High Rates Of Cervical Cancer Research Articles

HPV prevalence and genotype distribution among Vietnamese cervical cancer patients in the northern region of Vietnam, from 2018 – 2020

Background/purposeHPV infection is the primary cause of cervical cancer, and genotype distribution varies according to geographical location and carcinogenicity. Therefore, identifying HPV genotype and its association with cervical cancer features is critical for screening, diagnosis, and therapy. MethodsData from Vietnamese women with HPV-positive cervical cancer were collected from the northern region. The HPV genotype was identified using the Cobas®®4800 HPV system, whereas the nucleotide sequences of the E6, E7, and L1 genes were used to identify lineages and sublineages using DNASTAR, Bioedit, ATGC 7.2, and MEGA 11.0.10 softwares. ResultsOf the 180 patients infected with HPV, 82.8 % revealed single infections, and 17.2 % showed multiple infections. HPV16 (64.4 %), HPV18 (28.9 %), and other HPVs (6.7 %) were the most prevalent HPV genotypes. HPV16 lineages included European (sublineage A1 (11.2 %), A2 (1.72 %), and A3 (25.86 %); Asian (sublineage A4 (53.85 %); African-American (sublineage D1 (5.17 %); and Asian-American (sublineage D3 (2.59 %). The HPV18 lineage includes Asian-Ameridian (sublineages A1 (100 %)). HPV18 revealed a higher rate of cervical cancer, cervicitis, warts, and ulcers than HPV16 and other high-risk genotypes in the 35–54–year–old group, but did not show a difference in cancer stages. ConclusionsHPV16 and HPV18 genotypes are common in cervical cancer in northern Vietnam, with European, Asian, and Asian–Amerindian lineages predominating. HPV18 causes cervical cancer at a higher rate than other genotypes in the 35–54–year–old age group; thus, early identification of the genotype is critical for more successful therapy.

Norcantharidin Enhances the Antitumor Effect of 5-Fluorouracil by Inducing Apoptosis of Cervical Cancer Cells: Network Pharmacology, Molecular Docking, and Experimental Validation.

The high recurrence rate of cervical cancer is a leading cause of cancer deaths in women. 5-Fluorouracil (5-FU) is an antitumor drug used to treat many types of cancer, but its diminishing effectiveness and side effects limit its use. Norcantharidin (NCTD), a demethylated derivative of cantharidin, exhibits various biological activities. Here, we investigated whether NCTD could potentiate 5-FU to induce cervical cancer cell death. To assess the cell viability and synergistic effects of the drugs, cell counting kit-8 and colony formation assays were performed using HR-HPV-positive cervical cancer cell lines. Annexin V-FITC/PI staining and TUNEL assays were performed to confirm the induction of apoptosis. The synergistic effect of NCTD on the antitumor activity of 5-FU was analyzed using network pharmacology, molecular docking, and molecular dynamics simulations. Apoptosis-related proteins were examined using immunoblotting. The combination of NCTD and 5-FU was synergistic in cervical cancer cell lines. Network pharmacological analysis identified 10 common targets of NCTD and 5-FU for cervical cancer treatment. Molecular docking showed the strong binding affinity of both compounds with CA12, CASP9, and PTGS1. Molecular dynamics simulations showed that the complex system of both drugs with caspase-9 could be in a stable state. NCTD enhanced 5-FU-mediated cytotoxicity by activating apoptosis-related proteins. NCTD acts synergistically with 5-FU to inhibit cervical cancer cell proliferation. NCTD enhances 5-FU-induced apoptosis in cervical cancer cell lines via the caspase-dependent pathway.

Assessment of HPV Knowledge and Awareness among Students and Staff at IBB University, Niger State, Nigeria: Implications for Health Education and Prevention.

