Epidemiology Of Cervical Cancer Research Articles

Carcinogenesis and epidemiology of cervical cancer: The hallmark of human papillomavirus-associated cancer.

Cervical cancer affects women worldwide and is the most common human papillomavirus (HPV)-associated cancer. Carcinogenesis caused by HPV results in specific cancer behavior because of the underlying viral infection. The mechanism and timing of the transformation from viral infection to cancer cells have been elucidated in detail. Treatments for this cancer are based on its characteristics and are being implemented. Moreover, HPV infection is widespread worldwide and is transmitted through sexual activity. Although the HPV vaccination is the most effective strategy of preventing cervical cancer, it is not feasible to vaccinate the entire human population especially in low- and middle-income countries. In order to consider the next step for HPV vaccination, we need to understand the characteristics of HPV carcinogenesis and cervical cancer. Additionally, treatment aimed at preservation of reproductive function in patients with cervical cancer is often required, as the cervix is a reproductive organ and because the disease is more prevalent in the adolescent and young adult generation. Thus, there are still many challenges in the diagnosis, treatment, and prevention of cervical cancer.

Epidemiology of cervical cancer and HPV infection in Asia and Oceania.

Cancer will continue to be a major source of morbidity and mortality globally during the foreseeable future. Human papillomavirus (HPV)-related cancer is now a serious problem in both women and men. The most common HPV-related cancer is cervical cancer in females and oropharyngeal cancer in males. Eastern Africa has a high age-standardized incidence of HPV-related cancers, followed in order by Southern Africa, Central Africa, and then the rest of Africa. Among Asian and Oceania countries, Fiji, Papua New Guinea, Solomon Islands, Indonesia, Maldives, and Myanmar have extremely high age-standardized incidences and mortality. Oropharyngeal cancer is less common than cervical cancer, but the age-standardized incidence, for both females and males, is higher in Western Europe, Northern Europe, North America, and Australia/New Zealand. Oropharyngeal cancer incidence rates differ significantly from the rates of cervical cancer within the same countries. In Asia and Oceania, the incidence of oropharyngeal cancer is particularly high among females in Bhutan, Bangladesh, and Australia, and it is highest among males in Bangladesh, New Caledonia, Australia, and French Polynesia. To a certain extent, cervical cancer can be reduced through the development of cervical screening programs and improvements in screening uptake. On the other hand, for oropharyngeal cancer, as of yet, no effective means of cancer screening has been established. Widespread uptake of HPV vaccine will contribute to the reduction of HPV-related cancers in Asia and Oceania, but also in the rest of the world.

Epidemiology of cervical cancer in Iran in 2016: A nationwide study of incidence and regional variation.

Cervical cancer is a common, and fatal cancer in women worldwide. This cancer is the fourth most common cancer in women after breast, colorectal, and lung cancer. This study aims to investigate the age-standardized incidence rate (ASR) and the geographical distribution of Cervical Cancer in Iran. This study was designed as a descriptive cross-sectional investigation. The study sample comprised all individuals registered as cervical cancer patients in the National Cancer Registry system in 2016. The crude rate and ASRfor each province were computed independently. Furthermore, we employed ArcMap10.5 software and geographic information system to conduct an analysis of the gathered data. In order to ascertain the spatial distribution and clustering of cervical cancer incidence, we utilized Moran's I, which measures spatial autocorrelation. We studied a total of 808 cases of cervical cancer with a median age to be 52.19 years (IQR≈1.35). Among these cases, 685 (84.7%) were diagnosed based on the pathological reports with morphological verification, while 81 patients (10.1%) were clinically identified, and 42 cases (5.2%) were diagnosed using the death certificate-only method. Squamous cell carcinoma accounted for 61% of all cases (n = 497). The ASR of cervical cancer in Iran was 1.90 per 100 000 populations. The provincial ASR ranged from 0.29 to 5.03 per 100 000, with the highest rates observed in Golestan (5.03), East Azerbaijan (4.07), and Ilam (3.72). We found no clustering patterns in the distribution of provincial crude, age-specific, and age-standardized incidence rates (p > .05). The incidence of cervical cancer in Iran was lower than the global average, and we did not identify any significant disparities in the incidence rates among the provinces. Although there were differences in incidence rates among the areas, these were not clustered. It is crucial to remember that cervical cancer is still a major public health issue in Iran, and in order to lessen the disease's burden, national initiatives to enhance screening, early identification, and access to efficient treatment should continue to be top priorities.

