High Incidence Of Cervical Cancer Research Articles

Long-term follow-up on HIV infected and non-infected women with cervical cancer from Tanzania: staging, access to cancer-directed therapies and associated survival in a real-life remote setting

BackgroundWorldwide 85% of cervical cancer (CC) related deaths occur in low- and middle-income countries. Sub-Saharan Africa is burdend by an overlapping high incidence of CC as well as HIV infection, a risk factor for HPV associated disease progression. Recent upscaling of CC screening activities increased the number of CC diagnoses in a previous unscreened population. The aim of the 2H study was to follow up on women with CC in the context of available health care services in Tanzania in relation to their HIV infection status.MethodsThis longitudinal observational cohort study included women with histological confirmed CC from Mbeya, Tanzania, between 2013–2019. All women were referred for CC staging and cancer-directed therapies (CDT), including surgery and/or radio-chemotherapy, or palliative care. Annual follow-up focused on successful linkage to CDT, interventions and survival. We assessed factors on compliance, used Kaplan–Meier-Survivor functions to evaluate survival time and poisson regression models to calculate incidence rate ratios on mortality (IRR) two years after diagnosis.ResultsOverall, 270 women with CC (123 HIV infected) were included. Staging information, available in 185 cases, showed 84.9% presented with advanced stage disease (FIGO ≥ IIB), no difference was seen in respect to HIV status. HIV-infected women were 12 years younger at the time of cancer diagnosis (median age 44.8 versus 56.4 years, p < 0.001). Median follow up period was 11.9 months (range 0.2–67.2). Survival information, available in 231 cases, demonstrated for women diagnosed in early-stage disease a median survival time of 38.3 months, in advanced-stage 16.0 months and late-stage disease 6.5 months after diagnosis. Of all women, 42% received CDT or palliative support. HIV co-infection and education were associated with higher health care compliance. CDT was significantly associated with lower 2-year mortality rates (IRR 0.62, p = 0.004). HIV coinfection did not impact mortality rates after diagnosis.ConclusionHigh numbers of advanced and late staged CC were diagnosed, compliance to CDT was low. A beneficial impact of CDT on CC mortality could be demonstrated for local health care services. This study indicates challenges for successful linkage and supports an effective scale up of cancer care and treatment facilities.

The Accuracy of Cytology, Colposcopy and Pathology in Evaluating Precancerous Cervical Lesions.

Introduction: Cervical cancer (CC) is the third most common cancer in the world, and Romania has the highest incidence of cervical cancer in Europe. The aim of this study was to evaluate the correlation between cytology, colposcopy, and pathology for the early detection of premalignant cervical lesions in a group of Romanian patients. Methods: This observational type 2 cohort study included 128 women from our unit, “Bucur” Maternity, who were referred for cervical cancer screening. Age, clinical diagnosis, cytology results, colposcopy impression, and biopsy results were considered. Colposcopy was performed by two experienced examiners. The pathological examination was performed by an experienced pathologist. Results: The cytology found high-grade squamous intraepithelial lesions in 60.9% of patients, low-grade squamous intraepithelial lesions in 28.1%, atypical squamous cells for which a high-grade lesion could not be excluded in 9.4%, and atypical squamous cells of undetermined significance, known as repeated LSIL, in 1.6%. The first evaluator identified low-grade lesions in 56.3%, high-grade lesions in 40.6%, and invasion in 3.1% of patients. The second evaluator identified low-grade lesions in 59.4%, high-grade lesions in 32.0%, and invasion in 8.6% of patients. The pathological exam identified low-grade lesions in 64.1%, high-grade lesions in 25%, and carcinoma in 14% of patients. The colposcopic accuracy was greater than the cytologic accuracy. Conclusions: Colposcopy remains an essential tool for the identification of cervical premalignant cancer cells. Standardization of the protocol provided an insignificant interobserver variability and can serve as support for further postgraduate teaching.

