Global Burden Of Cervical Cancer Research Articles

Coverage and Socioeconomic Inequalities in Cervical Cancer Screening in Low- and Middle-Income Countries Between 2010 and 2019.

Cervical cancer screening is vital in addressing the global burden of cervical cancer. In this study, we describe the coverage and socioeconomic inequalities in the coverage of cervical cancer screening in low- and middle-income countries (LMICs). We analyzed data from the women's recode files of the Demographic and Health Surveys conducted in LMICs from 2010 to 2019 with variables on cervical cancer screening. We included women 21 years or older and determined the proportion of women who were screened for cervical cancer by age categories, wealth quintile, type of place of residence, level of education, and marital status. Socioeconomic inequality was measured using the concentration index (CIX) and the slope index of inequality (SII). A total of 269,506 women from 20 surveys in 16 countries were included in the survey. Generally, there was a low coverage of screening, with lower rates among women age 21-24 years, living in rural areas, in the poorest wealth quintile, with no formal education, and who have never been in union with or lived with a man. The CIX and SII values for screening for cervical cancer were positive (pro-rich) for all the countries except Tajikistan in 2012 where they were negative (pro-poor). The coverage of cervical cancer screening was low in LMICs with variations by the quintile of wealth (pro-rich) and type of place of residence (pro-urban). To achieve the desired impact of cervical cancer screening services in LMICs, the coverage of cervical cancer screening programs must include women irrespective of the type of place and wealth quintiles.

Analysis of the global burden of cervical cancer in young women aged 15-44 years old.

Understanding the burden of cervical cancer (CC) in young women aged 15-44 years old are essential for formulating effective preventive strategies. Utilizing the Global Burden of Disease 2019 Study, we estimated incidence, disability-adjusted life-years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) due to CC among young women from 1990 to 2019. Additionally, we evaluated the temporal trends using estimated annual percentage changes (EAPCs) during this period. We conducted a decomposition analysis to assess the absolute contributions of three components: population growth, population age structure and epidemiologic changes. Globally, there were 187 609.22 incident cases of CC worldwide, resulting in 2621 917.39 DALYs in 2019. From1990 to 2019, the age-standardized rates were decline, only the age-standardized YLDs rate (EAPC = 0.02; 95% CI: -0.02 to 0.05) showed a stable trend. The largest increase in age-standardized incidence rate (ASIR) and age-standardized YLDs rate observed in the high-middle social demographic index (SDI) quintiles. Population growth and age structure changes were associated with substantial changes in cases of CC, especially in South Asia and East Asia. Globally, the burden of CC in young women continues to increase, as measured by the absolute number. As populations are growing and age structure changes were associated with substantial changes in cases of CC, governments will face increasing demand for treatment, and support services for CC, especially in South Asia and East Asia.

Cervical Cancer and Human Papilloma Virus (HPV) Vaccines: A primer for General Physicians

India contributes close to 20% of the global cervical cancer burden. This article reviews the preventive strategies against cervical cancer and suggest a few way forward for the prevention of cervical cancer in India. A literature review of online databases (Embase, Google Scholar, PubMed, Scopus) and reports from government websites regarding cervical cancer and HPV vaccination in India was conducted. Currently, four different HPV vaccines are available in India: a bivalent vaccine, a nonavalent vaccine and two quadrivalent vaccines. To reduce India’s cervical cancer burden, the National Technical Advisory Group on Immunization (NTAGI) has advocated the widespread implementation of HPV vaccination. An indigenous HPV vaccine was given market authorisation by the Drugs Controller General of India (DCGI) in July 2022. There is a need to raise awareness regarding the benefits of HPV vaccines in India. The introduction of indigenous HPV vaccine might enhance the supply logistics and may increase the uptake of the vaccine.