EPH132 Epidemiology of Breast and Cervical Cancer in Women of the Colombian Caribbean Region During 2018-2021

EPH132 Epidemiology of Breast and Cervical Cancer in Women of the Colombian Caribbean Region During 2018-2021

Epidemiology of Cervical Cancer in the Caribbean.

Cervical cancer (CvC) is considered a preventable disease; however, in the Caribbean, it is still one of the fourth most common causes of death in women. Efforts to overcome obstacles to the treatment and control of this preventable disease are being made by several countries within the Caribbean. However, no health issue can be readily managed without first acquiring an understanding of the dynamics relating to its severity of impact reaching the target population, its clinical pathology, and the availability of treatment and/or preventative measures to control or halt its progression. To assess the status of CvC in the Caribbean, a review of the literature was conducted using PubMed.The Caribbean was defined in the review as comprising nations and islands whose coastlines are touched by the Caribbean Sea. This led to an assessment of the available literature on CvC for 33 Caribbean territories. The review showed a lack of published information on CvC and highlights the need for greater research. This also serves as a template for subsequent investigations.

Epidemiology and survival outcomes of HIV-associated cervical cancer in Nigeria.

Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America's National Institutes of Health/National Cancer Institute funded project titled 'Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria'. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan-Meier and compared between groups using the log-rank test. A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC +), and 47 (19.7%) were HIV-positive (HIV +/ICC +). The HIV +/ICC + patients were younger with median age 46 (IQR: 40-51) years compared to 57 (IQR: 45-66) among HIV-/ICC + (P < 0.001). Squamous cell carcinoma was the commonest histopathologic variant in 80.4% of ICC diagnosis, moderately differentiated tumor grade in 68.1% in both groups. HIV +/ICC + diagnosis was at FIGO advanced stages in 64.9% compared to 47.9% in HIV-/ICC +. The HIV-/ICC + women had better OS compared to HIV +/ICC + participants (p = 0.018), with 12-month OS 84.1% (95%CI 75-90%) and 67.6% (95%CI 42-84%) respectively. ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival.

Epidemiology of cervical cancer in elderly women: Analysis of incidence, treatment, and survival using German registry data.

Cervical cancer (CC) screening is generally recommended until age 65. The incidence of CC could be underestimated, particularly in older women, due to a lack of hysterectomy correction. Furthermore, elderly women (≥65 years) are more often diagnosed with late-stage disease and have worse outcomes than younger patients. This study aims to provide an in-depth overview of CC in Germany. Incidence rates of CC (ICD-10 C53) were determined using data from the German Centre of Cancer Registry data (ZfKD) of six federal state registries. Incidence was corrected by using hysterectomy prevalence values from a real-world study. The distribution of treatment modalities (surgery, chemotherapy, radiation therapy) was assessed. Relative survival was calculated using the period approach (2011-2015). Survival was stratified by tumor (T) stage and histological type. In total, 14,528 CC cases were included, 27.6% of which occurred in elderly women. Cumulative (2001-2015) age-standardized incidence rates were 12.5 per 100,000 women without hysterectomy correction and 15.5 per 100,000 women after hysterectomy correction (+24% relative change). A lower proportion of elderly women were treated, especially in advanced tumor stages. Younger women (20-64 years) had a higher 5-year relative survival compared to elderly women: 76.7% versus 46.9%, respectively. Survival was worse with increasing stage and for glandular histological subgroups, particularly among elderly women. CC incidence in elderly women is underestimated and survival is lower compared to younger women in Germany. Due to the high disease burden in elderly women, screening and treatment strategies need to be improved.

