Incidence Of Cervical Cancer Research Articles

Leveraging implementation science for secondary prevention of cervical cancer in South Africa

Aim Cervical cancer is the second most common cancer and the top cause of cancer deaths amongst women in South Africa. Evidence-based interventions for secondary prevention of cervical cancer (cervical screening followed by treatment of identified pre-cancerous lesions) are available in South Africa’s health system, yet cervical cancer incidence remains high. This paper argues that this is partly due to implementation failure, i.e., deploying a good intervention ineffectively. Interventions found efficacious in controlled research settings may not achieve desired health outcomes when deployed in the real world due to implementation failure. Methods The field of implementation science offers frameworks for enhancing effective implementation. These frameworks guide the identification of implementation barriers and selection of context-relevant strategies for addressing them. This paper applies implementation science frameworks to secondary prevention in South Africa and promotes using such frameworks in cervical cancer prevention programming. Findings The problem of secondary prevention of cervical cancer in South Africa is contextualised. The paper conceptualises effective implementation as the attainment of implementation outcomes including acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, reach, and sustainability of evidence-based interventions. Drawing from the South African literature, examples of ineffective and failed implementation of secondary prevention interventions are presented including: low acceptability of screening by users and providers, sub-optimal adoption of screening provision by providers, low feasibility of hospital-centred pre-cancer treatment provision, low implementation fidelity, and limited reach of screening and pre-cancer treatment. Finally, using two examples, the paper provides practical guidance on how implementation science frameworks could be leveraged in South Africa to mitigate implementation failure. Conclusions Greater application of and capacity building in implementation science are recommended to contribute towards strengthening cervical cancer secondary prevention in South Africa.

Progress and Challenges in Canada's Path Toward the Elimination of Cervical Cancer.

Cervical cancer is almost entirely preventable and treatable when detected early, making its elimination within reach for Canada and the world. However, cervical cancer is now the fastest-increasing cancer (+3.7% per year since 2015) in Canada as of 2023, marking the first significant increase in cervical cancer incidence since 1984. The human papillomavirus (HPV) vaccine and cervical screening are key preventive measures, with targets set by the WHO and the Canadian Partnership Against Cancer (CPAC) to eliminate cervical cancer in Canada by 2030 and 2040, respectively. These targets include increasing HPV vaccination rates, implementing primary HPV screening, and improving follow-up for abnormal HPV+ results. However, Canada's progress has been impeded by significant challenges. As of the most recent data, HPV vaccine coverage rates in Canada range from 47% to 81%, with an estimated national HPV vaccination completion rate of 64% in Canada, far below the target of 90% by 2025 set by the CPAC. With the exception of British Columbia and Prince Edward Island, the adoption of HPV DNA testing as the primary screening method has been slow across the Canadian provinces and territories despite its superior sensitivity compared with traditional cytology. This article reviews the current state of HPV vaccination and screening in Canada, emphasizing the need for coordinated efforts, transparency, and resource sharing to overcome barriers. Key recommendations include the dissemination of accessible educational materials, partnerships, and collaboration, including nationwide task forces and roundtables, and the implementation of standardized guidelines for HPV screening. Achieving cervical cancer elimination requires a united approach involving federal, provincial, and territorial health authorities, researchers, clinicians, NGOs, community groups, and patients' voices working together to ensure consistent, effective, timely, and meaningful cervical cancer prevention strategies are used across the country.

Abstract B064: Community-informed interventions to address cervical cancer disparities among people experiencing homelessness