The global burden of cervical cancer requiring surgery: database estimates

BackgroundScaling up surgical services for cervical cancer in low and middle income countries requires quantification of the need for those services. The aim of this study was to estimate the global burden of cervical cancer for which access to surgery is required.MethodsThis was a retrospective analysis of publicly available data. Cervical cancer incidence was extracted for each country from the World Health Organization, International Agency for Research, Global Cancer Observatory. The proportion of cases requiring surgery was extrapolated from the United States Surveillance, Epidemiology and End-Result database. The need for cervical cancer surgery was tested against development indicators.ResultsData were available for 175 countries, representing 2.9 billion females aged 15 and over. There were approximately 566,911 women diagnosed with cervical cancer (95% CI 565,462–568,360). An estimated 56.9% of these women (322,686) would require surgery for diagnosis, treatment or palliation (95% CI 321,955 − 323,417). Cervical cancers for which surgery is required represent less than 1% of cancers in high income countries, and nearly 10% of cancers in low income countries.ConclusionsAt least 300,000 cervical cancer cases worldwide require access to surgical services annually. Gathering data on available cervical cancer surgery services in LMIC are a critical next step.

Assessment of knowledge and attitude of cervical cancer among the youths in the Rayalaseema region of Andhra Pradesh - India.

India suffers a quarter of the global burden of cervical cancer (CC) but is controllable by taking some precautions. The major issue is the low amount of participation among women in screening and vaccination for disease. The objective of the research is to evaluate knowledge, attitude, and practice (KAP) regarding CC among college going students residing in the Rayalaseema region of Andhra Pradesh-India. A cross-sectional study was conducted on a total of 380 subjects whose ages ranged from 15 to 25 and older. The questionnaires were circulated through google forms. The socio-demographic variables and KAP levels are represented by descriptive statistics. The Chi-square test is used to determine the relationship between sociodemographic factors and KAP levels. Among 380 subjects, 172 (54.7%) are aware of CC, 71% have poor knowledge, and 20% have good knowledge about CC. More than three-fourths of women 374 (98.4%) are not having regular practice towards CC. The awareness about CC is very low in the population, so prevention of CC relies on routine screening, proper vaccination, and treatment. Awareness programs and promoting knowledge about cervical health in social media are required.

Improving community health volunteers’ knowledge on cervical cancer using dialogue-based training in rural Kisumu County

BackgroundThe global burden of cervical cancer continue to rise with the low- and middle-income countries bearing the greatest burden. East Africa recorded about 54560 cases and 36497 deaths attributed to cervical cancer in 2020 with 5236 cases and 3211 deaths being reported annually. This high burden can be attributed to low screening rates and late diagnosis, which lead to undesirable outcomes. Kenya still has low screening rates with only 16.4% of the eligible women screened against the WHO target of 70% by 2030. Kisumu has a lower screening rate of about 5.7% according to KHIS 2019 data. This low screening rate is due to lack of proper community health education. We evaluated the effectiveness of dialogue-based training in improving community health volunteers’ (CHV) knowledge on cervical cancer in Nyando.MethodsThe study adopted a pre-and-post, longitudinal study design. The CHVs knowledge was assessed before and after the training. We calculated the proportion net change in the number of CHVs with improved knowledge after the intervention. Statistical significance was assessed at p ≤ 0.05.ResultsThe pre-test mean score was 30.1%, this improved to 53.4% at post-test following the dialogue-based training of the CHVs. The knowledge on the various aspects: risk factors (p < 0.0001), signs and symptoms (p < 0.0001) and screening (p < 0.0001) significantly improved at the post-test following the dialogue-based training. The overall score also significantly improved (p < 0.0001) following the training among the CHVs. Occupation (p < 0.0001) was found to be significantly associated with knowledge on cervical cancer.ConclusionThe CHVs’ knowledge was inadequate but significantly improved following the dialogue-based training.

The American Brachytherapy Society and Indian Brachytherapy Society consensus statement for the establishment of high-dose-rate brachytherapy programs for gynecological malignancies in low- and middle-income countries

PURPOSEThe global cervical cancer burden is disproportionately high in low- and middle-income countries (LMICs), and outcomes can be governed by the accessibility of appropriate screening and treatment. High-dose-rate (HDR) brachytherapy plays a central role in cervical cancer treatment, improving local control and overall survival. The American Brachytherapy Society (ABS) and Indian Brachytherapy Society (IBS) collaborated to provide this succinct consensus statement guiding the establishment of brachytherapy programs for gynecological malignancies in resource-limited settings. METHODS AND MATERIALSABS and IBS members with expertise in brachytherapy formulated this consensus statement based on their collective clinical experience in LMICs with varying levels of resources. RESULTSThe ABS and IBS strongly encourage the establishment of HDR brachytherapy programs for the treatment of gynecological malignancies. With the consideration of resource variability in LMICs, we present 15 minimum component requirements for the establishment of such programs. Guidance on these components, including discussion of what is considered to be essential and what is considered to be optimal, is provided. CONCLUSIONSThis ABS/IBS consensus statement can guide the successful and safe establishment of HDR brachytherapy programs for gynecological malignancies in LMICs with varying levels of resources.