Cervical Cancer Screening and Prevention in Low- and Middle-Income Countries: A Perspective from Bangladesh

Cervical cancer is a major public health concern for women worldwide, particularly in low- and middle-come countries (LMICs). Despite a large number of women (nearly 58 million) are at risk of this preventable cancer, the issue of cervical cancer has not become a public health priority in Bangladesh. The understanding of the challenges and opportunities in Bangladesh about cervical cancer would provide valuable insights for other LMICs also. In this article, we review the epidemiology, risk factors, awareness and treatment of cervical cancer in the context of Bangladesh. Due to lack of awareness and an organized national screening program, the majority of patients are generally diagnosed at the advantaged stages of disease, in spite of having a big window of screening opportunity at precancer stage. Most LMICs lack resources for developing a parallel health service system dedicated for cancer prevention and management. In this context, we propose some recommendations including a cost-effective screening strategy by capitalizing available resources of COVID-19 diagnostic and GenXpert labs, and an innovative female-centric primary healthcare workers and high school-based approaches for generating awareness on cervical cancer risk factors, screening and vaccination. Our proposed strategy could also be effective for other similar settings in LMICs.&#x0D; Bangladesh J Microbiol, Volume 39, Number 2, December 2022, pp 76-82

Unpacking the Lay Epidemiology of Cervical Cancer: A Focus Group Study on the Perceptions of Cervical Cancer and Its Prevention among Women Late for Screening in Norway.

Nonattendance for cervical cancer screening is often understood in terms of a lack of 'appropriate' or 'correct' knowledge about the risks and prevention of the disease. Few studies have explored how lay persons-the users themselves-interpret and contextualise scientific knowledge about cervical cancer. In this study, we address the following research question: How is the epidemiology of cervical cancer and its prevention discussed among women who are late for cervical cancer screening in Norway? We completed nine focus group interviews (FGIs) with 41 women who had postponed cervical screening. The analyses were both inductive and explorative, aiming to unpack the complexity of lay understandings of cervical cancer. Interactive associations expressed in the FGIs reflected multiple understandings of aetiology and risk factors, screening, and interpretations of responsibility for acquiring cervical cancer. The term 'candidacy' was employed to provide an enhanced understanding of lay reasoning about the explanations and predictions of cervical cancer, as reflected in the FGIs. Both interpretations of biomedical concepts and cultural values were used to negotiate acceptable and nuanced interpretations of candidacy for cervical cancer. Uncertainties about risk factors for acquiring cervical cancer was an important aspect of such negotiations. The study's findings provide an in-depth understanding of the contexts in which screening may be rendered less relevant or significant for maintaining health. Lay epidemiology should not be considered inappropriate knowledge but rather as a productive component when understanding health behaviours, such as screening attendance.

Epidemiology and survival of cervical cancer in Iran based on national cancer registry data (2008-2014).

Cervical cancer (CC) is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in females worldwide, associated with the incidence of human papillomavirus (HPV) infection. The CC incidence is low in Iran, ranking 11th among cancers. This study aimed to estimate the survival rate of CC and the reasons for its low survival rate based on the data retrieved from the Iranian National Cancer Registry System. In this retrospective cohort study, data for patients diagnosed with CC from 2008 to 2014 were collected and analyzed. The Kaplan-Meier method was used for survival analysis based on epidemiological and clinical factors. A total of 5,304 women were diagnosed from March 10, 2008 to March 9, 2014 and 2,423 patients were followed. The mean age of the cases was 51.91 years, and 65.91% were alive. The 5- and 10-year survival rates were 58% and 50%, respectively, with no difference between younger cases with SCC or AC but better survival rates for older patients with SCC. As a preventable disease, CC is related to biological factors and geographical and sociodemographic indices. Geographical, cultural, and religious behaviors affect the CC incidence and survival. In Iran, the 5-year survival rate ranges from 34% to 70% among different geographic regions. Hence, effective screening based on cultural and sociodemographic issues is recommended.