Educational intervention for providers addressing the diversity gap in cervical cancer clinical study participation (579)

Objectives: Every year, over 570,000 women worldwide are diagnosed with cervical cancer. Cervical cancer accounts for 7.5% of female cancer deaths, and 85% of those deaths occur in low- to moderate-income countries. In the US, it is estimated that Black women have a 30% higher incidence of cervical cancer than White women. Additionally, Hispanic women are 40% more likely to be diagnosed with cervical cancer than non-Hispanic women. In 2020, the US Food and Drug Administration issued industry guidance for enhancing the diversity of clinical study participants, highlighting the critical need for representative studies that reflect the current US population demographics. This study aims to conduct an educational intervention aimed at cervical cancer investigators and patients to increase ethnocultural diversity in clinical study recruitment in a cervical cancer research program. Methods: This educational intervention implemented a pre-post study design of clinical investigators participating in both global Phase 2 and Phase 3 cervical cancer studies. The Phase 3 clinical study serves as the parent foundational study to the Phase 2 study (ongoing study, NCT04646005), as 77% of the clinical investigators participating in Phase 2 clinical study overlap with the Phase 3 study. The ongoing Phase 2 study will educate investigators on ethnocultural diversity, and the inclusion of the two studies will be compared from pre-intervention (Phase 3) to post-intervention (Phase 2). Education will be provided as a one-time virtual training and a supplementary pamphlet and will cover the incidence and mortality differences across races, current enrollment gaps, barriers to including diverse populations, and guidance for the broader inclusion of women in our sponsored studies. Race and ethnicity demographic data for the Phase 2 trial (post-intervention) will be compared with the Phase 3 trial (pre-intervention) using the chi-square statistical test. Assuming significant results, a Z-test will then be used to assess the proportions of each race and ethnicity group. Objectives: Every year, over 570,000 women worldwide are diagnosed with cervical cancer. Cervical cancer accounts for 7.5% of female cancer deaths, and 85% of those deaths occur in low- to moderate-income countries. In the US, it is estimated that Black women have a 30% higher incidence of cervical cancer than White women. Additionally, Hispanic women are 40% more likely to be diagnosed with cervical cancer than non-Hispanic women. In 2020, the US Food and Drug Administration issued industry guidance for enhancing the diversity of clinical study participants, highlighting the critical need for representative studies that reflect the current US population demographics. This study aims to conduct an educational intervention aimed at cervical cancer investigators and patients to increase ethnocultural diversity in clinical study recruitment in a cervical cancer research program. Methods: This educational intervention implemented a pre-post study design of clinical investigators participating in both global Phase 2 and Phase 3 cervical cancer studies. The Phase 3 clinical study serves as the parent foundational study to the Phase 2 study (ongoing study, NCT04646005), as 77% of the clinical investigators participating in Phase 2 clinical study overlap with the Phase 3 study. The ongoing Phase 2 study will educate investigators on ethnocultural diversity, and the inclusion of the two studies will be compared from pre-intervention (Phase 3) to post-intervention (Phase 2). Education will be provided as a one-time virtual training and a supplementary pamphlet and will cover the incidence and mortality differences across races, current enrollment gaps, barriers to including diverse populations, and guidance for the broader inclusion of women in our sponsored studies. Race and ethnicity demographic data for the Phase 2 trial (post-intervention) will be compared with the Phase 3 trial (pre-intervention) using the chi-square statistical test. Assuming significant results, a Z-test will then be used to assess the proportions of each race and ethnicity group.

Access to Radiation Therapy: From Local to Global and Equality to Equity.

