Screening Programs For Early Detection Research Articles

Prevalence and Predictors of Depression Amongst Hypertensive Individuals in Karachi, Pakistan.

ObjectiveWhile studies evaluating the prevalence of depression and hypertension have been extensively carried out in high income countries, there is a paucity of information assessing the prevalence of depression within hypertensive patients in low income nations. The primary objective of this study was to investigate the prevalence of undiagnosed depression in hypertensive patients within a tertiary care facility in Karachi, Pakistan. The secondary objective was to assess factors associated with undiagnosed depression in this group.MethodsA cross-sectional study was conducted at the Civil Hospital Karachi Outpatient Department from January 2017 to April 2017. The sample population was composed of 411 hypertensive patients. Interviews were conducted after taking informed consent, with data concerning basic demographic details and lifestyle habits gathered. Blood pressure was recorded and its severity was classified as per the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines. Depression was evaluated and its severity classified as per the Patient Health Questionnaire-9 (PHQ-9) scale, with a score of 10 or above set as the cut-off point. Data were entered and analyzed using the IBM Statistical Package for the Social Sciences 23.0. (IBM, NY, USA)ResultsThe prevalence of depression within 411 hypertensive patients was 40.1% (n = 165). The mean age of the sample was 45.7 ± 11.2 years, and the majority were females (72%, n = 295), unemployed (72%, n = 296), had primary or no education (67%, n = 277), and were of low socioeconomic status (78%, n = 321). The average systolic and diastolic blood pressures were 143.8 ± 21.7 and 93.3 ± 15.5 mm Hg, respectively. Factors which had a significant association with depression were gender (p = 0.009), age class (p = 0.035), educational status (p = 0.000), employment status (p = 0.003), socioeconomic status (p = 0.008), physical activity (p = 0.025), smoking (p = 0.017), and family history of hypertension (p = 0.022).ConclusionWith such a high prevalence rate of undiagnosed depression within hypertensive patients, it is pertinent to establish screening programs for early detection and community programs to raise awareness regarding long-term complications of untreated depression.

Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea.

In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

Pre-rheumatoid arthritis and its prevention.

Pre-rheumatoid arthritis (pre-RA) is the preclinical period of the disease that precedes the onset of clinically apparent RA. It includes the interaction between genetic and environmental risk factors and development of disease-related autoantibodies and joint symptoms and signs, which may be considered nonspecific or unclassified for RA. A better understanding of the pre-RA stage will be useful in developing screening programs for early detection of RA. Identifying and modifying risk factors such as smoking, periodontitis, obesity, viral infections, and hormonal or dietary factors will be useful in preventing RA in susceptible population.

Asymptomatic Pancreatic Cancer: Does Incidental Detection Impact Long-Term Outcomes?

BackgroundDetection of pancreatic ductal adenocarcinoma (PDAC) in asymptomatic patients is very rare, and the clinical implication of early detection of asymptomatic PDAC remains unclear. MethodsThis retrospective study included 569 consecutive patients with PDAC treated in our institution (250 underwent surgical resection and 319 had unresectable PDAC). The patients’ demographics, tumor locations, pathologic stages, treatment, and overall survival (OS) were compared between the asymptomatic and symptomatic patients. ResultsIn total, 163 (29%) patients presented without subjective symptoms. These patients had an earlier stage of PDAC on presentation (p < 0.001), higher resectability rate (64 vs. 36%, p < 0.001), and higher 5-year OS rate (18 vs. 7%, p < 0.001) than patients with symptoms. Among the patients who underwent resection, asymptomatic patients did not have a significantly higher chance of complete resection (88 vs. 78%, p = 0.06) or 5-year OS rate (23 vs. 22%, p = 0.09). However, symptomatic patients more often required complex operations such as concomitant vascular resection and reconstruction (57 vs. 29%, p < 0.001). ConclusionsAsymptomatic PDAC is associated with better long-term outcomes than symptomatic PDAC because of the earlier stage at presentation and higher chance of resectability. Our findings highlight the potential implication of screening programs for early detection of PDAC in selected high-risk populations.

The long-term spatial-temporal trends and burden of esophageal cancer in one high-risk area: A population-registered study in Feicheng, China.

