Cervical Cancer Incidence Rates Research Articles

Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative

Tracking progress and providing timely evidence is a fundamental step forward for countries to remain aligned with the targets set by WHO to eliminate cervical cancer as a public health problem (ie, to reduce the incidence of the disease below a threshold of 4 cases per 100 000 women-years). We aimed to assess the extent of global inequalities in cervical cancer incidence and mortality, based on The Global Cancer Observatory (GLOBOCAN) 2020 estimates, including geographical and socioeconomic development, and temporal aspects. For this analysis, we used the GLOBOCAN 2020 database to estimate the age-specific and age-standardised incidence and mortality rates of cervical cancer per 100 000 women-years for 185 countries or territories aggregated across the 20 UN-defined world regions, and by four-tier levels of the Human Development Index (HDI). Time trends (1988-2017) in incidence were extracted from the Cancer Incidence in Five Continents (CI5) plus database. Mortality estimates were obtained using the most recent national vital registration data from WHO. Globally in 2020, there were an estimated 604 127 cervical cancer cases and 341 831 deaths, with a corresponding age-standardised incidence of 13·3 cases per 100 000 women-years (95% CI 13·3-13·3) and mortality rate of 7·2 deaths per 100 000 women-years (95% CI 7·2-7·3). Cervical cancer incidence ranged from 2·2 (1·9-2·4) in Iraq to 84·6 (74·8-94·3) in Eswatini. Mortality rates ranged from 1·0 (0·8-1·2) in Switzerland to 55·7 (47·7-63·7) in Eswatini. Age-standardised incidence was highest in Malawi (67·9 [95% CI 65·7 -70·1]) and Zambia (65·5 [63·0-67·9]) in Africa, Bolivia (36·6 [35·0-38·2]) and Paraguay (34·1 [32·1-36·1]) in Latin America, Maldives (24·5 [17·0-32·0]) and Indonesia (24·4 [24·2-24·7]) in Asia, and Fiji (29·8 [24·7-35·0]) and Papua New Guinea (29·2 [27·3-31·0]) in Melanesia. A clear socioeconomic gradient exists in cervical cancer, with decreasing rates as HDI increased. Incidence was three times higher in countries with low HDI than countries with very high HDI, whereas mortality rates were six times higher in low HDI countries versus very high HDI countries. In 2020 estimates, a general decline in incidence was observed in most countries of the world with representative trend data, with incidence becoming stable at relatively low levels around 2005 in several high-income countries. By contrast, in the same period incidence increased in some countries in eastern Africa and eastern Europe. We observed different patterns of age-specific incidence between countries with well developed population-based screening and treatment services (eg, Sweden, Australia, and the UK) and countries with insufficient and opportunistic services (eg, Colombia, India, and Uganda). The burden of cervical cancer remains high in many parts of the world, and in most countries, the incidence and mortality of the disease remain much higher than the threshold set by the WHO initiative on cervical cancer elimination. We identified substantial geographical and socioeconomic inequalities in cervical cancer globally, with a clear gradient of increasing rates for countries with lower levels of human development. Our study provides timely evidence and impetus for future strategies that prioritise and accelerate progress towards the WHO elimination targets and, in so doing, address the marked variations in the global cervical cancer landscape today. French Institut National du Cancer, Horizon 2020 Framework Programme for Research and Innovation of the European Commission; and EU4Health Programme.

A Drosophila model of HPV16-induced cancer reveals conserved disease mechanism.

High-risk human papillomaviruses (HR-HPVs) cause almost all cervical cancers and a significant number of vaginal, vulvar, penile, anal, and oropharyngeal cancers. HPV16 and 18 are the most prevalent types among HR-HPVs and together cause more than 70% of all cervical cancers. Low vaccination rate and lack of molecularly-targeted therapeutics for primary therapy have led to a slow reduction in cervical cancer incidence and high mortality rate. Hence, creating new models of HPV-induced cancer that can facilitate understanding of the disease mechanism and identification of key cellular targets of HPV oncogenes are important for development of new interventions. Here in this study, we used the tissue-specific expression technique, Gal4-UAS, to establish the first Drosophila model of HPV16-induced cancer. Using this technique, we expressed HPV16 oncogenes E5, E6, E7 and the human E3 ligase (hUBE3A) specifically in the epithelia of Drosophila eye, which allows simple phenotype scoring without affecting the viability of the organism. We found that, as in human cells, hUBE3A is essential for cellular abnormalities caused by HPV16 oncogenes in flies. Several proteins targeted for degradation by HPV16 oncoproteins in human cells were also reduced in the Drosophila epithelial cells. Cell polarity and adhesion were compromised, resulting in impaired epithelial integrity. Cells did not differentiate to the specific cell types of ommatidia, but instead were transformed into neuron-like cells. These cells extended axon-like structures to connect to each other and exhibited malignant behavior, migrating away to distant sites. Our findings suggest that given the high conservation of genes and signaling pathways between humans and flies, the Drosophila model of HPV16- induced cancer could serve as an excellent model for understanding the disease mechanism and discovery of novel molecularly-targeted therapeutics.