Distribution of Human Papillomavirus Genotypes among the Women of South Andaman Island, India.

Human Papillomavirus (HPV) causes various types of cancer in both men and women. Woman with HPV infection has a risk of developing invasive cervical cancer. Globally, HPV 16 and 18 were predominant. This study aims to find the distribution of various HPV types in South Andaman. A cross-sectional study was conducted among women in South Andaman, where cervical scrapes were collected after collecting written informed consent. Detection of HPV genotypes was carried out by using a PCR assay. Further, sequencing analysis was performed using MEGA11 to identify various genotypes in this territory. Of these 1000 samples, 32 were positive for HR-HPV 16, and four were positive for HR-HPV 18. Fifteen HPV genotypes were detected using molecular evolutionary analysis. Six cases were identified with multiple genotypes. The most prevalent genotype is HPV 16 which belongs to Lineage-A and sub-lineage A2. HPV 18 identified in South Andaman belonged to the lineage A1 to A5. Various HPV types were identified among women in South Andaman. Global burden of cervical cancer associated with various HPV sub-lineages. HPV-16 A1 sub-lineage was globally widespread, whereas sub-lineages A1, A2 and D1 prevailed in South Andaman. HR-HPV identified in this study enlightens the importance of HPV vaccination among women in remote places. These findings will help to strengthen public health awareness programs and prevention strategies for women in remote areas.

Global and regional estimates of cervical cancer burden associated with human immunodeficiency virus infection from 1990 to 2019.

Previous studies reported human immunodeficiency virus (HIV) could enhance human papillomavirus (HPV)-induced cervical cancer. Therefore, the burden of cervical cancer associated with HIV across different regions and time periods need to be assessed. We aim to investigate the global burden of cervical cancer associated with HIV infection. Age standardized rates (ASRs) of cervical cancer disability-adjusted life-years (DALYs) in females (≥15 years old) were calculated by standardization, according the age-specific DALYs numbers extracted from GBD data set 2019. Population attributable fractions was calculated by combining the published risk ratio, with the HIV prevalence (≥15 years old) from Joint United Nations Programme on HIV and AIDS (UNAIDS), and transferred to estimate the HIV-associated cervical cancer burden. Expected annual percentage changes (EAPCs) was calculated to describe the temporal trend of ASR from 1990 to 2019. Pearson correlation analysis were conducted to assess the correlation between the ASR or EAPCs and the socio-demographic index. The worldwide DALYs ASR caused by HIV-associated cervical cancer rose from 3.78 (95% confidence interval [CI]: 2.19-5.56) in 1990 to 9.50 (95% CI: 5.66-13.79) in 2019 per 100k population. In 2019, the region with the greatest burden was Eastern and Southern Africa, with the highest DALYs of 273 900 (95% CI: 149 100-476 400) and ASR of 254.44 per 100k population (95% CI: 168.86-329.28). Notably, the Eastern Europe and Central Asia regions had the highest EAPC (14.07%) of HIV-associated DALYs ASR. Women in Eastern and Southern Africa experience the greatest burden of HIV-associated cervical cancer, while the Eastern Europe and Central Asia regions had witnessed the largest increase over the last 30 years. Prioritize the promotion of HPV vaccination and cervical cancer screening for women living with HIV were crucial in these regions.

Comparison of the AmpFire® Multiplex HPV Assay to the Xpert® HPV Assay for detection of human papillomavirus and cervical disease in women with human immunodeficiency virus: a pragmatic performance evaluation