BackgroundFeicheng County is a high-risk area for esophageal cancer in Shandong province, China. It is important to determine the long-term spatio-temporal trends in epidemiological characteristics and the burden of esophageal cancer, especially since the implementation of the national esophageal cancer screening program for early detection and treatment in 2005.MethodsThe data collected in Feicheng County from 2001 to 2012 was extracted from the whole-population cancer registry system. The incidence, mortality, disability-adjusted life years (DALY) and changing trends in esophageal cancer according to age and sex were calculated and described.ResultsThe incidence rate of esophageal cancer in Feicheng was consistently high, and increased significantly for male, but not for female from 2001 to 2012, according to the joinpoint regression analysis. The highest and lowest yearly crude incidence rates were 160.78 and 95.97 per 100000 for males, and 81.36 and 52.17 per 100000 for females. The highest and lowest crude yearly mortality rates were 122.26 and 94.40 per 100000 for males, and 60.75 and 49.35 per 100000for females. Esophageal squamous cell carcinoma was the main pathology type and the tumor location changed significantly from 2001 to 2012. Overall, the DALY remained roughly stable and was estimated as 11.50 for males and 4.90 for females per 1000 people. The burden was mainly caused by premature death. There is an obvious spatial pattern in the distribution of incidence density and burden.ConclusionEsophageal cancer remains a public health issue in Feicheng County with a high incidence, mortality and disease burden. The incidence and burden have obvious spatial heterogeneity, and further studies should be conducted to identify geographical risk factors for precise local prevention and control measures.

Incidentally discovered pancreatic ductal adenocarcinoma: Is detection of asymptomatic cancer associated with better outcomes than symptomatic cancer?

243 Background: The number of incidentally discovered asymptomatic pancreatic ductal adenocarcinoma (APDAC) has been increasing along with recent wide spread use of imaging studies in general practice. However, the clinical implication in early detection of asymptomatic pancreatic cancer remains yet to be determined. In this study, we reviewed our experience of patients with PDAC in high volume cancer center and compared the characteristics and long-term outcomes between those with APDAC and symptomatic PDAC (SPDAC). Methods: This retrospective study included 569 consecutive patients with PDAC initially treated in our institution from January 2007 to December 2012. Median follow-up period was 29 months for the survivors. Two hundred and fifty patients underwent surgical resection and 319 patients were deemed unresectable. The patient’s demographics, tumor locations, pathologic stages, and treatment type received, and the overall survival (OS) were compared between the patients with APDAC and those with SPDAC. Results: One hundred and sixty-three patients (29%) presented without any subjective symptoms. When compared with SPDAC, APDAC was associated with early stage (stage I, 6% vs. 1%, p&lt;0.01). Among 163 patients with APDAC, 104 patients (64%) underwent surgical resection, while only 146 patients (36%) out of 406 SPDAC underwent resection ( p&lt;0.01). The 5-year OS rate of the patients with APDAC was 18%, comparing with 7% for those with SPDAC ( p&lt;0.01). Among the patients who underwent resection, the presence of symptoms did not affect the chance of incomplete resection (R1, 12% vs. 22% for patients with APDAC and SPDAC, respectively, p=0.06) and the 5-year OS rate (23% vs. 22%, p=0.09). However, the patients with SPDAC required complex operation (concomitant vascular resection and reconstruction 56% vs. 29% for those with APDAC, p&lt;0.01). Conclusions: Asymptomatic PDAC is associated with better long-term outcomes than symptomatic PDAC due to early stage at presentation and higher chance of resectability. Our findings highlight the potential implication of screening program for early detection of PDAC for selected high-risk patient population.

Abstract TP415: A Pilot Study on the Effect of Neck Irradiation Treatment for Nasopharyngeal Carcinoma on Carotid Artery Stenosis

Introduction: Extracranial carotid stenosis, a risk factor for ischemic stroke, is thought to be accelerated by irradiation to the neck region. Nasopharyngeal carcinoma (NPC) has a predilection for East Asian with an incidence of 200-300 annually in Singapore. We studied the prevalence and severity of extracranial carotid disease in patients with prior neck irradiation for NPC, who were at different timepoints from the time of irradiation. Hypothesis: The prevalence of extracranial carotid disease is high among patients with prior neck irradiation, and this may justify a screening programme for early detection and primary stroke prevention. Methods: We conducted a pilot study to examine 50 patients (median age 55.2 years) with prior radiation for NPC with intensity-modulated radiation therapy (IMRT): 26 with &lt;5 years after treatment and 24 with &gt;=5 years after treatment. All patients received radiation therapy to the neck. Carotid disease was assessed by duplex sonography for severity of stenosis. The European Carotid Surgery Trial (ECST) criteria was employed for assessment for degree of stenosis. Results: Among patients with IMRT &gt;=5 years ago, 25% (6/24) had carotid stenosis of &gt;=50% compared to only 8% (2/26) of patients with IMRT within 5 years. Of these 8 patients with carotid stenosis &gt;=50%, 5 (63%) had plaques with irregular or ulcerated surfaces, which is known to be associated with stroke risk. Based on these preliminary data, the study would require a larger sample size of 100 in each group to be powered at 90% with an alpha of 0.05. All 8 patients with carotid stenosis &gt;=50% from the screening were referred for further evaluation for symptoms and risk factors, and management for secondary stroke prevention. Conclusions: Based on our findings, there is a rationale for screening for carotid disease among patients with prior neck irradiation and the timing of screening is more optimal after 5 years from IMRT. Patients found to have carotid disease should be counselled about risk factor control, antiplatelet medication and possibly carotid intervention for primary stroke prevention.