Cervical cancer screening history among women diagnosed with cervical cancer in Estonia 2017-18.

Despite the national cervical cancer screening programme launched in 2006, Estonia has one of the highest cervical cancer incidence rates in Europe. While the overall coverage of cervical cytology is high, the factors related to cancer screening history prior to cancer diagnosis need to be studied. In this study, we aimed to examine the 10-year screening history of women diagnosed with cervical cancer in Estonia in 2017-18, using data collected from laboratory reports from 2007 to 2018. From each report, we extracted information on the date and result of cytology and on the laboratory where the sample was assessed. We analysed these data across cancer histology, the time interval between the last test result and cancer diagnosis and the laboratory type (local or regional). Among 319 women with cervical cancer, 181 (56.7%) did not have any cytology reports available. Among 138 women with at least one cytology, 60% had 1-3, 24% 4-6 and 16% ≥7 tests (mean 3.7) before cancer. In 78% of women, the last test was performed less than 5 years before cancer diagnosis and 62% of these tests did not report any abnormalities. The last cytology results differed significantly between the regional and local laboratories (P = 0.028). Women received the cervical cancer diagnosis in Estonia despite having several screening tests 10 years prior to the diagnosis. The proportion of cytology tests without any abnormalities less than 5 years before the diagnosis was worryingly high and needs further investigation together with the difference between laboratory types.

Estimating the effect of HIV on cervical cancer elimination in South Africa: Comparative modelling of the impact of vaccination and screening.

In 2020, the World Health Organization (WHO) launched its initiative to eliminate cervical cancer as a public health problem. To inform global efforts for countries with high HIV and cervical cancer burden, we assessed the impact of human papillomavirus (HPV) vaccination and cervical cancer screening and treatment in South Africa, on cervical cancer and the potential for achieving elimination before 2120, considering faster HPV disease progression and higher cervical cancer risk among women living with HIV(WLHIV) and HIV interventions. Three independent transmission-dynamic models simulating HIV and HPV infections and disease progression were used to predict the impact on cervical cancer incidence of three scenarios for all women: 1) girls' vaccination (9-14 years old), 2) girls' vaccination plus 1 lifetime cervical screen (at 35 years), and 3) girls' vaccination plus 2 lifetime cervical screens (at 35 and 45 years) and three enhanced scenarios for WLHIV: 4) vaccination of young WLHIV aged 15-24 years, 5) three-yearly cervical screening of WLHIV aged 15-49 years, or 6) both. Vaccination assumed 90% coverage and 100% lifetime protection with the nonavalent vaccine (against HPV-16/18/31/33/45/52/58). Cervical cancer screening assumed HPV testing with uptake increasing from 45% (2023), 70% (2030) to 90% (2045+). We also assumed that UNAIDS 90-90-90 HIV treatment and 70% male circumcision targets are reached by 2030. We examined three elimination thresholds: age-standardised cervical cancer incidence rates below 4 or 10 per 100,000 women-years, and >85% reduction in cervical cancer incidence rate. We conducted sensitivity analyses and presented the median age-standardised predictions of outcomes of the three models (minimum-maximum across models). Girls' vaccination could reduce age-standardised cervical cancer incidence from a median of 47.6 (40.9-79.2) in 2020 to 4.5 (3.2-6.3) per 100,000 women-years by 2120, averting on average ∼4% and ∼46% of age-standardised cumulative cervical cancer cases over 25 and 100 years, respectively, compared to the basecase. Adding 2 lifetime screens helped achieve elimination over the century among all women (2120 cervical cancer incidence: 3.6 (1.9-3.6) per 100,000 women-years), but not among WLHIV (10.8 (5.3-11.6)), and averted more cumulative cancer cases overall (∼45% over 25 years and ∼61% over 100 years compared to basecase) than girls' vaccination alone. Adding three-yearly cervical screening among WLHIV (to girls' vaccination and 2 lifetime cervical screens) further reduced age-standardised cervical cancer incidence to 3.3 (1.8-3.6) per 100,000 women-years overall and to 5.2 (3.9-8.5) among WLHIV by 2120 and averted on average 12-13% additional cumulative cancer cases among all women and 21-24% among WLHIV than girls' vaccination and 2 lifetime cervical screens over 25 years or longer. Long-term vaccine protection and using the nonavalent vaccine was required for elimination. High HPV vaccination coverage of girls and 2 lifetime cervical screens could eliminate cervical cancer among women overall in South Africa by the end of the century and substantially decrease cases among all women and WLHIV over the short and medium term. Cervical cancer elimination in WLHIV would likely require enhanced prevention strategies for WLHIV. Screening of WLHIV remains an important strategy to reduce incidence and alleviate disparities in cervical cancer burden between women with and without HIV, despite HIV interventions scale-up. World Health Organization. National Cancer Institute, National Institutes of Health. MRC Centre for Global Infectious Disease Analysis, UK Medical Research Council. National Institute of Child Health and Human Development research. Cancer Association of South Africa. Canadian Institutes of Health Research and the Fonds de recherche du Québec - Santé research.

