Highest Cervical Cancer Incidence Rates Research Articles

Region of origin and cervical cancer stage in multiethnic Hispanic/Latinx patients living in the United States.

Hispanic/Latinx people have the second highest cervical cancer incidence rates in the U.S. However, there is a lack of disaggregated data on clinical outcomes for this diverse and populous group, which is critical to direct resources and funding where they are most needed. This study assessed differences in stage at diagnosis of cervical cancer among Hispanic/Latinx subpopulations and associated factors. We analyzed patients with primary cervical cancer from 2004 to 2019 in the National Cancer Database. Hispanic/Latinx patients were further categorized into Mexican, Puerto Rican (PR), Cuban, Dominican, and Central/South American, as per standard NCDB categories, and evaluated based on stage at diagnosis and sociodemographic characteristics. Multinomial logistic regression quantified the odds of advanced stage at presentation. Regression models were adjusted for age, education, neighborhood income, insurance status, and additional factors. Hispanic/Latinx cervical cancer patients were more likely to be uninsured (18.9% vs. 6.0%, p < 0.001) and more likely to live in low-income neighborhoods (28.6% vs. 16.9%, p < 0.001) when compared to non-Hispanic White populations. Uninsured Hispanic/Latinx patients had 37.0% higher odds of presenting with regional versus localized disease (OR 1.37; 95% CI, 1.19-1.58) and 47.0% higher odds of presenting with distant versus. Localized disease than insured patients (OR 1.47; 95% CI, 1.33-1.62). When adjusting for age, education, neighborhood income, and insurance status, PR patients were 48% more likely than Mexican patients to present with stage IV versus stage I disease (OR 1.48; 95% CI, 1.34-1.64). Disaggregating health data revealed differences in stage at cervical cancer presentation among Hispanic/Latinx subpopulations, with insurance status as a major predictor. Further work targeting structural factors, such as insurance status, within specific Hispanic/Latinx subpopulations is needed.

Cervical cancer screening history among women diagnosed with cervical cancer in Estonia 2017-18.

Despite the national cervical cancer screening programme launched in 2006, Estonia has one of the highest cervical cancer incidence rates in Europe. While the overall coverage of cervical cytology is high, the factors related to cancer screening history prior to cancer diagnosis need to be studied. In this study, we aimed to examine the 10-year screening history of women diagnosed with cervical cancer in Estonia in 2017-18, using data collected from laboratory reports from 2007 to 2018. From each report, we extracted information on the date and result of cytology and on the laboratory where the sample was assessed. We analysed these data across cancer histology, the time interval between the last test result and cancer diagnosis and the laboratory type (local or regional). Among 319 women with cervical cancer, 181 (56.7%) did not have any cytology reports available. Among 138 women with at least one cytology, 60% had 1-3, 24% 4-6 and 16% ≥7 tests (mean 3.7) before cancer. In 78% of women, the last test was performed less than 5 years before cancer diagnosis and 62% of these tests did not report any abnormalities. The last cytology results differed significantly between the regional and local laboratories (P = 0.028). Women received the cervical cancer diagnosis in Estonia despite having several screening tests 10 years prior to the diagnosis. The proportion of cytology tests without any abnormalities less than 5 years before the diagnosis was worryingly high and needs further investigation together with the difference between laboratory types.

HPV Vaccination among Polish Adolescents-Results from POLKA 18 Study.