The discipline of radiation oncology is the most resource-intensive component of comprehensive cancer care because of significant initial investments required for machines, the requirement of dedicated construction, a multifaceted workforce, and recurring maintenance costs. This review focuses on the challenges associated with accessible and affordable radiation therapy (RT) across the globe and the possible solutions to improve the current scenario. Most common cancers globally, including breast, prostate, head and neck, and cervical cancers, have a RT utilization rate of > 50%. The estimated annual incidence of cancer is 19,292,789 for 2020, with > 70% occurring in low-income countries and low-middle–income countries. There are approximately 14,000 teletherapy machines globally. However, the distribution of these machines is distinctly nonuniform, with low-income countries and low-middle–income countries having access to < 10% of the global teletherapy machines. The Directory of Radiotherapy Centres enlists 3,318 brachytherapy facilities. Most countries with a high incidence of cervical cancer have a deficit in brachytherapy facilities, although formal estimates for the same are not available. The deficit in simulators, radiation oncologists, and medical physicists is even more challenging to quantify; however, the inequitable distribution is indisputable. Measures to ensure equitable access to RT include identifying problems specific to region/country, adopting indigenous technology, encouraging public-private partnership, relaxing custom duties on RT equipment, global/cross-country collaboration, and quality human resources training. Innovative research focusing on the most prevalent cancers aiming to make RT utilization more cost-effective while maintaining efficacy will further bridge the gap.

Advanced stage cervical cancer: Who is at risk and is it related to screening and vaccination practices? (441)

<b>Objectives:</b> Advanced-stage cervical cancer is challenging to treat and is usually a terminal diagnosis focusing on palliation, not cure. We aimed to examine the trends in advanced-stage cervical cancer and explore the groups where this diagnosis is increasing. We also looked at changes in cervical cancer screening and vaccination patterns to understand if there is a correlation between these trends. <b>Methods:</b> Data on cervical carcinoma incidence and rates were obtained from the U.S. Cancer Statistics program from 2001 to 2018. Rates of cervical cancer screening and HPV vaccination were evaluated using the Behavioral Risk Factor Surveillance System and TeenVaxView (BRFSS: 2001-2016, TeenVaxView: 2008-2016, 13-17 years olds). SEER*Stat 8.3.8 and Joinpoint regression program 4.8.0.1 were used to calculate incidence trends. Since all the data used in this study were derived from de-identified files, no institutional review board approval was required for this study. <b>Results:</b> The incidence of advanced cervical cancer was 0.94/100,000 in 2018. Non-Hispanic Black (NHB) women had the highest incidence of cervical cancer at 1.33/100,000. Between the years 2001 and 2018, advanced-stage cervical cancer had been on the rise in all women with an average annual percent change (AAPC) of 1.24% (p<0.001). When examining race, rates were stable in all groups except Non-Hispanic White (NHW) women, where there was an increase of 1.67% per year (p<0.001). The South had the largest increase of all regions in the US with an AAPC of 2.11% (p<0.001). NHW women in the South had the largest increase with an AAPC of 2.79% (p<0.001). Dividing age into five years age groups, 85% of the increasing rate were found in patients younger than 60 years. More specifically, those within the age range of 30-34 years had a 3.27% increase per year. When examining age, rates were increasing in most younger age groups less than 60 years, with the largest increase in the 30-34 years old age group at 3.27% (p<0.001). When performing an intersection analysis, NHW in the South aged 40-44 had the highest rise in advanced cervical cancer at a rate of 4.56% annually (p<0.001). Using the BRFSS data, we found that NHW women had the highest rates of non-guideline screening (last pap smear > 5 years ago) at 26.65%, almost double compared to NHB women at 13.79%. The suboptimal screening had been increasing in all racial groups at 6.1% annually (p<0.001). When looking at vaccination, NHB women had the highest vaccination rate at 17.07%; however, vaccination rates were rising most quickly in NHW at an AAPC of 24.8% (p<0.001). When looking specifically at the teenage population, NHW girls aged 13-17 had the lowest vaccination rate at 66.10% compared to Hispanic girls at 75.30%. Rates of vaccination were rising the most in NHB girls at 6.9% annually (p<0.001). <b>Conclusions:</b> Disparities exist among diagnoses of advanced-stage cervical cancer, with rates disproportionately affecting minorities. However, advanced-stage cervical cancer is on the rise in the United States, especially in younger NHW women. Upon examining the screening and vaccination practices, NHW were more likely to be non- compliant with pap smear screening, and young NHW girls, for whom the vaccine was recommended, had the lowest vaccination rates. These factors could contribute to a rise in more advanced stage diagnosis.