Abstract Background: Cervical cancer incidence and mortality rates are up to four-fold higher among people experiencing homelessness (PEH) compared to the housed US population. Even beyond typical social and structural barriers to healthcare, homeless women experience high rates of sexual violence and trauma, often leading to discomfort with cervical cancer screening and delays/refusals of Pap tests. Despite these issues, strategies for appropriate cervical cancer screening in homeless communities are scarce, and no frameworks exist for routine screening in shelters. Methods: Leveraging an established multisectoral community-academic partnership addressing homelessness and health disparities in Indiana, USA, ongoing community-engaged research is examining barriers to cervical cancer screening among PEH and co-designing strategies to address them. Rapid assessment surveys were conducted with PEH at two large homeless service agencies in Indianapolis and Lafayette to document cervical cancer screening coverage and characteristics of individuals who are unscreened/overdue. In-depth interviews explored knowledge of cervical cancer, key barriers and facilitators to screening, and acceptability of shelter-based HPV self-sampling delivered by trusted community health workers (CHW). Results: Of n=167 survey respondents, 48% were white, 38% Black, 7% Hispanic, 7% other. Mean age was 43.18 years, and mean lifetime years of homelessness was 3.18. Nearly half of participants (49%) were unsheltered, 44% stayed at a shelter, the remainder couch-surfed. One third (32%) were unscreened or overdue for screening, far above state and national averages (24% and 22% respectively). The majority (84%) reported wanting to be screened and believing it is important for their health. Provider mistrust and competing priorities surrounding their homelessness were main reported barriers to screening. Qualitative findings identified key benefits, concerns, and preferences for HPV self-sampling, with many participants expressing interest and willingness to adopt this screening method. Conclusion: Despite a vast majority of PEH reporting a desire and willingness to be screened for cervical cancer, key identified barriers limit access for this uniquely vulnerable population. Ongoing qualitative analysis is directly informing community context-specific CHW-delivered cervical cancer education and HPV self- sampling interventions. This work will ultimately lead to broadly implementable strategies for shelter-based routine cancer screening and preventive healthcare delivery for PEH. Citation Format: Natalia M. Rodriguez, Lara Balian, Rebecca Ziolkowski, Xue Case, Kalesia Smith, Janelle Tipton. Community-informed interventions to address cervical cancer disparities among people experiencing homelessness [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B064.

Abstract A118: Barriers and facilitators to cervical cancer screening among older Hispanic women living in San Antonio, TX

Abstract Background: Disparities among Hispanic women getting screened for cervical cancer compared to non-Hispanic White women continue to exist, despite Hispanic women having higher incidence and mortality rates of cervical cancer. Previous work has shown limited knowledge and awareness about cervical cancer and screening, low health literacy, and cultural aspects such as fatalism as barriers to screening. On the other hand, having health insurance, a family history of cervical cancer and religiosity have been found to facilitate cervical cancer screening among Hispanic women. Moreover, in Texas, research has shown that women older than 50 and Hispanic women have lower rates of screening. Methods: Informed by the social determinants of health framework, we are interviewing Hispanic women living in San Antonio, TX about their experiences regarding cervical cancer screening. Questions cover the areas of knowledge about cervical cancer and cervical cancer screening, and barriers and facilitators to cervical cancer screening. We have completed 11 out of 36 planned interviews. Data analysis is guided by applied thematic analysis techniques. Preliminary Results: Currently, ages range from 50 to 64 years old. Most women are married and half are retired. Preliminary analysis shows continued low levels of knowledge about cervical cancer and screening. Barriers include feelings of fear and embarrassment about the test, physician’s gender, and access to healthcare, such as issues with transportation. Facilitators include physician’s attitude, clinic reminders, and having health insurance. Conclusion: More research is needed to understand and address barriers and facilitators to cervical cancer screening in this age group. Targeted public health efforts, including educational and multilevel interventions, should continue to increase knowledge about cervical cancer, and acceptability and access to cervical cancer screening among older Hispanic women living in San Antonio, TX. Citation Format: Coralia Vázquez-Otero, Audrey Cordova, Rita Pedraza, Selena Baglini, Amelie G. Ramírez. Barriers and facilitators to cervical cancer screening among older Hispanic women living in San Antonio, TX [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A118.

