Incidence Of Invasive Cervical Cancer Research Articles

Invasive cervical cancer incidence following bivalent human papillomavirus vaccination: a population-based observational study of age at immunization, dose, and deprivation.

High-risk human papillomavirus causes cervical cancer. Vaccines have been developed that significantly reduce the incidence of preinvasive and invasive disease. This population-based observational study used linked screening, immunization, and cancer registry data from Scotland to assess the influence of age, number of doses, and deprivation on the incidence of invasive disease following administration of the bivalent vaccine. Data for women born between January 1, 1988, and June 5, 1996, were extracted from the Scottish cervical cancer screening system in July 2020 and linked to cancer registry, immunization, and deprivation data. Incidence of invasive cervical cancer per 100 000 person-years and vaccine effectiveness were correlated with vaccination status, age at vaccination, and deprivation; Kaplan Meier curves were calculated. No cases of invasive cancer were recorded in women immunized at 12 or 13 years of age irrespective of the number of doses. Women vaccinated at 14 to 22 years of age and given 3 doses of the bivalent vaccine showed a significant reduction in incidence compared with all unvaccinated women (3.2/100 000 [95% confidence interval (CI) = 2.1 to 4.6] vs 8.4 [95% CI = 7.2 to 9.6]). Unadjusted incidence was significantly higher in women from most deprived (Scottish Index of Multiple Deprivation 1) than least deprived (Scottish Index of Multiple Deprivation 5) areas (10.1/100 000 [95% CI = 7.8 to 12.8] vs 3.9 [95% CI = 2.6 to 5.7]). Women from the most deprived areas showed a significant reduction in incidence following 3 doses of vaccine (13.1/100 000 [95% CI = 9.95 to 16.9] vs 2.29 [95% CI = 0.62 to 5.86]). Our findings confirm that the bivalent vaccine prevents the development of invasive cervical cancer and that even 1 or 2 doses 1 month apart confer benefit if given at 12-13 years of age. At older ages, 3 doses are required for statistically significant vaccine effectiveness. Women from more deprived areas benefit more from vaccination than those from less deprived areas.

Ethnic disparities in the incidence of gynecologic malignancies among Israeli Women of Arab and Jewish Ethnicity: a 10-year study (2010-2019).

Ethnic disparities in healthcare outcomes persist, even when populations share the same environmental factors and healthcare infrastructure. Gynecologic malignancies are a significant health concern, making it essential to explore how these disparities manifest in terms of their incidence among different ethnic groups. To investigate ethnic disparities in the incidence of gynecologic malignancies incidence among Israeli women of Arab and Jewish ethnicity. Our research employs a longitudinal, population-based retrospective cohort design. Data on gynecologic cancer diagnoses among the Israeli population from 2010 to 2019 was obtained from a National Registry. Disease incidence rates and age standardization were calculated. A comparison between Arab and Jewish patients was performed, with Poisson regression models being used to analyze significant rate changes. Among Jewish women, the age-standardized ratio (ASR) for gynecologic malignancies decreased from 288 to 251 (p < 0.001) between 2014 and 2019. However, there was no significant change in the ASR among Arab women during the same period, with rates going from 192 to 186 (p = 0.802). During the study period, the incidence of ovarian cancer decreased significantly among Jewish women (p = 0.042), while the rate remained stable among Arab women (p = 0.102). A similar trend was observed for uterine cancer. The ASR of CIN III (Cervical Intraepithelial Neoplasia Grade 3) in Jewish women notably increased from 2017 to 2019, with an annual growth rate of 43.3% (p < 0.001). A similar substantial rise was observed among Arab women, with an annual growth rate of 40.5% (p < 0.001). In contrast, the incidence of invasive cervical cancer remained stable from 2010 to 2019 among women of both ethnic backgrounds. Our findings indicate that Arab women in Israel have a lower incidence rate of gynecologic cancers, warranting further investigation into protective factors. Both ethnic groups demonstrate effective utilization of cervical screening.