Clinicopathological Profile of Breast Cancer Patients at a Tertiary Care Hospital in Kashmir Valley

Introduction: Breast cancer is the commonest malignancy in women worldwide. There are considerable variations in risk factors and presentation of the disease region wise. The present study aimed to describe clinical and pathological profile of breast cancer patients attending tertiary care hospital. Method: All consenting patients attending to surgical out-patient department (OPD) with complaints pertaining to breast disease were enrolled from 16th June 2015 to 15th June 2016. The patients were followed and demographic, clinical and pathologic information was recorded and analysed. Results: Total Of 180 patients with breast disease were enrolled. 34/100 were diagnosed of malignancy and formed the cases of the present study. Age of the patients ranged from 22 to 60 years with mean age of 42.06 ± 10.7 years. All the patients presented as breast lump variably associated with pain or discharge. Infiltrating Ductal Carcinoma Not Otherwise Specified (IDC NOS) was common histologic diagnosis (76.47%). Conclusion: Breast carcinoma presents with painless lump and patients are usually diagnosed in our setup at locally advanced stage. Implementation of the simple and effective screening programs for early detection is urgent need in our population.

363PD Community based screening for early detection of head and neck cancer among tribal community in Wayanad District, India

Background Head and neck cancer ranks in the top three of all cancers in India. Wayanad district in Kerala state is a region in which 17% of the population is represented by tribal groups. These tribes generally live under severe socioeconomically deprived conditions. Common risk factors include tobacco use, culturally determined practices, alcohol consumption, and nutrition deficits. Head and neck cancer, despite its high incidence and prevalence in the region, does not benefit from significant prioritization like other cancer entities. The objectives are to create awareness regarding common cancers among tribal community in Wayanad District, India; to detect pre-cancers of head and neck region by conducting screening with simple low-cost technology within the community; and to facilitate confirmation of diagnosis among screen positives and treatment and follow-up among the diagnosed cases. This is community based screening program for early detection of head and neck cancer being implemented among socio-economically disadvantaged tribal community in Wayanad District, India. Methods The process involves selection of clusters, household surveys, health education and screening the tribes for common cancers by primary health care workers at temporarily set-up clinics within the community. Stratification was done according to age and in consistent with W.H.O pathfinder methodology. The program will cover 142320 disadvantaged people in one year. 11670 people have been covered to date. Results The compliance for screening head and neck cavity are 86.70%and the screen positivity rates is 3.01% respectively. 78 head and neck pre-cancers have been diagnosed among the screened tribes and all of them have complied to treatment. The prevalence of precancerous lesion on head and neck region was found to be 41% among the population It was observed that 23% had leukoplakia, 18% population suffered fromoral submucous fibrosis(OSMF), and 12% of them were recorded with smokers palate in their oral cavity. Conclusions Screening for head and neck cancer with simple, low cost, acceptable and effective technology is feasible at community level in developing countries and can assist detection of precancers and early stage cancers. Clinical trial indentification DM WIMS2 Legal entity responsible for the study Shanavas Palliyal Funding DM Foundation Disclosure All authors have declared no conflicts of interest.