Abstract A117: Cervical cancer screening rates among older Hispanic women living in Texas: results using the BRFSS 2018, 2020, and 2022 survey data

Abstract Background: Despite cancer risk increasing with age, older women are less likely to be up-to- date with cervical cancer screening (CCS). CCS is recommended up-to 65 years, absent history of abnormal results. CCS rates are significantly lower among Hispanic women, despite higher cervical cancer incidence and mortality rates compared to non-Hispanic white women. In Texas, women older than 50 years have lower odds of timely pap testing. We examined CCS rates among older Hispanic women in Texas using data from the Behavioral Risk Factor Surveillance System. Methods: Our sample included 5,291 self-identified Hispanic women, ages 50-64. Outcome: receipt of pap smear within the last 3 years following the U.S. Preventive Services Task Force guidelines at the time each survey was conducted (years: 2018, 2020 and 2022). Descriptive analysis and chi-square tests were used to examine the proportion of women who reported receiving CCS within the recommended timeframe. Results: Only 63.75% (mean age = 56.4) reported getting a pap smear. Significant decreases were found among women who had a pap smear from 87.03% in 2018, 71.95% in 2020, and 43.24% in 2022 (p=0.00). Additional analyses will be conducted to test relationships with sociodemographic and healthcare variables. Conclusion: Older Hispanic women in Texas represented in this dataset are far from the 2030 Healthy People goal of 79% CCS. Decreases in CCS rates are possibly due to the COVID-19 pandemic impact on healthcare access. As the US population ages, research is needed to identify the potential systemic barriers this group is confronting to access preventive cancer care. Citation Format: Coralia Vázquez-Otero, Bilikisu Elewonibi, Adaobi Ankwe, Rhonda BeLue. Cervical cancer screening rates among older Hispanic women living in Texas: results using the BRFSS 2018, 2020, and 2022 survey data [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A117.

Immunoprognostic analysis of indoleamine 2,3-dioxygenase 1 in patients with cervical cancer.

The incidence of cervical cancer is increasing. Immunotherapies show better patient outcomes than monotherapies; however, the mainstay treatment for cervical cancer remains surgery and chemotherapy. Indoleamine 2,3-dioxygenase 1 (IDO1) acts on multiple tryptophan substrates, exhibiting antitumor, immunomodulatory, and antioxidant activities. Despite the association of elevated IDO1 expression with unfavorable outcomes in various cancers, its precise function in cervical cancer remains ambiguous. Here, we explored the prognostic significance of IDO1 in cervical carcinoma. Gene expression datasets were obtained from The Cancer Genome Atlas. Gene Expression Omnibus datasets were used for differential expression and functional correlation analyses. Using Human Protein Atlas alongside Tumor-Immune System Interaction Database, we assessed the association of IDO1 with survival rates. Given the link between cervical cancer prognosis and immune invasion, CIBERSORT was used to assess the connection between immune cells and IDO1, while the percentage of tumor-penetrating immune cells based on IDO1 expression in cervical cancer patients was analyzed using Tumor-Immune System Interaction Database. Incorporating a clinicopathological characteristic-based risk score model with IDO1 risk score, we devised a nomogram to predict cervical cancer patient survival. The effects of IDO1 in immune regulation and its prognostic significance were validated using data from patients with cervical cancer obtained from The Cancer Imaging Archive database. Compared with that in normal cervical tissues, IDO1 expression was significantly upregulated in cervical cancer tissues and significantly correlated with cervical cancer progression and prognosis. IDO1 expression showed a positive association with monocyte and macrophage abundance, while exhibiting a negative correlation with that of endothelial cells and eosinophils. Cox regression analyses highlighted IDO1 as the core immune gene implicated in cervical cancer. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses revealed an association of IDO1 with the metabolic pathways of tryptophan, phenylalanine, and tyrosine. Univariate and multivariate analyses revealed that elevated IDO1 expression correlates markedly with cervical cancer outcomes, suggesting it as a promising therapeutic target. The Cancer Imaging Archive data analysis revealed that the impact of anti-PD1 and CTLA4 therapy is more pronounced in cervical cancer patients exhibiting elevated IDO1 expression. IDO1 is a potential target for immunotherapy for cervical cancer.

Awareness of HPV and HPV vaccine among college students in China.