Effect of Pap-smear and sociodemographic factors on cervical cancer risk in Estonia: A population-based case-control study

BackgroundLike many Eastern-European countries, Estonia struggles with ineffective cervical cancer (CC) screening. Despite a long-term organised screening programme and high overall Pap-smear coverage, CC incidence and mortality remain very high. The aim of the study was to examine the reasons for high CC incidence in Estonia by analysing the effect of Pap-smears and sociodemographic factors on CC risk. MethodsIn this population-based case-control study, women aged ≥ 25 years with an in situ/invasive CC diagnosed in Estonia in 2011–2017 were defined as cases. Using a density sampling scheme, controls were randomly selected from general population. To estimate CC risk associated with having no Pap-smears during seven years before diagnosis (cases) or index date (controls), place of residence, interruption in health insurance, and several sociodemographic factors, multivariate logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Individual-level data from three population-based registries were used. ResultsAmong 1439 cases and 4317 controls, proportion of women with no Pap-smears was 53% and 35%, respectively. Women with no Pap-smears were at higher risk for CC (OR=2.35; 95% CI: 1.85–2.98). CC risk was increased among women who were younger, living in more remote regions, lower-educated, or divorced/widowed. Interruption in health insurance was associated with a 23% risk increase. Regional differences in CC risk were observed among screened women. ConclusionTo reduce the risk of CC in Estonia, efforts are necessary to increase screening coverage among high-risk women and ensure the quality of CC screening programme. Screening approaches and communication should be tailored to the needs of different population groups. Further studies are warranted to identify the reasons for regional differences in CC risk.

Incidence and risk factors associated with the development of metastatic spinal cord compression due to bone metastasis in women with cervical cancer.

The aim of this study was to determine the incidence and factors associated with the development of metastatic spinal cord compression (MSCC) after cervical cancer (CC). This retrospective cohort of 3551 women with CC who underwent treatment at the Brazilian National Cancer Institute were included in the study. Clinical and sociodemographic variables were obtained from the Hospital Cancer Registry and from hospital records. A descriptive study of the population was carried out, using means and standard deviations or frequencies and percentages. The Kaplan-Meier curve was used to identify annual incidence rates. Associations between the independent variables and the outcome (MSCC) were evaluated by a univariate analysis, applying crude and adjusted odds ratios (aOR) assuming 95% confidence intervals. The MSCC incidence was of 1.5% (n = 51), associated to advanced staging (aOR = 2.65, 95% CI: 1.45-4.85, p = 0.001) and initial treatment with concomitant chemotherapy and radiotherapy (aOR = 4.40, 95% CI: 1.74-11.13, p = 0.002). Our findings revealed the incidence and factors associated with MSCC, indicating a subset of patients who may be potential targets for the prevention and early treatment of this condition, indicating unprecedented and relevant data for the Brazilian epidemiological scenario due to the high CC incidence rates.

Evaluation of human papillomavirus (HPV) knowledge among healthcare professionals: A study of conference attendees in Angola

ABSTRACT Human papillomavirus (HPV) plays an essential role in cervical cancer development. Angola has a high cervical cancer incidence rate (36.1 per 100,000); therefore, knowledge of HPV among clinicians is essential for the prevention of cervical cancer and educating at-risk individuals. This study aimed to evaluate knowledge of HPV among healthcare professionals in Angola. A 44-item questionnaire was distributed to 65 healthcare professionals who attended a conference on the cancer burden in Angola. Non-parametric and multiple regression analyses were conducted. Of the participants (55.6%) were male, and 33.3% were aged 31–40 years, 56.3% had an undergraduate degree, and 35.9% had a postgraduate degree. All participants worked in healthcare in academic and/or clinical settings, with 36.7% in joint contracts. Most (62.2%) knew that early sexual debut increases the risk of contracting HPV, and HPV vaccines are most effective if administered before sexual debut. However, there was limited knowledge regarding the virus transmission. The mean HPV knowledge score was 11.08 ± 8.76 and knowledge was higher among older healthcare workers (>50 years) with a postgraduate degree and working in a clinical role. Overall, HPV knowledge was limited among the respondents. Policymakers should consider promoting knowledge and targeted public health initiatives among healthcare professionals in Angola.