Low bone mineral density among young healthy adult Saudi women

Objectives:To screen for low bone mineral density among young adult Saudi women using quantitative ultrasound (QUS) and exploring the high risk groups.Methods:A cross-sectional study was performed on 279, 20-36 years old female students and employees of Taibah University, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia between January and May 2014. The study included bone status assessed using QUS, a structured self-reported questionnaire, anthropometric measurements, and evaluation of bone markers of bone metabolism.Results:The prevalence of low bone mineral density was 9%. Serum osteocalcin was found significantly higher in candidates with low bone mineral density, 20.67 ng/ml versus 10.7 ng/ml, and it was negatively correlated with T-scores. At any given point in time the exposed subjects to low calcium intake and inadequate sun exposure in the population were 11 times and 3 times more likely to have low bone mineral density, (adjusted odds ratio [OR], 11.0; 95%confidence interval [CI]=3.16, 38.34; p=0.001) and (adjusted OR, 3.32, 95%CI=1.27, 8.66, p<0.01).Conclusion:Early detection screening programs for low bone mineral density are needed in Saudi Arabia as it affects young Saudi women specially the high-risk group that includes young women with insufficient calcium intake and insufficient sun exposure. Serum osteocalcin as a biomarker for screening for low bone mineral density could be introduced.

Detection of exudates in fundus photographs using deep neural networks and anatomical landmark detection fusion

Background and objectiveDiabetic retinopathy is one of the leading disabling chronic diseases and one of the leading causes of preventable blindness in developed world. Early diagnosis of diabetic retinopathy enables timely treatment and in order to achieve it a major effort will have to be invested into automated population screening programs. Detection of exudates in color fundus photographs is very important for early diagnosis of diabetic retinopathy. MethodsWe use deep convolutional neural networks for exudate detection. In order to incorporate high level anatomical knowledge about potential exudate locations, output of the convolutional neural network is combined with the output of the optic disc detection and vessel detection procedures. ResultsIn the validation step using a manually segmented image database we obtain a maximum F1 measure of 0.78. ConclusionsAs manually segmenting and counting exudate areas is a tedious task, having a reliable automated output, such as automated segmentation using convolutional neural networks in combination with other landmark detectors, is an important step in creating automated screening programs for early detection of diabetic retinopathy.

2.51 A NEW MODEL: DEVELOPING A SCREENING PROGRAM FOR EARLY DIAGNOSES OF NEURODEVELOPMENTAL DISORDERS

The neurodevelopmental disorders (NDDs) are a heterogeneous group of disorders and usually symptomatic in early childhood, leading to impairments in functioning. Early diagnosis is one of the most important aspects for the treatment of children with NDDs. Our aim is to develop a new model for a web-based screening program for early detection and intervention for the common NDDs, such as ADHD, ASD, speech and language disorders (SLD), and intellectual disabilities (ID).

TARGETING DEMENTIA SCREENING IN PRIMARY CARE SITES

With potentially promising therapeutics on the horizon, there is increasing interest in implementing routine dementia screening programs for early detection. Critics have cited since no treatments are currently available, there is no benefit to screening, and that screening itself, may lead to harm. The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of dementia screening (CHOICE) study is currently assessing if routine screening in primary care is associated with benefits or harms. Quality of life, depression, and anxiety are measured at 12 months post screening to determine screening impact. A randomized controlled trial of 4,000 older primary care patients in Indiana. Patients are randomized to receive dementia screening or no dementia screening. Patients are screened with the Memory Impairment Screen (MIS) at baseline either by phone (MIS-T; rural sites) or in person (MIS; urban sites). The positive screen rate varied significantly by site. We performed a logistic regression analysis to determine if patient factors associated with positive screening explained these varying rates. As of December 31, 2015 3,157 patients had been enrolled and 1,585 were randomized to the screening arm. Overall, rates of positive screening tests were 4.6%; lower than the expected and lower than published literature. Results from a logistic regression analysis showed that males (OR=1.97; 95% CI =1.16-1.33), patients age ≥80 years (OR=2.51; 95% CI =1.37-4.59), those with lower education (OR=3.61; 95% CI =1.50-8.70), and who self-reported forgetfulness on the Health Utility Index (OR=4.69; 95% CI =1.51-14.55) had significantly increased odds of screening positive for dementia. Even after adjusting for the demographic differences across recruitment sites, there was a marginally significant difference between sites. Specifically, the two sites where MIS administration was in person had marginally (p=0.096) higher odds (ORs=2.37 and 2.16) of screening positive than the site where administration was by phone. The success of dementia screening programs in primary care will depend on the target population, choice of screening instrument, and mode of administration. These strategies will likely minimize any harm associated with screening (negative and false positive screens) as well as maximize the benefit of detecting early cases.