Human Papillomavirus (HPV) is the main cause of cervical cancer and genital warts and constitutes one of the most common sexually transmitted infections. Cervical cancer is the only reproductive cancer that has a primary prevention programme through the introduction of HPV vaccinations. Even though the majority of European countries have nationally funded HPV vaccination programmes, in Poland these are exclusively local and scarcely funded. Moreover, the majority of local programmes are directed to females only. Meanwhile, Poland has one of the highest cervical cancer incidence rates among high income countries. The aim of this study was to measure HPV vaccination levels among final-year students in Poland and to establish the association between vaccination status and gender, region and level of sexual education received. This study is a part of the POLKA 18 Study, which used original self-reported paper-based questionnaires distributed in schools in six Polish regions. The study was conducted between April and December 2019. The obtained data were analysed in STATA 17. In total, 2701 fully completed questionnaires were collected. Over half of the respondents (58.2%) did not know their HPV vaccination status. Only 16.0% of the respondents replied that they have been vaccinated against HPV (18.2% of females and 14.5% of males). There was no direct association between vaccination status and access to 'family life education' classes. The vaccination level significantly differed among the different regions of Poland (p &lt; 0.0001), with the Śląskie and Wielkopolskie regions achieving the highest rates. At least a quarter of adolescents after their sexual debut have not been vaccinated against HPV. Regions with immunization programmes introduced to their provincial capitals had higher vaccination rates. Our findings indicate the need for the introduction of state-funded vaccination programmes at the national level for the vaccination rate to increase, which will have the potential to decrease cervical cancer incidence in the country.

Profiling the real-world management status of high-risk human papillomavirus infection: a protocol to establish a prospective cohort of high-risk human papillomavirus-infected women in Lueyang County, China

IntroductionPersistent infection with high-risk human papillomavirus (hrHPV) is the main cause of cervical cancer. Thus, the effective treatment against HPV represents an opportunity to reduce the incidence of cervical cancer....

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.

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.

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.

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.

Time Trends Analysis of Cervical Cancer Incidence in Cluj County, Romania, Using Data from a Population-Based Cancer Registry.

(1) Background: Romania has one of the highest cervical cancer incidence rates in Europe. In Cluj County, the first screening program was initiated in 1998. We aimed to investigate the time trends of cervical cancer incidence in women from Cluj County and to evaluate the data quality at the Cancer Registry. (2) Methods: We calculated time trends of standardized incidence rates in the period 1998–2014 and the Annual Percent Change (APC%). To assess data quality, we used the indicators: mortality/incidence ratio (M/I), percentage of cases declared only at death (DOD%), and percentage of cases with pathological confirmation (PC%). (3) Results: The standardized incidence rate increased steadily, from 23.74 cases/100,000 in 1998, to 32/100,000 in 2014, with an APC% of 2.49% (p < 0.05). The rise in incidence affected both squamous cell carcinoma (APC% 2.49%) (p < 0.05) and cervical adenocarcinoma (APC% 10.54%) (p < 0.05). The M/I ratio was 0.29, DOD% 2.66%, and MC% 94.8%. The last two parameters are within the silver standard concerning data quality. (4) Conclusions. Our study revealed an ascending trend of cervical cancer incidence, more consistent for adenocarcinoma, in the context of a newly introduced screening program and partially due to the improvement of the quality of case reporting at the Cancer Registry from Cluj.

The role and utility of population-based cancer registries in cervical cancer surveillance and control

Population–based cancer registries (PBCR) are vital to the assessment of the cancer burden and in monitoring and evaluating national progress in cervical cancer surveillance and control. Yet the level of their development in countries exhibiting the highest cervical cancer incidence rates is suboptimal, and requires considerable investment if they are to document the impact of WHO global initiative to eliminate cervical cancer as a public health problem. As a starting point we propose a comprehensive cancer surveillance framework, positioning PBCR in relation to other health information systems that are required across the cancer control continuum. The key concepts of PBCR are revisited and their role in providing a situation analysis of the scale and profile of the cancer-specific incidence and survival, and their evolution over time is illustrated with specific examples. Linking cervical cancer data to screening and immunization information systems enables the development of a comprehensive set of measures capable of assessing the short- and long-term achievements and impact of the initiative. Such data form the basis of national and global estimates of the cancer burden and permit comparisons across countries, facilitating decision-making or triggering cancer control action. The initiation and sustainable development of PBCR must be an early step in the scale-up of cervical cancer control activities as a means to ensure progress is successfully monitored and appraised.

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.

