Cervical Cancer Control Research Articles

El cáncer cervical: Nuevas perspectivas de prevención y control

El más importante avance para el control global del cáncer cervical es la emergencia de vacunas profilácticas contra VPH 16 y 18. Se inicia una etapa que cambia el paradigma de prevención y control del cáncer cervical, cuyo impacto en la reducción de la incidencia y mortalidad podrá ser observado por muchos de nosotros en los próximos 20 años. El principal desafío será establecer una respuesta social organizada acorde a nuestra infraestructura física y de recursos humanos, nuestra factibilidad financiera para implementar en el ámbito poblacional las nuevas tecnologías, y muy importantemente, considerar la necesidad de educación y promoción de la salud acordes con las necesidades locales y regionales; todo ello para garantizar uno de los principales derechos a la salud, la equidad de acceso a toda nuestra población.

IL-10 gene promoter and intron polymorphisms as genetic biomarkers of cervical cancer susceptibility among Tunisians

ObjectiveWe investigated the association between polymorphisms in the promoter and intron regions of the interleukin-10 (IL-10) gene with the risk of cervical cancer (CC) in Tunisian patients and control women. MethodsStudy subjects comprised 86 CC cases and 126 control women. Genotyping of IL-10 intron (rs3024491, rs3024490) and promoter (rs1800872, rs1800871, rs1800896) variants was done by real-time PCR, with defined clusters. ResultsThe minor allele frequencies of the five tested IL-10 SNPs were not significantly different between cervical cancer cases and control women. However, significantly higher frequencies of homozygous minor allele-carriers in cases was seen for rs3024490 (P=0.023), rs1800872 (P=0.037), and rs1800871 (P=0.028). IL-10 serum levels were significantly reduced in rs3024490 T/T vs. G/G genotype carriers, and in rs1800871 T/T than C/C genotype carriers. While carriage of rs1800872 and rs3024491 minor allele was associated with reduced IL-10 secretion, this was not statistically significant. Haploview analysis demonstrated high linkage disequilibrium (LD) among the IL10 SNPs studied, and only seven haplotypes were common, capturing 98.8% of the total possible haplotypes. Reduced frequency of haplotypes GTCCA (P<0.001) and TGATG (P<0.001) was seen in cervical cancer cases than in control women, thus conferring disease protection nature to these haplotype. This association remained significant for GTCCA (Pc=0.006) and TGATG (P=0.045) after correcting for multiple comparisons. ConclusionSpecific IL-10 variants (rs3024490, rs1800872, and rs1800871) and haplotype (GTCCA and TGATG) may contribute to the development of cervical cancer among Tunisian women.

Epidemiology of cancers of infectious origin and prevention strategies.

Infectious and parasitic diseases represent the third cause of cancer worldwide. A number of infectious and parasitic agents have been suspected or recognized to be associated with human cancers, including DNA viruses, such as papillomaviruses (several HPV types), herpesviruses (EBV and KSHV), polyomaviruses (SV40, MCV, BK, and JCV), and hepadnaviruses (HBV); RNA viruses, such as flaviviruses (HCV), defective viruses (HDV), and retroviruses (HTLV-I, HTLV-II, HIV-1, HIV-2,HERV-K, and XMRV); bacteria, such as H. pylori, S. typhi, S. bovis, Bartonella, and C. pneumoniae; protozoa, such as P. falciparum; trematodes, such as S. haematobium, S. japonicum, S. mansoni, O. viverrini, O. felineus, and C. sinensis. Each one of the chronic infections with H. pylori, HPV, and HBV/HCV is responsible for approximately the 5% of all human cancers. The primary prevention of infection-related cancers is addressed both to avoidance and eradication of chronic infections and to protection of the host organism. Vaccines provide fundamental tools for the prevention of infectious diseases and related cancers. The large-scale application of the HBV vaccine has already shown to favorably affect the epidemiological burden of primary hepatocellular carcinoma, and HPV vaccines have specifically been designed in order to prevent cervical cancer and other HPV-related cancers. The secondary prevention of infection-associated cancers has already found broad applications in the control of cervical cancer. Detection of early gastric cancer by endoscopy has been applied in Asian countries. Avoidance of local relapses, invasion, and metastasis may be achieved by applying tertiary prevention, which targets specific mechanisms, such as angiogenesis.