In Nigeria, statistics reveal that there is a high rate of cervical cancer among women and a significant lack of awareness surrounding Human Papillomavirus (HPV), which poses a substantial risk of HPV infection. This cross-sectional survey, conducted at Ibrahim Badamasi Babangida (IBB) University, focuses on adapting and exploring the factors that influence a 20-item scale to measure HPV knowledge, evaluating knowledge-associated patterns and HPV-associated risk factors. We examined HPV vaccination rates, infection awareness, vaccine awareness, and the impact of ethnicity on HPV knowledge. Various validated forms were adapted to measure HPV awareness and knowledge. Non-parametric tests addressed non-normality. Data were presented using median and IQR and categorical data were frequency-based. Bivariate tests (Mann-Witney, Kruskal Wallis) explored knowledge-associated factors, while quantile regression (75th percentile) examined HPV knowledge factors. Variables were considered statistically significant at p < 0.05. The adapted 20-item knowledge scale revealed strong reliability (Cronbach's alpha = 0.913), ensuring internal consistency. The median knowledge score was 0, with an interquartile range (IQR) of 0-5. Our findings revealed a significant lack of awareness and knowledge about HPV; only 34.8% of the population were aware of HPV infection and 25.0% were familiar with HPV vaccination. Furthermore, ethnicity was found to be significantly associated with knowledge of HPV. This study emphasizes the necessity for targeted interventions to enhance HPV awareness, especially within specific ethnic groups. Despite a robust knowledge scale, educational initiatives such as seminars/conferences about HPV and cervical cancer remain crucial in addressing this gap, ultimately reducing HPV infection and cervical cancer risks in Nigeria.

Unveiling the Dual Threat: How Microbial Infections and Healthcare Deficiencies Fuel Cervical and Prostate Cancer Deaths in Africa.

Cervical and prostate cancer account for 7.1 and 7.3 deaths per 100,000 people globally in 2022. These rates increased significantly to 17.6 and 17.3 in Africa, respectively, making them the second and third leading cause of cancer deaths in Africa, only surpassed by breast cancer. The human papillomavirus is the prime risk factor for cervical cancer infection. On the other hand, prostate cancer risks include ageing, genetics, race, geography, and family history. However, these factors alone cannot account for the high mortality rate in Africa, which is more than twice the global mortality rate for the two cancers. We searched PubMed, Embase, Scopus, and Web of Science to select relevant articles using keywords related to microorganisms involved in cervical and prostate cancer and the impact of poor healthcare systems on the mortality rates of these two cancers in Africa by carrying out a detailed synopsis of the studies on microbial agents involved and the contributory factors to the deteriorating healthcare system in Africa. It became apparent that the developed countries come first in terms of the prevalence of cervical and prostate cancer. However, more people per capita in Africa die from these cancers as compared to other continents. Also, microbial infections (bacterial or viral), especially sexually transmitted infections, cause inflammation, which triggers the pathogenesis and progression of these cancers among the African population; this has been linked to the region's deficient health infrastructure, making it difficult for people with microbial infections to access healthcare and hence making infection control and prevention challenging. Taken together, untreated microbial infections, primarily sexually transmitted infections due to the deficient healthcare systems in Africa, are responsible for the high mortality rate of cervical and prostate cancer.

Prevalence of cervical intraepithelial lesions and associated factors among women attending a cervical cancer clinic in Western Uganda; results based on Pap smear cytology.

There are high incidence and mortality rates of cervical cancer among females in East Africa. This is exacerbated by limited up-to-date data on premalignant lesions and associated factors in this setting. In this study, we determined the prevalence of cervical intraepithelial lesions and associated factors among women attending the Mbarara Regional Referral Hospital cervical cancer clinic in Southwestern Uganda. In this cross-sectional study, 364 participants were recruited from among women attending the Mbarara Regional Referral Hospital cervical cancer clinic from 1 April to 30 June 2023. On consent, the study nurse collected demographic data and Pap smears, which were microscopically examined and reported by a laboratory scientist and a pathologist following the Bethesda grading system (2014). Statistical analyses were done in STATA version 17, using proportions, Chi-square, bivariate, and multivariate logistic regression analysis to determine associated factors at ⩽0.05 significance level. The mean age of participants was 41.9 years. A third of all study participants (37.6%, 132/351) were contraceptive users, mostly hormonal contraceptives (87.1%, 115/132). Almost 88% (307/351) had an unknown Human Papilloma Virus status. The prevalence of cervical intraepithelial lesions among our study participants was 6.6% (23/351), of which 73.9% (17/23) were low-grade squamous intraepithelial lesions. More than half (9/17, 52.9%) of low-grade squamous intraepithelial lesions were active hormonal contraceptive users. Use of hormonal contraceptives (OR: 3.032, p: 0.0253), use of intrauterine devices (OR: 6.284, p: 0.039), and any family history of cervical cancer (OR: 4.144, p: 0.049) were significantly associated with cervical intraepithelial lesions. The prevalence of cervical intraepithelial lesions was 6.6%, lower than global estimates. Use of hormonal and intrauterine device contraceptives, as well as family history of cervical cancer, were significantly associated with cervical intraepithelial lesions among our study population. Prospective studies are recommended to further understand associations between different types of intrauterine devices and hormonal contraceptives, and cervical lesions.

