Higher Cervical Cancer Mortality Research Articles

Educational inequalities in cervical cancer mortality in the Baltic Sea region in 2008–2015

Abstract Background Reducing inequalities in cervical cancer mortality is a public health priority. This study aims to assess the absolute and relative educational inequalities in cervical cancer mortality in the Baltic countries and Finland in 2008-2015. Methods Data for Estonia, Latvia and Lithuania were obtained from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, and data for Finland from the longitudinal register-based population data file of Statistics Finland. Cervical cancer deaths (ICD-10 code C53) were linked from national mortality registries. Educational level was census- or registry-based. Absolute and relative educational inequalities in cervical cancer mortality were assessed in 2008-2015 for women aged 30-49 and 50-64, using age-standardized mortality rates (ASMRs) per 100 000 person-years and mortality rate ratios (RRs) with 95% confidence interval (CI). Results This study included 1724 cervical cancer deaths and about 22 million person-years. Absolute and relative educational inequalities in cervical cancer mortality were considerably larger in the Baltic countries compared to Finland. Among 30-49-year-olds, ASMRs for high educated ranged from 0.6 (95% CI: 0.4-1.0) in Finland to 3.6 (95% CI: 2.5-5.0) in Lithuania, and for low educated from 2.2 (95% CI: 1.2-3.7) in Finland to 24.6 (95% CI: 18.2-32.4) in Lithuania. RRs for low educated compared to high educated ranged from 3.51 (95% CI: 1.57-7.68) in Finland to 9.11 (95% CI: 4.28-19.32) in Estonia. Among 50-64-year-olds, ASMRs for high educated ranged from 1.3 (95% CI: 0.8-2.0) in Finland to 9.8 (95% CI: 7.2-13.1) in Estonia and for low educated from 2.9 (95% CI: 1.9-4.1) in Finland to 43.9 (95% CI: 34.4-55.1) in Lithuania. RRs for low educated compared to high educated ranged from 2.18 (95% CI: 1.20-4.05) in Finland to 6.32 (95% CI: 4.30-9.36) in Lithuania. Conclusions Equitable prevention is a key to reducing cervical cancer mortality in the Baltic countries. Key messages • Lower-educated women largely drive high cervical cancer mortality in the Baltic countries. • Equity-focused prevention is crucial for reducing cervical cancer mortality in the Baltic countries.

Acceptability of HPV self-collection: A qualitative study of Black women living with type II diabetes and social vulnerability

IntroductionHuman papillomavirus (HPV) causes 99.7% of cervical cancer cases. Cervical cancer is preventable through early detection via HPV testing. However, the number of women screened for cervical cancer has not increased in the last several years. Lower screening rates among women living in high poverty and social vulnerability areas, Black women, and women with chronic co-morbidities (e.g., type 2 diabetes (T2D)) are associated with their higher cervical cancer mortality rates. When screened, Black women are more likely to be diagnosed at later stages and die from cervical cancer. HPV self-collection decreases barriers to cervical cancer screening and can help lessen disparities among underserved women. This study aimed to examine the acceptability of HPV self-collection among Black women with T2D living in socially vulnerable communities. MethodsQualitative semi-structured interviews were conducted with 29 Black women with T2D living in communities with high social vulnerability. The Health Belief Model informed the development of the interview guide to gather data on the acceptability of HPV self-collection. ResultsThree main themes aligned with the Health Belief Model were identified: (1) HPV self-collection provides a comfortable alternative to in-clinic HPV testing (perceived benefits); (2) HPV self-collection would result in awareness of current HPV status (health motivation); and (3) Women were concerned about collecting their sample accurately (perceived barriers). Discussion/ConclusionBlack women with T2D living in communities with high social vulnerability identified multiple benefits of cervical cancer screening through HPV self-collection. Women are concerned about their ability to collect these samples correctly. Our findings call for future studies focusing on increasing self-efficacy and skills to collect HPV samples among Black women with chronic conditions like T2D who reside in underserved communities with high social vulnerability.