CD14+ macrophage-like cells as the linchpin of cervical cancer perpetrated immune suppression and early metastatic spread: A new therapeutic lead?

A number of studies point to an aberrant differentiation and accumulation of CD14+ PD-L1+ M2-macrophage-like cells in the microenvironment of cervical cancer, which promote immunosuppressive conditions and are associated with tumor invasion, angiogenesis and metastasis. Therapeutic targeting of these macrophages may tip the balance in favor of antitumor immunity. Cervical cancer is the fourth most common cancer among women worldwide and is caused by a persistent infection and subsequent integration of high-risk types of the human papillomavirus. Continuous expression of the viral oncoproteins E6 and E7 has been shown essential to maintain the transformed state of infected keratinocytes. As these non-self oncoproteins are immunogenic, cervical cancer requires a highly immune suppressed tumor microenvironment to metastasize through lymphovascular space invasion (LVSI) to the pelvic tumor-draining lymph nodes (TDLN). Unraveling the mechanisms underlying this immune suppression may uncover novel therapeutic targets aimed at loco-regional control of cervical cancer.

Control of cervical cancer: actions taken by nurses based on collective subject discourse

Objetivo: compreender o processo do trabalho do enfermeiro da Estratégia de Saúde da Família (ESF) no controle do câncer do colo do útero do munícipio de Carpina-PE. Métodos: estudo interpretativo com abordagem qualitativa, realizado com onze enfermeiras da ESF. Os dados foram coletados através de entrevista semiestruturada e processados usando a técnica do Discurso do Sujeito Coletivo (DSC). Sendo aprovado pelo CEP com CAAE: 19630113.5.0000.5192. Resultados: após análise, foram estabelecidos cinco temas: estratégias para as ações de educação em saúde; convocando o público para realizar o citopatológico; recomendações acerca do rastreamento; limitações ao rastreamento e adesão ao exame preventivo e redes de atenção à saúde: encaminhamento e acompanhamento das usuárias. Conclusão: os achados do estudo refletem o diagnóstico situacional da região e impulsionam reflexões sobre a assistência prestada pelo enfermeiro da ESF. Descritores: Neoplasias do colo do útero, Atenção primária à saúde, Pesquisa qualitativa.

Cervical Cancer Screening and Sexual Risky Behaviors among a Population of Hispanic Origin

ObjectiveTo assess the prevalence of cervical cancer screening through Papanicolaou (Pap) test utilization and its association with sexual behaviors among a population-based sample of Hispanic women in Puerto Rico (PR). MethodsThis study was a secondary data analysis of the database of a cross-sectional study of HPV infection in PR (2010–2013; n = 554 women). Pap test utilization (past 3 years) was self-reported and sexual risky behavior was defined as an index that considered the following sexual behaviors: early age of sexual debut (≤16 years), 11 or more lifetime sexual partners, and 2 or more sexual partners in the last year. Multivariable logistic regression was used to estimate the magnitude of the association between sexual risk behavior and Pap test utilization, after adjusting for socioeconomic and lifestyles characteristics. ResultsThe overall prevalence of Pap test utilization was 78.0%. Pap test screening varied with sexual behavior, with women with none or one risky sexual behavior having higher odds of Pap test utilization in the past 3 years (odds ratio [OR], 1.74; 95% CI, 1.03–2.93) compared with those with two or three risky sexual behaviors. This difference remained marginally significant (p < .10) after adjusting for age, educational attainment, smoking status and STI history (OR, 1.72; 95% CI, 0.96–3.08). ConclusionsThe prevalence of cervical cancer screening in this population (78%) is still below Healthy People 2020 recommendations (93%). Also, women with risky sexual behaviors are less likely to have been screened. Efforts to promote cervical screening programs should focus on these high-risk women as a method for cervical cancer prevention and control.

Screening history of cervical cancers in Emilia-Romagna, Italy: defining priorities to improve cervical cancer screening.