Lower Compliance with Cervical Cancer Screening Guidelines Among Vegetarians in North America.

Cervical cancer is preventable and treatable through regular screening and follow-up. However, the utilization of cervical cancer screening may vary widely based on individual lifestyles. The purpose of this study was to examine the differences in the adherence to cervical cancer screening guidelines in various dietary groups. Our study included 21,376 women from the United States and Canada, aged 30-69 from the Adventist Health Study-2, a large population-based prospective cohort study. Modified Poisson regression with robust variance estimation was used to determine the prevalence ratios of cervical cancer screening behavior in participants following five different dietary patterns (non-vegetarians, semi-vegetarians, pesco-vegetarians, lacto-ovo-vegetarians, and vegans). All analyses were adjusted for age, race/ethnicity, marital status, education, personal income, body mass index, smoking, alcohol use, exercise, and family history of all female cancer. Vegetarians, in general, had similar screening prevalence as non-vegetarians. However, vegans were 16% less likely to have had a Pap test compared to non-vegetarians (prevalence ratio (PR) = 0.84, 95% confidence interval 0.81-0.86). Women who were younger, Black, married, more educated, had a family history of all female cancer, had a higher income, and exercise reported higher compliance to a Pap test. It remains to be seen whether vegan women in Adventist Health-2 experience a higher incidence of cervical cancer or are diagnosed at a later stage compared to non-vegetarians.

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.

A qualitative descriptive study of providers\u2019 perspectives on human papillomavirus vaccine administration among Latino/a adolescents in South Texas clinics: barriers and facilitators

BackgroundSouth Texas Latinas experience higher cervical cancer incidence and mortality compared to Latinas nationwide. Despite the availability of effective human papillomavirus vaccines, South Texas Latino/a adolescents sub-optimally complete the series. Research shows provider recommendation strongly predicts vaccine uptake, but minority adolescents are less likely to report that their provider recommended the vaccine and series completion. There is also scant information on the HPV vaccine administration process in clinic practices providing vaccination services to Latino adolescents with limited access to healthcare resources. The purpose of the study was to describe providers’ experience with administering the HPV vaccine to Latino/a patients in their practices.MethodsThe study used qualitative description to describe the experience of 15 South Texas healthcare providers (doctors and nurses) with the process of HPV vaccine administration in their practices. We conducted open ended, audio-recorded interviews, which were subsequently transcribed verbatim and uploaded into Atlas.(ti) 7.0 for analysis. The interviews yielded detailed descriptions of barriers and facilitators that could potentially impact HPV vaccine uptake.ResultsProviders identified parental exposure to provider recommendation as enhancing HPV acceptance and existing policies and implementation of evidence-based practices as facilitators of HPV vaccine uptake. Barriers ranged from parental fears of adolescent sexual activity and potential vaccine side effects to lack of transportation and the cost of the vaccine.ConclusionThese findings reflect barriers and facilitators to administering the HPV vaccine previously identified and also highlight issues unique to the situation among Latinos in South Texas. Implications include the need to design and implement efforts to improve provider-parent communication and enhance parental and adolescent patients’ understanding of and confidence in the HPV vaccine. Furthermore, policy changes are needed to rectify organizational/structural challenges to HPV vaccine administration.

Cervical cancer, geographical inequalities, prevention and barriers in resource depleted countries.

Cervical cancer (CC) remains a current global issue, with >90% of cervical cancer cases being attributed to human papilloma virus (HPV). The highest burden of cervical cancer is reported in resource-depleted geographical areas with a high incidence of HPV infection. Recent developments in primary prevention include vaccinations against specific strains of HPV and the psychoeducation of the public. Yet, despite the availability of vaccinations, there is high incidence of both HPV and cervical cancer in developing countries, which is attributed to a multitude of barriers including inaccessibility to expensive vaccines. With regards to secondary prevention, progress is actively being made to develop more effective methods of screening and to specifically address the needs of low-income countries. In the past few years, more novel screening methods, such as self-assessment kits, immunohistochemistry and methylation marker analysis, have been developed. Barriers to screening in resource-depleted countries include limited financial resources and infrastructure to develop screening programmes, a lack of screening programmes that are accessible to populations, inadequate training of healthcare teams and stigma related to medical examinations performed as part of screening. Developing primary and secondary prevention programs, as well as addressing the barriers involved in countries with low socioeconomic levels, can drastically reduce morbidity and mortality rates associated with cervical cancer, thus reducing the burden associated with this gynaecological malignancy.