HPV Vaccination among Polish Adolescents-Results from POLKA 18 Study.

Human Papillomavirus (HPV) is the main cause of cervical cancer and genital warts and constitutes one of the most common sexually transmitted infections. Cervical cancer is the only reproductive cancer that has a primary prevention programme through the introduction of HPV vaccinations. Even though the majority of European countries have nationally funded HPV vaccination programmes, in Poland these are exclusively local and scarcely funded. Moreover, the majority of local programmes are directed to females only. Meanwhile, Poland has one of the highest cervical cancer incidence rates among high income countries. The aim of this study was to measure HPV vaccination levels among final-year students in Poland and to establish the association between vaccination status and gender, region and level of sexual education received. This study is a part of the POLKA 18 Study, which used original self-reported paper-based questionnaires distributed in schools in six Polish regions. The study was conducted between April and December 2019. The obtained data were analysed in STATA 17. In total, 2701 fully completed questionnaires were collected. Over half of the respondents (58.2%) did not know their HPV vaccination status. Only 16.0% of the respondents replied that they have been vaccinated against HPV (18.2% of females and 14.5% of males). There was no direct association between vaccination status and access to 'family life education' classes. The vaccination level significantly differed among the different regions of Poland (p < 0.0001), with the Śląskie and Wielkopolskie regions achieving the highest rates. At least a quarter of adolescents after their sexual debut have not been vaccinated against HPV. Regions with immunization programmes introduced to their provincial capitals had higher vaccination rates. Our findings indicate the need for the introduction of state-funded vaccination programmes at the national level for the vaccination rate to increase, which will have the potential to decrease cervical cancer incidence in the country.

Disruptions of cytological screening procedures due to the COVID-19 pandemic in Slovakia

Abstract Background During the COVID-19 pandemic, most settings experienced healthcare service disruptions. The majority of cytological screening procedures were postponed to focus on assisting patients infected with COVID-19. In this study, we aimed to analyse the impact of the impact of the COVID-19 pandemic on the uptake of cervical cancer screening in Slovakia. Methods Data on cytological screening procedures were obtained from two of the three health insurance companies in Slovakia for the years 2019 and 2020, covering the population of women aged 15 and older. All data were calculated stratified for age groups. Rates of cytological screenings were calculated as the number of procedures per women registered in the insurance company in the same age group and rate ratios were calculated as ratios of the rates for the years 2020 and 2019 for the same age group. Incidence rates were calculated as the number of newly diagnosed cervical cancer cases per women registered in the insurance company in the respective year. Results Rate ratios of cytological screening procedures revealed that in both examined health insurance companies, the rate of cytological exams was lower in 2020 compared to 2019 (0.95 and 0.89). This was observed across all age groups. The results showed a clear and statistically significant age gradient, indicating that the level of disruption increased with age. The age group 60-69 years had the highest incidence rate of cervical cancer in 2019, at 54.3 per 100 000. In 2020, the highest rate was 48.3 in the age group 50-59 years. The lowest rates were in children and young adults (<20 years). Conclusions This study confirms the significant impact of the pandemic on cervical cancer screening uptake in Slovakia, which may have delayed the diagnosis of cervical cancer into later stages of the disease with a worse prognosis. This may lead to increased mortality and years lived with disability due to this disease in Slovakia. Key messages • Disruptions in cervical cancer screenings were observed in Slovakia during the COVID-19 pandemic which may result in an increase in cervical cancer incidence and mortality. • Strategies should be implemented to maintain cancer screening programs during health emergencies to avoid excessive mortality and morbidity.