Most invasive cervical cancers in industrialized countries are due to the lack of Pap test coverage, very few are due to screening failures. This study aimed at quantifying the proportion of invasive cancers occurring in nonscreened or underscreened women and that in women with a previous negative screening, that is, screening failure, during the first two screening rounds (1996-2002) and in the following rounds (2003-2008) in the Emilia-Romagna region. All cases of invasive cancers registered in the regional cancer registry between 1996 and 2008 were classified according to screening history through a record linkage with the screening programme registry. The incidence significantly decreased from 11.6/100 000 to 8.7/100 000; this decrease is due to a reduction in squamous cell cancers (annual percentage change -6.2; confidence interval: -7.8, -4.6) and advanced cancers (annual percentage change -6.6; confidence interval: -8.8, -4.3), whereas adenocarcinomas and microinvasive cancers were essentially stable. The proportion of cancers among women not yet invited and among nonresponders decreased over the two periods, from 45.5 to 33.3%. In contrast, the proportion of women with a previous negative Pap test less than 5 years and 5 years or more before cancer incidence increased from 5.7 to 13.3% and from 0.3 to 5.5%, respectively. Although nonattendance of the screening programme remains the main barrier to cervical cancer control, the introduction of a more sensitive test, such as the human papillomavirus DNA test, could significantly reduce the burden of disease.

Communication Challenges Of Culture And Stigma In The Control Of Cervical Cancer Among Rural Women In Kenya.

The paper is part of the literature review of an ongoing doctorate research on communication challenges in the control of cervical cancer among rural women in Kenya. The paper looks at communication challenges arising from culture and stigma, which contribute to setbacks in the control of cervical cancer among rural women. Culture and stigma are discussed in this paper because they address some of the concerns of the research questions in the study. Cervical cancer is preventable and also treatable at early stages, but statistics from various credible sources worldwide indicate that it is one of the cancers that is high in morbidity rates especially in sub-Saharan Africa. This paper interrogates how culture and stigma pose communication challenges that prevent women from seeking the necessary healthcare in order to achieve the four components of cancer control which are: prevention, detection, treatment and palliative care. The paper uses a qualitative approach in its methodology because the main research takes an interpretivist –constructivist philosophical stance. Recommendations and conclusions made are hoped to contribute knowledge to the field of cervical cancer control especially in rural communities. Key words: cervical cancer, culture, stigma, communication, and qualitative research

HPV vaccination: The most pragmatic cervical cancer primary prevention strategy.

The evidence that high-risk HPV infections cause cervical cancers has led to two new approaches for cervical cancer control: vaccination to prevent HPV infections, and HPV screening to detect and treat cervical precancerous lesions. Two vaccines are currently available: quadrivalent vaccine targeting oncogenic HPV types 16, 18, 6, and 11, and bivalent vaccine targeting HPV 16 and 18. Both vaccines have demonstrated remarkable immunogenicity and substantial protection against persistent infection and high-grade cervical cancer precursors caused by HPV 16 and 18 in HPV-naïve women, and have the potential to prevent 70% of cervical cancers in adequately vaccinated populations. HPV vaccination is now implemented in national programs in 62 countries, including some low- and middle-income countries. The early findings from routine national programs in high-income countries are instructive to encourage low- and middle-income countries with a high risk of cervical cancer to roll out HPV vaccination programs and to introduce resource-appropriate cervical screening programs.

Effect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer (the EMA study): a population-based cluster-randomised trial.