Community and provider perceptions and experiences of cervical cancer screening in Rural Bolivia: a qualitative study

BackgroundDespite efforts to increase cervical cancer screening access in rural Bolivia, uptake remains low. Bolivia has one of the highest cervical cancer mortality rates in the Americas. As it redoubles efforts to deliver Universal Health Care, the Bolivian government needs information on the factors constraining cervical cancer screening access and utilization, especially in rural areas.MethodsOur qualitative study explored cervical cancer screening barriers and described community and provider perceptions and experiences of care. Bolivian and US researchers analyzed data collected from eight focus groups with male and female community members (n = 80) and interviews with healthcare providers (n = 6) in four purposively selected rural communities in Hernando Siles, Bolivia. Deductive and inductive codes were used to thematically analyze data using MaxQDA software.ResultsFour themes emerged from the data: lack of knowledge/misconceptions, health system inadequacy, lack of confidence in providers, and opportunities for improvement. Both men and women displayed misconceptions about the causes of cervical cancer, its consequences, the recommended screening frequency, and the means of accessing care. Providers noted community members’ lack of knowledge and low risk-perception as utilization barriers but also highlighted poor health service quality and inconsistent health education as factors. Poor healthcare quality was a significant barrier; this included poor patient-provider communication, lack of transportation to screening facilities, and severe delays in receiving test results. Providers also noted problems with provider training and physical space for screening. Community members reported low confidence in nurses to perform screening, preferring doctors and specialists. They also expressed discomfort in having male healthcare providers conduct screening. Suggestions for improvements included more intensive cervical cancer outreach to rural areas and having specialists train lower-level providers to perform screening.ConclusionsOur findings suggest that poor healthcare quality has affected screening uptake in addition to physical barriers to care. They indicate a need for initiatives to reduce reporting time for Pap test results, the incorporation of community-based HPV self-sampling into screening protocols, and the implementation of programs to improve community confidence in providers’ ability to perform screening.

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.

Triptonide Inhibits the Cervical Cancer Cell Growth via Downregulating the RTKs and Inactivating the Akt-mTOR Pathway.

The high incidence and mortality of cervical cancer (CC) require an urgent need for exploring novel valuable therapeutics. Triptonide (TN) is a small molecule monomer extracted from the Chinese herb Tripterygium wilfordii Hook. Our results showed that TN, at only nanomolar concentrations, strongly inhibited growth, colony formation, proliferation, migration, and invasion of established and primary human cervical cancer cells. TN induced apoptosis and cell cycle arrest in cervical cancer cells. Moreover, cervical cancer cell in vitro migration and invasion were suppressed by TN. It was however noncytotoxic and proapoptotic to normal cervical epithelial cells and human skin fibroblast cells. Gene set enrichment analysis (GSEA) of RNA sequencing data of differentially expressed genes (DEGs) in TN-treated cervical cancer cells implied that DEGs were enriched in the receptor tyrosine kinase (RTK) signaling and PI3K-Akt-mTOR cascade. In cervical cancer cells, RTKs, including EGFR and PDGFRα, were significantly downregulated and Akt-mTOR activation was largely inhibited after TN treatment. In vivo, oral administration of TN significantly inhibited subcutaneous cervical cancer xenograft growth in nude mice. EGFR and PDGFRα downregulation as well as Akt-mTOR inactivation was detected in TN-treated HeLa xenograft tumor tissues. Thus, TN inhibits human cervical cancer cell growth in vitro and in vivo. Its anticervical cancer activity was associated with RTK downregulation and Akt-mTOR inactivation.

Signature of seven cuproptosis-related lncRNAs as a novel biomarker to predict prognosis and therapeutic response in cervical cancer.