Cervical cancer is the fourth most common cancer among women, HPV vaccine can reduce the incidence of cervical cancer by approximately 70%. Sexual behavior is a direct risk factor for HPV infection, and sexually active college students, therefore, receive attention for HPV vaccination. This study aimed to investigate the awareness of HPV and its vaccine among college students in Zhengzhou, and to explore the factors influencing their awareness of HPV vaccine, to understand college students' willingness to receive the vaccine. The findings of this study will lay a foundation for cervical cancer prevention. Using a multistage random sampling method, 650 college students from four universities in Zhengzhou were selected. A self-administered questionnaire on the awareness of HPV and its vaccine, and willingness to receive HPV vaccination was carried out. Logistic regression was used to analyze the factors influencing students' awareness of the HPV vaccine. 58.0% of college students had heard of HPV, and 72.8% of college students had heard of HPV vaccine. Logistic regression showed that gender, major, grade, mean monthly consumption level, sexual history, and mother cervical cancer screening participation significantly influenced the awareness of HPV vaccine (p < 0.05). Only 27(4.2%) college students had received the HPV vaccine. 63.2% of college students expressed their willingness to get vaccinated. The awareness of HPV and its vaccine among college students in Zhengzhou needs improvement. Although the vaccination rate is low, most college students are willing to be vaccinated. Diverse health education programs should be conducted for different groups to improve awareness of cervical cancer prevention and promote vaccination.

Validation and usability of SeDAR e-health video for enhancing cervical cancer screening.

The cervical cancer (CC) incidence rate is increasing among young women aged <50 years despite early screening is proven effective. Electronic health (e-health) has great potential for disseminating health education. This study validated a newly developed e-health tool "SeDAR®" and assessed its usability via evaluations by health experts (HE), media experts (ME), and women. The SeDAR® content was developed based on protection motivation theory (PMT) using the nominal group technique and in-depth interviews that involved HE and women, respectively. Content validation was performed among the HE (n = 12) and ME (n = 5) using the content validation index (CVI) to identify their agreement. Subsequently, the Video Engagement Scale (VES®) was used to validate SeDAR® among women of different ethnicities (n = 11) to achieve ecological validity. The experts and women also commented on the presentation of the video. The validation yielded a good CVI among the HE (scale-level CVI-average [SCVI/Ave] = 0.986; scale-level CVI-universal agreement [SCVI/UA] = 0.900) and ME (SCVI/Ave = 0.979, SCVI/UA = 0.897). The highest VES® score [mean (±SD) = 92.90(±3.46)] proved the ecological validity of SeDAR®. The experts' feedback established that SeDAR® conveyed a clear message about awareness of performing CC screening and was suitable for public viewing. The women considered SeDAR® easy to understand, and it advised early exposure for early CC screening. SeDAR® was valid and could constitute an important e-health tool to improve motivation and uptake of CC screening.

Implementation of the cervical cancer prevention policy in one of the regions of Lithuania.

Although the Lithuanian government increases funding for the cervical cancer prevention program every year, the incidence and mortality rates of cervical cancer are among the highest in Europe. In order to improve the prevention policy regarding cervical cancer, it is necessary to investigate the implementation of the cervical cancer prevention policy in one of the regions in Lithuania. A quantitative survey method using a questionnaire, was applied in one of the regions of Lithuania. The study was conducted in the period 1-18 April 2022. During the study, 213 residents of the investigating region were interviewed. Respondents evaluated the cervical cancer prevention program in the investigated region positively, but not all women received invitations to participate in this program. The research revealed that the residents of the city of investigation have received this invitation more often than the women living in other districts. Women's opinion about the effectiveness of the cervical cancer prevention program is positive. Still, there is an emphasis on the wish that this program could be used from an the age of 25 years and continue to 59 years. The prevention program could be carried out more often than is currently established.

Trends in the incidence and mortality of cervical, ovarian, and corpus uteri cancers in Wales, UK: A joinpoint regression analysis from 2002 to 2021