Control of cervical cancer in developing countries has been hampered by a failure to achieve high screening uptake. HPV DNA self-collection could increase screening coverage, but implementation of this technology is difficult in countries of middle and low income. We investigated whether offering HPV DNA self-collection during routine home visits by community health workers could increase cervical screening. We did a population-based cluster-randomised trial in the province of Jujuy, Argentina, between July 1, 2012, and Dec 31, 2012. Community health workers were eligible for the study if they scored highly on a performance score, and women aged 30 years or older were eligible for enrolment by the community health worker. 200 community health workers were randomly allocated in a 1:1 ratio to either the intervention group (offered women the chance to self-collect a sample for cervical screening during a home visit) or the control group (advised women to attend a health clinic for cervical screening). The primary outcome was screening uptake, measured as the proportion of women having any HPV screening test within 6 months of the community health worker visit. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02095561. 100 community health workers were randomly allocated to the intervention group and 100 were assigned to the control group; nine did not take part. 191 participating community health workers (94 in the intervention group and 97 in the control group) initially contacted 7650 women; of 3632 women contacted by community health workers in the intervention group, 3049 agreed to participate; of 4018 women contacted by community health workers in the control group, 2964 agreed to participate. 2618 (86%) of 3049 women in the intervention group had any HPV test within 6 months of the community health worker visit, compared with 599 (20%) of 2964 in the control group (risk ratio 4·02, 95% CI 3·44-4·71). Offering self-collection of samples for HPV testing by community health workers during home visits resulted in a four-fold increase in screening uptake, showing that this strategy is effective to improve cervical screening coverage. This intervention reduces women's barriers to screening and results in a substantial and rapid increase in coverage. Our findings suggest that HPV testing could be extended throughout Argentina and in other countries to increase cervical screening coverage. Instituto Nacional del Cáncer (Argentina).

Cervical cancer control and prevention in Malawi: need for policy improvement.

IntroductionMalawi has the highest incidents of cervical cancer followed by Mozambique and Comoros thus according to the 2014 Africa cervical cancer multi indicator incidence and mortality score card. Despite having an established cervical cancer prevention program, there is low screening coverage. Studies have been carried out to determine socio-cultural and economical barriers to cervical cancer prevention services utilization and very few have concentrated on health system and policy related barriers to cervical cancer prevention and control. The paper presents finding on a qualitative study which carried out to determine the suitability of the national sexual and reproductive health and rights [SRHR] in mitigating challenges in cervical cancer control and prevention.Methodsa desk review of the Malawi National Sexual and Reproductive Health and Rights [SRHR] policy 2009 was done with an aim of understanding its context, goal and objectives. Analysis of the policy history provided insight into the conditions that led to the policy. Policies from countries within the region were referred in the review. Government officials were interviewed to solicit information on the policy.ResultsMalawi does not have a standalone policy on cervical cancer; however, cervical cancer is covered under reproductive cancer theme in the SRHR. Unlike some policies within the region, the Malawian SRHR policy does not mention the age at which the women should be screened, the frequency and who is to do the screening. The policy does not stipulate policy implications on the ministry of health, the SRH programs and health service providers on cervical cancer. Furthermore the policy does not include HPV vaccination as a key component of cervical cancer control and prevention.Conclusionthe policy does not reflect fairly the best attempt to reduce the incidence and mortality of cervical cancer as such we recommend that the Reproductive Health Directorate to consider developing a standalone policy on cervical cancer control and prevention.

Cervical cancer screening coverage in a high-incidence region.

OBJECTIVE To analyze the coverage of a cervical cancer screening program in a city with a high incidence of the disease in addition to the factors associated with non-adherence to the current preventive program.METHODS A cross-sectional study based on household surveys was conducted. The sample was composed of women between 25 and 59 years of age of the city of Boa Vista, RR, Northern Brazil who were covered by the cervical cancer screening program. The cluster sampling method was used. The dependent variable was participation in a women’s health program, defined as undergoing at least one Pap smear in the 36 months prior to the interview; the explanatory variables were extracted from individual data. A generalized linear model was used.RESULTS 603 women were analyzed, with an mean age of 38.2 years (SD = 10.2). Five hundred and seventeen women underwent the screening test, and the prevalence of adherence in the last three years was up to 85.7% (95%CI 82.5;88.5). A high per capita household income and recent medical consultation were associated with the lower rate of not being tested in multivariate analysis. Disease ignorance, causes, and prevention methods were correlated with chances of non-adherence to the screening system; 20.0% of the women were reported to have undergone opportunistic and non-routine screening.CONCLUSIONS The informed level of coverage is high, exceeding the level recommended for the control of cervical cancer. The preventive program appears to be opportunistic in nature, particularly for the most vulnerable women (with low income and little information on the disease). Studies on the diagnostic quality of cervicovaginal cytology and therapeutic schedules for positive cases are necessary for understanding the barriers to the control of cervical cancer.