Background: Given the high incidence and high mortality of cervical cancer (CC) among women in developing countries, identifying reliable biomarkers for the prediction of prognosis and therapeutic response is crucial. We constructed a prognostic signature of cuproptosis-related long non-coding RNAs (lncRNAs) as a reference for individualized clinical treatment. Methods: A total of seven cuproptosis-related lncRNAs closely related to the prognosis of patients with CC were identified and used to construct a prognostic signature via least absolute shrinkage and selection operator regression analysis in the training set. The predictive performance of the signature was evaluated by Kaplan–Meier (K-M) analysis, receiver operating characteristic (ROC) analysis, and univariate and multivariate Cox analyses. Functional enrichment analysis and single-sample gene set enrichment analysis were conducted to explore the potential mechanisms of the prognostic signature, and a lncRNA–microRNA–mRNA network was created to investigate the underlying regulatory relationships between lncRNAs and cuproptosis in CC. The associations between the prognostic signature and response to immunotherapy and targeted therapy were also assessed. Finally, the prognostic value of the signature was validated using the CC tissues with clinical information in my own center. Results: A prognostic signature was developed based on seven cuproptosis-related lncRNAs, including five protective factors (AL441992.1, LINC01305, AL354833.2, CNNM3-DT, and SCAT2) and two risk factors (AL354733.3 and AC009902.2). The ROC curves confirmed the superior predictive performance of the signature compared with conventional clinicopathological characteristics in CC. The ion transport-related molecular function and various immune-related biological processes differed significantly between the two risk groups according to functional enrichment analysis. Furthermore, we discovered that individuals in the high-risk group were more likely to respond to immunotherapy and targeted therapies including trametinib and cetuximab than those in the low-risk group. Finally, CC tissues with clinical data from my own center further verify the robustness of the seven-lncRNA risk signature. Conclusion: We generated a cuproptosis-related lncRNA risk signature that could be used to predict prognosis of CC patients. Moreover, the signature could be used to predict response to immunotherapy and chemotherapy and thus could assist clinicians in making personalized treatment plans for CC patients.

Dual-enzyme cascade amplification electrochemical biosensor for human papillomavirus based on DNA nanoflower structure

The lack of large-scale human papillomavirus (HPV) DNA screening is a major contributor to the high incidence and mortality of cervical cancer in economically undeveloped areas. The development of sensitive, rapid, and low-cost screening techniques is urgently needed. Here, DNA nanoflowers encapsulating glucose oxidase and horseradish peroxidase (GHDFs) were synthesized by one-pot rolling circle amplification, and then the GHDFs were used as the cargo of DNA hydrogel and applied for HPV DNA detection. When target DNA was present, the DNA hydrogel cross-linking structure was disrupted, releasing GHDFs, which then catalysed the oxidation of glucose and tetramethylbenzidine in a cascade, generating a significant electrical signal. Signal intensity had a linear relationship with the logarithm of target DNA concentration in the range of 10 fM-1 nM with a detection limit of 3.76 fM. The detection time of the proposed biosensor was 25 min, which was suitable for large-scale HPV DNA screening in economically underdeveloped areas and provides a blueprint for the detection of other DNA of interest.

Cervical cancer knowledge and barriers and facilitators to screening among women in two rural communities in Guatemala: a qualitative study

BackgroundApproximately 80% of deaths due to cervical cancer occur in low- and middle-income countries. In Guatemala, limited access to effective screening and treatment has resulted in alarmingly high cervical cancer incidence and mortality rates. Despite access to free-of-cost screening, women continue to face significant barriers in obtaining screening for cervical cancer.MethodsIn-depth interviews (N = 21) were conducted among women in two rural communities in Guatemala. Interviews followed a semi-structured guide to explore knowledge related to cervical cancer and barriers and facilitators to cervical cancer screening.ResultsCervical cancer knowledge was variable across sites and across women. Women reported barriers to screening including ancillary costs, control by male partners, poor provider communication and systems-level resource constraints. Facilitators to screening included a desire to know one’s own health status, conversations with other women, including community health workers, and extra-governmental health campaigns.ConclusionsFindings speak to the many challenges women face in obtaining screening for cervical cancer in their communities as well as existing facilitators. Future interventions must focus on improving cervical cancer-related knowledge as well as mitigating barriers and leveraging facilitators to promote screening.