Cervical cancer rates in relation to the Roma population distribution in Slovakia in 2013 – 2020

Abstract Background Globally, more than 300 000 women die due to cervical cancer (CC) each year despite its high preventability and treatability in its early stages. This study aimed to analyse CC rates at the regional level in Slovakia from 2013 to 2020 in relation to the distribution of the Roma population. Methods An ecological study was conducted using data obtained from the relevant national and regional authorities in Slovakia. Mortality, incidence, precancerous lesions incidence and the number of colposcopy and oncocytology examinations per 100 000 females 15 years and older were calculated. Linear regression models were performed in the R Project to assess associations between the rates and the estimated percentage of the Roma population at the regional level after adjusting for the unemployment, at-risk-of-poverty rate, and average disposable household income per month. Results CC mortality in Slovakia declined from 10.0 in 2013 to 7.1/100 000 in 2020 (p < 0.05). Average mortality ranged from 5.9 in the Presov region to 10.7 in Kosice. Incidence varied from 108 in 2019 to 160/100 000 in 2017, with the highest average rates in Bratislava and the lowest in Banska Bystrica (194 and 89/100 000). Precancerous lesions incidence rates significantly differed between the regions (400 in Kosice, 984/100 000 in Trnava). The average colposcopy and oncocytology examinations rates were found to be lower in Presov (177 and 226) and Kosice (166 and 223) compared to the other regions (318 and 283/100 000 on average). After adjusting for the selected factors, CC mortality (p < 0.05), incidence (p < 0.05) and both preventive examination rates (p < 0.01) were statistically significantly associated with the percentage of the Roma population. Conclusions Substantial differences in CC rates and preventive examinations were identified at the regional level in Slovakia. To eliminate CC in line with the WHO Global Strategy, suitable approaches to reaching those at the highest risk should be implemented. Key messages • Substantial regional differences in preventive examination and cervical cancer incidence and mortality rates were identified in Slovakia in relation to the distribution of the Roma population. • Strategies to eliminate cervical cancer should be adjusted to the regional differences and seek alternative approaches for implementing screening in hard-to-reach communities at the highest risk.

Modelling cervical cancer elimination using single-visit screening and treatment strategies in the context of high HIV prevalence: estimates for KwaZulu-Natal, South Africa.

IntroductionIn settings with high HIV prevalence, cervical cancer incidence rates are up to six‐fold higher than the global average of 13.1 cases per 100,000 women‐years. To inform strategies for global cervical cancer elimination, we used a dynamic transmission model to evaluate scalable screening and treatment strategies, accounting for HIV‐associated cancer risks and weighing prevention gains against overtreatment.MethodsWe developed a dynamic model of HIV‐HPV co‐infection and disease progression, which we calibrated to KwaZulu‐Natal, South Africa. Our baseline scenario reflects the current practice of HPV vaccination with a multi‐visit screening and treatment strategy involving cytology and colposcopy triage. We evaluated 13 comparator scenarios with increased vaccination coverage and one‐time, two‐time or repeat HIV‐targeted cervical cancer screening with the following single‐visit strategies: HPV DNA testing, HPV genotyping, automated visual evaluation (AVE) and HPV DNA with AVE triage. In all scenarios, HIV antiretroviral therapy, condom use and voluntary male medical circumcision continue at baseline levels. We simulated cancer incidence under each scenario from 2020 to 2120 using the 25 best‐fitting parameter sets. We present the median and range of model output from these simulations to account for parameter uncertainty.ResultsWe estimate that cervical cancer incidence will decrease by 87% with the continuation of current cervical cancer and HIV prevention strategies, from an age‐standardized rate per 100,000 women of 80.4 (range 58.2, 112.1) in 2020 to 10.7 (4.2, 29.9) in 2120. Scenarios scaling up vaccination and single‐visit strategies resulted in near‐ and long‐term gains. With repeat HIV‐targeted screening, incidence rates were projected to be 29–34% lower in 2030 relative to the baseline scenario, and elimination (incidence <4/100,000) was achieved with HPV DNA testing in 2095 and with AVE in 2114. A strategy of HPV DNA with AVE triage optimized the tradeoff between cancer cases averted and overtreatment.ConclusionsSingle‐visit screening strategies could avert a substantial burden of cervical cancer and accelerate progress towards elimination in settings with a high burden of HIV. Increasing the screening frequency among women with HIV and reducing loss‐to‐follow‐up for treatment will be key components of a successful elimination strategy.

The burden of cervical cancer in China.

ObjectiveTrends in the incidence, disability-adjusted life-years (DALYs), and mortality rate of cervical cancer remain unknown.MethodsThe average annual percent changes (AAPCs) and relative risks (RR) in the incidence, DALYs, and mortality rate were determined using a joinpoint regression analysis; the net age, period, and cohort effects on above rates were evaluated.ResultsA significant increase in age-standardized incidence (AAPC, 0.9%; 95CI: 0.8, 1.1) but significant decreases in age-standardized DALYs (AAPC, -0.4%; 95%CI: -0.60, -0.20) and the mortality rate (AAPC, -0.4%; 95CI: -0.6, –0.3) were observed. As for age-specific rates, the incidence was higher in younger age groups, and the DALYs and mortality rate were lower in older age groups. The effects of age included a slight but significant increase in the RR with advancing age from 35 to 94 years; the period effect included a significant increase in the incidence over the 2005–2019 periods; and the cohort effect included a substantial increase in the incidence from earlier to later birth cohorts.ConclusionsThe incidence of cervical cancer increased from 1990 to 2019, particularly in younger age groups, and the DALYs and mortality rate decreased in the older age groups. Furthermore, the incidence increased with age, period, and cohort.