Cervical cancer screening uptake and associated factors among Women Living with Human Immunodeficiency Virus in public hospitals, eastern Ethiopia

BackgroundCervical cancer, the second leading cancer in Ethiopia women, is six times higher among women infected with the Human Immune Virus 1-infected women. Its screening provides protective advantages, and is linked to a decrease in the incidence of invasive cervical cancer and mortality. Although cancer screening has great advantages for early treatment and prevention of further complications, cervical cancer screening uptake is low among women in developing countries. Cervical cancer screening uptake among Women Living with Human Immunodeficiency Virus (WLHIV) is not well known in Eastern Ethiopia. Thus, we aimed to assess cervical cancer screening uptake and its associated factors among WLHIV in public hospitals in Harar, eastern Ethiopia.MethodsAn institution-based cross-sectional study was carried out on 412 randomly selected HIV-positive women from March 20 to April 20, 2022. The results of the study were presented descriptively in percentages and analytically in odds ratio. Bivariate and multivariable logistic regression analyses were used to determine the presence and degree of association between dependent and independent variables. In the multivariable logistic analysis, a p-value of 0.05, and an adjusted odds ratio with a 95% confidence interval were considered to determine independent predictors for the uptake of cervical cancer screening.ResultsCervical cancer screening uptake among WLHIV was 57.5% (95% CI: 52.5, 62.9%). The uptake of cervical cancer screening was significantly associated with age between 20-29 years (AOR = 7.33; 95% CI: 1.98, 27.1), 40-49 years (AOR = 4.37; 95% CI: 1.48, 12.89), tertiary level of education (AOR = 0.197; 95% CI: 0.041, 0.946), good knowledge (AOR = 3.591; 95% CI: 2.123, 6.073), and monthly income of 2501(45.52 $) and above Ethiopian Birr (AOR = 0.389; 95% CI: 0.158, 0.959).ConclusionsMore than half of the participants had undergone cervical cancer screening. Age, marital status, educational status, monthly income, and awareness of cancer screening uptake were all factors related to cervical cancer screening. To maximize uptake, it is necessary to create specific counseling and education programs that target HIV-positive women.

Human papillomavirus vaccine impact on invasive cervical cancer in Japan: Preliminary results from cancer statistics and the MINT study.

The first prophylactic vaccine against human papillomavirus (HPV) 16 and HPV18 was licensed in Japan in 2009. HPV vaccine effectiveness against high-grade cervical lesions has been demonstrated among young Japanese women, but evidence of its effects on invasive cervical cancer (ICC) is lacking. Using data from two different cancer registries, we compared recent trends of new ICC cases by age group using Poisson regression analysis. We also analyzed time trends in HPV16/18 prevalence among 1414 Japanese women aged <40 years newly diagnosed with ICC in the past decade. Based on the population-based cancer registry, the incidence of ICC among young women aged 20-29 years showed a significant decline from 3.6 to 2.8 per 100 000 women-years during 2016-2019, but no similar decline was observed for older age groups (p < 0.01). Similarly, using data from the gynecological cancer registry of the Japan Society of Obstetrics and Gynecology, the annual number of ICCs among women aged 20-29 years also decreased from 256 cases to 135 cases during 2011-2020 (p < 0.0001). Furthermore, a declining trend in HPV16/18 prevalence in ICC was observed only among women aged 20-29 years during 2017-2022 (90.5%-64.7%, p = 0.05; Cochran-Armitage trend test). This is the first report to suggest population-level effects of HPV vaccination on ICC in Japan. Although the declining trend in HPV16/18 prevalence among young women with ICC supports a causal linkage between vaccination and results from cancer registries, further studies are warranted to confirm that our findings are attributable to vaccination.

Age-Specific Trends of Invasive Cervical Cancer Incidence in British Columbia, Canada, 1971-2017.

This study examined invasive cervical cancer (ICC) incidence trends in British Columbia (BC) by age and stage-at-diagnosis relative to World Health Organization ICC elimination targets (4 per 100,000 persons). Incident ICC cases (1971-2017) were obtained from the BC Cancer Registry. Annual age-standardized incidence rates (ASIRs) per 100,000 persons were generated using the direct method. ASIRs were examined among all ages 15+ years and eight age groups using Joinpoint Regression with the Canadian 2011 standard population. Standardized rate ratios (SRRs) compared stage II-IV (late) versus stage I (early) ASIRs by age (2010-2017). ICC ASIRs did not reach the elimination target. ASIRs declined from 18.88 to 7.08 per 100,000 persons (1971-2017). Stronger declines were observed among ages 45+ years, with the largest decline among ages 70-79 years (AAPC = -3.2%, 95% CI = -3.9% to -2.6%). Among ages 25-69 years, varying levels of attenuation in declining trends and stabilization were observed since the 1980s. SRRs indicated higher rates of late-stage ICC among ages 55+ years (SRR-55-69 years = 1.34, 95% CI = 1.08-1.71). Overall, ICC incidence declined in BC since 1971 but did not reach the elimination target. The pace of decline varied across age groups and increased with age. Continued efforts are needed to progress cervical cancer elimination among all age groups.