Relationship between Human Papillomavirus Prevalence and DNA Damage in Cervical Cancer Population in Gansu Province, China.

The aim of this study was to assess the possible reason of the high incidence and mortality of cervical cancer in Longnan, China. 147 and 124 invasive squamous-cell carcinoma (SCC) samples from Longnan and different cities and districts of Gansu province were collected in the present study. All the samples were obtained from patients who underwent biopsies with colposcopy or advanced operations and were evaluated by experienced pathologists. HPV genotypes were examined with a validated HPV subtypes kit. The prevalence of HPV infection in SCC patients of China was analyzed by evidence-based medicine in the published literature. The markers of DNA damage response (DDR) - ATMpSer1981, H2AXp Ser139 (γH2AX), Chk2pThr68, and p53 - were analyzed by immunohistochemistry. HPV positivity, high-risk and multiple HPV positivity, and HPV58 infection were significantly higher in Longnan. Our results show that the prevalence of HPV infection in SCC patients of Longnan are consistent with the HPV prevalence in China. ATM, γH2AX, and p53 expressions in total and HPV+ samples were also higher in Longnan. HPV-related DDR activation may be one reason for the high incidence and mortality of Longnan cervical cancer.

Cervical cancer prevention among older women - challenges in screening, diagnostic workup and treatment.

Cervical cancer incidence and mortality have declined dramatically after screening for cervical cancer was implemented. Yet, studies have reported high cervical cancer incidence and mortality rates at older age despite low HPV prevalence and incidence of precursor lesions. The underlying reason for these findings remains unclear. However, it is well known that the impact of screening depends not only on the uptake and effectiveness of screening but also on the uptake and effectiveness of diagnostic workup (ie colposcopy), treatment and follow-up. In older women, sensitivity of screening and performance of colposcopy are impaired due to age-dependent changes to the cervix. In this commentary, we aimed to discuss challenges in screening and clinical management of older women, and to identify crucial areas of particular interest for future research.

A Comparative Study of Health Disparities in Cervical Cancer Mortality Rates Through Time Between Black and Caucasian Women in Alabama and the US.

Background:The main purpose of this study was to assess changes in cervical cancer mortality rates through time between Black and Caucasian women residing in Alabama and the US.Methods:Alabama cervical cancer mortality rates (MR), percentage differences, percentage changes and annual percentage changes for trends were compared with the US baseline and target rates. The US Baseline data and target objectives of utilization of cervical cancer screening and MR were obtained from Healthy People 2020. The cervical cancer behavioral risk factors and utilization of screening tests data were obtained from CDC’s Behavioral Risk Factor Surveillance System (BRFSS). The cervical cancer MR data were obtained from the Surveillance, Epidemiology, and End Results (SEER). The analysis was done using SEER*Stat and Linear Trendlines analysis.Results:Although Blacks in Alabama had higher cervical cancer MR through times, a decreasing trend was noted for both races. However, in Alabama, there is no significant change in Blacks aged 65 years and older in cervical cancer MR, despite a high screening rate compared to Whites. In contrast, between 2002 and 2012, Whites in Alabama and the US made a significant progress toward the Healthy People 2020 goal.Conclusions:In Alabama, there exists cervical cancer MR disparity in Blacks despite the higher rates of screening for cervical cancer as would otherwise be expected. The state has not yet achieved the Healthy People 2020 goal. Public health officials should monitor progress toward reduction and/or elimination of these disparities by focusing in a follow up of screening.

Beliefs related to Pap smear intention among Jamaicans: A qualitative research study.

Globally, most women who are diagnosed with cervical cancer do not obtain regular screening with the Pap smear/test. Women in developing countries have high cervical cancer incidence and mortality. Therefore, a qualitative research study was conducted to determine the referents, and salient and control beliefs related to Pap smear/test intention among Jamaicans.

Downstaging of cervical cancer in Tanzania over a 16-year period.