Prevalence of high-risk human papilloma virus types and cervical smear abnormalities in female sex workers in Chandigarh, India

Purpose: Cervical cancer is the most common cancer among women in developing nations. Nearly 90% of the cases have been linked to the presence of high-risk human papillomavirus (hrHPV) types 16 and 18. The risk of cervical cancer may be high in female sex workers (FSWs) due to multiple sexual partners. This study aimed to determine the prevalence of cytological abnormalities and hrHPV types 16 and 18 in FSWs in Chandigarh, North India using the liquid-based cytology (LBC) approach. Materials and Methods: The cervical brush samples were collected from 120 FSW and 98 age-matched healthy controls (HCs). These were subjected to pap smear using conventional method, LBC and the detection of hrHPV types 16 and 18 was carried out using polymerase chain reaction. Results: The LBC samples showed better cytological details and also reduced the number of unsatisfactory smears from 11% in Pap to 1.5% in the LBC. A significantly higher number of inflammatory smears were reported in FSWs (51.7% vs. 34.7%, P = 0.01). The hrHPV types 16/18 were detected in 33/120 (27.5%) FSW versus 23/98 (23.5%) HCs. The risk of acquiring hrHPV was higher in FSWs, who had age at first sex ≤25 years, higher income and the habit of smoking. Conclusion: The high prevalence of hrHPV among FSWs and HCs suggests the need for the implementation of effective National Screening Programme for early detection of hrHPV types to decrease the burden of cervical cancer, especially in high-risk population.

Estimation of the Survival Benefit Obtainable From Screening for the Early Detection of Pancreatic Cancer.

The chance to improve survival from pancreatic adenocarcinoma relies on early diagnosis through screening, but any screening program is subject to lead-time bias and no data are available in this regard. Aim of the present study was to evaluate the benefit obtainable from a screening program for early detection of pancreatic adenocarcinoma, considering screen-related biases. Monte Carlo simulation was performed using data from 1000 pancreatic cancer patients admitted in a tertiary referral hospital and from pertinent literature. Lead-time bias was assessed and subtracted from expected survival. Mean expected life expectancy was 13.0 months. Assuming a 20%, 30%, or 50% stage III/IV reduction with screening, pancreatic resections would increase from 217 to 290 in front of a 20% stage III/IV reduction to 324 in front of a 30% reduction and to 385 in front of a 50% reduction. After lead-time adjustment, life expectancies were 14.0, 14.6, and 15.9 months, respectively. The number-needed-to-screen calculation suggests that screening can be harmful in a proportion of patients inversely dependent on the length of follow-up and a significant improvement of survival after diagnosis. Pancreatic adenocarcinoma screening program would probably be successful in the presence of a considerable improvement of postdiagnostic survival; otherwise, it only increases surgical procedure amount.

Initiating opportunistic breast cancer screening program for asymptomatic self-referring women in Iraq

Background: Breast cancer is the most frequently diagnosed cancer in women worldwide and organized national mammographic screening has been adopted as gold standard for breast cancer early detection in most developed countries in the world.Objectives: to evaluate and emphasize the performance of the initiative opportunistic breast cancer screening program in Iraq and to determine the incident malignancy rate of breast cancer among asymptomatic self-referring women aged 40 years or older via digital mammography by mean of the breast imaging reporting and data system (BI-RADS©).Patients and methods: this retrospective study included a total of 809 asymptomatic self-referring women over age 40 years, mostly consisted of employees of the different Iraqi ministries who attended the national center of early detection of cancer in Medical City Complex at Baghdad for screening purpose during the period from September 2012- October 2013 by using digital mammography. Ultrasound examination performed as complementary study in particular cases and all cases are graded according BIRADS lexicon. BIRADS category 4 and 5 were followed by cytopathological analysis.Results: 809 asymptomatic self-referring women were included in this initiative screening program for early detection of breast cancer at the main breast care referral center in Baghdad. The mean age at presentation was 49 years (range 40–76 years). The current study found that overall incident malignancy rate among total sample of the study was 1.11% whilst individual malignancy rate per BI-RADS category was 11.1% for BI-RADS 4 lesions and 80% for BI-RADS 5 lesions.Conclusion: introduction of individual opportunistic screening program of breast cancer has led to a significant increase in early detection rate of breast cancer and enhance the health awareness for breast cancer screening among asymptomatic women.

The Nonmydriatic Fundus Camera in Diabetic Retinopathy Screening: A Cost-Effective Study with Evaluation for Future Large-Scale Application.