RELATIONSHIP BETWEEN KNOWLEDGE AND ATTITUDES TOWARDS ADHERENCE IN DETECTION OF CERVICAL CANCER

Background: Cervical cancer is an uncontrolled cell growth that occurs in the cervix caused by the Human Papilloma Virus (HPV) virus. Early detection programs for cervical cancer can be done in several ways, including Visual Inspection of Acetic Acid (IVA), pap smear, colposcopy, cervicography, and pap net. This method has been shown to reduce the incidence of invasive cervical cancer by the amount and mortality of cervical cancer. The purpose of this study was to determine the relationship between knowledge and attitudes towards Women of Childbearing Age (WCA) compliance in early detection of cervical cancer at the Ulak Karang Health Center in Padang City. Method: Cross Sectional. The population in this study was all WCA mothers (19-69 years old) in the working area of the Ulak Karang Health Center in Padang City as many as 2,916 people with a total sample of 97 people taken using quota sampling. This research was carried out in the working area of the Ulak Karang Health Center, Padang City in May-July 2023. The variables in this study are knowledge, attitudes and compliance with IVA examination. Data were analyzed univariately, bivariately (chi square) and multivariate. Results: There was a significant association between knowledge and WCA compliance in early detection of cervical cancer (p value 0.000). There was a significant relationship between attitude and WCA compliance in early detection of cervical cancer (p value 0.000). The relationship between knowledge and attitudes towards adherence is that there is a significant relationship between knowledge and attitudes towards WCA adherence in early detection of cervical cancer (p value 0.000). Conclusion: There is a relationship of knowledge and attitudes towards WCA compliance in early detection of cervical cancer.

The recent natural history of human papillomavirus cervical infection in women living with HIV: A scoping review of meta-analyses and systematic reviews and the construction of a hypothetical model.

Women with HIV are more often infected with human papillomavirus (HPV) and are more prone to develop precancerous cervical lesions (squamous intraepithelial lesions, SIL) and invasive cervical cancer (ICC) than HIV-negative women. This scoping-review analyses the impact of HIV on HPV prevalence, incidence and evolution to SIL and ICC. We selected all PubMed systematic reviews and meta-analyses published between January 2000 and July 2021 reporting data about HPV, cervical intraepithelial neoplasia (CIN), SIL and ICC prevalence, incidence and evolution in women with HIV. A hypothetical model comparing the history of HPV infection in HIV-negative, combined antiretroviral therapy (cART)-treated and -untreated women with HIV was built. Data from 11 meta-analyses and 10 systematic reviews were selected, which included between 770 and 236 127 women with HIV. Women with HIV have a 3 to 6 times higher risk of being infected by HPV, of progression to high-grade SIL (HSIL) and to ICC. These risks are exacerbated when the CD4 cell counts are low and when they are not using cART, whereas these risks are reduced by 20%-30% when they are optimally treated with cART and have had a suppressed HIV viral load for at least 2 years. In our model, we illustrated that optimal HIV treatment and preventing HIV reduce the number of ICC cases by 2.5 and 6 times, respectively. Optimal treatment and care of HIV patients are essential to reduce their prevalence of ICC, as are preventive strategies which include HPV vaccination, cervical cancer screening strategies and treatment of HSIL.

Role of NAT-1 gene polymorphism in the etiology and progression of cervical cancer

Cervical cancer (or carcinoma of cervix) incidences show higher occurrence rate in women population residing in poor socio-economic and unhygienic conditions especially in rural areas. However implication of various effective screening and health programmes in western countries, the incidence of invasive cervical cancer has declined greatly. In spite of that, still today cervical cancer remains the most common cancer in women, next to breast and lung cancer, therefore a leading cause of death in India. Gene polymorphisms modify risk of developing cancer like urinary bladder, colorectal, breast cancer etc. The effect of NAT-1gene polymorphism on cancer risk varies with organ involved, reflecting tissue specific expression of these genes. Strong associations exist with cause and increased risk for development of cervical cancer in individuals carrying specific alleles among the population.