Globally, the highest cervical cancer mortality rates are found in East Africa. Visual inspection with acetic acid (VIA)-based screening in resource-poor settings has been shown to decrease the proportion of women presenting with late-stage cervical cancer, a process known as clinical downstaging. The only cancer treatment center in Tanzania, Ocean Road Cancer Institute (ORCI) in Dar es Salaam, opened a VIA-based cervical cancer screening program in 2002. We reviewed 6,676 medical records of cervical cancer patients at the ORCI from 2002-2011 to 2014-2018 for stage at diagnosis and screening status, among other variables. We investigated whether clinical downstaging occurred in this period among women screened at the ORCI, when compared to unscreened women. Our results indicated that the proportion of women presenting with late-stage cervical cancer among women screened at the ORCI decreased by 27.7% over the 16-year period (χ2 = 16.99; p = 0.0002). Among unscreened women, a non-significant 13.2% decrease in late-stage disease was observed (χ2 = 1.74; p = 0.4179). Our results suggest clinical downstaging occurred among women screened at the ORCI over the 16-year period, and this difference may be attributed to the screening program as the same decrease in stage was not observed among unscreened women during the same time period. At present, less than one percent of Tanzanian women receive yearly cervical cancer screenings. Access to screening through expansion of the ORCI screening clinic and the creation of more clinics should be prioritized.

A therapeutic DNA vaccine and gemcitabine act synergistically to eradicate HPV-associated tumors in a preclinical model

ABSTRACT Although active immunotherapies are effective strategies to induce activation of CD8+ T cells, advanced stage tumors require further improvements for efficient control. Concerning the burden of cancer-related to Human papillomavirus (HPV), particularly the high incidence and mortality of cervical cancer, our group developed an approach based on a DNA vaccine targeting the HPV-16 E7 oncoprotein (pgDE7h). This immunotherapy is capable of inducing an antitumour CD8+ T cell response but show only partial control of tumors in more advanced growth stages. Here, we combined a chemotherapeutic agent (gemcitabine- Gem) with pgDE7h to overcome immunosuppression and improve antitumour responses in a preclinical mouse tumor model. Our results demonstrated that administration of Gem had synergistic antitumor effects when combined with pgDE7h leading to eradication of both early-stages and established tumors. Overall, the antiproliferative effects of Gem observed in vitro and in vivo provided an optimal window for immunotherapy. In addition, the enhanced antitumour responses induced by the combined therapeutic regimen included enhanced frequencies of antigen-presenting cells (APCs), E7-specific IFN-γ-producing CD8+ T cells, and cytotoxic CD8+ T cells and, concomitantly, less pronounced accumulation of immunosuppressive myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs). These findings demonstrated that the combination of Gem and an active immunotherapy strategy show increased effectiveness, leading to a reduced need for multiple drug doses and, therefore, decreased deleterious side effects avoiding resistance and tumor relapses. Altogether, our results provide evidence for a new and feasible chemoimmunotherapeutic strategy that supports future clinical translation.

Abstract PO-252: Exploratory study of cervical cancer screening among Latinas in a remote agricultural community