ANALYSIS OF APOPTOSIS FACTORS IN PATIENTS WITH PREINVASIVE AND INVASIVE CERVICAL CANCER

This article assesses the disturbance degree of apoptotic program in patients with preinvasive and invasive cervical cancer by investigating the expression level of genes of caspases-3, -6, -8 и -9 in mononuclear cells of periphery blood and in tumor tissue on the two regulating levels – on mRNA level (transcriptional) and proteolytic activity (post transcriptional). 75 patients with stage III of cervical intraepithelial neoplasias (CIN) III (middle age of 32,9 ± 7,4),45 patients with stage IA (31,3 ± 6,0), 21 – with stage II (43,6 ± 13,2), 15 – with stage III–IV (46,9 ± 11,1) have been examined. The control group has been formed from 30 almost healthy donors without any cervical pathology and papilloma human virus (control 1) and 30 patients with a preinvasive and microinvasive cervical cancer (control 2). It has been found that in proportion of progress of cervix cancer, the membranous expression of CD95 increases in MPB – fraction (peripheral blood monocytes) when the a CIN and initial stages of cervix cancer, more than two times. Herewith number CD95+-lymphocytes is positively correlated with stage of cervical cancer (r = 0,91; R 2 = 0,82; p << 0,01). It has been found out that the activity gain of caspase-8 (r = 0,92; R 2 = 0,86; p << 0,01), caspase-6 (r = 0,77; R 2 = 0,59; p << 0,01) and reduction activity of caspase-9 (r = –0,60; R 2 = 0,36; p < 0,01) in mononuclear cells of peripheral blood pointed out on the sensitivity increase to Fas-induced apoptosis. Opposite, in tumor tissue, beginning from CIN stage III, apoptosis-resistant phenotype is formed, it were defined by the expression of caspase-3 (r = –0,72; R 2 = 0,52, p < 0,01), caspase-6 (r = –0,59; R 2 = 0, 38; p < 0,01) и caspase-9 (r = –0,67; R 2 = 0,45; p < 0,01) by mRNA level and proteolytic activity. It has been shown, that the cervical cancer development is accompanied by multilateral disturbances of apoptotic processes, which are realized in decreased function of caspases and multilateral resistance of tumor cells in against signals of apoptosis. The obtained results give an opportunity to examine the genes of caspase as a probable prospective biomarkers in complex diagnostic of a CIN and early diagnosis of a cervical cancer (in combination with morphological criteria and other molecular markers of viral origin)

Underutilization of cervical cancer prevention services in low and middle income countries: a review of contributing factors.

This review aims at identifying barriers to utilization of cervical cancer prevention services in low- and middle-income countries. An electronic search was conducted using the following key words, HPV vaccination, screening, barriers, utilization and low and middle income/developed countries. Using the Garrard (1999) Matrix method approach, a modified matrix was designed and used as a data collection tool and data related to each category listed on the tool were entered into a matrix containing columns reflecting the categories. Constant comparative analysis was used to identify thematic categories. 31 articles published between 2001 and 2014 were yielded from the search. Analysis of the contents of the articles showed that the underutilization of cervical cancer screening services in low and middle-income countries is the result of barriers in accessing and utilizing of the prevention services. Though not mutually exclusive, the barriers were categorized in three categories; individual, community and health system related. Individual barriers include lack of awareness and knowledge about risk factors and prevention of cervical cancer. Age, marital status, diffidence, social economic status, cultural and religious belief of the women also determine the women's' willingness to utilize the services. In some communities there is stigma attached to discussing reproductive health issues and this limits the young women's awareness of cervical cancer and its prevention. Understanding individual, community and health system barriers that hinder women's utilization of cervical cancer prevention services is very crucial in designing effective cervical cancer control programs in low- and middle-income countries.

Problemy związane z wykrywaniem raka szyjki macicy w krajach rozwijających się

Problemy związane z wykrywaniem raka szyjki macicy w krajach rozwijających się

Implementation of cervical cancer screening and prevention in China--challenges and reality.