ObjectivesThe primary objective of this study was to examine the secular trends of cervical, ovarian, and corpus uteri neoplasm in Wales, UK, over the period from 2002 to 2021. We aimed to identify changes in the incidence and mortality rates of these cancers to inform future healthcare policies and cancer prevention programs. MethodsWe sourced incidence data from 2002 to 2019 and mortality data from 2002 to 2021 from the Welsh Cancer Intelligence and Surveillance Unit. The data were analysed using Joinpoint regression to compute the average annual percentage change (AAPC) in age-standardized incidence rates (ASIR) and mortality rates (ASMR) per 100,000 population for each type of cancer. ResultsThe results showed that the ASIR for cervical cancer remained stable between 2002 and 2019 (AAPC = −0.5; 95 %CI = −1.4–0.4). However, the ASMR significantly declined from 4.88 in 2002–3.03 in 2021 (AAPC = −2.3; 95 %CI = −3.4 to −1.1). The ASIR for ovarian cancer significantly decreased from 27.39 in 2002–17.87 in 2019 (AAPC = −2.6; 95 %CI = −3.0 to −2.1), and the ASMR showed a statistically significant decreasing trend from 15.92 in 2002–11.2 in 2021 (AAPC = −1.7; 95 %CI = −2.5 to −0.9). In contrast, the ASIR for corpus uteri neoplasm significantly increased from 22.24 in 2002–30.41 in 2019 (AAPC = 2.2; 95 %CI = 1.2–3.4), and ASMR also showed a statistically significant increasing trend from 3.27 in 2002–6.42 in 2021 (AAPC = 3.8; 95 %CI = 2.3–5.3). ConclusionsThe study concludes that while the incidence and mortality rates for cervical and ovarian cancers in Wales have significantly decreased, corpus uteri neoplasm rates have increased during the study period. These findings underscore the need for continued efforts to improve early detection and treatment strategies, including national screening programs and public health initiatives, to mitigate the burden of these cancers.

Barriers and Facilitators to Shared Decision-Making for HPV Self-Sampling in LMICs: A Thematic Analysis

Cervical cancer is the second most common cancer among women in lower-middle-income countries (LMICs), contributing to the disproportionately high number of disability-adjusted life years in these regions.1,2 Shared decision-making (SDM) is a healthcare model that promotes patient-centered care by involving patients and family caregivers in collaborative treatment decision-making.3 Despite relatively high SDM awareness in high-income countries (HICs), seven studies have highlighted low awareness among healthcare professionals in LMICs, with cultural and operational barriers impeding its practice.4 The HPV-Automated Visual Evaluation (PAVE) Study is a multinational initiative focused on improving cervical cancer prevention in resource-constrained regions.5 This study aims to investigate stakeholders' understanding, views, and attitudes towards cervical cancer prevention and screening, and their preferences for receiving information and participating in decision-making.5 This will be achieved by analyzing the qualitative interviews with scientific experts and healthcare providers from the four participating sites (Brazil, El Salvador, Nigeria, and Tanzania).5 Thematic analysis is being applied to the interview transcripts to identify common themes and patterns, and enhance our understanding of stakeholder perspectives. Due to structural and cultural differences between HICs and LMICs, we expect that tailoring SDM to address specific barriers in LMICs will enhance its acceptance and utilization, leading to improved patient outcomes and satisfaction in cervical cancer prevention and treatment. If validated, the findings from the PAVE study may inform the widespread adoption and enhancement of cervical cancer prevention programs on a global scale. References Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [published correction appears in CA Cancer J Clin. 2020 Jul;70(4):313. doi: 10.3322/caac.21609]. CA Cancer J Clin. 2018;68(6):394-424. doi:10.3322/caac.21492 Momenimovahed, Z., Mazidimoradi, A., Maroofi, P., Allahqoli, L., Salehiniya, H., &amp; Alkatout, I. (2023). Global, regional and national burden, incidence, and mortality of cervical cancer. Cancer reports (Hoboken, N.J.), 6(3), e1756. https://doi.org/10.1002/cnr2.1756 Faiman B, Tariman JD. Shared Decision Making: Improving Patient Outcomes by Understanding the Benefits of and Barriers to Effective Communication. Clin J Oncol Nurs. 2019;23(5):540-542. doi:10.1188/19.CJON.540-542 Sam S, Sharma R, Corp N, Igwesi-Chidobe C, Babatunde OO. Shared decision making in musculoskeletal pain consultations in low- and middle-income countries: a systematic review. Int Health. 2020;12(5):455-471. doi:10.1093/inthealth/ihz077 de Sanjosé S, Perkins RB, Campos NG, et al. Design of the HPV-Automated Visual Evaluation (PAVE) Study: Validating a Novel Cervical Screening Strategy. Preprint. medRxiv. 2023;2023.08.30.23294826. Published 2023 Oct 23. doi:10.1101/2023.08.30.23294826

Our Daughters-Ourselves: Evaluating the Impact of Paired Cervical Cancer Screening of Mothers with HPV Vaccination for Daughters to Improve HPV Vaccine Coverage in Bamako, Mali.