BackgroundLow- and middle-income countries (LMICs) account for nearly 85% of the global cervical cancer burden, yet have the least access to high-performance screening. International guidelines recommend human papillomavirus testing (HPV) as primary screening, yet implementation is inhibited by the cost of HPV testing. Atila AmpFire® HPV Assay (AmpFire) is both affordable and easy to use, and offers individual genotyping. The objective of this study was to compare the performance of the AmpFire HPV assay to the Xpert® HPV assay in detection of both HPV and clinically significant cervical disease.MethodsWe utilized stored cervical specimens from a prospective cohort study of women living with human immunodeficiency virus (HIV) in Botswana conducted from May to July 2018. Positive and negative percent agreement was calculated for the AmpFire and Xpert assays, as was detection of high-grade cervical dysplasia.Results63 stored cervical specimens had detectable DNA after thawing and were included in the analysis. The positive percent agreement was 91.2% (95%CI 76.3–98.1) and negative percent agreement was 79.3% (95% CI 60.3–92.0). Six cases positive by AmpFire but negative by Xpert were HPV genotypes 35, 52 (n = 2), 58, 68, and co-infection with HPV 45 and 68. Both Xpert and AmpFire assays detected HPV in all 10 samples of women who had high-grade cervical dysplasia.ConclusionsThe AmpFire HPV assay demonstrated excellent analytic performance in both detection of HPV and clinically significant cervical disease. AmpFire HPV is a promising option to increase access to affordable, type-specific HPV screening for cervical cancer in LMICs.

THE EXISTENCE OF HPV VACCINATION PROGRAM AND ITS RELEVANCE IN THE PREVENTION OF CERVICAL CANCER IN RUSSIAN FEDERATION, BRAZIL, INDIA, JAPAN, CHINA, MALAYSIA, NIGERIA AND SWITZERLAND Authors

Background: Cervical cancer remains a significant health concern globally. The introduction of the Human Papilloma Virus (HPV) vaccine and the Papanicolaou smear (Pap smear) screening test have contributed to reducing cervical cancer morbidity and mortality. This study aims to evaluate the impact of these preventive measures on cervical cancer mortality rates in eight countries: Russia, Nigeria, India, China, Japan, Switzerland, Brazil, and Malaysia. Methods: We conducted a systematic review and meta-analysis using data from the World Health Organization (WHO), United Nations, World Bank, International Agency for Research on Cancer (IARC), and other sources for 2019 and 2020. Mortality rates, HPV vaccination programs, screening usage, and cervical cancer risk among females aged 0-74 years were analyzed and compared. Results: China reported the highest number of cervical cancer deaths (51,600), but Brazil had the highest mortality rate (1.56%). The lowest mortality rate was observed in Switzerland (0.30%). HPV vaccination was included in the national schedule for Japan, Switzerland, Brazil, and Malaysia. Screening for cervical cancer was implemented in all eight countries, with Russia and Switzerland having the highest frequency (8:10 each) and India having the least (&lt;1:10). Conclusion: The combination of HPV vaccination programs and active screening is the most effective measure for preventing cervical cancer mortality, as demonstrated by Switzerland. However, the importance of screening cannot be understated, as seen in Russia, where screening alone plays a significant role in cervical cancer prevention. Further efforts should focus on integrating both preventive strategies to reduce the global burden of cervical cancer.

Immunogenicity and Safety of One-Dose Human Papillomavirus Vaccine Compared With Two or Three Doses in Tanzanian Girls (DoRIS): An Open-Label, Randomised, Non-inferiority Trial