Cervical Cancer Among Older Women: Analyses of Surveillance, Epidemiology and End Results Program Data

Objective:To describe age-specific cervical cancer incidence rates based on demographic and clinical characteristics.Methods:Women with cervical cancer in the SEER program were grouped into 3 age categories. Demographics, clinical characteristics, and incidence rates were obtained for each age group.Results:Older women (≥65 years) had higher incidence rates of cervical cancer than women <65 years with the highest rates in black women ≥75 years. Older black women had more adverse factors at diagnosis than similarly aged white and younger black women. There was a higher incidence rate of cervical cancer in women with lower socioeconomic status (SES), with the highest rates in older black women. However, the incidence rates were similar for older black women regardless of SES.Conclusion:Older black have the highest cervical cancer incidence rates, regardless of SES, suggesting an age and race disparity when compared to younger and white women.

The Prevalence of Genital Human Papillomavirus Subtypes in a Cohort of Hispanic Women Presenting for Cervical Cancer Screening Along the US-Mexico Border.

Introduction : Hispanic women residing along the US-Mexico border have the highest cervical cancer incidence rates in the US. Genital human papillomavirus (HPV) is the major causative agent, but more information is needed about the prevalence and distribution of genital HPV subtypes in this high-risk population. Methods : A population-based cross-sectional study of uninsured Hispanic women along the US-Mexico border was conducted and participants had their cervical specimens undergo DNA extraction followed by HPV genotype testing using the Linear Assay from Roche® Diagnostics, to identify 37 genital HPV subtypes. Results : Among the 585 women aged 21-65 years, 584 self-identfied as Hispanic. Any HPV subtype prevalence was 53.2% (95% CI: 49.0%-57.3%) and of these 52% (i.e. 27.5% of the total) had single infections and 48% (i.e. 25.6% of the total) had multiple infections. High-risk HPV prevalence was 15.6% (95% CI: 24-31.3%). The mean number of subtypes among those testing positive was 2.1 (SD 1.6). The prevalence of any HPV and high-risk HPV showed a U shaped pattern with age; and prevalence of 16/18 and non-16/18 high-risk subtypes (e.g. 31, 33, 35, 39, 45, 51, 52, 58); also varied with age. Forty-one percent of high-risk HPV occurrences were of a subtype not covered by the current nonavalent HPV vaccine. Discussion : Our findings suggest a different high-risk HPV subtype pattern and age distribution among Hispanic women in the USA, which could have implications for future cervical cancer prevention strategies.

Lay knowledge of cervical cancer in Manhi\xe7a district, Mozambique: a qualitative study

BackgroundMozambique has one of the highest cervical cancer incidence rates in the world. Health interventions are still being conceived solely from a non-communicable disease standpoint despite that it is also a sexual and reproductive health problem. The objective of this study was to assess the extent to which lay perceptions of cervical cancer align with biomedical knowledge from the standpoint of sexual and reproductive health.Methods10 focus group discussions were carried out with 10 target groups in Manhiça. The target groups were diverse in terms of age, sex, educational level and occupation. There were a total of 116 participants. The focus groups discussions were applied to obtain verbal information and trigger debates around beliefs and attitudes about cervical cancer as well as to explore notions of transmission and aetiology of the disease. The discussions were recorded for later transcription and analysis, following a combination of content and thematic analysis.ResultsParticipants were familiar with the biomedical term ‘cervical cancer’ but knowledge of its aetiology and transmission was limited. Cervical cancer was readily associated to sexual transmission and sexually transmitted infections, and conceived as a ‘wound that does not heal’. The term ‘cancer’ caused confusion, as it was perceived to happen only in limbs, understood as hereditary, not transmissible and as an illness of the West.ConclusionsLay perceptions of cervical cancer do, to a large extent, align with biomedical ones, thus, there is common ground to frame future health interventions from a sexual and reproductive health standpoint. Some misperceptions were identified which could be reduced through social behaviour change communication initiatives.

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.