An overview of cervical cancer epidemiology and prevention in the Baltic States

AimsTo inform future Baltic States-specific policy analyses, we aimed to provide an overview of cervical cancer epidemiology and existing prevention efforts in Estonia, Latvia and Lithuania.MethodsA structured desk review: we compiled and summarized data on current prevention strategies, population demography and epidemiology (high risk human papillomavirus (HPV) prevalence and cervical cancer incidence and mortality over time) for each Baltic State by reviewing published literature and official guidelines, performing registry-based analyses using secondary data and having discussions with experts in each country.ResultsWe observed important similarities in the three Baltic States: high burden of the disease (high incidence and mortality of cervical cancer, changes in TNM (Classification of Malignant Tumors) stage distribution towards later stage at diagnosis), high burden of high-risk HPV in general population and suboptimal implementation of the preventive strategies as low screening and HPV vaccination coverage.ConclusionsCervical cancer remains a substantial health problem in the region and the efforts in addressing barriers by implementing a four-step plan for elimination cervical cancer in Europe should be made. This goal is achievable through evidence-based steps in four key areas: vaccination, screening, treatment, and public awareness.

HPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK.

Cervical cancer is the fourth most common malignancy in females worldwide, and a leading cause of death in the United Kingdom (UK). The human papillomavirus (HPV) is the strongest risk factor for developing cervical intraepithelial neoplasia and cancer. Across the UK, the national HPV immunisation programme, introduced in 2008, has been successful in protecting against HPV-related infections. Furthermore, the National Health Service (NHS) implemented the cytology-based cervical cancer screening service to all females aged 25 to 64, which has observed a decline in cervical cancer incidence. In the UK, there has been an overall decline in age-appropriate coverage since April 2010. In 2019, the COVID-19 pandemic disrupted NHS cancer screening and immunisation programmes, leading to a 6.8% decreased uptake of cervical cancer screening from the previous year. Engagement with screening has also been associated with social deprivation. In England, incidence rates of cervical cancer were reported to be 65% higher in the most deprived areas compared to the least, with lifestyle factors such as cigarette consumption contributing to 21% of cervical cancer cases. In this article, we provide an update on the epidemiology of cervical cancer, and HPV pathogenesis and transmission, along with the current prevention programmes within the NHS.

Maximizing the cost-effectiveness of cervical screening in the context of routine HPV vaccination by optimizing screening strategies with respect to vaccine uptake: a modeling analysis

BackgroundRegarding primary and secondary cervical cancer prevention, the World Health Organization proposed the cervical cancer elimination strategy that requires countries to achieve 90% uptake of human papillomavirus (HPV) vaccines and 70% screening uptake. The optimal cervical screening strategy is likely different for unvaccinated and vaccinated cohorts upon national HPV immunization. However, health authorities typically only provide a one-size-fits-all recommendation for the general population. We aimed to evaluate the cost-effectiveness for determining the optimal screening strategies for vaccinated and unvaccinated cohorts.MethodsWe considered the women population in Hong Kong which has a unique HPV infection and cervical cancer epidemiology compared to other regions in China and Asia. We used mathematical models which comprise a deterministic age-structured compartmental dynamic component and a stochastic individual-based cohort component to evaluate the cost-effectiveness of screening strategies for cervical screening. Following the recommendations in local guidelines in Hong Kong, we considered strategies that involved cytology, HPV testing, or co-testing as primary cervical screening. We also explored the impacts of adopting alternative de-intensified strategies for vaccinated cohorts. The 3-year cytology screening was used as the base comparator while no screening was also considered for vaccinated cohorts. Women’s lifetime life years, quality-adjusted life years, and costs of screening and treatment were estimated from the societal perspective based on the year 2022 and were discounted by 3% annually. Incremental cost-effectiveness ratios (ICERs) were compared to a willingness to pay (WTP) threshold of one gross domestic product per capita (US $47,792). Probabilistic and one-way sensitivity analyses were conducted.ResultsAmong unvaccinated cohorts, the strategy that adds reflex HPV to triage mild cytology abnormality generated more life years saved than cytology-only screening and could be a cost-effective alternative. Among vaccinated cohorts, when vaccine uptake was 85% (based on the uptake in 2022), all guideline-based strategies (including the cytology-only screening) had ICERs above the WTP threshold when compared with no screening if the vaccine-induced protection duration was 20 years or longer. Under the same conditions, HPV testing with genotyping triage had ICERs (compared with no screening) below the WTP threshold if the routine screening interval was lengthened to 10 and 15 years or screening was initiated at ages 30 and 35 years.ConclusionsHPV testing is a cost-effective alternative to cytology for vaccinated cohorts, and the associated optimal screening frequency depends on vaccine uptake. Health authorities should optimize screening recommendations by accounting for population vaccine uptake.