Abstract Background: Cancer is the leading cause of death among Latinos. Compared to non- Hispanic Whites, Latinos are more likely to be diagnosed with advanced stages of disease and to experience poorer outcomes and quality of life after a cancer diagnosis. Latino women (Latinas) have among the highest cervical cancer incidence rates. Overall, the cervical cancer incidence rate among US Latinas is about 44% higher than among non-Hispanic Whites. Low rates of screening and poor adherence to recommended follow-up after an abnormal test are thought to contribute to the higher cervical cancer mortality rates among Latinas. The lack of timely cancer screening negates the benefits otherwise afforded by early detection of cancer. Limitations in the research contributes to our lack of understanding of the potential web of factors that likely influences cervical cancer screening in Latinas. Purpose: This study aimed to identify and describe potential modifiable factors in the participants that would explain the lack of cervical cancer screening utilization. Methods: In this exploratory study, we recruited Latinas in Monterey County who received primary care in a local community clinic from January 2014 to December 2018. We conducted 7 in-depth interviews to identify the stages of change, health behaviors, health beliefs, perceptions of cancer risk, and self-efficacy to complete recommended cancer screening. All interviews were conducted in Spanish and were audio-recorded. The transcripts were translated from Spanish to English for analysis. Preliminary Findings: The mean age of participants was 52.0 years (SD, 13.7; range, 29-63 years) and all were of Mexican origin. The predictors of cancer screening were identified through the analysis of the transcripts. The lack of income to see a doctor, lack of insurance, lack of knowledge about cancer prevention and risk, and the absence of primary care utilization in their native country, created barriers to cervical cancer screening. Healthy foodways, positive outlook on life, and attending Women, Infant, and Children (WIC) classes facilitated cancer screening use. Religion and cultural factors expressed as “male machismo”, as well as the use of home remedies, and having family support mediated cancer screening behaviors. Conclusion: This exploratory study informs the direction for future intervention research that ultimately can increase community knowledge of the benefits afforded by cancer early detection and timely treatment. Such interventions may result in an increase in cervical cancer screening rates in Latinas. Citation Format: Meng-Han Tsai, Daramola N. Cabral. Exploratory study of cervical cancer screening among Latinas in a remote agricultural community [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-252.

Abstract D125: Disparities in cervical cancer mortality across the Siberian related ethnic regions: The Republic of Sakha, the Republic of Khakassia, Buryatia, the Altai Republic, and Tuva (2007-2017)

Abstract Introduction. Cervical cancer mortality (CCM) varies throughout Russia, including Siberia. Nevertheless, disparities in CCM of Siberian native ethnic population have not yet been investigated. The objective of this study was to determine the differences of CCM during 2007-2017 in Siberian regions, where gene related ethnic groups live – the Republic of Sakha (Sakha), Buryatia, the Republic of Khakassia (Khakassia), the Altai Republic (Altai) and Tuva. Four out of these five regions, except for Sakha, geographically located in the south of Siberia. Sakha is located in the northern part of Siberia. Methods. Annual mortality rates from cervical cancer were analyzed from 2007 to 2017. This data was obtained from the annual reports entitled “Malignant neoplasms in Russia (incidence and mortality)” of P. Hertzen Moscow Oncology Research Institute - branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation. Age-adjusted mortality rates (per 100,000 populations) were compared for each region - Sakha, Buryatia, Khakassia, Altai and Tuva. Kruskal-Wallis H-test was used to determine the statistically significant differences in CCM variances of three or more regions and Mann-Whitney U test for two regions. T-test was used to determine the statistically significant differences in paired CCM rates. Differences with a probability less than the significance level of 0.05 were considered as a statistically significant. Results. Comparisons showed CCM heterogeneity between all five regions of Siberia. The highest CCM rates from 2007 to 2017 were found in Buryatia - the average value of CCM rates (avCCM) is 11.46. CCM rates in this region from 2007 to 2017 were significantly higher than in all other regions, except for the Tuva. The lowest mortality rates during the observed timeframe were detected in Sakha, avCCM - 5.82. Mortality rates in Sakha during this timeframe were significantly lower compared to the other four regions. CCM rates comparison of Altai (avCCM - 9.85), Tuva (avCCM - 9.62) and Khakassia (avCCM - 7.76) did not reveal the significance of the differences between these three regions (although was close to significance). But when paired comparison of CCM variances was used, the CCM rates in Tuva were significantly higher than in Khakassia. When all regions’ CCM rates in 2007 to 2017 were compared, then no significant changes of four regions, except for Altai, were found. In the Altai, compared to 2007, the mortality rate in 2017 significantly decreased, about 2 times (7.61 vs. 15.97). Conclusion. Despite the genetic relationships of the native ethnic populations of Siberia, CCM in the analyzed regions between 2007 and 2017 differs. The highest CCM were observed in Buryatia. The lowest mortality rates were detected in Sakha. CCM rates for the Altai, Tuva and Khakassia were not significantly different. CCM in the Altai in 2007 compared to 2017 decreased twice. The same comparison in Sakha, Khakassia, Buryatia and Tuva showed no changes. Citation Format: Irina V. Kononova, Sargylana N. Mamaeva, Maria P. Kirillina, Petr V. Nikiforov. Disparities in cervical cancer mortality across the Siberian related ethnic regions: The Republic of Sakha, the Republic of Khakassia, Buryatia, the Altai Republic, and Tuva (2007-2017) [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D125.