Integrated cervical cancer screening in Mayuge District Uganda (ASPIRE Mayuge): a pragmatic sequential cluster randomized trial protocol

BackgroundCervical cancer is almost entirely preventable through vaccination and screening, yet remains one of the ‘gravest threats to women’s lives’ according to the World Health Organization. Specific high-risk subtypes of human papillomavirus (HR-HPV) are well-established as the primary cause of cervical cancer. Uganda has one of the highest cervical cancer incidence rates in the world (54.8 per 100,000) as a result of limited screening access and infrastructure. The integration of a self-collected cervical cancer screening program using HPV testing within existing community-based primary health care services could increase access to screening and reduce cervical cancer rates among Ugandan women.MethodsUsing a pragmatic, sequential, cluster randomized trial design; we will compare the effectiveness of two cervical cancer screening models for self-collected HPV testing: 1) community health worker recruitment (door-to-door); and 2) community health meetings. In Mayuge district, Uganda, 31 villages are randomized to one of two treatment arms. Due to the nature of this trial, blinding is not possible. Women are eligible to participate if they have no previous history of hysterectomy or treatment for cervical cancer or pre-cancer and are aged 25–49 years old. All participants receive an integrated package of cervical cancer screening and education. Samples are tested for HPV using GeneXpert point of care testing. All women who test positive for HR-HPV types are referred to a designated health centre for follow-up inspection by Visual Inspection with Acetic acid (VIA) and treatment with thermal ablation. The primary outcome for the trial is the number of women who attend follow-up for VIA screening at a designated Health Centre after a positive HR-HPV test out of all women screened per arm. Secondary outcomes include: cervical cancer screening knowledge; patient-reported experience measures for self-collected cervical cancer screening; and HPV incidence.DiscussionResults from this study will inform the national scale-up of cervical cancer screening in Uganda, aligning with the World Health Organization’s target of achieving cervical cancer elimination through the pillar of increased HPV screening coverage.Trial registrationISRCTN, ISRCTN12767014. Registered 14 May 2019, https://doi.org/10.1186/ISRCTN12767014;clinicaltrials.gov, NCT04000503; Registered 27 June 2019, https://clinicaltrials.gov/ct2/show/NCT04000503Protocol versionJanuary 8, 2020, version 1.

Level and factors associated with uptake of human papillomavirus infection vaccine among female adolescents in Lira District, Uganda.

Introductionthe principal burden of human papillomavirus (HPV) infections is cervical cancer. Cervical cancer ranks as the fourth most common malignancy in women affecting 500,000 women each year with an estimated 266,000 deaths. Uganda has one of the highest cervical cancer incidence rates globally with an age-standardised incidence rate per 100,000 of 47.5. This study assessed the level and the factors associated with uptake of HPV vaccine by female adolescents in Lira district, Uganda.Methodsa mixed methods approach was employed using a survey among 460 female adolescents. We collected data using an interviewer-administered questionnaire. We interviewed five key informants and conducted ten in-depth interviews. Uptake was defined as completing three doses of the vaccine as per the recommended schedule. Prevalence risk ratios were used as measures of association and were computed using modified poison regression. Content analysis was used for qualitative data.Resultsthe mean age of the respondents was 13.97 (SD=1.24). Uptake was at 17.61% (81/460). The factors associated with uptake of HPV vaccine were: attaining ordinary level of education (aPR 1.48, 95%CI 1.11-1.97), positive attitude towards the vaccine (aPR 3.46, 95%CI 1.70-7.02), receiving vaccine doses from different vaccination sites (aPR 1.59, 95% CI 1.10-2.28) and encouragement from a health worker (aPR 1.55, 95%CI 1.15-2.11) or Village Health Team (aPR 3.47, 95%CI 1.50-8.02) to go for the vaccine. Other factors associated with uptake of HPV vaccine included; the existence of community outreaches (aPR 1.47, 95%CI 1.02-2.12), availability of vaccines at vaccination sites (aPR 4.84, 95%CI 2.90-8.08) and receiving full information about the vaccine at the vaccination site (aPR 1.90, 95%CI 1.26-2.85).ConclusionHPV vaccine uptake was low in Lira district. Efforts to improve uptake of HPV vaccine should focus on ensuring a consistent supply of vaccines at the vaccination sites, health education aimed at creating a positive attitude towards the vaccine, sensitisation of the adolescents about the vaccine and conducting community outreaches.

Results From a Pilot Video Intervention to Increase Cervical Cancer Screening in Refugee Women.