Enhancing early cervical cancer detection through the mobile-based DEDIKASI application

The incidence rate of cervical cancer in Indonesia remains high; however, it can be prevented through early detection. The study aimed to assess the effectiveness of the DEDIKASI mobile application, a continuation of the Early Warning System (EWS) cancer application for cervical cancer risk assessment in women of reproductive age. Employed a quasi-experimental design with a nonequivalent group posttest-only approach, the research included 388 participants chosen through random sampling. The EWS Application group showed a majority categorized as "Very Suspect" (52.6%), while the DEDIKASI group had the majority in the "High Risk" category (40.7%). ISO 25010 testing revealed an excellent overall score of 92% for the DEDIKASI application, indicating strong functional suitability and usability. The t-test results (p-value = 0.000) indicated that the DEDIKASI application was more effective than the EWS Cervical Ca application in assessing cervical cancer risk. The findings underscore the potential of the DEDIKASI mobile application for improving early detection and risk assessment of cervical cancer in women of childbearing age, offering a valuable tool to address the high incidence rate of cervical cancer in Indonesia.

Overweight and obesity as risk factors for cervical cancer and detection of precancers among screened women: A nationwide, population-based cohort study

ObjectiveObesity is a known risk factor for many types of cancer. However, there is no clear evidence whether overweight and obesity increases the risk of cervical cancer. We investigated the association between body mass index (BMI) and detection of squamous and glandular cervical cancer and precancer. MethodsBased on the Medical Birth Registry, we conducted a nationwide cohort study in Denmark of 384,559 women with BMI ≥18.5 kg/m2 (pre-pregnancy BMI reported at the start of the pregnancy) having a cervical cytology screening at age 23–49 years within 5 years following the date of childbirth. The cohort was followed for 10 years from the first cervical cytology screening after the childbirth. We assessed absolute risks of cervical lesions according to BMI with the Aalen-Johansen estimator. We conducted Cox proportional hazards regression analyses to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Analyses were adjusted for age, calendar year, parity, oral contraception use, HPV vaccination, smoking, country of origin, and education. ResultsOverweight and obesity were associated with higher rates of cervical cancer (HR = 1.24, 95% CI 1.04–1.49 and HR = 1.14, 95% CI 0.91–1.43, respectively) and lower rates of cervical precancer detection (HR = 0.88, 95% CI 0.84–0.92 and HR = 0.67, 95% CI 0.63–0.71, respectively). ConclusionsHigher than normal BMI was associated with higher incidence rates of cervical cancer and lower rates of precancer detection, emphasizing the importance of further research in possible mechanisms behind this association.

The burden of travelling for cervical cancer treatment in Uganda: A mixed-method study.

Uganda has one of the highest rates of cervical cancer in the world. Many women are diagnosed and treated with advanced stages of the disease. With only one facility offering comprehensive cervical cancer care in Uganda, many women are required to travel significant distances and spend time away from their homes to receive cervical cancer care. It is important to understand the burden of time away from home while attending treatment because it can inform the expansion of cervical cancer treatment programmes. The aim of this mixed-methods paper is to describe how the distance to cervical cancer treatment locations impacts women in Uganda. Women were recruited from 19 September, 2022, to 17 January, 2023, at the Uganda Cancer Institute (UCI) and the cancer clinic at Jinja Regional Referral Hospital (JRRF). Women were eligible for the study if they were (i) aged ≥18 years with a histopathologic diagnosis of cervical cancer; (ii) being treated at the UCI or JRRF for cervical cancer; and (iii) able to provide consent to participate in the study in English, Luganda, Lusoga, Luo, or Runyankole. All participants completed a quantitative survey and a selected group was sampled for semi-structured interviews. Data were analysed using the convergent parallel mixed-methods approach. Descriptive statistics were reported for the quantitative data and qualitative data using an inductive-deductive thematic analysis approach. In all, 351 women participated in the quantitative section of the study and 24 in the qualitative. The quantitative and qualitative findings largely aligned and supported one another. Women reported travelling up to 14 h to receive treatment and 20% noted that they would spend three or more nights away from home during their current visit. Major themes of the qualitative include means of transportation, spending the night away from home, and financial factors. Our findings show that travelling to obtain cervical cancer care can be a significant burden for women in Uganda. Approaches should be considered to reduce this burden such as additional satellite cervical cancer clinics or subsidised transportation options.