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 situation in Malaysia: A systematic literature review

Cervix cancer is one of Malaysia’s most significant cancers for women (around 12.9%, with an age-standardised incidence rate of 19.7 per 100,000). It was higher than other Asian, West, and even worldwide nations. The National Strategic Plan for Cancer Control Program 2016–2020 (Health Ministry) was presented to minimize cancer and mortality. The high incidence of cervical cancer in Malaysia is mainly due to women’s insufficient knowledge about its prevention and importance. Compared with traditional literature reviews, the systemic analysis provides many advantages. A clearer review process, a more prominent field of study, and essential priorities that can manage research bias can all help to enhance these reviews. However, better integration, cooperation, and coordination between government and private sector as well as NGOs and professional organisations are essential for optimal cancer control and treatment across the country.

Abstract PO-270: Evaluation of attitudes, beliefs and influences and their impact on HPV vaccination rates among minority health science students

Abstract Introduction: Human Papillomavirus (HPV) is the most common sexually transmitted disease. The contraction of HPV is associated with the development of several different types of cancers, including anal, cervical, and oropharyngeal cancers. These cancers have proven to impact Black and Hispanic women disproportionately across the United States, suffering from high rates of HPV infection and high incidence of cervical cancer. Despite knowledge of this risk, HPV vaccination rates remain low among minority women. Personal beliefs and access surrounding HPV vaccination may be contributors to these disparities. This survey aims to study the motivations behind the choice to receive HPV vaccination among health science students. Health science students are the target for this study as they are uniquely situated as the future providers of their communities. If the study is able to gauge how they feel about HPV vaccination, then the scientific community can target interventions to impact change beginning with the providers themselves. Females specifically were chosen as they are the primary targets of HPV vaccination. HPV vaccination rates among female health science students are a secondary result. Methods: A 37-item electronic survey was sent out to female health science students at the University of Florida which include the schools of Dentistry, Medicine, Nursing, Pharmacy, Public Health, and Veterinary Science. The online survey was then distributed in July of 2021 through Qualtrics. The survey evaluated previous HPV knowledge, motivations for or against HPV vaccination, and beliefs surrounding HPV vaccination. Results: The survey was delivered and distributed in July of 2021. In this study there are four different types of questions analyzed to gather information on previous HPV knowledge, attitudes, beliefs and external influences. Results will be categorized and compared based on race/ethnicity. By analyzing these groups there is an opportunity to understand how one's racial or ethnic background can affect their medical decisions in health science students and the recommendations they give to others. Results are pending. Conclusion: This being the first study of its kind warrants further investigation as health science students are trusted individuals of the medical community. If these students are against HPV vaccination, then medical schools could target interventions to teach students about racial disparities in HPV infection and vaccination recommendation. So, when given the opportunity as a provider these students can recommend vaccination to their patients. These results are indicative of knowledge gaps and attitudes within the younger generations of the medical community. Citation Format: Katya M Marcia, John M Allen. Evaluation of attitudes, beliefs and influences and their impact on HPV vaccination rates among minority health science students [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-270.

