screening and disease burden indicators in the period 2011–2020, using data from Kenya Health Information System and the Global Burden of Disease database.FindingsPolicy guidance improved over time, but the implementation of screening was poor. Before 2016, a clear leadership and accountability structure was lacking; improvement occurred after the establishment of the National Cancer Control Program. The main health system gaps included the lack of a trained healthcare workforce and poor data collection. Annual screening coverage varied between <1% and 36% of the target population for the year for HIV-negative women and between <1% and 7% for HIV-positive women, from 2011 to 2020. Test positivity for visual inspection with acetic acid was below 5% for most of the period. Compliance to treatment of precancerous lesions ranged between 22% and 39%. The detection rate of cervical cancer ranged between 0.5% and 1.0%. The burden of invasive cervical cancer did not change significantly: world age-standardised incidence and mortality rates of 26.3–27.4 and 16.6–18.0/100,000 women-years, respectively; disability-adjusted life years of 579–624/100,000 life years.ConclusionThe Kenyan cervical cancer control programme suffered from inadequate health system strengthening and poor quality implementation. Evidence-based policy implementation and sustained health system strengthening are necessary to move towards cervical cancer elimination as a public health problem.

Nursing assistance as a precursor for the prevention and monitoring of cervical cancer in the family health strategy

Cervical cancer, also known as cervical cancer, is caused by persistent infection with some types of Human Papillomavirus-HPV (called oncogenic types). In Brazil, it is the third most common malignant neoplasm among women, only surpassed by non-melanoma skin and breast cancers. Health professionals, such as nurses, are able to develop care for women who need attention, in different contexts, especially in carrying out educational activities and in the prevention of cervical cancer. The main strategy used by nursing to detect the disease in Brazil is through the early performance of the preventive cytopathological examination of cervical cancer, popularly known as the Pap smear. This is an Integrative Literature Review (ILR) on nursing care as a precursor to the prevention and monitoring of cervical cancer in the family health strategy. The search for scientific articles took place in the electronic databases/databases: Virtual Health Library (VHL), National Library of Medicine (PUBMED) and Scientific Online Electronic Library (SciELO). For the sample provided, the following inclusion criteria will be used: complete articles available in the integration; published from January/2015 to June/2022. Will be used as inclusion criteria: complete articles available in the integration; published from January/2015 to June/2022. Will be used as inclusion criteria: complete articles available in the integration; published from January/2015 to June/2022.As a member of the Family Health Strategy (ESF), nurses provide contact and interaction between users, the community and professionals, seeking to improve health care actions. According to the Ministry of Health andAccording to the National Cervical Cancer Control Program (PNCCU), the nurse is one of the professionals trained to perform the Pap smear, which is considered the predominant form of screening for Cervical Cancer in women who have had or have sexual intercourse. It is classified as the main strategy to detect lesions early and make the diagnosis of the disease very early, before the woman has symptoms. It is essential to insist on constant educational activities, to take better advantage of the opportunities that the demand for the service makes possible in approaching women on different occasions of attendance at the FHS for various reasons, also providing an opportunity to strengthen the bond between women and nurses.