Abstract PR016: Viewing Native American cervical cancer disparities through the lens of the vaginal microbiome: A pilot study

Abstract Cervical cancer disproportionally affects Native American (NA) women who have higher rates of cervical cancer, are often diagnosed at later stages and are more likely to die from the disease compared to White women. This cancer disparity is primarily attributed to a lack of screening and unequal access to healthcare; however, other factors in NA women might contribute. Vaginal dysbiosis has been implicated in persistent HPV infection and cervical cancer. Yet, there is a paucity of data on the HPV infection patterns and the vaginal microbiota composition in NA communities. Here, we aimed to elucidate the relationships between HPV, microbiome, and genital inflammation to better understand how these factors relate to increased cervical cancer risk in NA women. In this cross-sectional study, we enrolled 31 women at the Native American for Community Action clinic (Flagstaff, AZ). Participants provided two self- or physician-collected vaginal swabs. Vaginal pH was also measured. One vaginal swab was used for DNA extraction and subsequent HPV genotyping and 16S rRNA gene sequencing. The microbiome analysis was conducted using QIIME 2. Levels of 48 immune mediators in the second vaginal swab were quantified by Bio-Plex. Most participants identified as American Indian or Alaska Native (n=16), White (n=11) or Hispanic (n=5). The average age was 29 years old (ranging from 18 to 46). High-risk HPV genotypes (HPV 39, 45, 52, 53, 58, 59) were detected in 23% of women (5 NA and 2 non-NA). Intriguingly, the current nonavalent HPV vaccine does not target half of genotypes detected in this cohort. Vaginal microbiota profiles were dominated by Lactobacillus in 56% of NA women, which was similar to levels observed in non-NA participants but overall lower than in previously reported non-Hispanic White cohorts. The most prevalent Lactobacillus species included L. crispatus (associated with optimal health) and L. iners (considered non-optimal). Lactobacillus-depleted profiles consisted of typical communities of anaerobes associated with bacterial vaginosis: Gardnerella, Fannyhessea, Prevotella, and Sneathia. Lactobacillus dominance was highly associated with low (≤4.5) vaginal pH (p=0.0017). Moreover, HPV-positive women tended to have lower Lactobacillus abundance compared to HPV-negative women, though this relationship was not statistically significant (p=0.07). Immune marker profiles also related to the vaginal microbiota composition with proinflammatory cytokines (IL-1beta, IL-12, IL-15 and TNFalpha) being significantly elevated (p&amp;lt;0.05) in women with Lactobacillus depletion. In addition, GM-CSF levels were decreased in women with Lactobacillus depletion, as well as in HPV-positive women. In conclusion, our pilot study suggests an interplay between HPV, vaginal microbiota and host defense may play a role in cervical cancer health disparity among NA women. Future longitudinal studies are ongoing to determine the mechanistic role of vaginal microbiota in HPV persistence, toward the long-term goal of reducing health disparities between White and NA populations. Citation Format: Pawel Laniewski, Tawnjerae R. Joe, Tristen L. Eddie, Skyler J. Bordeaux, Verity Quiroz, Donna J. Peace, J. Gregory Caporaso, Naomi R. Lee, Melissa M. Herbst-Kralovetz. Viewing Native American cervical cancer disparities through the lens of the vaginal microbiome: A pilot study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR016.

Knowledge about Cervical Cancer Prevention and Screening in Women with Cervical Cancer Attending Gynecological Services in Southern Mozambique.

Mozambique has high rates of cervical cancer and cancer-related deaths among women. A high rate of refusal and low acceptance of treatment is observed among cervical cancer patients. The extent of their knowledge of the disease is unknown. To assess knowledge about this disease (prevention, risk factors, and the possibilities of early diagnosis) in women with cervical cancer attended in gynecological services in Gaza province, Mozambique. This cross-sectional study took place in the city of Xai-Xai at the Provincial Hospital of Xai-Xai (HPXX) in the southern province of Gaza (Mozambique). Non-probability convenience sampling was used. Eligible patients (women) aged 35-50 years, diagnosed with cervical cancer and followed at the HPXX in the second quarter of 2021 (n = 60), took part in the survey during their scheduled consultations. Descriptive statistics were calculated using SPSS statistical software (version 16). The study included 60 women, 39 (65%) HIV positive. More than half (55.0%) believed that having a single sexual partner was an effective form of prevention; 50.0% reported that excessive alcohol consumption and having many sexual partners could cause the disease, and 46.7% affirmed that having many children increased the risk. Thirty-eight (63.3%) women reported that early diagnosis of cervical cancer was important for receiving prompt treatment, and 54 (90.0%) said regular visits to the gynecologist were important for an early diagnosis. Thirty-five (58.3%) mentioned acetic acid screening as a diagnostic test. There are significant gaps in awareness of cervical cancer among high-risk groups.