Abstract PO-252: Impact of COVID-19 public policies on utilization on cervical cancer screening in Puerto Rico during March 15, 2020 to July 31, 2020

Abstract Introduction: Among jurisdictions of the United States, Puerto Rico (PR) has the highest incidence of cervical cancer, and cervical cancer screening (CCS) is below 80%. Public health emergencies have an impact on people's access to health care services. We examined the impact of the public policy implemented by the government of Puerto Rico during the first 5 months of the COVID-19 pandemic in the utilization of CCS for participants of the Government's Public Health Plan. Methodology: This was a retrospective cohort study. A total of 40 government executive orders (issued between March 15 to July 31, 2020) were analyzed according to the level of restrictions they imposed on the population. Three periods with the greatest restrictions were identified: two of them in the government's initial response phase (March 15-30th &amp; March 31st-April 12th) and one in the re-opening phase (July 17-July 31st). We examined the utilization of all modalities of CCS (pap test only and pap + HPV contesting). Rate ratios (RRs) were estimated to compare to CCS rates during periods of 2020 and compared to 2018-2019. Results: In comparison to 2019, CCS decreased during the most restricted period (March 31st-April 12th) of the response phase (RR= 0.19, 95% CI=0.15-0.24 for women 21-29 years; RR= 0.04 95% CI= 0.03-0.05 for women 30-65 years). During the re-opening phase, screening services started to rebound. However, an increase in COVID-19 cases led to another restriction (July 17-July31st), which led to a second phase of decrease in utilization of CCS (RR=0.17, 95% CI=0.13-0.21 for women 21-29 years (RR= 0.09, 95% CI=0.08-0.10 for women 30-65 years). Conclusion: Our results evidence how the public policy implemented as a result of the COVID-19 pandemic in Puerto Rico had a direct impact on the utilization of CCS services in this Hispanic population. Future studies should examine screening patterns and social barriers of service utilization after July 2020 in Puerto Rico. Citation Format: Axel Gierbolini-Bermúdez, Karen Ortiz-Ortiz, Jeslie M Ramos- Cartagena, Kalyani Sonawane, Vivian Colón-Lopez, Ashish Deshmukh, Ana P Ortiz. Impact of COVID-19 public policies on utilization on cervical cancer screening in Puerto Rico during March 15, 2020 to July 31, 2020 [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-252.

Targeting elimination of cervical cancer by 2030: a baseline assessment in six African countries-part II.

Africa is home to many countries with the highest incidence of cervical cancer in the world. It is encouraging to see that the efforts to prevent and manage this disease are intensifying across the continent. The World Health Organization (WHO) has, in the last years, led a world-wide initiative to eliminate cervical cancer as a public health problem, starting by setting clear targets for 2030. To assist those African countries with the largest burden of cervical cancer, to reach the set targets, as a first step, WHO initiated a baseline capacity assessment in African high burden countries. We present and discuss the results thereof in this paper. The countries selected for the baseline evaluation were Eswatini, Guinea, Malawi, Rwanda, Uganda and Zambia. The data were collected by a mailed questionnaire in English, with 129 questions, most of them with preset answer options. It was answered by national coordinators of non-communicable diseases, cancer control or reproductive health programmes in the ministries of health and by the WHO country representatives. Based on the answers, suggestions were made towards optimising the efforts for cancer control. Except for Eswatini and Guinea, vaccination against the human papilloma virus (HPV) has reached between 74% and 98% of girls in the age bracket. The main method for cervical screening is still inspection with acid acetic. HPV testing, recommended by WHO, is being introduced slowly. The numbers of women screened are not yet nearing the required levels. Between 30% and 70% of the cervical cancers diagnosed are being treated with palliative intent. A deficit of personnel was reported for all professions involved in cervical cancer care. Guinea will need assistance to implement HPV immunisations and expand screening. In all six countries surveyed, steps should be taken to introduce or scale up the more precise HPV screening instead of acid acetic inspection of the cervix, to replace the current cryoablation of the preinvasive lesions of the cervix with thermal ablation and to increase the capacity for screening. Solutions need to be found for covering the dearth in gynaecological oncologists and radiotherapy installations and personnel.