Proposal for a descriptive and differentiated presentation of the longitudinal impact of the new organized cancer screening guideline and HPV vaccination in Germany

IntroductionSince 01/01/2020, the cervical cancer screening in Germany has been carried out due to the organized early cancer diagnosis guideline (oKFE-RL). In 2007, HPV vaccination was initiated in Germany. The main goal of both initiatives is to further reduce the incidence of invasive cervical cancer. To assess the effect of the new screening strategy in a timely manner, monitoring of short-term changes need to be considered. Ideally, the effects of both prevention methods would be presented together in one model.Materials and methodsBecause no change in the incidence of invasive cervical cancer is initially expected, the incidence of CIN 3 is used as a surrogate parameter to assess the effects of the prevention efforts. Based on expected additional effects of vaccination and co-testing, a model-based estimation of the expected CIN 3 incidence during the evaluation of the screening program is performed using the CIN 3 incidence in the Saarland population.Modeling resultsThe oKFE-RL provides for two groups: Primary cytodiagnosis continues until 35 years of age. Here, in the next few years, CIN 3 incidence will be reduced not by the oKFE-RL but by the increasing proportion of vaccinated women. In the group over 35 years, co-testing was introduced with a stringent algorithm. Due to the higher sensitivity of the HPV test, significantly more CIN 3 are detected in the first round of 3 years and thus, the CIN 3 incidence initially increases. As these CIN 3 are absent in the second round, significantly fewer CIN 3 cases will be detected then. These effects suggest a global decrease in CIN 3 incidence of 25.8% after 6 years.ConclusionObservation of the age distribution curve of CIN 3 allows both effects of prevention to be assessed in a timely manner and separately. In the future, data from epidemiologic cancer registries should be incorporated into the model to replace modeling with real data.

HPV genotyping by L1 amplicon sequencing of archived invasive cervical cancer samples: a pilot study

BackgroundHuman papillomavirus (HPV) is the primary cause of invasive cervical cancer (ICC). The prevalence of various HPV genotypes, ranging from oncogenically low- to high-risk, may be influenced by geographic and demographic factors, which could have critical implications for the screening and prevention of HPV infection and ICC incidence. However, many technical factors may influence the identification of high-risk genotypes associated with ICC in different populations.MethodsWe used high-throughput sequencing of a single amplicon within the HPV L1 gene to assess the influence of patient age, race/ethnicity, histological subtype, sample type, collection date, experimental factors, and computational parameters on the prevalence of HPV genotypes detected in archived DNA (n = 34), frozen tissue (n = 44), and formalin-fixed paraffin-embedded (FFPE) tissue (n = 57) samples collected in the Los Angeles metropolitan area.ResultsWe found that the percentage of off-target human reads and the concentration of DNA amplified from each sample varied by HPV genotype and by archive type. After accounting for the percentage of human reads and excluding samples with especially low levels of amplified DNA, the HPV prevalence was 95% across all ICC samples: HPV16 was the most common genotype (in 56% of all ICC samples), followed by HPV18 (in 21%). Depending upon the genotyping parameters, the prevalence of HPV58 varied up to twofold in our cohort. In archived DNA and frozen tissue samples, we detected previously established differences in HPV16 and HPV18 frequencies based on histological subtype, but we could not reproduce those findings using our FFPE samples.ConclusionsIn this pilot study, we demonstrate that sample collection, preparation, and analysis methods can influence the detection of certain HPV genotypes and must be carefully considered when drawing any biological conclusions based on HPV genotyping data from ICC samples.

Problems with catch-up HPV vaccination after resumption of proactive recommendations.