Reducing Geographic Barriers for Breast Cancer Diagnosis

PURPOSE Increasing travel times to the nearest diagnostic facilities and cancer centers are correlated with decreasing prevalence of breast cancer diagnosis and increasing stage of cancer at diagnosis. Moi Teaching and Referral Hospital (MTRH), in Uasin Gishu County, houses the only public cancer center in western Kenya. A MTRH program, the Academic Model Providing Access to Healthcare Breast and Cervical Cancer Control Program (ABCCCP) hosted health fair breast cancer screening events and mentored nurses at local health facilities to complete clinical breast exams (CBEs). The objective is to understand the effect of the ABCCCP in reducing geographic barriers for breast cancer screening/early diagnosis. METHODS This is a retrospective review of the 61,392 patients who underwent breast cancer screening at a ministry of health facility in western Kenya from 2017-2021. ABCCCP hosted health fairs targeted at communities and mentored nurses at health facilities to complete clinical breast exams (CBEs) to target individual patients. Facility distances from MTRH were mapped via Google Maps. Descriptive analyses were performed to a significance of α &lt; 0.05. RESULTS Two-thirds of the screening/early diagnosis CBEs occurred in five of the 22 counties in western Kenya: Busia, Uasin Gishu, Trans-Nzoia, Bungoma, and Kakamega. However, these five counties only had 25% of all ABCCCP screening sites in western Kenya. Only Uasin Gishu and Kakamega provided chemotherapy while Busia and Trans-Nzoia had additional programming promoting preventative healthcare through integration of community health volunteers. In these five counties, no association between the distance of the ministry of health facilities from MTRH and number of CBEs completed existed. CONCLUSION ABCCCP programming reduced some geographic disparities in breast cancer screening/diagnosis in the top five counties. It may be result of the number of mentored nurses and health fair events. Further work should be completed to understand if a relationship between geographic distance from MTRH and the stage and treatment patterns of these patients is also reduced by ABCCCP.

137P Impact of staffing a breast cancer screening clinic with clinical officers at a public referral center in Western Kenya

Cancer screening relies on effective coordination between specialists and general practitioners; both are in shortage in sub-Saharan Africa. The Academic Model Providing Access to Healthcare Breast and Cervical Cancer Control Program (ABCCCP) addressed this need by training and relying on Clinical Officers (COs) for daily activities. COs are licensed by Kenyan Clinical Officer Council after 3.5 years of training and supplement the provision of primary care. We aimed to understand the impact of three full-time COs who staff a specialty breast cancer screening clinic.

Anal cancer: an essay on etiology, risk conditions, vulnerability, and care of carriers

Introduction: The incidence of anal cancer is influenced by individual factors and socially determined conditions of vulnerability. In Brazil, it has increased in recent decades. A probable explanation for the growing incidence is the low coverage of screening and prevention programs. Objective: The aim of this study was to reflect on risk factors, the need for early diagnosis, and care of people with anal cancer and to associate social vulnerability in the understanding of illness and care in the Unified Health System (SUS). Methods: This is a systematic literature review with consultations carried out in open electronic databases: SciELO, Digital Library of Theses and Dissertations, and CAPES Publications Portal. The descriptors used were “anal cancer,” “anal cytology,” “anal cancer precursor lesions,” “primary prevention,” “integrality in health,” and “public health policies.” Results: Ensuring access to services is a common guideline in the literature. Based on the recovered references, two axes of analysis were built: in the first, ideas to reflect on care with collective health approaches were systematized, mainly on the etiology, biological risk factors, and conditions of vulnerability for cancer development to which the subjects are exposed. In the second, ideas to propose care technologies are put forward, with evidence from similar protocols and policies, especially the “Cervical Cancer Control Program,” which deals with a pathology with cytohistological and etiological similarities, risk factors, diagnostic techniques, and skilled health professionals. Conclusion: The reviewed sources point to the possibility of incorporating, as a SUS policy, large-scale actions of prevention, screening, and early diagnosis, to qualify and expand the initiatives of promotion and care. The professional cytotechnologist can be a decisive factor in the implementation of the care policy, expanding assistance to the population and qualifying the services.

Profile of cervical cancer screening in Campo Grande, Mato Grosso do Sul, Brazil: an evaluative study, 2006-2018.

To assess the coverage and quality of screening by the Cervical Cancer Control Program in Campo Grande, Mato Grosso do Sul, Brazil, between 2006 and 2018. This was a descriptive study of the cytology screening time series among women living in Campo Grande. A descriptive analysis of the demographic characteristics of these women and the quality of the tests performed in the last five years of the period was carried out. Temporal trends were analyzed using polynomial regression models. 578,417 cytology tests were recorded, of which 1.8% showed pre-malignant/malignant cytological changes. There was a 48.4% reduction in the number of tests performed in the Program's target age group. Test positivity varied between 2.2% and 3.3% and the percentage of unsatisfactory samples increased. The cervical cancer screening program has weaknesses that need to be overcome, such as low coverage of the target population, growth in the number of unsatisfactory samples and a low positivity rate.