Aims. The study aimed to present the experience of a screening programme for early detection of diabetic retinopathy (DR) using a nonmydriatic fundus camera, evaluating the feasibility in terms of validity, resources absorption, and future advantages of a potential application, in an Italian local health authority. Methods. Diabetic patients living in the town of Ponzano, Veneto Region (Northern Italy), were invited to be enrolled in the screening programme. The “no prevention strategy” with the inclusion of the estimation of blindness related costs was compared with screening costs in order to evaluate a future extensive and feasible implementation of the procedure, through a budget impact approach. Results. Out of 498 diabetic patients eligible, 80% was enrolled in the screening programme. 115 patients (34%) were referred to an ophthalmologist and 9 cases required prompt treatment for either proliferative DR or macular edema. Based on the pilot data, it emerged that an extensive use of the investigated screening programme, within the Greater Treviso area, could prevent 6 cases of blindness every year, resulting in a saving of €271,543.32 (−13.71%). Conclusions. Fundus images obtained with a nonmydriatic fundus camera could be considered an effective, cost-sparing, and feasible screening tool for the early detection of DR, preventing blindness as a result of diabetes.

Review of the implementation seven-year screening program for early detection of breast cancer in the Khanty-Mansi autonomous okrug – Yugra

Breast cancer is the leading cancer pathology of the female population and one of the leading causes of death. The possibility of early diagnosis makes a significant contribution to the reduction in mortality from breast cancer. We studied the frequency of breast cancer from 2002 to 2014 by age groups. As part of the screening from 2007 to 2014, 352,780 women were surveyed in the region, which accounted for about 95 % of the total coverage of screening for each round (2 years) – 32 %. 9.4 % of the women surveyed were aimed at further examination. During the initial screening detection rate of breast cancer was 2.8 per 1,000 women surveyed. The sensitivity of the test for the first round was 80 %.

Cervical intraepithelial neoplasia: Prevalence, risk factors, and utilization of screening services among an urban population in Nigeria

Background: Cervical intraepithelial lesion is a precursor lesion for cancer of the cervix. It is usually asymptomatic and can only be detected through screening. Purpose: This study was designed to determine the prevalence, risk factors, and utilization of screening services for cervical intraepithelial neoplasia among the women. Methods: It was a cross-sectional study during an organized screening program for cervical intraepithelial neoplasia (CIN) using Pap smear among women in July 2013 at the University Teaching Hospital, North Central Nigeria. Results: Out of the 286 women interviewed, 208 agreed to be screened giving a response rate of 72.7%. Most (72.1%) of them were 31–50 years, 78.4% were married, and 65.4% had a tertiary level of education. Approximately, 77% became sexually active as teenagers. CIN 1 and CIN 2/3 accounted for 4.8% and 2.9%, respectively. Overall, low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion amounted to 7.7%. The risk of intraepithelial lesion is higher among those with multiple sexual partners, early coitarche, and ever use of oral contraceptive pills (odds ratio 1.76, 0.8, and 1.4). Only 9.8% of the total population interviewed had ever screened at least once in the past. Even among those with a positive result for CIN, only 18.8% had ever screened. Conclusion: Organized screening programs for early detection and treatment of CIN, modification of risky social behaviors, and vaccination of teenage women should be promoted as crucial steps to preventing cancer of the cervix.

Worldwide Prostate Cancer Epidemiology: Differences Between Regions, Races, and Awareness Programs

Prostate cancer, according to the World Health Organization, is the second most common cause of cancer worldwide. With an estimated 1.1 million people affected by prostate cancer in 2012, composing 15% of all new cancer cases worldwide, this condition poses a significant burden of mortality and morbidity on society. Even though the burden of prostate cancer is present worldwide, there are disparities in mortality rates worldwide. While in Sub-Saharan Africa and Caribbean, the age-adjusted mortality rates are as high as 24 per 100,000, in Asia the age-adjusted mortality rates are as low 2.9 per 100,000. Specific countries in Sub-Saharan Africa like Uganda have a prostate cancer mortality rate as high as 38.8 per 100,000, which is close to the incidence rate of 48.2 per 100,000. Even though in the United Kingdom the incidence rate is much higher at 111.1 per 100,000, the mortality rate is comparable to that of Sub-Saharan Africa at 22.8 per 100,000. As demonstrated in this global review of prostate cancer, the age-adjusted incidence rate and mortality rate are closer together in Sub-Saharan Africa than in high income countries. Also, there are disparities in age-adjusted mortality rates of prostate cancer. There is plausibly a large gap in data on incidence and mortality rates of prostate cancer, leading to potential underreporting of incidence rates. There are also different awareness related gaps in developing and developed countries. Improved surveillance systems need to be established in order to improve early detection screening programs and prioritized interventions for evidence-based policy for prostate cancer in all countries.