Understanding the cervical cancer self-collection preferences of women living in urban and rural Rwanda.

Cervical cancer is a leading cause of cancer among women in low- and middle-income countries. Women in Rwanda have high rates of cervical cancer due to limited access to effective screening methods. Research in other low-resource settings similar to Rwanda has shown that HPV-based self-collection is an effective cervical cancer screening method. This study aims to compare the preferences of Rwandan women in urban and rural settings toward self-collection and to report on factors related to self-collection amenability. A cross-sectional survey was conducted from June 1-9, 2022. Women were recruited from one urban and one rural clinic in Rwanda. Women were eligible for the study if they were ≥ 18 years and spoke Kinyarwanda or English. The survey consisted of 51 questions investigating demographics and attitudes towards self-collection for cervical cancer screening. We reported descriptive statistics stratified by urban and rural sites. In total, 169 urban and 205 rural women completed the survey. The majority of respondents at both sites had a primary school or lower education and were in a relationship. Both urban and rural respondents were open to self-collection; however, rates were higher in the rural site (79.9% urban and 95.6% rural; p-value<0.001). Similarly, women in rural areas were more likely to report feeling unembarrassed about self-collection (65.3% of urban, 76.8% of rural; p-value<0.001). Notably, almost all urban and rural respondents (97.6% urban and 98.5% rural) stated they would go for a cervical cancer pelvic examination to a nearby health center if their self-collected results indicated any concern (p-value = 0.731). Rwandan women in both urban and rural areas largely support self-collection for cervical cancer screening. Further research is needed to better understand how to implement self-collection screening services in Rwanda.

The magnitude of precancerous cervical lesions and its associated factors among women screened for cervical cancer at a referral center in southern Ethiopia, 2021: a cross-sectional study.

Cervical cancer is the most prevalent gynecologic cancer in women and the second leading cause of cancer death worldwide. Africa's southern, eastern, and western regions have the highest rates of cervical cancer. Cervical cancer is treatable and curable when detected early, but it is nonetheless fatal in low- and middle-income (LMIC) nations where screening and early detection are not widely accessible. The objective of this study is to assess the magnitude of precancerous cervical lesions and their associated factor among women screened for cervical cancer at a referral center in southern Ethiopia, in 2021. A retrospective institution-based cross-sectional study was conducted from February 21 to April 14, 2022, among randomly selected 372 records of women screened for cervical cancer at Hawassa University Specialized Hospital. Data were extracted from clients' charts using a data extraction checklist. Statistical Package for Social Sciences version 26 and logistic regression analysis were applied to determine the association between dependent and independent variables, and significance was declared at p-value <0.05. The magnitude of abnormal cervical dysplasia in this study was 18.3% of which 14% were precancerous cervical lesions and 4.3% were cervical cancer. Early coitarche: Adjusted odds ratio (AOR) = 5.6 [95% (confidence interval) CI = 1.87-16.78], having more than one sexual partner: AOR = 2.6 [95% CI = 1.2-5.68], being HIV positive: AOR = 3.56 [95% CI = 1.53-8.29], and having sexually transmitted infections: AOR = 4.64 [95% CI = 2.08-10.35] were independent predictors of precancerous cervical lesions. The magnitude of precancerous cervical lesions in the study setting is 18% and the magnitude of cervical cancer is 14%, which is higher than the pooled prevalence of precancerous cervical lesions in Ethiopia. Having multiple sexual partners, being HIV positive, having sexual intercourse before 21 years, and new STI diagnosis was independently associated with abnormal precancerous cervical lesions.

Impact and Cost-Effectiveness of Alternative Human Papillomavirus Vaccines for Preadolescent Girls in Mozambique: A Modelling Study.