We previously reported that the suspension of the proactive recommendation for human papillomavirus (HPV) vaccination in Japan led to an increase in infection rates and incidence of cytological abnormalities, 1 Sekine M Yamaguchi M Kudo R et al. Suspension of proactive recommendations for HPV vaccination has led to a significant increase in HPV infection rates in young Japanese women: real-world data. Lancet Reg Health West Pac. 2021; 16100300 PubMed Google Scholar , 2 Yagi A Ueda Y Ikeda S et al. The looming health hazard: a wave of HPV-related cancers in Japan is becoming a reality due to the continued suspension of the governmental recommendation of HPV vaccine. Lancet Reg Health West Pac. 2022; 18100327 PubMed Google Scholar and appealed for proactive recommendations to be reinstated. 3 Ueda Y Yagi A Ikeda S Enomoto T Kimura T Beyond resumption of the Japanese government's recommendation of the HPV vaccine. Lancet Oncol. 2018; 19: 1563-1564 Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar In response to our findings, the Japanese Ministry of Health, Labour, and Welfare resumed proactive recommendations for the HPV vaccine in April, 2022, and initiated catch-up vaccinations for women who might have missed the opportunity to receive the vaccine during the period when proactive recommendations were suspended. 4 Haruyama R Obara H Fujita N Japan resumes active recommendations of HPV vaccine after 8·5 years of suspension. Lancet Oncol. 2022; 23: 197-198 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar A large proportion of women in the target age group (17–25 years) in Japan's fiscal year 2022 will be eligible for the recommended catch-up vaccination (figure). 5 Nakagawa S Ueda Y Yagi A Ikeda S Hiramatsu K Kimura T Corrected human papillomavirus vaccination rates for each birth fiscal year in Japan. Cancer Sci. 2020; 111: 2156-2162 Crossref PubMed Scopus (24) Google Scholar To reduce the incidence of invasive cervical cancer in Japan, a catch-up vaccination programme with at least 50% coverage will be required. 6 Simms KT Hanley SJB Smith MA Keane A Canfell K Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study. Lancet Public Health. 2020; 5: e223-e234 Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar To date, England, Sweden, Denmark, and the USA have successfully implemented national catch-up HPV vaccination programmes. In these countries, catch-up vaccination has been reported to have substantially reduced the incidence of cervical precancer and invasive cancer. However, in England, low vaccination coverage among the catch-up generation has been reported. Coverage of three doses of the HPV vaccine was high for women who received the routine vaccination at age 12–13 years (80·9–88·0%), but lower for the catch-up cohorts (70·8–75·7% for age 14–16 years, and 38·9–48·1% for age 16–18 years). 7 Falcaro M Castañon A Ndlela B et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet. 2021; 398: 2084-2092 Summary Full Text Full Text PDF PubMed Scopus (116) Google Scholar Catch-up vaccination is challenging in Japan because no national HPV vaccine register exists, and immunisation histories are maintained individually by each municipality (approximately 1700) that has provided routine vaccinations. 8 Yamaguchi M Sekine M Kudo R et al. Differential misclassification between self-reported status and official HPV vaccination records in Japan: implications for evaluating vaccine safety and effectiveness. Papillomavirus Res. 2018; 6: 6-10 Crossref PubMed Scopus (26) Google Scholar For example, if a woman who received the HPV vaccination at age 12–16 years in one municipality moves to a residential address in another municipality, it would not be possible to ascertain her vaccination history from the previous municipality. Thus, a woman who has received three doses of the HPV vaccine in one municipality would be advised to receive three more doses of the HPV vaccine if she moved to another municipality. Thus, the vaccination programme will rely on patient recall regarding personal vaccination history. In our previous study, 1230 women aged 20–22 years between fiscal year 2014 and fiscal year 2017 were asked in a questionnaire whether they had been vaccinated in the past. 140/308 (45·5%) of those who responded that they had not been vaccinated had received 1–3 doses of the vaccine. 8 Yamaguchi M Sekine M Kudo R et al. Differential misclassification between self-reported status and official HPV vaccination records in Japan: implications for evaluating vaccine safety and effectiveness. Papillomavirus Res. 2018; 6: 6-10 Crossref PubMed Scopus (26) Google Scholar In our current analysis of 1778 women aged 20–26 years in fiscal year 2020 (appendix), 199/879 (22·6%) of those vaccinated reported that they had never been vaccinated. Recall of women who visited clinics with their parents at age 12–16 years and received the HPV vaccine was poor.

Current data on the efficacy of prophylactic HPV vaccination in the primary prevention of cervical lesions.

A review of current knowledge on the efficacy of HPV (human papillomavirus) HPV vaccination against pre-cancers and cervical cancer. HPV infection is probably the most common sexually transmitted disease and the cause of approximately 5% of all human cancers. Currently, three prophylactic vaccines against HPV infection are on the market: bivalent Cervarix, quadrivalent Gardasil (formerly Silgard) and nonavalent Gardasil9. The Czech Republic is one of the countries with a national vaccination program where HPV vaccination is covered by health insurance for girls and boys aged 13-14 years. Extensive scientific data on the efficacy of the vaccines clearly demonstrate significant efficacy against the development of cervical pre-cancers for all three vaccines. According to a high-certainty evidence of the Cochrane database, the efficacy of HPV vaccines against cervical intraepithelial neoplasia grade 2 or 3 associated with HPV 16, 18 compared with placebo in girls and women aged 15-26 is 99%. There is also moderate-certainty evidence that HPV vaccines reduce the risk of adenocarcinoma in situ for approximately 90% for the same population. Initial data also demonstrate a direct impact on reducing the incidence of invasive cervical cancer in vaccinated individuals. In addition, quadrivalent and nonavalent vaccines are highly effective in preventing genital warts. All three available prophylactic vaccines show high efficacy in preventing the development of cervical lesions. Efficacy is highest against lesions caused by vaccine genotypes and the highest efficacy is achieved in the HPV naive population.