Many refugee women emigrate from countries with high cervical cancer incidence rates and have low rates of cervical cancer screening both before and after resettlement. Refugee women face many barriers to cervical cancer screening, including limited knowledge of cervical cancer and screening recommendations and cultural and linguistic barriers to being screened. Our pilot study aimed to develop and evaluate educational videos to promote cervical cancer screening among Karen-Burmese and Nepali-Bhutanese refugees, two of the largest groups of refugees arriving to the United States in recent years. We developed culturally tailored narrative videos for each ethnic group. Karen-Burmese and Nepali-Bhutanese women ( N = 40) were recruited through community health educators to participate in a pre- and posttest study. We assessed changes in cervical cancer knowledge and intentions to be screened, and satisfaction with the videos. We found that women were significantly more likely to report having heard of a test for cervical cancer and indicated significantly greater intentions to be screened after watching the video. Their knowledge about cervical cancer and screening also improved significantly, and they reported high levels of acceptability with the video. Our results suggest that culturally tailored narrative educational videos were acceptable to the target audiences and may be effective in increasing cervical cancer screening among refugee women. Further research should assess how health care and social service providers could implement video-based interventions to encourage women to be screened for cervical cancer during early resettlement.

Abstract IA3: The impact of premature death of women from preventable cancers, such as cervical cancer

Abstract Cervical cancer is the second most common cancer among women living in sub-Saharan Africa, yet more women die from cervical cancer than women with breast cancer. Despite cervical cancer being preventable, services for prevention, early detection and treatment are rare in most poorer countries, and most women die in the 4th-5th decade, a time when their children are particularly vulnerable, especially the girl child. The global adult mortality rate per 1000 population by WHO region in 2011 was 160, with the highest rate being in Lesotho at 541/1000. The under 5 mortality rate per 1000 live births in the African WHO region was 95/1000 in 2012 and 12 in Europe. The Gender Inequality Index (GII) is a composite index that reflects women's relative social disadvantage in three dimensions - reproductive health, empowerment and the labour market. Using the GII, among a number of other indices, it was found that overall women in developing countries had two-fold higher cervical cancer incidence rates and three-fold higher mortality rates than their counterparts from developed countries. Deprivation levels or poverty rates were a strong predictor of cross-national variations in cervical cancer incidence and mortality. Losing a parent, especially a mother for young girls may be catastrophic as her health and care is likely to deteriorate significantly. This paper will explore the range of effects of premature deaths of mothers on children in poor countries. Citation Format: Lynette Denny. The impact of premature death of women from preventable cancers, such as cervical cancer [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr IA3.

Health professional feedback on HPV vaccination roll-out in a developing country

BackgroundWorldwide, Zambia has the highest cervical cancer incidence rates (58.4/100,000 per year) and mortality rates (36.2/100,000 per year). The human papilloma virus (HPV) vaccine is considered a vital preventative measure against cervical cancer, particularly in sub-Saharan countries, such as Zambia. Past research suggests health professionals’ experiences with HPV vaccination rollout can have practical implications for effective delivery. ObjectiveTo explore health professionals’ perspectives on the HPV vaccination programme in Zambia. MethodsResearcher travelled to Zambia and conducted semi-structured interviews with fifteen health professionals working in private, government, and missionary clinics/hospitals. Observation was conducted for triangulation purposes. Thematic analysis was used to analyse the data. FindingsFive main themes emerged; medical misconceptions about the HPV vaccination, particularly with regards to infertility; fear of the unknown, including possible side effects and inadequate empirical research; need for prior desensitisation to resolve cultural barriers prior to vaccination rollout; a rural-urban divide in health awareness, particularly in relation to cancer vaccines; and economic concerns associated with access to the HPV vaccination for most of the Zambian population. ConclusionOverall, the findings indicate that an essential avenue for facilitating HPV vaccination rollout in Zambia is by implementing a pre-rollout community effort that removes or softens cultural barriers, particularly in rural areas. It is also essential to correct erroneous HPV presumptions health professionals may have around infertility. Affordability remains a seemingly intractable hindrance that hampers HPV vaccination rollout in Zambia.