Mozambique has one of the highest rates of cervical cancer in the world. Human papillomavirus (HPV) vaccination was introduced in 2021. This study evaluated the health and economic impact of the current HPV vaccine (GARDASIL® hereafter referred to as GARDASIL-4) and two other vaccines (CECOLIN® and CERVARIX®) that could be used in the future. A static cohort model was used to estimate the costs and benefits of vaccinating girls in Mozambique over the period 2022-2031. The primary outcome measure was the incremental cost per disability-adjusted life-year averted from a government perspective. We conducted deterministic and probabilistic sensitivity analyses. Without cross-protection, all three vaccines averted approximately 54% cervical cancer cases and deaths. With cross-protection, CERVARIX averted 70% of cases and deaths. Without Gavi support, the discounted vaccine program costs ranged from 60 million to 81 million USD. Vaccine program costs were approximately 37 million USD for all vaccines with Gavi support. Without cross-protection, CECOLIN was dominant, being cost-effective with or without Gavi support. With cross-protection and Gavi support, CERVARIX was dominant and cost-saving. With cross-protection and no Gavi support, CECOLIN had the most favorable cost-effectiveness ratio. Conclusions: At a willingness-to-pay (WTP) threshold set at 35% of Gross Domestic Product (GDP) per capita, HPV vaccination is cost-effective in Mozambique. The optimal vaccine choice depends on cross-protection assumptions.

Abstract 90: Understanding the Self-Collection Preferences of Women Living in Rwanda

Abstract Purpose: Cervical cancer is a leading cause of cancer death among women in low- and middle-income countries. Women in Rwanda have high rates of cervical cancer due to limited access to effective screening methods. Research in low-resource settings similar to Rwanda has shown that self-collection for cervical cancer screening is an effective method. This study aimed to compare the preferences of Rwandan women in urban and rural settings toward self-collection and to report on factors related to self-collection amenability. Methods: A cross-sectional survey was conducted from June 1-9, 2022. Women were recruited from an urban and rural clinic in Rwanda. Women were eligible for the study if they were ≥ 18 years and spoke Kinyarwanda or English. The survey consisted of 51 questions investigating demographics and attitudes towards self-collection for cervical cancer screening. All results were stratified by clinic site. We performed descriptive statistics stratified by urban and rural sites. Results: In total, 374 Rwandan women completed the survey (urban n=169 and rural n=205). The mean age was 33.09 years for urban and 32.89 years for rural respondents. The majority of respondents at both sites had a primary school or less education and were in a relationship. Both urban and rural respondents were open to self-collection; however, rates were higher in the rural site (79.9% urban and 95.6% rural; p-value&amp;lt;0.001). Similarly, women in rural areas were more likely to report feeling unembarrassed about self-collection (65.3% of urban, 76.8% of rural; p-value&amp;lt;0.001). Both urban (87.6%) and rural (90.2%) respondents were similarly unafraid of social stigma around cervical cancer. Notably, almost all urban and rural respondents (97.6% urban and 98.5% rural) stated they would go for a cervical cancer pelvic examination to a nearby health center if their self-collected results indicated any concern (p-value=0.731). Conclusion: Rwandan women in both urban and rural areas largely support the implementation and integration of self-collection for cervical cancer screening. Further research is needed to better understand how to implement self-collection screening services. Expanding self-collection for cervical cancer screening in Rwanda will contribute the global elimination of cervical cancer. Citation Format: Varun Nair, Hallie Dau, Marianne Vidler, Maryam AboMoslim, Barbra Mutamba, Zoey Nesbitt, Nadia Mithani, Laurie Smith, Stephen Rulisa, Gina Ogilvie. Understanding the Self-Collection Preferences of Women Living in Rwanda [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 90.

Abstract 22: Collaboratively Adapting a Telebehavioral Mobile Platform to Enhance Patient-Provider Communication Regarding Cervical Cancer Prevention Efforts in Bluefields, Nicaragua