Contributors to cervical cancer disparities in American Indian/ Alaska Native women: Is sufficient research being performed in this population? (572)

<b>Objectives:</b> American Indian/Alaska Native (AIAN) women have 1.5 times the incidence and twice the mortality rate of cervical cancer compared to Non-Hispanic White (NHW) women. This disparity is not limited to cervical cancer but is seen in pap smear screening and HPV vaccination uptake. There appear to be few studies in the literature specific to AI/AN women and the prevention and treatment of cervical cancer. We performed a systematic scoping review to evaluate what is known and what gaps in the literature exist related to cervical cancer and its prevention specific to AI/AN women. <b>Methods:</b> We conducted a systematic scoping review of the literature published between 1990 and 2020 regarding <i>1)</i> cervical cancer epidemiology (incidence, prevalence, and mortality); <i>2)</i> cervical cancer screening and prevention (HPV status, HPV vaccine initiation and completion, cervical cancer screening); and <i>3)</i> cervical cancer diagnoses (presence of cervical dysplasia, and cervical cancer stage) among AI/ANs. Medical Subject Headings (MeSH) terms and key search terms were developed to search PubMed and Scopus databases. Abstracts were separately reviewed and compared; disagreements were discussed, and a consensus was achieved. Data were abstracted for included articles. <b>Results:</b> Our search yielded 515 citations; 146 articles met inclusion criteria and were included in our review. The median impact factor for published articles was 2.14 (0-292). Descriptive studies represented 58.9% of all published articles, followed by observational (23.2%) and interventional studies (11.6%). Cervical cancer screen- ing/dysplasia was the most commonly published topic (50.6%), followed by epidemiologic studies (23.9%), HPV (22.6%), and invasive cancer (2.7%). The Indian Health Service (IHS) regions most heavily represented were the Alaska Area and Great Plains Area (Figure 1). Of the 110 articles in which the funding source was documented, 83.6% were federally funded, 11.8% were funded by a non-profit agency, and the remaining 4.6% were funded by a combination of federal, nonprofit, and/or private industry. <b>Conclusions:</b> AI/AN women continue to experience persistent health disparities related to severe dysplasia and cervical cancer. Our review demonstrates that AI/AN women remain understudied in the literature, with a scant 146 articles published over a 20-year period. We conclude that more resources are needed to be invested in the future to eliminate this preventable cancer in AI/AN women.

International prevalence, patient and disease characteristics, and prognostic factors of locally advanced cervical cancer: A systematic literature review (418)