Incidence of cervical, breast and colorectal cancers between 2010 and 2015 in people living with HIV in France.

We aimed to evaluate the incidence rates between 2010 and 2015 for invasive cervical cancer (ICC), breast cancer (BC), and colorectal cancer (CRC) in people living with HIV (PLWH) in France, and to compare them with those in the French general population. These cancers are targeted by the national cancer-screening program. This is a retrospective study based on the longitudinal data of the French Dat'AIDS cohort. Standardized incidence ratios (SIR) for ICC and BC, and incidence rates for all three cancers were calculated overall and for specific sub-populations according to nadir CD4 cell count, HIV transmission category, HIV diagnosis period, and HCV coinfection. The 2010-2015 CRC incidence rate was 25.0 [95% confidence interval (CI): 18.6-33.4] per 100,000 person-years, in 44,642 PLWH (both men and women). Compared with the general population, the ICC incidence rate was significantly higher in HIV-infected women both overall (SIR = 1.93, 95% CI: 1.18-3.14) and in the following sub-populations: nadir CD4 ≤ 200 cells/mm3 (SIR = 2.62, 95% CI: 1.45-4.74), HIV transmission through intravenous drug use (SIR = 5.14, 95% CI: 1.93-13.70), HCV coinfection (SIR = 3.52, 95% CI: 1.47-8.47) and HIV diagnosis before 2000 (SIR = 2.06, 95% CI: 1.07-3.97). Conversely, the BC incidence rate was significantly lower in the study sample than in the general population (SIR = 0.56, 95% CI: 0.42-0.73). The present study showed no significant linear trend between 2010 and 2015 in the incidence rates of the three cancers explored in the PLWH study sample. Specific recommendations for ICC screening are still required for HIV-infected women and should focus on sub-populations at greatest risk.

Trends in cervical cancer incidence and mortality of young and middle adults in Japan.

In most high‐resource countries with organized screening programs, the incidence and mortality of cervical cancer is decreasing. Recent statistics have also revealed a reduction in invasive cervical cancer incidence as a result of national vaccination programs. Paradoxically, cervical cancer incidence has increased in Japan, particularly amongst women of reproductive age. This study aimed to examine the trends in cervical cancer incidence and mortality for young and middle adult women in Japan, by analyzing trends in 10‐year interval age‐groups. Cervical cancer incidence for young and middle adult women (ages 20‐59 years) was obtained from high‐quality population‐based cancer registries in three prefectures from 1985 to 2015. National cancer mortality data were obtained from published vital statistics from 1985 to 2019. Trends in crude and age‐standardized rates (ASR) were analyzed using Joinpoint regression. The cervical cancer incidence trend in 20‐59‐year‐old women combined significantly increased over the observation period. Both crude and ASR increased from 1985 to 2015 with an annual percent change (APC) of +1.6% (95% confidence interval, 1.1, 2.1) and +1.7% (1.2, 2.3), respectively. Similar increases were seen in ages 20‐29, 30‐39, and 40‐49 years with higher APCs especially in 20s and 30s. Both crude and ASR mortality significantly increased after the early 1990s in ages 20‐59 years combined. Based on the recognition that current cervical cancer control strategies in Japan have not been effective in reducing the cervical cancer burden in young and middle adults, promotion of screening and vaccination should be urgently strengthened.

Abstract PO-038: Assessing Spanish health literacy and cervical cancer knowledge, attitudes, and behaviors in a student-run free clinic