Abstract Purpose: Nicaragua has the highest rate of cervical cancer in Central America. Cervical cancer screening is available nationally, however substantial barriers to screening engagement persist. Azulado is a telebehavioral, patient-centered mobile platform that was culturally, linguistically, and regionally created to specifically address the cervical cancer screening and treatment needs of women in Bluefields, Nicaragua, on the Caribbean coast. The app was successfully piloted in summer 2021. In summer 2022, the research team explored healthcare provider perspectives of Azulado, collaborating with providers to design an accompanying portal for the app. Methods: The team conducted a mixed-methods, community-based participatory investigation to elicit healthcare provider perspectives to inform the design of a provider portal. Focus groups and individual interviews were conducted with providers at healthcare facilities throughout Bluefields. A tablet-based survey adapted from mHealth App Usability Questionnaire (MAUQ) and System Usability Scale (SUS) was administered. The team conducted thematic analysis and descriptive statistics. Results: Three provider focus groups (n=8) and multiple individual interviews (n=18) were conducted in six unique healthcare settings in Bluefields. Twenty participants completed the survey (15 women and 5 men). Provider years of experience ranged from 1 to 37 years (average 17.0 years, median 16.5 years). Quantitative findings demonstrated that when asked if they agreed that the app would be useful for patient health and well-being, the average response was 4.89 (SD 0.32) on a Likert scale (0= strongly disagree, 5= strongly agree). The average response for the statement “I would recommend this app” was 4.68 (SD 0.58). Emergent themes included the importance of inclusivity and representation of different regional ethnicities and situations, clarity and functionality of the app, emotional support by community or provider, ability to input clinic visit reminders, and ability to anonymously and confidentially communicate with patients. Conclusion: The study demonstrated feasibility and acceptability of the Azulado patient-provider interface. Providers gave suggestions for how to improve patient education and facilitate communication between patients and clinics. Future studies will include trialing the updated app with patients and determining its effectiveness in improving prevention and treatment efforts in Bluefields. Citation Format: Maria Geba, Katherine Hall, Anneda Rong, Michelet McLean Estrada, Rebecca Dillingham, Emma McKim Mitchell. Collaboratively Adapting a Telebehavioral Mobile Platform to Enhance Patient-Provider Communication Regarding Cervical Cancer Prevention Efforts in Bluefields, Nicaragua [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 22.

Women's Knowledge and Attitudes Towards Cervical Cancer Screening in Morocco.

High incidence rates of cervical cancer are still common in low- and middle-income countries (LMICs) with ineffective prevention policies. This study assessed Moroccan women's knowledge and practices regarding the cervical cancer screening program. A cross-sectional study was conducted in 2019 in four primary healthcare centers in Casablanca. Women over the age of 18 who came to these centers during the study period were invited to participate in the study. The variables collected were related to women's knowledge of cervical cancer, the screening program, and their reasons for not participating in the screening program. The main risk factors identified by the participants were multiple sexual partners (4.3%) and sexually transmitted diseases (4%). About 77% of the cases (95% confidence interval (CI): 72.1%; 80.4%) knew that a cervical cancer screening program exists in Morocco. However, a small proportion had an idea about the population targeted by the program (46%) and the recommended interval between two screening tests (20%). Only 28% (95% CI: 19.2%; 38.2%) of eligible women had ever been screened for cervical cancer. These results underline the importance of implementing a communication strategy to increase women's awareness of the cervical screening program and their involvement in it.

Utilization of cervical cancer screening services and its associated factors in Iran: a case–control study

BackgroundConsidering the high incidence rate of cervical cancer (CC) in Iran, screening is an effective way of reducing the impact of the disease due to early detection. Thus, the recognition of the factors affecting the use of cervical cancer screening (CCS) services is essential.The present study aimed to determine the associated factors of CCS in women living in the suburbs of Bandar Abbas in the south of Iran.MethodsThe present case–control study was conducted between January and March 2022 in the suburban areas of Bandar abbas. Two hundred participants were assigned to the case group and 400 participants were assigned to the control group. A self-constructed questionnaire was used to collect the data. This questionnaire contained demographic information, reproductive information, knowledge of CC, knowledge of CCS and access to the screening. Univariate and multivariate regression analyses were run to analyze the data. The data were analyzed in STATA 14.2 at a significance level of p < 0.05.ResultsThe mean and standard deviation of participants’ age in the case group was 30.33 ± 4.892, and in the control group was 31.35 ± 6.149. The mean and standard deviation of knowledge in the case group was 10.21 ± 1.815 and in the control group was 7.24 ± 2.447. The mean and standard deviation of access was 43.72 ± 6.339 in the case and 37.17 ± 4.828 in the control group. The results of multivariate regression analysis showed the following factors increased the odds of CCS: knowledge (OR medium = 18.697, OR high = 13.413), access (OR medium = 4.028, OR high = 8.126), being married (OR = 3.193), being educated (OR diploma = 2.587, OR university degree = 1.432), middle and high SES (OR Middle = 6.078, OR Upper = 6.608), and not smoking (OR = 1.144). Also, women's reproductive status, including history of sexually transmitted diseases (OR = 2.612), use of oral contraceptives (OR = 1.579), sexual hygiene (OR = 8.718).ConclusionsIn the light of the present findings, it can be concluded that besides increasing suburban women’s knowledge, their access to screening facilities should be improved. The present findings showed the need to remove the barriers to CCS in women of low SES to increase the rate of CCS. The present findings contribute to a better understanding of factors involved in CCS.