Status of incidence of cervical cancer in the Republic of Tajikistan

Background. Cervical cancer (CC) still occupies a leading position in the structure of oncological diseases in the world. In the Republic of Tajikistan, there is a tendency for the growth of oncological diseases, and CC is consistently ranked second.Objective: comparison of overall incidence rates of CC in the Republic of Tajikistan for the period from 2000 to 2020.Materials and methods. To track the dynamics of CC in the structure of cancer incidence, we studied the data of reports on diseases of malignant neoplasms according to forms No. 7 and No. 35 of the Agency on Statistics under the President of the Republic of Tajikistan for the period 2000–2020.Results. The incidence rates of cervical cancer in the republic ranged from 4.7–8.7 per 100,000 of the female population. A similar incidence of cervical cancer is noted in the most densely populated regions – Khatlon (3.5–9.9 per 100,000 female population) and Sughd (5.9–10.8 per 100,000 female population), lower rates in districts of republican subordination (3.3–7.9 per 100,000 women), and in the Gorno-Badakhshan Autonomous Region, the rates varied from 4.6 to 14.7 per 100,000 women, being the highest. CC most often occurred at the age of 35–64 years. CC can be detected at stages I–II in 65–83 % of cases. In 10–19 %, this is a locally advanced process that characterizes the III stage of the disease, and on average, every tenth patient with CC treats with an advanced process (stage IV). Every year, 50–93 % of patients die from the number of newly diagnosed cases. The highest rates of newly diagnosed cases of malignant neoplasms were noted in the B. Gafurov district – from 154 to 198 patients. In Panjakent and Kushoniyon district, these figures are 7–10 times lower: 27–74 and 23–44 cases, respectively. CC was the leading nosology in the structure of oncological morbidity in the Kushoniyon district, while in the district of B. Gafurov and the city of Penjikent, breast cancer was the leader for all the years under study.Conclusion. Regional features can have a direct impact on the system of practical health care and their ability to provide quality care to the population, i. e. the remoteness and inaccessibility of the regions of residence determine the possibility of providing full-fledged medical care to the population, and, as a result, higher mortality rates from malignant neoplasms, in particular, CC. Consequently, our republic needs new approaches and views to reduce the mortality of women from CC in conditions of limited resources.

Case study of cervical cancer prevention in two sub-Saharan African countries: Rwanda and Sierra Leone.

BackgroundCervical cancer is a public health issue of global concern. It is a preventable disease but continues to threaten the lives of women, especially in developing countries in sub-Saharan Africa.MethodsWe selected two African countries in sub-Saharan Africa (the Republic of Rwanda and the Republic of Sierra Leone) to show a good example of cervical cancer prevention and constrains hindering countries from effectively implementing cervical cancer programs. Secondary data were collected from the World Health Organization (WHO), the International Agency for Research on Cancer (IARC), the Global Burden of Cancer (GLOBOCAN), the United Nations Development Programme (UNDP), and the World Bank and from official websites of the selected countries. A descriptive analysis method was used to source data and compare variables such as the associated factors, disease burden, prevention programs, health workforce, success factors, and challenges.ResultsRwanda achieved 93.3% human papillomavirus (HPV) vaccination of the three doses vaccinating girls in class 6, as a result of effective school-based platform delivery system and community partnership to identify girls who are out of school. Rwanda reduced the historical two-decade gap in vaccine introduction between high- and low-income countries. The country also introduced a nationwide cervical cancer screening and treatment program. An impressive decreased cervical cancer incidence rate in Rwanda in recent years was observed. Sierra Leone lags behind in terms of almost all cervical cancer prevention programs. Therefore, Sierra Leone needs more efforts to implement cervical cancer intervention programs at the national level, including HPV vaccination, and train and increase the number of health professionals, treatment, and palliative care services to accelerate cervical cancer activities.ConclusionThe disease burden of cervical cancer for Rwanda and Sierra Leone is heavy. There remains huge room for improvement in preventing and controlling cervical cancer in these countries. The goal of cervical cancer elimination would not be feasible in countries without the awareness and will of the policymakers and the public, the compliance to fund cervical cancer programs, the prioritization of cervical cancer activities, the availability of resources, the adequate health workforce and infrastructure, the cross-sectional collaboration and planning, inter-sectorial, national, regional, and international partnerships.

Epidemiology of human papillomavirus related cancers in India: findings from the National Cancer Registry Programme.