This article summarizes great efforts that Chinese scholars had made in fighting against cervical cancer from aspects of the epidemiology, etiology, population-based screening studies, novel screening technology development, guideline, strategy and policy making and population delivery. After decades of continuous efforts, Chinese scientists successfully translated their scientific discovery to appropriate screening product development and eventually, delivered it to the whole population. We hope our experience could serve as a 'case-story' for cancer prevention in other low- and middle-income countries. Moreover, challenges confronted in the prevention and control of cervical cancer in China are reviewed as well to appeal for future multi-collaborations and potential solutions to acquire the final success of the campaign.

Cervical cancer trends in Mexico: incidence, mortality and research output.

To evaluate the recent incidence and mortality of and scientific research trends in cervical cancer in Mexican females. Data between 2000 and 2010 from the Department of Epidemiology of the Ministry of Health, and International Agency for Research on Cancer (IARC) of World Health Organization were analyzed, and age-standardized rates (ASRs) were calculated. In addition, scientific research data were retrieved from the Web of Science database from 2003 to 2012, using different terms related to cervical cancer. The incidence rate decreased during last five years, while mortality rates showed an annual decrease of 4.93%. A total of 780 articles were retrieved, and the institutions with the majority of publications were National Autonomous University of Mexico (34.87%), Social Security Mexican Institute (16.02%), and National Institute of Cancerology (15%). The main types of research were treatment, diagnosis, and prevention. The above results show that incidence of cervical cancer decreased over time in Mexico during last five years; similarly, the downturn observed in mortality mainly reflects improved survival as a result of earlier diagnosis and cancer treatment. Also, this article demonstrates the usefulness of bibliometrics to address key evaluation questions and to establish priorities, define future areas of research, and develop cervical cancer control strategies in Mexico.

Abstract B69: Outreach efforts for cervical and breast cancer prevention and control in Puerto Rico: Cultivando la Salud

Abstract Background: Research has established that mammograms reduce breast cancer mortality, and regular Pap testing reduces both incidence and mortality from cervical cancer. Despite clear recommendations and benefits, Puerto Rican women remain disproportionally under-screened. Behavioral interventions in PR are scarce, therefore Puerto Rico Cancer Control Outreach Program (PRCCOP) trained lay health workers (Promotoras) to focus on increasing breast and cervical screening practices among non-adherent women. This effort was possible through a partnership with Taller Salud, a community based organization. Objectives: To summarizes the methodology of recruitment and intervention delivery of this population-based intervention among non-adherent women living in Canóvanas, PR. Methods: A systematic random sample of 444 women (236 intervention arm; 208 control arm). Eligible women were: 40+ years old with no mammogram in the past year or 21+ years old with no Pap test in the last 3 years. According to their non-adherence status, women were assigned to either a Mammography or a Pap group, and randomly assigned to intervention or control groups. We conducted a baseline survey that included questions about history of breast and Pap test screening, knowledge, perceptions and attitudes about breast and cervical cancer screening and sociodemographic characteristics. Promotoras delivered educational sessions to women in the intervention group. Follow-up surveys were conducted four months after the baseline survey (control group) or after intervention delivery (intervention group), to assess self-reported mammogram and Pap test screening rates. Results: Study period was July 2012-July 2013 and included collaboration from 25 interviewers and 12 Promotoras. Trainings for the Promotoras lasted about 8 hours and included topics such as: role of the Promotora, reaching women, finding breast cancer early, breast cancer screening: barriers and responses, Pap Test: barriers and responses, teaching methods, practices session using program materials and resources and referrals. Participation rate for the baseline survey was 94.8%. A total of 210 interventions (88.9%) were completed. Mean age of study participants was 50 ±14.1 years. Eighteen percent of the women 40+ years old reported never having a mammography, while 12.4% of the sample reported never having had a Pap in their lifetime. Over half of the participants had not completed high school (52%) and were married (58%). Almost two thirds of the sample reported having a household gross income of less than $19,999 and 9.5% reported having no medical plan. Fifty percent of the participants reported having Mi Salud, a governmental healthcare plan of Puerto Rico. Conclusions: The experience gained in this educational intervention will help establish similar studies island-wide. It also highlights the need to reach under screened women and maintaining efforts with Community Based Organizations to promote cancer screening among Puerto Rican women. Citation Format: Maria E. Fernandez, Vivian Colon-Lopez, Edna Acosta, Camille Velez, Natalie Fernandez, Marievelisse Soto-Salgado, Erick Suarez, Alana Feldman, Alelí Ayala Marín, Angela Pattatucci. Outreach efforts for cervical and breast cancer prevention and control in Puerto Rico: Cultivando la Salud. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B69. doi:10.1158/1538-7755.DISP13-B69