Abstract A128: Building sustainable partnerships between cancer centers and safety net community hospitals to increase access to and quality of cancer care

Abstract Background: Cervical cancer outcomes are influenced by race, socioeconomic status and region. African American women have the highest mortality rate from cervical cancer and Hispanic and American Indian/Alaska Native women have the highest cervical cancer incidence rates among racial/ethnic groups. Disparities in cervical cancer can be greatly improved by increasing access to and awareness of Pap screening and HPV vaccination among vulnerable populations. Safety net and community hospitals offer broader opportunities to reach at-risk individuals, however these hospitals face many challenges that mirror those of the patients they serve, including: decreased access to innovative research and treatment, decreased access to the full range of specialty care, and funding challenges. Public-Public partnerships between academic medical centers, cancer centers and private service organizations that extend to safety net and community hospitals can increase cervical cancer screening rates among individuals at greatest risk. Methods: The Loretto Hospital and Norwegian American Hospital serve communities that suffer the highest cervical cancer mortality rates in Chicago. Funded by the Bristol Myers Squibb Foundation, the University of Illinois Cancer Center partnered with these two community hospitals located on the west sides of Chicago to increase cervical cancer screening rates through clinical and community patient navigation. Evidence based methods such as small media interventions, client reminders, and one-on-one education will also be used to increase screening awareness and education. The evidence-based, implementation science program is guided by the RE-AIM framework. Reach, adoption and sustainability will be maximized through the integration of community hubs that comprise faith-, community-, school-based organizations and policy makers. Results: The project is a three year project. Now in its pre-implementation phase, the program is currently piloting data instrumentation and implementation processes. Preliminary results will be presented at the meeting. The Partnership development phase has been achieved and Full implementation will begin August 2019. Conclusion: It is expected that building partnerships between large academic medical centers, cancer centers and community hospitals will increase the capacity of community hospitals to offer quality screening and specialized care to community members and increase access to cervical cancer screening and education among at-risk populations ultimately decreasing cervical cancer disparities among underserved populations in the University of Illinois Cancer Center catchment. Citation Format: Vida Henderson, Jessica Madrigal, Jeanette Gonzalez, Erica Martinez, Katherine Tossas-Milligan, Patricia Doykos, Karriem Watson, Robert Winn. Building sustainable partnerships between cancer centers and safety net community hospitals to increase access to and quality of cancer care [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A128.

A cross-sectional study of barriers to cervical cancer screening uptake in Ghana: An application of the health belief model.

The high incidence (32.9, age-standardized per 100,000) and mortality (23.0, age-standardized per 100,000) of cervical cancer (CC) in Ghana have been largely attributed to low screening uptake (0.8%). Although the low cost (Visual inspection with acetic acid) screening services available at various local health facilities screening uptake is meager. The purpose of the study is to determine the barriers influencing CC screening among women in the Ashanti Region of Ghana using the health belief model. A analytical cross-sectional study design was conducted between January and March 2019 at Kenyase, the Ashanti Region of Ghana. The study employed self-administered questionnaires were used to collect data from 200 women. Descriptive statistics were used to examine the differences in interest and non-interest in participating in CC screening on barriers affecting CC screening. Multivariable logistic regression was used to determine factors affecting CC screening at a significance level of p<0.05. Unemployed women were less likely to have an interest in CC screening than those who were employed (adjustes odds ratio (aOR) = 0.005, 95%CI:0.001-0.041, p = 0.005). Women who were highly educated were 122 times very likely to be interested in CC screening than those with no or low formal education (aOR = 121.915 95%CI: 14.096-1054.469, p<0.001) and those who were unmarried were less likely to be interested in CC screening than those with those who were married (aOR = 0.124, 95%CI: 0.024-0.647, p = 0.013). Also, perceived threat, perceived benefits, perceived barriers and cues for action showed significant differences with interest in participating in screening with a P-values <0.003. The association was different for long waiting time, prioritizing early morning and late evening screening which showed no significant difference (P-value > 0.003). Married women, unemployed and those with no formal education are less likely to participate in CC screening. The study details significant barriers to cervical cancer screening uptake in Ghana. It is recommended that the Ghana health services should develop appropriate, culturally tailored educational materials to inform individuals with no formal education through health campaigns in schools, churches and communities to enhance CC screening uptake.