Human papillomavirus (HPV) causes more than one-fourth of infection related cancers globally. The present study summarises the epidemiology of HPV related cancers in India, with a special focus on cervical and oropharyngeal cancer, utilising the National Cancer Registry Programme (NCRP) data. The data on HPV related cancer incidence and treatment were extracted from 28 population-based and 96 hospital-based cancer registries under the NCRP network. Incidence was presented as rates, clinical extent of disease and treatment provided as percentages. Joinpoint regression analysis was performed to calculate annual percent change in age adjusted incidence rates (AARs) over time. Incidence of HPV related cancers for 2025 was projected. Among all cancers, 7.5% were HPV related cancers. Cervical cancer (87.6%) and oropharyngeal cancer (63.2%) were the most common HPV related cancers in India among females and males, respectively. Cervical cancer was highest in Papumpare district (AAR: 27.7 per 100,000) and oropharyngeal cancer among males in East Khasi Hills district Population Based Cancer Registry (AAR: 11.4 per 100,000). In most PBCRS, cervical cancer incidence rate decreased significantly over the period of time. The majority of these cancers presented at locoregional spread stage of the disease and were treated with chemoradiation. The projected incidence of HPV related cancers is expected to increase to 121,302 by 2025. Implementation of effective prevention and control strategies like HPV vaccination and scaling up of screening could reduce the burden of HPV related cancers. Evidence from NCRP serves as the baseline to monitor the impact of HPV related policies and programmes in improving the outcome and prognosis.

Comparison of Cancer Survival Trends in Hungary in the Periods 2001-2005 and 2011-2015 According to a Population-Based Cancer Registry.

Background: Assessment of population-based cancer survival may provide the most valuable feedback about the effectiveness of oncological surveillance and treatment. Aims: Based on the database of the Hungarian National Cancer Registry, standardized incidence rates of lung, breast, colorectal, prostate and cervical cancer were compared to standardized mortality data of the Hungarian Central Statistical Office in the period between 2001 and 2015. Then survival analysis was performed on cleansed database. Results: The incidence of colorectal, breast and prostate cancer increased, while standardized rates of lung and cervical cancer declined. The survival of colorectal, breast and prostate cancer showed improvement. Contrarily, lung cancer exhibited a mild decline, while that of cervical cancer did not change significantly. In earlier stages survival was improved among almost every studied tumor type, while in advanced stages improvement was not observed. Comparison of stage distribution revealed that in the 2011–2015 period colorectal, breast and prostate cancer cases were diagnosed at earlier stages, while lung and cervical cancer patients were typically discovered at more advanced stages. Discussion: The outcome of advanced cancer treatments is better in earlier stages, which highlighted the importance of screening network. However, growth of oncological treatment costs with longer patient survival imposes a constantly increasing burden on society.

Profiling the real-world management status of high-risk human papillomavirus infection: a protocol to establish a prospective cohort of high-risk human papillomavirus-infected women in Lueyang County, China

IntroductionPersistent infection with high-risk human papillomavirus (hrHPV) is the main cause of cervical cancer. Thus, the effective treatment against HPV represents an opportunity to reduce the incidence of cervical cancer....

Factors Affecting the Cervical Cancer Screening Behaviors of Japanese Women in Their 20s and 30s Using a Health Belief Model: A Cross-Sectional Study.

In recent years, the incidence and mortality rates of cervical cancer (CC) have increased among young women. Cervical cancer screening (CCS) is crucial to reducing the incidence and mortality of CC in a country such as Japan, where it is challenging to raise HPV vaccination rates. The purpose of this study was to identify psychological and personal characteristics relating to CCS participation among young people by using the Health Belief Model (HBM). For this cross-sectional study, an internet survey was conducted between February–March 2018. Based on HBM and personal characteristics, χ2 tests and logistic analyses were used to identify factors influencing CCS. Responses obtained from 816 women in their 20s and 30s were used in the analysis. For HBM-based psychological characteristics, the odds ratios were significantly higher for “cues to participation in screening” and “barriers to participation at the time of cancer screening”, while “barriers to participation before cancer screening” showed significantly lower odds ratios. On the other hand, it was found that the presence of children and having regular health checkups affected the attributes of screening that were significant for decision-making. Therefore, it is important to create proactive measures to encourage younger women to undergo medical examinations.