<b>Objectives:</b> Cervical cancer (CC) epidemiology and natural history are often reported for an overall population; however, focusing on specific groups of patients (pts), such as those with locally advanced CC (LACC), may help to understand the unique risks. We conducted a systematic literature review (SLR) to create a global picture and identify gaps in the prevalence and natural history of LACC. <b>Methods:</b> Literature databases (2010-2020) were searched for English-language observational studies reporting prevalence, pt and disease characteristics, and risk factors for pts with stages IB2-IVA CC. The proportion of pts with LACC (prevalence) in studies of all stages of CC was calculated as follows: <i>1)</i> if stage reported as I/II/III/ IV, stage II/III were deemed LACC; <i>2)</i> if stage reported as <i>in situ</i>/local- ized/regional/distant, regional was deemed LACC per SEER staging; <i>3)</i> if stage reported as FIGO group, IB2-IVA were deemed LACC. For natural history, only characteristics/prognostic factors for overall survival (OS) reported in >7 studies are discussed. <b>Results:</b> Twenty-nine studies reported CC prevalence by disease stage, without population exclusions. Six of these studies reported a high proportion of CC pts with unknown stage: Gulf nations (25%), Trinidad & Tobago (26%), Jordan (28%), South Africa (29-42%), Morocco (36%), and Kenya (54%). For LACC prevalence, the interquartile range was 26-52% among pts with CC. Lower LACC prevalence was observed in North America versus Asia, Europe, and other regions, with Asia having the highest overall prevalence (Table). Thirty studies reported natural history data for LACC pts; 13 in Asia, seven Europe, six US, two Colombia, and two in Africa. Across countries, pts with LACC had a median age of 45-55y (26 studies), Charlson/Deyo comorbidity score of 0 or 1 (seven studies), and low hemoglobin level (seven studies). Stage II was most frequent in Europe, and LACC was split between II and III in the US and Asia (Table). Lymph node (LN) involvement varied, with no clear regional trend (Table). Most studies on prognostic factors of OS for LACC pts found stage III/IVA (8/13 studies), tumor size >4-6 cm (6/9 studies), absence of chemo/ brachytherapy (6/9 studies), and positive LN (6/8 studies) predicted worse OS; age (8/11 studies) was not predictive of OS, with no consensus on histology. <b>Conclusions:</b> Median LACC prevalence was 27-47% among pts with CC globally—this is likely underestimated due to our conservative approach to calculating LACC, as well as limitations within the studies comprising this SLR (e.g., inconsistent use of staging, pts with unknown stage, etc.). Characteristics of pts with LACC were similar globally, but the stage and LN involvement varied regionally. The consensus was that stage, tumor size, treatment type, and LN status were prognostic factors for OS. Continued research and individual local assessment will be critical in aptly identifying LACC pts and their clinical profiles for optimal treatment.

Cervical cancer prevention program in Nepal: A comprehensive "train the trainer" approach.

5530 Background: Cervical cancer is the leading cause of cancer and cancer-related deaths among women in Nepal, due in part to a lack of access to screening and limited medical providers trained to diagnose and treat women with preinvasive cervical disease. Cancer Care Nepal has partnered with The University of Texas MD Anderson Cancer Center (MD Anderson) and the American Society of Clinical Oncology (ASCO) to implement a ‘train the trainer’ (TOT) program to teach visual inspection with acetic acid (VIA), colposcopy, cervical biopsy, cryotherapy, thermal ablation, and loop electrosurgical excision procedure (LEEP). Methods: An initial cervical cancer prevention course was held in Kathmandu, Nepal in November 2019, supported by ASCO and with faculty from Civil Service Hospital, Bhaktapur Cancer Hospital, and National Academy of Medical Sciences and MD Anderson. As a continuation of this program, a TOT course was implemented for local specialists from five participating institutions throughout Nepal to learn how to deliver these trainings. Each participating institution then holds their own local course for nurses and doctors in their region. The training is complemented with monthly Project ECHO (Extension for Community Healthcare Outcomes) telementoring videoconferences. Results: The program was launched in November 2021. To date, two TOT training courses (2-day duration) have been held for clinicians from the 5 participating regions. Due to COVID-19 pandemic travel restrictions, didactic lectures were held virtually with MD Anderson and ASCO staff and included epidemiology of cervical cancer, screening guidelines, colposcopy, and treatment of cervical dysplasia. This was followed by hands-on training using simulation models to teach VIA, colposcopy, ablation and LEEP, led by the Nepalese faculty who had participated in the 2019 course. There were 41 participants in total (23 in the first course and 18 in the second course), including 21 gynecologists, 4 gynecologic oncologists, 1 medical oncologist, 1 general practitioner, and 14 nurses. 39 participants (73%) completed both the pre- and post- survey results. 86% of respondents from the first course and 100% of respondents from the second course reported that they intended to change their practice as a result of knowledge gained from the course. In addition, Cancer Care Nepal became a new hub for Project ECHO and held its first session in January 2022, with 20 participants representing two regions. The specialists from each of the 5 participating sites will be holding local courses for doctors and nurses in their respective regions throughout 2022. Conclusions: Our work shows that the TOT strategy can widen the reach of training in cervical cancer prevention in Nepal. Despite travel restrictions during the COVID-19 pandemic, global health training and mentoring can continue, though they require adaptions and use of virtual platforms.