Abstract It is well-established that Hispanic populations in the United States have a higher incidence of invasive cervical cancer compared to non-Hispanic populations. Variations in cancer screening utilization and socioeconomic status are thought to account for much of this observed difference, and examination of health literacy has the potential to illuminate further aspects of this disparity. In addition to an association between English health literacy and Papanicolau (Pap) test knowledge, research has shown that in the setting of Spanish health materials low Spanish health literacy is strongly associated with never having a Pap test. This indicates that even when health information is provided in Spanish, low functional health literacy limits adequate care. The objective of this project is to examine Spanish health literacy and cervical cancer screening knowledge, attitudes, and behaviors in the patient population of the BRIDGE Healthcare Clinic; a student-run free clinic that serves primarily Spanish-speaking populations in the Tampa area. Spanish health literacy will be measured by the Short Assessment of Health Literacy–Spanish (SAHL-S), a validated health literacy questionnaire. A short questionnaire examining functional cervical cancer health literacy will measure the knowledge and attitudes of BRIDGE patients. Cervical cancer screening behaviors will be measured via the electronic medical record. Patients will be approached for recruitment as they wait for their appointments. Eligibility criteria include having a cervix, speaking Spanish as a primary language, and being over 21. Spanish health literacy will be assessed using the SAHL-S followed by a Spanish questionnaire assessing cervical cancer screening knowledge and attitudes. This questionnaire will consist of simple words and short sentences, with question structure based on previous studies of cancer health literacy. Patients will be asked to agree or disagree with knowledge statements such as “HPV causes cervical cancer” as well as attitude statements such as “I think it is important to get regular Pap smears.” Data quality will be monitored as the questionnaires are completed and manually transcribed into an Excel file. All data will be managed and analyzed using SPSS. This project is not powered to test hypotheses, but to robustly describe Spanish health literacy and cervical cancer screening knowledge, attitudes, and behaviors using descriptive statistics. Results will be used to generate information on how Spanish health literacy may mediate adequacy of cervical cancer screening. Additionally, quality improvement will be pursued by creating targeted cervical cancer educational materials for BRIDGE patients. There is also potential for future projects, such as re-administering the knowledge and attitudes questionnaire after an educational intervention. Ultimately, this project will illuminate understudied aspects of the widening disparity in Hispanic cervical cancer incidence and identify future directions for addressing this disparity from a health literacy perspective. Citation Format: Anna Ulyanenkova Fusani, Nat Jones, Sage Hewitt, Valeria Pereira Martinez, Lucy Guerra, Eduardo Gonzalez. Assessing Spanish health literacy and cervical cancer knowledge, attitudes, and behaviors in a student-run free clinic [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-038.

Spatiotemporal modelling and mapping of cervical cancer incidence among HIV positive women in South Africa: a nationwide study

BackgroundDisparities in invasive cervical cancer (ICC) incidence exist globally, particularly in HIV positive women who are at elevated risk compared to HIV negative women. We aimed to determine the spatial, temporal, and spatiotemporal incidence of ICC and the potential risk factors among HIV positive women in South Africa.MethodsWe included ICC cases in women diagnosed with HIV from the South African HIV cancer match study during 2004–2014. We used the Thembisa model, a mathematical model of the South African HIV epidemic to estimate women diagnosed with HIV per municipality, age group and calendar year. We fitted Bayesian hierarchical models, using a reparameterization of the Besag-York-Mollié to capture spatial autocorrelation, to estimate the spatiotemporal distribution of ICC incidence among women diagnosed with HIV. We also examined the association of deprivation, access to health (using the number of health facilities per municipality) and urbanicity with ICC incidence. We corrected our estimates to account for ICC case underascertainment, missing data and data errors.ResultsWe included 17,821 ICC cases and demonstrated a decreasing trend in ICC incidence, from 306 to 312 in 2004 and from 160 to 191 in 2014 per 100,000 person-years across all municipalities and corrections. The spatial relative rate (RR) ranged from 0.27 to 4.43 in the model without any covariates. In the model adjusting for covariates, the most affluent municipalities had a RR of 3.18 (95% Credible Interval 1.82, 5.57) compared to the least affluent ones, and municipalities with better access to health care had a RR of 1.52 (1.03, 2.27) compared to municipalities with worse access to health.ConclusionsThe results show an increased incidence of cervical cancer in affluent municipalities and in those with more health facilities. This is likely driven by better access to health care in more affluent areas. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers, such as transportation to health centres and strengthening of screening programmes.

Sociodemographic characteristics of women with invasive cervical cancer in British Columbia, 2004-2013: a descriptive study.