ABSTRACT The global burden of cervical cancer remains very high, with more than 340,000 potentially preventable deaths annually and disproportionally affects low-income and middle-income countries. Countries that have adopted HPV vaccination administer a multidose schedule with 2 doses offered to girls younger than 15 years, and 3 offered to girls 15 years and older or immunocompromised individuals. Unfortunately, several barriers to full immunization remain, and only 15% of girls in the target age group worldwide are estimated to be fully vaccinated. A single-dose vaccine would remove many barriers and be significantly cheaper; however, evidence is needed on the immunogenicity and efficacy. This randomized phase 3 clinical trial (DoRIS) aimed to examine immune responses after a single dose of HPV vaccine in the target age group for HPV vaccination in Tanzania. Girls aged 9–14 years who have not been vaccinated for HPV and did not have any history of cervical lesions, treatment for positive cervical cancer screening, or immunocompromised status were invited from Government schools to participate. Participants were randomized to 1 of 6 arms comprising 3 different dose schedules of 2 different HPV vaccines (3 doses over 6 months, 2 doses given 6 months apart, or a single dose for either the 2-valent vaccine or the 9-valent vaccine). Blood samples were collected for immunological assays at 1, 7, 12, and 24 months after vaccination. The primary study outcome was noninferiority of HPV 16 and HPV 18 specific seropositivity after a single dose compared with 2 or 3 doses of the same vaccine 24 months after vaccination. Primary analyses were undertaken in the per-protocol population, including those who received the allocated doses of HPV vaccine in the protocol-defined window. A sensitivity analysis included all participants who received at least 1 dose of HPV vaccine. A total of 930 girls were enrolled and randomized with 155 participants per group. At 24 months, 856 (93%) girls were included in the per-protocol analysis of anti-HPV 16 antibody responses, and 831 (91%) in the per-protocol analysis of anti-HPV 18. All but 2 participants were seropositive for HPV 16 IgG at 24 months (1 participant in each of the 1-dose arms was not), and all but 6 participants were HPV 18 seropositive at 24 months (2 in the 1-dose 2-valent group, 3 in the 1-dose 9-valent group, and 1 in the 3-dose 9-valent group). Noninferiority of HPV 16 seroconversion was met at 24 months for 1 dose compared with 2 doses or 3 doses for both vaccines; however, noninferiority for HPV 18 seroconversion was not met despite 98% of girls in the 1-dose arms of both vaccines testing positive for anti-HPV 18. There was no difference in serious adverse events among study groups or any serious adverse events related to the vaccine. The results of this study demonstrate that, in healthy Tanzanian girls, a single dose of the 2-valent or 9-valent HPV vaccines was well tolerated and resulted in high seropositivity and induced stable vaccine responses that persisted to 24 months.

Mn(II) assisted synthesis of N-phenyl-5-(pyridin-3-yl)-1,3,4-oxadiazol-2-amine and evaluation of its antiproliferative activity

The global burden of cervical cancer is continuously increasing day by day affecting the world population. Wide arrays of agents are prevalent for the treatment of this chronic disease but the survival rates are still limited. The titled compound N-phenyl-5-(pyridin-3-yl)-1,3,4-oxadiazol-2-amine (Pypao) was prepared through the cyclization of nicotinoyl-N-phenyl hydrazine carbothioamide catalyzed by manganese (II) acetate. Uv-Vis, IR, NMR, elemental analyses, and single-crystal X-ray data were utilized for the description of the compound Pypao. The crystal structure of Pypao is stabilized via intermolecular hydrogen bonding interactions, which is further confirmed with Hirshfeld surface analysis. The DFT methods were also used to optimize the Pypao and obtained bond parameters have been found coherent with the experimental data. FMO and TD-DFT studies are also performed to gain insights into the electronic behavior of Pypao. Furthermore, the binding potential of Pypao to different oncoproteins of HPV namely E6, E6AP, and E7 have been examined through a molecular docking study. The in-vitro anticancer activity of Pypao has been investigated against SiHa cells. The anticancer potential of Pypao has been evaluated through various assays including MTT, DAPI stating, AO/PI staining, etc. Both time and dose-dependent activity of Pypao have been investigated.

Understanding no-show behaviour for cervical cancer screening appointments among hard-to-reach women in Bogotá, Colombia: A mixed-methods approach

The global burden of cervical cancer remains a concern and higher early mortality rates are associated with poverty and limited health education. However, screening programs continue to face implementation challenges, especially in developing country contexts. In this study, we use a mixed-methods approach to understand the reasons for no-show behaviour for cervical cancer screening appointments among hard-to-reach low-income women in Bogotá, Colombia. In the quantitative phase, individual attendance probabilities are predicted using administrative records from an outreach program (N = 23384) using both LASSO regression and Random Forest methods. In the qualitative phase, semi-structured interviews are analysed to understand patient perspectives (N = 60). Both inductive and deductive coding are used to identify first-order categories and content analysis is facilitated using the Framework method. Quantitative analysis shows that younger patients and those living in zones of poverty are more likely to miss their appointments. Likewise, appointments scheduled on Saturdays, during the school vacation periods or with lead times longer than 10 days have higher no-show risk. Qualitative data shows that patients find it hard to navigate the service delivery process, face barriers accessing the health system and hold negative beliefs about cervical cytology.

High-resolution disease maps for cancer control in low-resource settings: A spatial analysis of cervical cancer incidence in Kampala, Uganda.