Knowledge, Attitude, and Practice on Cervical Cancer and HPV Vaccination among Medical Students in Jakarta, Indonesia: A Cross-Sectional Study

BACKGROUND: Cervical cancer is the second-most common cancer in Indonesian women. While the cervical cancer screening has been integrated in Indonesian primary health-care facilities, the HPV vaccination has not yet become a national program. AIM: The objective of this research was to measure the knowledge, attitude, and behavior of medical students in Jakarta toward cervical cancer and its prevention. The result of this study could be implemented to develop a more comprehensive national educational program and public health policy. METHODS: We conducted a cross-sectional study on medical students at 10 different universities in Jakarta, Indonesia. Student’s knowledge, attitude, and behavior were collected through a self-administered online questionnaire consist of a total of 27 questions concerning cervical cancer epidemiology, pathogenesis, screening, diagnosis, and prevention. RESULTS: A total of 2159 medical students participated in this study. More than half (55%) of the students obtained satisfactory knowledge score. The students’ knowledge regarding HPV vaccination was low. However, 87.2% of them agreed to get the HPV vaccination. Only 7.0% had participated in cervical cancer screening program and only 16.8% had received HPV vaccination. Female gender, second or third year of study, and three universities had better odds to have good practice score. CONCLUSION: The knowledge and attitude score did not reflect on student’s practice on cervical cancer and its prevention. Effort to increase the awareness toward cervical cancer should be endorsed through university curriculum and public health policy.

Cervical Cancer in the Baltic States: Can Intelligent and Personalized Cancer Screening Change the Situation?

.The three Baltic States (Estonia, Latvia, and Lithuania) are among the European Union countries with the highest incidence and mortality rates for cervical cancer. In order to tackle this public health challenge, there is an urgent need to implement more advanced and effective methods in cervical cancer prevention in Baltic countries.Nationwide cervical cancer screening programs in the Baltic States commenced in 2004–2009. While the organized screening programs in these countries differ in some relevant details (target age groups, screening interval), the underlying principles and problems, barriers are universal. However, the outcomes of present screening programs are unsatisfactory. In addition, universal screening programs are extremely costly. There is a potential need for more intelligent and personalized cervical cancer screening program. In 2019 the project “Towards elimination of cervical cancer: intelligent and personalized solutions for cancer screening” (2020–2023) was developed with the main objective – to develop improved and personalized cancer screening methods within a sustainable health care system.It is expected, that more sophisticated cervical cancer screening model will be implemented in Estonia, Latvia, and Lithuania, and will have a positive impact to epidemiology of cervical cancer and public health in general.

Epidemiology and diagnosis of cervical cancer

The data of populational and hospital cancer registers, cytological and immunological laboratories of Saint-Petersburg are examined. More than 350 new invasive cervical cancer cases are registered annually. Since 1970 up to 1991 oncological morbidity decreased from 14,7 to 8,1 per 100000 women, but then we witness steady rise of standardized indeces up to 9,9 in 1999. Increasingrate of so called neglectedforms of cervical cancer (III-IV stages), especially amongyoung women, is a disturbing fact. The issues of prophylaxis and early diagnostics of cervical cancer are discussed in the article. The results of cytological and virological examination of women of different contingents are drawn.

Chlamydia trachomatis. Co-factor or factor in cancer of the cervix?

The objective of this article was to review and to analyze the possible role that Chlamydia trachomatis has as a co-factor in the origin and development of cervical cancer. For that purpose, the Latin-American and international bibliography was reviewed using the Pub-Med, Google Scholar, Springer, the Cochrane Library, Embase, Scielo, Imbiomed-L, Redalyc and Latindex databases. The searches included the key words: Chlamydia trachomatis, epidemiology of Chlamydia trachomatis, epidemiology of cervical cancer, Chlamydia trachomatis and infection, Chlamydia trachomatis and inflammation mechanisms, cervical cancer and co-factors, sexually transmitted infections and cervical cancer, cancer and inflammation mechanisms, carcinogenesis, inflammation mechanisms. Publications from 1970 to June 2020 were reviewed and analyzed. This review article analyzes the possible mechanisms that Chlamydia trachomatis could play in the carcinogenesis of the cervical cancer as a co-factor with the human papilloma virus or as an independent factor.