Background:Although cancer screening has led to reductions in the incidence of invasive cervical cancer (ICC) across Canada, benefits of prevention efforts are not equitably distributed. This study investigated the sociodemographic characteristics of women with ICC in British Columbia compared with the general female population in the province.Methods:In this descriptive study, data of individuals 18 years and older diagnosed with ICC between 2004 and 2013 were obtained from the BC Cancer Registry. Self-reported sociodemographic characteristics were derived from standardized health assessment forms (HAFs) completed upon admission in the BC Cancer Registry. Standardized ratios (SRs) were derived by dividing observed and age-adjusted expected counts by ethnicity or race, language, and marital, smoking and urban–rural status. Differences between observed and expected counts were tested using χ2 goodness-of-fit tests. General population data were derived from the 2006 Census, 2011 National Household Survey and 2011/12 Canadian Community Health Survey.Results:Of 1705 total cases of ICC, 1315 were referred to BC Cancer (77.1%). Of those who were referred, 1215 (92.4%) completed HAFs. Among Indigenous women, more cases were observed (n = 85) than expected (n = 39; SR 2.16, 95% confidence interval [CI] 2.15–2.18). Among visible minorities, observed cases (n = 320) were higher than expected (n = 253; 95% CI 1.26–1.26). Elevated SRs were observed among women who self-identified as Korean (SR 1.78, 95% CI 1.76–1.80), Japanese (SR 1.77, 95% CI 1.74–1.79) and Filipino (SR 1.60, 95% CI 1.58–1.62); lower SRs were observed among South Asian women (SR 0.63, 95% CI 0.62–0.63). Elevated SRs were observed among current smokers (SR 1.34, 95% CI 1.33–1.34) and women living in rural-hub (SR 1.29, 95% CI 1.28–1.31) and rural or remote (SR 2.62, 95% CI 2.61–2.64) areas; the SR was lower among married women (SR 0.90, 95% CI 0.90–0.90).Interpretation:Women who self-identified as visible minorities, Indigenous, current smokers, nonmarried and from rural areas were overrepresented among women with ICC. Efforts are needed to address inequities to ensure all women benefit from cervical cancer prevention.

Routine Screening for Cervical Cancer

Objective: To describe the screening for uterine cancer by visual methods. Method: We conducted a prospective and descriptive study over a period of 12 months from January to December 2020. Direct observation of providers and interview of patients were performed for data collection. Results: Out of 3400 patients, 1024 were enrolled for the study, or 30.11%. The average age of the patients was 41 years with the extremes of 17 to 87 years. Women aged 40 to 45 were the most represented with 58.78%, (n = 602). Housewives 85.83% (n = 879), they had a primary education level in 71.09% of cases (n = 728), the vast majority were married 92.28% (n = 945). Multiparous represented 58.78% (n = 602) of the sample, nulliparous 18.26% (n = 187), women living in rural areas 30.17% (n = 309), in urban areas 69.82% (n = 715). The test was positive in 43 patients (4.19%) but squamocylindrical junction was not visible in 17% of cases. The preparation of acetic acid and lugol: good preparation in 100% of cases; the conditions of use are not respected in 27% for acetic acid and 38% for lugol. Conclusion: Routine screening for cervical cancer (SCC) by visual methods is essential to decrease the incidence of invasive cervical cancer.

Estro-progestin Contraceptives and Risk of Cervical Cancer: A Debated Issue.

Steroid contraceptive hormones may promote human papilloma virus (HPV) - DNA integration into the host genome, may bind to specific HPV-DNA sequences within transcriptional regulatory regions, and may modulate cell apoptosis. Most epidemiological studies, reported in this narrative review, have shown that oral contraception is associated with a 1.5-3.3-fold higher relative risk of cervical carcer, but only in users for >5 years and especially in HPV-positive women. The relative risk declines with increasing time since last use and is not different from that of never users after >10 years. Ten-year oral contraceptive use from the age of 20 years is associated with an increase in the cumulative incidence of invasive cervical cancer at the age of 50 years of approximately 1 case per 1,000. Oral contraception has a very small negative impact on the absolute risk of cancer of the uterine cervix.

Differing Age-Specific Cervical Cancer Incidence Between Different Types of Human Papillomavirus: Implications for Predicting the Impact of Elimination Programs.

The elimination of cervical cancer rests on high efficacy of human papillomavirus (HPV) vaccines. The HPV type distribution among cases of invasive cervical cancer (ICC) is used to make predictions about the impact of eliminating different types of HPV, but accumulating evidence of differences in age-specific cancer incidence by HPV type exists. We used one of the largest population-based series of HPV genotyping of ICCs (n = 2,850; Sweden, 2002–2011) to estimate age-specific ICC incidence by HPV type and obtain estimates of the cancer-protective impact of the removal of different HPV types. In the base case, the age-specific ICC incidence had 2 peaks, and the standardized lifetime risk (SLTR, the lifetime number of cases per birth cohort of 100,000 females) for HPV-positive ICC was 651 per 100,000 female births. In the absence of vaccine types HPV 16 and HPV 18, the SLTR for ICC was reduced to 157 per 100,000 female births (24% of HPV-positive SLTR). Elimination of all 9 types that can currently be vaccinated against reduced the remaining SLTR to 47 per 100,000 female births (7%), the remaining ICC incidence only slowly increasing with age. In conclusion, after elimination of vaccine-protected HPV types, very few cases of ICC will be left, especially among fertile, reproductive-age women.