BackgroundThe global burden of cervical cancer is concentrated in low-and middle-income countries (LMICs), with the greatest burden in Africa. Targeting limited resources to populations with the greatest need to maximize impact is essential. The objectives of this study were to geocode cervical cancer data from a population-based cancer registry in Kampala, Uganda, to create high-resolution disease maps for cervical cancer prevention and control planning, and to share lessons learned to optimize efforts in other low-resource settings.MethodsKampala Cancer Registry records for cervical cancer diagnoses between 2008 and 2015 were updated to include geographies of residence at diagnosis. Population data by age and sex for 2014 was obtained from the Uganda Bureau of Statistics. Indirectly age-standardized incidence ratios were calculated for sub-counties and estimated continuously across the study area using parish level data.ResultsOverall, among 1873 records, 89.6% included a valid sub-county and 89.2% included a valid parish name. Maps revealed specific areas of high cervical cancer incidence in the region, with significant variation within sub-counties, highlighting the importance of high-resolution spatial detail.ConclusionsPopulation-based cancer registry data and geospatial mapping can be used in low-resource settings to support cancer prevention and control efforts, and to create the potential for research examining geographic factors that influence cancer outcomes. It is essential to support LMIC cancer registries to maximize the benefits from the use of limited cancer control resources.

Good News! Indigenous HPV Vaccine on Shelf by this Year End what India Must do to Hasten Cervical Cancer Elimination by 2030?

In May 2018, the WHO announced a global call for action to make elimination a reality and calling for all stakeholders to unite behind this common goal. Vaccination against HPV and screening and treatment of pre-cancer lesions are cost-effective ways to prevent cervical cancer. Human papillomavirus (HPV) vaccines, introduced in many countries in the past decade, have shown promising results in decreasing HPV infection and related diseases, such as warts and precancerous lesions. However currently, vaccine’s coverage, in low- and middle-income countries including India is very low to show any impact in the next 2-3 decades. Govt. of India had launched a National Cancer Control Programme in 1975, revised its strategies in 1984-85 and again under National Health Policy 2017. While it stresses on primary prevention for Tobacco related cancers, addresses only secondary prevention of cancer of the uterine cervix, mouth, breast etc. and tertiary prevention of therapeutic services including pain relief. Cervical cancer is the fourth most common cancer among women globally, with an estimated 604 000 new cases and 342 000 deaths in 2020. About 90% of the new cases and deaths worldwide in 2020 occurred in low- and middle-income countries. India accounts for about a fifth of the global burden of cervical cancer with about 1.25 Lakh cases and 67,000 deaths every year. Cervical cancer in India ranks as the second most frequent cancer among women between 15 and 44 years of age. Most cervical cancers are associated with human papillomaviruses, a sexually transmitted disease. HPV vaccination has been attempted in the sates of Delhi, Punjab, Odisha on a pilot project mode. So far, the cost of the vaccines (US 60-80 $) has been prohibitive for an average Indian. Coupled with Poor awareness even among educated and affordable population and the cultural hurdles of vaccinating young girls for a condition that manifests after 40 years is a communication challenge. The first hurdle in India of production of affordable indigenous HPV vaccine has been achieved (5 September 2022) recently opening a big opportunity. Governments (both federal and provincial) must make all-out efforts vaccinate all eligible females of the country; we owe it Indian women! In my opinion India must introduce pan-gender vaccination programs and start tracking all HPV-related (head and neck and anal) cancers and evaluate impact of HPV every decade for the next 50 years. A Mission mode is required to cover all the eligible in the next 2-5 years paid by the government (for at least below poverty line -BPL) families and provision of education through education system and social mobilization on a large scale are the key strategies to achieve this goal. This manuscript is a review the status of Cervical cancer, screening and diagnostic efforts, HPV vaccination status and recommends the way ahead to achieve national commitment for elimination of HPV related cervical and other cancers by 2030. Materials &amp; Methods: GOI annual reports, HPV vaccination project efforts and outputs and Program implementation plans and Campaign approaches of vaccination under NHM, Indigenous vaccine producers’ statement and DCGs clearance.

Machine Learning Assisted Cervical Cancer Detection.