Abstract PO-005: Geospatial hotspot analysis of cervical cancer among Asian American Native Hawaiian Pacific Islander (AANHPI) population in Los Angeles County

Abstract Background: Higher cervical cancer incidence rates among subgroups of Asian American Native Hawaiian Pacific Islander (AANHPI) women are often overlooked in studies that aggregate this extremely heterogeneous population. There is a need to geographically target ethnic subgroup communities with the highest needs with culturally responsive services for cancer prevention. We analyzed the distribution of cervical cancer clusters among the ethnic subgroups of AANHPI women in Los Angeles County. Methods: We included data for first primary cancer cases with any stage of cervical cancer (only malignant tumors) diagnosed from 2000 to 2018 among AANHPI from the Los Angeles County Cancer Surveillance Program. We performed hotspot analyses using the Getis-Ord GI*statistic in ArcGIS to compare the distribution of statistically significant clusters of cervical cancer cases in Los Angeles County using a fixed band. Hot and cold spots with less than 11 cases were suppressed to protect patient confidentiality. Results: Among 8,708 cases of cervical cancer, AANHPI population accounted for 1332 cases (15%). Among the AANHPI population, the three most prevalent ethnic groups were Filipino (n=364, 28%), Chinese (n=314, 24%), and Korean (n=232, 18%) Americans. The hotspots varied by ethnic subgroups and emerged in areas with high proportions of Filipino (Glendale/Carson), Chinese (Arcadia/El Monte), and Korean (Hollywood Hills) American residents, respectively. Discussion: Our findings geospatially disaggregate the cervical cancer prevalence among AANHPI population in Los Angeles County by ethnic subgroups. Specifically, the cervical cancer hotspots contextualize potential geographic- and area-level factors that affect access to preventive services for these vulnerable populations and can facilitate allocating resources for culturally responsive services to increase uptake of HPV vaccination and screening. Citation Format: Michelle B. Shin, Bibiana Martinez, Jennifer Tsui. Geospatial hotspot analysis of cervical cancer among Asian American Native Hawaiian Pacific Islander (AANHPI) population in Los Angeles County [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-005.

Profil Kejadian Kanker Serviks Di Rumkital Dr Ramelan Periode Januari – Desember 2018

Background: cervical cancer as the highest case in Indonesia in 2013, especially in the regions of East Java and Central Java. For the main cause itself is a persistent infection of the Human Papilloma Virus (HPV). However, there are also many factors that can be a risk such as age, parity, hormonal contraceptive use, and sexual activity. Because of the high incidence of cervical cancer in East Java, the purpose of this study was to determine the profile of cervical cancer events in Rumkital DR Ramelan Surabaya during the period January - December 2018.&#x0D; Method : descriptive study with a qualitative approach carried out at the Rumkital Oncology Clinic DR Ramelan surabaya during May - August 2019.&#x0D; The results showed that the majority of cervical cancer cases occur in women &gt; 51 years old. Women with a history of parity ≥ 3 children have the highest percentage of 60%. The age group for first sexual intercourse has the same incidence both at age ≤ 20 years and &gt; 20 years which is 50%. As many as 60% of women have a history of hormonal contraceptive use longer than 4 years. And the highest history of changing sexual partners occurred in those with only one sexual partner, which was 93.3%.&#x0D; Conclusions women aged &gt; 51 years, have a history of parity ≥ 3 children, have sex at an early age ≤ 20 years, and use hormonal contraception ≥ 4 years, have a high risk of being cervical cancer.&#x0D; &#x0D; Keywords: cervical cancer, age, parity, age at first sexual intercourse, duration of use of hormonal contraception, multiple sexual partners.

Cervical cancer in the Russian Federation and the risks of vaginal fistula

This review aims to provide up-to-date information on the factors associated with an increased risk of vaginal fistula in women with cervical cancer, as well as on methods of their prevention and treatment. It includes data on various types of vaginal fistulas in cervical cancer patients and risk factors for their development, according to foreign and Russian research articles published over the last 20 years. Cervical cancer is one of the most challenging oncological diseases in the Russian Federation, because it is detected at stage III–IV in more than 30 % of women. Such a high incidence of cervical cancer and the need for radiotherapy determine high risk of fistulas, which significantly impairs the quality of life. Thus, identification of factors associated with vaginal fistulas, as well as methods of their prevention and treatment remains a highly relevant task for the Russian healthcare system.