“I'm Not Ashamed to Talk on It!”: African-American Women's Decisions About Cervical Cancer Prevention and Control in South Carolina

BackgroundCervical cancer disparities persist despite cervical cancer prevention advances and declining mortality rates, particularly among African-American women in the South. The purpose of this qualitative study was to explore behavior, knowledge, and attitudes as influences on health decisions and preferences for cervical cancer prevention and control among African-American women in South Carolina. MethodsData were collected from three focus groups conducted with 28 adult women aged 18 to 70 years in South Carolina. Purposive snowball sampling was employed. Data were coded using a content analysis approach in NVivo 10. Fleiss' kappa coefficient, a measure of interrater reliability, was 0.83. FindingsTwenty-seven participants self-identified as African American. The mean age of focus group participants was 45.3 years. Knowledge of human papillomavirus (HPV) and cervical cancer risk was relatively low. Participants positively viewed cervical cancer screening and HPV vaccination. Lack of health insurance and costs were screening barriers. Providers were viewed as trusted health information sources, yet stigma and fear negatively influenced screening. Cultural identity served as a facilitator and barrier for screening. Motivated by strength, identified as a central to African-American womanhood, participants viewed cervical cancer prevention as an important responsibility. However, the “Strong Black Woman” script, which has been associated with self-care and coping strategies, was also a screening barrier owing to competing priorities. ConclusionsStudy findings provide insight into cervical cancer prevention decision making and support tailored interventions. Culturally relevant interventions may better convey evidence-based messages about advances in cervical cancer prevention and control.

Potential impact of a 9-valent HPV vaccine in HPV-related cervical disease in 4 emerging countries (Brazil, Mexico, India and China)

BackgroundWe estimated the potential impact of an investigational 9-valent human papillomavirus (HPV) vaccine (HPVs 6/11/16/18/31/33/45/52/58) in HPV-related cervical disease in Brazil, Mexico, India and China, to help to formulate recommendations on cervical cancer prevention and control. MethodsEstimations for invasive cervical cancer (ICC) were based on an international study including 1356 HPV-positive cases for the four countries altogether, and estimations for precancerous cervical lesions were extracted from a published meta-analysis including 6 025 HPV-positive women from the four mentioned countries. Globocan 2012 and 2012 World Population Prospects were used to estimate current and future projections of new ICC cases. ResultsCombined proportions of the 9 HPV types in ICC were 88.6% (95%CI: 85.2–91.3) in Brazil, 85.7% (82.3–88.8) in Mexico, 92.2% (87.9–95.3) in India and 97.3% (93.9–99.1) in China. The additional HPV 31/33/45/52/58 proportions were 18.8% (15.3–22.7) in Brazil, 17.6% (14.2–21.2) in Mexico, 11.3% (7.5–16.1) in India and 11.9% (7.5–17.2) in China. HPV6 and 11 single types were not identified in any of the samples.Proportion of the individual 7 high risk HPV types included in the vaccine varied by cytological and histological grades of HPV-positive precancerous cervical lesions. HPV 16 was the dominant type in all lesions, with contributions in low grade lesions ranging from 16.6%(14.3–19.2) in Mexico to 39.8% (30.0–50.2) in India, and contributions in high grade lesions ranging from 43.8% (36.3–51.4) in Mexico to 64.1% (60.6–67.5) in Brazil. After HPV 16, variations in other majors HPV types were observed by country, with an under representation of HPV 18 and 45 compared to ICC. ConclusionThe addition of HPVs 31/33/45/52/58 to HPV types included in current vaccines could increase the ICC preventable fraction in a range of 12 to 19% across the four countries, accounting the 9-types altogether 90% of ICC cases. Assuming the same degree of efficacy of current vaccines, the implementation of the 9-valent HPV vaccine in Brazil, Mexico, India and China would substantially impact on the reduction of the world cervical cancer burden.