Cervical malignant growth is the fourth most typical reason for disease demise in women around the globe. Cervical cancer growth is related to human papillomavirus (HPV) contamination. Early screening made cervical cancer a preventable disease that results in minimizing the global burden of cervical cancer. In developing countries, women do not approach sufficient screening programs because of the costly procedures to undergo examination regularly, scarce awareness, and lack of access to the medical center. In this manner, the expectation of the individual patient's risk becomes very high. There are many risk factors relevant to malignant cervical formation. This paper proposes an approach named CervDetect that uses machine learning algorithms to evaluate the risk elements of malignant cervical formation. CervDetect uses Pearson correlation between input variables as well as with the output variable to pre-process the data. CervDetect uses the random forest (RF) feature selection technique to select significant features. Finally, CervDetect uses a hybrid approach by combining RF and shallow neural networks to detect Cervical Cancer. Results show that CervDetect accurately predicts cervical cancer, outperforms the state-of-the-art studies, and achieved an accuracy of 93.6%, mean squared error (MSE) error of 0.07111, false-positive rate (FPR) of 6.4%, and false-negative rate (FNR) of 100%.

PREVENTION OF CERVICAL CANCER

Cervical cancer is the fourth most common cancer in women globally. In 2018, 570.000 women were diagnosed with cervical cancer, and 311.000 of them died from the disease.1 In Indonesia, cervical cancer is the second most common cancer. According to GLOBOCAN, there was a decrease in incidence from 17.2% to 9.2% from 2018 to 2020. This decrease has also been seen in other countries such as the United States. However, the distribution of cervical cancer varies widely among countries. WHO projected that the global burden of cervical cancer is projected to continue to increase, rising to 700 000 cases (21% increase) and 400 000 deaths (27% increase) in 2030 compared to 2018. Preventive measures become an important step to manage this situation. Preventions such as HPV vaccination, screening, and treatment of precancerous lesions have been found to be effective.

A Review of the Implementation Status of and National Plans on HPV Vaccination in 17 Middle-Income Countries of the WHO Western Pacific Region.

The World Health Organization’s Western Pacific Region is responsible for one-fourth of the global cervical cancer burden, and nearly 90% of that burden is concentrated in middle-income countries (MICs). Applying a conceptual model of implementation of population-based interventions, we synthesized the current implementation status of human papillomavirus (HPV) vaccination and national plans that form the basis of its implementation in 17 MICs. We gathered information from a range of governmental documents, published studies, and global databases. For all available national cancer-related plans and immunization plans, we examined the description of HPV vaccination. We found that, as of July 2021, only four countries (24%) had a mature HPV vaccination program with a high first-dose coverage; three (18%) had introduced HPV vaccination, but needed further efforts to scale it up, seven (41%) had not been able to introduce it after conducting demonstration projects, and three (18%) did not have any experience in HPV vaccination. In the national plans, most of the countries recognized the importance of HPV vaccination, but only 10 (59%) provided an implementation strategy on how it would be introduced or scaled up. Countries with a mature program were more likely to have their implementation strategy detailed in their national cancer control plan. Successful implementation of HPV vaccination requires overcoming known challenges and having a clear national plan. Positioning HPV vaccination clearly in the overall national cancer control plan may be key to accelerating its nationwide implementation.

Human Papilloma Virus Vaccine for Cervical Cancer Prevention

HPV infection is estimated to be responsible for about 5% of human cancers worldwide. Among all HPV-associated malignancies, cervical cancer is the most important cause of morbidity and mortality worldwide. Cervical cancer is the fourth most common cancer in women worldwide and leading cause of cancer death among females in less developed countries. Persistent HPV infection is a necessary cause of invasive cervical cancer with a prevalence of 99.7% in cervical cancer worldwide.At least 70% of cervical cancers are caused by HPV 16 and HPV 18. HPV vaccination in combination with regular screening offers the most effective way for women to be protected against cervical cancer.The global burden of cervical cancer falls heaviest on the developing countries which haven’t introduced the HPV vaccine as part of their national public health strategy to prevent and control cervical cancer. Different studies showed a drop in the prevalence of HPV associated diseases in vaccinated populations. Sustained efficacy, immunogenicity, and safety of the bHPV vaccine were observed in the final analysis of a follow-up study up to 9.4 years postvaccination. Cervical cancer is a major public health problem in Bangladesh. There has been little success with screening program against cervical cancer in Bangladesh. Therefore, a National HPV Vaccination Program seems to be the window of opportunity to reduce the mortality and morbidity of cervical cancer in Bangladesh.&#x0D; J Bangladesh Coll Phys Surg 2021; 39(2): 123-131