Pasifika women's knowledge and perceptions of cervical-cancer screening and the implementation of self-testing in Aotearoa New Zealand: A qualitative study

SummaryBackgroundIn Aotearoa New Zealand, Pasifika women have a higher rate of cervical cancer incidence and mortality than European/Other women and a lower screening rate. Despite actions to reduce the barriers, there has been little change in screening coverage for Pasifika women since 2007. Novel strategies are therefore required. Persistent cervical infection with oncogenic human papillomavirus (HPV) causes virtually all cervical cancers and HPV testing will be implemented in Aotearoa in 2023, with women being able to choose to self-test. We undertook a qualitative focus group (FG) study with Pasifika women to explore their perspectives on the barriers to, and facilitators of, HPV self-testing and how best to implement this in Aotearoa.MethodsA trained female Pasifika Research Assistant facilitated participant recruitment and the FGs. Eligible participants self-identified as Pasifika, were aged 30-69 years, in the Wellington area, who had never been screened or who were overdue (≥5 years) for cervical-cancer screening. Recruitment was predominantly through Pasifika key-informant networks and in collaboration with Pasifika primary care providers. Participants were offered face-to-face FGs but, due to occasional Covid-19 restrictions and personal preferences, FGs via Zoom were also used. The FGs were audio-recorded and transcribed verbatim. The FG transcripts were thematically analysed.FindingsSeven FGs were conducted with 24 participants. We identified five main themes around barriers and potential facilitators of HPV self-testing in Pasifika women: 1) perceptions and knowledge of cervical-cancer screening; 2) challenges to engaging in organised cervical screening; 3) perceptions of self-testing for HPV and challenges women face when deciding to self-test; 4) enthusiasm for an HPV self-test; and 5) information and communication. Knowledge about cervical cancer and screening varied considerably among participants, with some never having heard about cervical-cancer screening. The main challenges that were raised were personal privacy and confidentiality and time management. There was consensus around the need for adequate, consistent, and accurate accessible information to boost the confidence of women undertaking self-testing. In general, the participants were eager for self-testing to be made available soon. This was accompanied by the need for the promotion and implementation of self-testing to include a collective/community approach consistent with Pasifika worldviews.InterpretationAlthough participants were enthusiastic about HPV self-testing, multi-level and interacting barriers exist to participation by Pasifika women in HPV self-testing. Implementation of self-testing in Aotearoa New Zealand should be accompanied by clear information about the entire process, using culturally appropriate tailored educational campaigns in different Pasifika languages.FundingThe study was supported by the Collaboration for Cancer Research Aotearoa New Zealand (CCR).

HPV Vaccination Coverage Rate in a Rural Area: An Observational, Retrospective, and Cohort Study.

In order to reduce the incidence and mortality rate of cervical cancer, the World Health Organization (WHO) declared the Global Strategy Goal for 2030, advocating for reaching a vaccination coverage rate of >90% against human papillomavirus for girls by the age of 15 years. The main objectives of this study were (1) to determine the papillomavirus vaccination coverage among women 15–40 years old and (2) to identify the at-risk subgroups and possible barriers to achieving WHO’s 2030 goal. Multicentre, observational, retrospective, and community-based cohort studies were conducted on women from a rural area in southern Catalonia until 31 December 2021. A total of 23,136 women were included, with a mean age of 26.6 (SD = 5.6) years. The average dose number was 1.7 (SD = 0.7). The results showed overall vaccination coverage of 17.4% among the target women. This coverage was unequal across regions (16.6–24.5%, p < 0.001), primary healthcare teams (15.5–24.3%, p < 0.001), and age groups (56.7% (15–19-year-olds) vs. 3.8% (35–40-year-olds), p < 0.001), related to accessibility to vaccination and economic–geographical indicators. Clinical practice guidelines on screening individuals at risk in terms of vaccination access and public vaccination protocols should be implemented in order to improve the vaccination coverage rate.

The Trend and Prediction of Cervical Cancer Incidence in Delhi, India: An Age-Period-Cohort Analysis.

The objective of the study is to assess the trend of age-standardised incidence rate (ASIRs) of cervical cancer, standardised median age at diagnosis, and projection of cervical cancer incidence rate and the number of new cases up to 2030. The projections help in making strategies for resource allocation to circumvent the future burden. The data were extracted from the Delhi population-based cancer registry from 1990 to 2014. Joinpoint regression analysis was applied to ASIRs to assess the trend. The natural cubic splines age-period-cohort (APC) model was fitted to project the incidence rate and incidence cases. The trend of standardised median age at diagnosis and percentage of cervical cancer to total women cancer was also assessed using regression analysis. Projections of new cases are decomposed into three components aging, the structure of the population, and age-specific incidence rate. The age-standardised incidence rate of cervical cancer decreased with an annual decline at a rate of 2.98% (95% CI -3.48 to -2.47) from 1990 to 2014. The standardised median age at diagnosis showed an upward trend with an average annual increase of 0.167 per year and the median age increased by 4.18 years during 25-years period, this change was due to the shifting of the peak from 40-44 in 1990 to 60-64 in 2014. The APC model revealed ASIRs would decline by 43.8% in 2030 compared to average ASIRs 2010-2014, albeit a net 12% increase in the incidence cases. An increase in incidence cases is primarily attributed to the aging of the population and population growth by 38.87% and 33.84% respectively. The trend analysis of cervical cancer ASIRs in pre (< 50 years) and post menopause (≥ 50 years) showed a decreasing trend. However, the ratio of cervical to total women increased over time from 1:1 in 1990 to 2:3 in 2014. The declining trend in ASIRs was observed in Delhi and will continue to decrease up to 2030. The burden of the number of new cases of cervical cancer showed an upward trend primarily due to the aging of the population and shifting of population structure. To counter this big challenge a cost-effective vaccination for vulnerable populations, community-based screening programs, and awareness about cervical cancer prevention might help in eliminating this preventable cancer.