Recent Advances in Cervical Cancer Management: A Review on Novel Prognostic Factors in Primary and Recurrent Tumors

Several pathological parameters, including tumor size, depth of stromal invasion, lympho-vascular space invasion and lymph node status, have been proposed as prognostic predictors in cervical cancer. However, given the high mortality and recurrence rate of cervical cancer, novel parameters that are able to provide additional prognostic information are needed in order to allow a better prognostic stratification of cervical cancer patients. A search was conducted on PubMed to identify relevant literature data regarding prognostic factors in cervical cancer. The key words "cervical cancer", "prognostic factors", "pathology", and "outcome" were used. The novel pathological grading system based on tumor budding and cell nest size appeared the most relevant prognostic factor in primary neoplasms. Moreover, other potentially useful prognostic factors were tumor size, depth of stromal invasion, lympho-vascular space invasion, perineural invasion, tumor-free distance and tumor-infiltrating lymphocytes. Prognostic factors related to advanced-stage cervical cancer, including lymph-nodes status, endometrial and cervical involvement as well as distant metastases, were also taken into consideration. According to our findings, tumor budding and cell nest size grading system, depth of stromal invasion, lympho-vascular space invasion, perineural invasion, tumor-free distance and tumor-infiltrating lymphocytes appeared the most relevant factors included in the pathology report.

Uterine and Cervical Cancer in Iran: An epidemiologic analysis of the Iranian National Population-Based Cancer Registry.

Gynecologic cancers, including neoplasms of the cervix and uterine, are the fourth most common malignancies, causing 3.46% of deaths in women aged 15 to 59. We aimed to report the Iranian National Population-based Cancer Registry (INPCR) results for Cervical and Uterine cancers in 2017. The total population of Iran in 2017 was 80881792. INPCR collected data on cervical and uterine cancer incidence from 31 provinces of Iran. In this project, we retrospectively examined all the country's regions in terms of screening for the existence of these two cancers. The registry data bank in Iran was used. Overall, 3481 new cervical and uterine cancer cases were registered in INPCR, including 842 cases of cervical cancer (with a crude rate of 1.04) and 2639 cases of uterine cancer (with a crude rate of 3.26). The average age-standardized incidence rate (ASR) was 0.99 for cervical cancer and 3.29 for uterine cancer. Out of 3481 new cervical and uterine cancer cases, 2887 were registered with pathological findings and 594 without pathological confirmation. In cervical cancers, the highest rate was related to squamous cell carcinoma, with 486 cases (57.72%). Our results showed that Iran is a low-risk area for the incidence of cervical and uterine cancers. In this study, the highest rate of cervical cancer was related to squamous cell carcinoma, confirming previous reports. However, this rate was lower than previous studies and suggested an increase in other types of cervical cancer in Iran.

Prevalence of cervical cancer in Ain Defla region (Algeria).

The high rate of cervical cancer in Algeria and the absence of organized screening programs are well shown in this study, which aims to determine the prevalence of cervical cancer and describe the risk factors associated with this alarming prevalence. This retrospective study is based on data collected from medical records and A questionnaire was developed to assess the risk factors (such as: parity, age at first marriage, smoking, oral contraceptive, and Hormonal status) of cervical cancer among the participants. Face to Face interview were conducted with the participants. The result obtained from this study revealed that cervical cancer occupies the fourth place of cancer in the Wilaya of Ain Defla (4,71 %); the results confirm the effect of several risk factors such as early marriage age (below 20 years: 46.66 %), multiparity (53.33%), menopause (66.66 %); taking contraception (53.33%) and smoking in the development of this pathology. The adoption of an early and annual screening program in our region would be very important to us. In addition, the interest of annual screening is to raise women's awareness of this pathology, particularly in isolated regions.