Cervical cancer (CC) is the second most common cancer in Western Africa, accounting for 12,000 cases and 6000 deaths annually. While vaccination against human papilloma virus (HPV) and CC screenings reduce the incidence and mortality of CC in many developed countries, 90% of CC deaths are in low-income countries. Lack of knowledge about the connection between HPV and CC, lack of access to vaccines and screenings, weak healthcare infrastructure, and stigma related to sexually transmitted diseases are among the factors that contribute to this disparity. Previously, we evaluated the knowledge of HPV and CC in Bamako, Mali, showing that knowledge of the link between HPV and CC was very low (less than 8% of participants) and that less than 3% of women were screened for CC. Subsequent implementation of a community-based education program and support for local clinics resulted in a five-fold increase in CC screening at the five participating clinics in 2015. In this study, we paired CC screenings of mothers with HPV vaccination of their daughters to target out-of-school (OOS) girls whom school-based vaccination campaigns would not reach. Our campaign resulted in a 10.7% increase in HPV vaccination.

Directions for Improving the Laboratory Component in Secondary Prevention of Cervical Cancer

Relevance. Effective responses are required due to the high incidence of cervical cancer (Cc) throughout the World. RT-PCRbased HPV-testing is becoming more prominent in secondary prevention worldwide, replacing cytology. Russian practice still relies on cytology as the primary method mainly because there is a lack of comparative evaluation of the diagnostic characteristics of cytology and HPV-tests. Aim. Evaluation of diagnostic characteristics of laboratory methods and the relevance of extended HPV genotyping for secondary prevention of cervical cancer. Materials &amp; methods. The study included data (liquid cytology, histology, HPV-test results) from a survey of 653 women (M = 33.55 years old, ME = 32.0 years old, IQR: 26-38 years old) infected with 14 HPV types (16, 18, 31, 33, 35, 39, 45, 45, 51, 52, 56, 58, 59, 66, 68), with presence or absence of intraepithelial neoplasia of varying severity. The study analyzed the correlation of cervical cytology - histology, clinical sensitivity for high-grade squamous intraepithelial lesions (HSIL+), the incidence and the role of 14 oncogenic HPV types in the development of cervical intraepithelial pathology, positive predictive value (PPV) and the diagnostic accuracy of the HPV-test. Results. The agreement between cytology and histology is 67.20%. Clinical sensitivity of cytology is 83.78% for HSIL+ and 94.34% for any other than NILM result. The structure of the HPV population varies depending on the degree of neoplasia, with a constant predominance of HPV16. The clinical sensitivity of the laboratory component rises to 99.5% by conducting HPV-test for at least 12 types of virus. HSIL is more commonly associated with viruses of alpha-9 phylogenetic group, than with alpha-7 and alpha-5/6. The positive predictive value for HSIL+ is reduced depending on the HPV type: 16&gt;33&gt;58&gt;35&gt;45&gt;31&gt;18&gt;52&gt;39&gt;59&gt;58&gt;56&gt;68&gt;66. Conclusions. Clinical sensitivity of the HPV-test exceeds that of cytology, so that secondary prevention of cervical cancer can be effectively achieved through HPV testing. The introduction of an extended genotyping provides more complete information about the risk of having HSIL+. The data obtained will form the basis for the development of directions for improving the epidemiological surveillance information subsystem of HPVassociated cervical diseases

HPV vaccination strategy for 14-year-old females and economic returns for cervical cancer prevention in Wuxi City, China: a cost effectiveness analysis