Integrating cervical cancer screening and prevention treatment with voluntary family planning in Mozambique (038)

<b>Objectives:</b> Mozambique has cervical cancer incidence and mortality rates of 50.2 and 38.7 per 100,000 women, respectively. These high rates are due in part to a lack of access to cervical cancer screening and few medical providers skilled in the treatment of women with preinvasive cervical disease. The objective of this study was to develop, implement and test models integrating cervical cancer screening and prevention treatment with voluntary family planning programs using strategies to optimize the uptake and health impact of both services. <b>Methods:</b> Women aged 30 to 49 in Maputo City and Gaza Province, Mozambique, were prospectively enrolled in the study. Women were offered cervical cancer screening and/or voluntary family planning services as appropriate. Women were screened for high-risk human papillomavirus (HPV) DNA using the GeneXpert® (Cepheid Inc, Sunnyvale, CA, USA) platform. Participants were offered self-collection or provider collection of cervicovaginal samples. HPV-positive women underwent a pelvic examination by a nurse and visual assessment for treatment using visual inspection with acetic acid to determine eligibility for ablation. Prior to treatment, a photograph of the cervix was taken for quality assurance. Patients with lesions eligible for ablation underwent thermal ablation (87%) or cryotherapy (13%). If ineligible, women were referred to a gynecologist for evaluation and excisional treatment as appropriate. Local nurses and doctors were trained in cervical cancer screening and treatment of pre-invasive disease. Continuing education sessions were held weekly. Surveys were conducted to evaluate the integration of cervical cancer screening and family planning services, and these results will be reported separately. <b>Results:</b> From January 2020 to July 2021, 4,344 women were enrolled and screened with HPV testing. The median age of participants was 38 years. Among the participants, 45.7% of women were living with HIV (WLWH). The HPV positivity rate was 34.0% overall and 43.6% in WLWH. A total of 96% of the patients chose self-collection of HPV testing. Of the 1,477 HPV-positive women, 87.8% had been evaluated and treated. Treatments included ablation (<i>n</i>=1193, 80.8%), LEEP (<i>n</i>=84, 5.7%) or cold-knife-conization (<i>n</i>=4, 0.3%). Fifteen (1.0%) women were diagnosed with invasive cancer and navigated to gynecologic oncology treatment, whereas 12.2% were lost to follow-up. <b>Conclusions:</b> Preliminarily results indicate it is feasible to screen women for cervical cancer with primary HPV testing using self-collected samples in Mozambique. Almost 90% of screen-positive patients completed follow-up treatment. This study is ongoing, supporting a comprehensive approach to improve screening methods and uptake through integration with voluntary family planning, to test the feasibility of HPV testing and self-collection, and to improve provider education and skills through regular training.

Association between common vaginal and HPV infections and results of cytology test in the Zhoupu District, Shanghai City, China, from 2014 to 2019

BackgroundHPV (human papillomavirus) is an important cause of cervical cancer. Cervical-vaginal infection with pathogens, such as herpes simplex virus (HSV), bacterial vaginosis Trichomonas vaginalis and vaginal candidiasis could be a cofactor. This study aimed to assess the relationship between vaginal infection with HPV genotype and cytology test results and analyze the relationship between vaginal and HPV infections and cervical cancer.MethodsWe performed a district-based study to elucidate the relationship among the vaginal and HPV infections and cervical cancer. We collected the cervical exfoliation data of 23,724 women admitted to the Shanghai Zhoupu Hospital and received ThinPrep cytology test (TCT) and HPV detection between 2014 and 2019.ResultsTotal vaginal infection rate was 5.3%, and the HPV-positive group had a slightly higher vaginal infection rate than the HPV-negative group (P < 0.01). The incidence rate of cervical intraepithelial neoplasia or cervical cancer with vaginal infection was higher than without vaginal infection (P < 0.001).ConclusionHPV/vaginal infection-positive women tended to have abnormal results of TCT. Women with vaginal infection were more likely to develop HPV infection. HSV combined with HPV infection was noted as a causal factor for HSIL.