Association of cervical and breast cancer mortality with socioeconomic indicators and availability of health services

ObjectiveAnalyze cervical and breast cancer mortality in Brazil and its relationship with socioeconomic population indicators and availability of health services in the period 2011–2015. MethodsAn ecological study is presented herein. Mortality data were extracted from the Mortality Information System, based on ICD-10, per area of residence and age group, for the period 2011–2015. Socioeconomic variables were extracted from the Brazilian Human Development Atlas, and the National Register of Health Facilities (CNES) provided data on the density of physicians and health services. Statistical analysis was carried out using the Chi-squared test and Poisson regression, with robust variance and 95 % confidence level. ResultsThe median age-standardized mortality rates for cervical and breast cancers were, respectively, 5.95 (± 3.97) and 10.65 (± 3.12) per 100,000 women. High cervical cancer mortality rates presented a statistically significant association with GINI Index (p=0.000) and Human Development Index - HDI (p=0.030). High breast cancer mortality rates were positively associated with the variables “number of general physicians per 100,000 inhabitants” (p = 0.005) and “Number of licensed oncology centers per 1,000,000 inhabitants” (p = 0.002). ConclusionThe importance of organization and equity in the access to health services is highlighted herein, enabling the reorientation of public policies aimed at the minimization of health disparities.

HPV infection associated DNA damage correlated with cervical precancerous lesions and cancer in the highest area of cervical cancer mortality, Longnan, China.

ObjectivesThis study was to assess whether human papillomavirus (HPV) resulting in genetic instability is one reason for the high incidence and mortality of cervical cancer in Longnan.MethodsBetween 2012 and 2016, a total of 346 samples from Longnan were collected and divided into four groups: cervicitis group (n=57), cervical intraepithelial neoplasia I group (CIN I, n=63), CIN II/III group (n=79) and invasive squamous cell carcinoma group (SCC, n=147). HPV E6/E7 mRNA was detected by Quantivirus® HPV E6/E7 RNA 3.0 assay (bDNA). The markers of DNA damage response (DDR) – ataxia telangiectasia mutated (ATM) pSer1981, H2AX pSer139 (γH2AX), Chk2 pThr68 and P53 – were analyzed by immunohistochemistry.ResultsThe activation of ATM, γH2AX, Chk2 and P53 was increased with increasing severity of cervical lesion. A significant difference of ATM expression in simple infection was also shown accompanied by the cervical lesion. The expression of γH2AX between HPV16+ and HPV16- specimens, γH2AX and P53 between HPV58+ and HPV58- groups had statistical significance. The expression and copy number of HPV E6/7 mRNA increases with the cervical lesion severity. A significant difference was shown for P53 expression between HPV E6/7 mRNA+ and mRNA- specimens. A close correlation with CHK2 expression for HPV E6/7 mRNA+ and HPV16 E6/7 mRNA+ specimens and γH2AX and CHK2 expression for SCC specimens was shown between low and high viral load groups.ConclusionsDDR, HPV genotypes and HPV E6/E7 oncogene expression correlated with the level of dysplasia of cervical lesions. HPV infection resulted in genetic instability may be one reason for the high incidence and mortality in Longnan.