BackgroundSince December 2021, Wuxi, China has offered a two-dose human papillomavirus (HPV) vaccination to 14-year-old females for free. This study evaluated the costs and benefits of this vaccination scheduled in the Expanded Program on Immunization in Wuxi from the perspective of the cities’ demographic characteristics, economic development, and policy support.MethodsThe model-based economic evaluation used TreeAge Pro software to construct a decision tree-Markov model for the vaccination strategy in which 100,000 14-year-old females received two doses of bivalent HPV vaccine or no vaccination. Costs and effects of the strategy were assessed from a societal perspective through literature research and data obtained from the Wuxi Centre for Disease Control and Prevention. Univariate, multivariate, and probabilistic sensitivity analyses assessed the stability of the findings.ResultsThe cost of the bivalent HPV vaccine in Wuxi is 711.3 CNY. The two-dose of bivalent HPV vaccine for 100,000 14-year-old females would cost an additional 658,016 CNY compared to no vaccination, but would result in 1,960 Quality Adjustment Years of Life (QALYs). Using the per capita gross domestic product of 187,415 CNY in 2021 in Wuxi as the willingness-to-pay threshold, the vaccination strategy costs 3,357.37 CNY per QALY gained, which is much lower than the threshold, suggesting that it is a very cost-effective strategy. In addition, the vaccine strategy reduced the incidence of cervical cancer by 300 cases and cervical cancer deaths by 181 cases, representing a benefit-cost ratio of 2.86 (> 1) when health output outcomes were measured in monetary terms. These results suggested that the vaccination strategy was advantageous. Sensitivity analyses showed that changes in the parameters did not affect the conclusions and that the findings were robust.ConclusionsCompared to no vaccination, the delivery of two doses of bivalent HPV vaccine for 14-year-old females was a more highly cost-effective and optimal strategy.

Cervical precancer and invasive cancer among women living with HIV in Latin America: A systematic review and meta-analysis.

Data on the occurrence of cervical precancer and cancer among women living with HIV (WLHIV) in Latin American countries (LAC) are scarce and highly heterogeneous. We conducted a systematic review summarizing data about the incidence/prevalence of invasive cervical cancer (CC) and high-grade precancerous lesions among WLHIV in LAC. Literature in PubMed and LILACS was searched. The primary outcome was invasive cancer incidence, and prevalence of high-grade lesions as key indicators for the WHO CC elimination strategy. Individual reports on invasive cancer incidence and prevalence of precancerous lesions were obtained, and a random effects meta-analysis was conducted for the latter. In total, 34,343 WLHIV from four studies reporting CC incidence in seven LAC were included, and 6079 WLHIV from 17 studies reporting prevalence of precancerous lesions in three LAC were included. CC incidence ranged between 136.0 and 398.4 per 100,000 WLHIV (with or without antiretroviral therapy). The weighted prevalence of high-grade lesions was 4.1% (95%CI: 3.8%-6.0%) with a double peak at ages 20-24 and 35-39 years. Differences in prevalence of high-grade lesions were also observed by screening approach: co-testing (11.9%), colposcopy (6.0%), cytology (4.2%), and HPV tests (3.2%). The high incidence of invasive cancer and prevalence of high-grade lesions underline challenges to reach the WHO's elimination goal of CC incidence below four per 100,000 among WLHIV. Moreover, the high prevalence of high-grade lesions at younger ages than in the general population is a call to accelerate the implementation of the new WHO screening recommendations in WLHIV.

Increasing knowledge and early detection of cervical cancer in women of childbearing age through IVA examination

Cervical cancer is one of the cancers that has a high prevalence in women, especially in childbearing age. Early detection through Visual Inspection of Acetic Acid (IVA) is an effective method to reduce the incidence and mortality rate due to cervical cancer. This Community Service Activity (PKM) aims to increase the knowledge of women of childbearing age about the importance of early detection of cervical cancer and facilitate IVA examinations for them. The methods used include health counseling through interactive lectures, distribution of educational materials, and the implementation of free IVA examinations. The results of the activity showed a significant increase in participants' knowledge about cervical cancer and the importance of early detection. In addition, enthusiasm and participation in IVA examinations increased, with more than 80% of participants attending undergoing examinations. This activity is expected to contribute to reducing the incidence of cervical cancer through preventive and educational efforts. A continuation of this program is the establishment of support groups in the community that will continue to promote reproductive health and early detection of cancer.

Trends in incidence and mortality for gynaecological cancers in Southeastern China during 2011–2020: a retrospective analysis of registry data

ObjectivesThis study aimed to investigate the changes in the incidence and mortality trends of ovarian cancer (OC), cervical cancer (CC) and uterine cancer (UC) in the Fujian Province, southeastern China.DesignProvincial,...

Multiscale Optical Imaging Fusion for Cervical Precancer Diagnosis: Integrating Widefield Colposcopy and High-Resolution Endomicroscopy.

Early detection and treatment of cervical precancers can prevent disease progression. However, in low-resource communities with a high incidence of cervical cancer, high equipment costs and a shortage of specialists hinder preventative strategies. This manuscript presents a low-cost multiscale in vivo optical imaging system coupled with a computer-aided diagnostic system that could enable accurate, real-time diagnosis of high-grade cervical precancers. The system combines portable colposcopy and high-resolution endomicroscopy (HRME) to acquire spatially registered widefield and microscopy videos. A multiscale imaging fusion network (MSFN) was developed to identify cervical intraepithelial neoplasia grade 2 or more severe (CIN 2+). The MSFN automatically identifies and segments the ectocervix and lesions from colposcopy images, extracts nuclear morphology features from HRME videos, and integrates the colposcopy and HRME information. With a threshold value set to achieve sensitivity equal to clinical impression (0.98 [p = 1.0]), the MSFN achieved a significantly higher specificity than clinical impression (0.75 vs. 0.43, p = 0.000006). Our findings show that multiscale optical imaging of the cervix allows the highly sensitive and specific detection of high-grade precancers. The multiscale imaging system and MSFN could facilitate the accurate, real-time diagnosis of cervical precancers in low-resource settings.

Bridging the Gap: Immune Checkpoint Inhibitor as an Option in the Management of Advanced and Recurrent Cervical Cancer in Sub-Saharan Africa.

Cervical cancer remains a leading cause of cancer-related mortality in women in low and middle-income countries despite efforts to improve prevention and standard-of-care interventions. Sub-Saharan Africa (SSA) leads the numbers for global cervical cancer incidence and mortality, with the majority of the incidence diagnosed in the late stage of the malignancy. Although the global cervical cancer death rate has been on the decline for the last two decades owing to advancements in screening and treatment options, the mortality rate in SSA has not declined very much. Chemotherapy has been the treatment of choice for cervical cancer in SSA without meeting the expected survival outcomes in these patients, with the majority having advanced diseases at diagnosis. Immune checkpoint inhibitors have recently shown clinical promise in improving the survival of patients with advanced cervical cancer and have been integrated into the treatment guidelines in most high-income countries, which have helped further reduce the mortality rate of cervical cancer. However, many SSA countries are yet to fully benefit from using immune checkpoint inhibitors in cervical cancer. In this review, we discuss the challenges hindering the effective use of immune checkpoint inhibitors for advanced cervical cancer in Africa and possible solutions.

SEOM-GEICO Clinical Guidelines on cervical cancer (2023)

Cervical cancer (CC) is the fourth most common cancer and the fourth leading cause of mortality in women worldwide. It is strongly associated with high-risk human papillomavirus infection. High-income countries that have implemented human papillomavirus (HPV) vaccination and screening programs have seen dramatic reductions in CC incidence, while developing countries where these programs are not available continue to experience high rates of CC deaths. In early-stage CC, the primary treatment is surgery or radiotherapy, whereas concurrent chemo-radiotherapy (CRT) remains the conventional approach in locally advanced stages until the upcoming approval of immunotherapy. The incorporation of immunotherapy in combination with chemotherapy (with or without bevacizumab) in first line and as monotherapy in second line after platinum-based chemotherapy, has significantly increased overall survival (OS) in recurrent or metastatic CC. The purpose of this guideline is to summarize the most relevant evidence in the diagnosis, treatment, and follow-up of CC and to provide evidence-based recommendations for clinical practice.