Secondary Prevention Of Cervical Cancer Research Articles

Primary and Secondary Prevention of Cervical Cancer at Two District Health Centres in the West Region of Cameroon

We evaluated the knowledge and practices of the female population towards the prevention of cervical cancer in the city of Bafoussam, West Cameroon, considering that poor awareness about the disease and its prevention drives its progression in Africa.

Secondary prevention of cervical cancer in modern conditions

Secondary prevention of cervical cancer in modern conditions

Knowledge and awareness of human papillomavirus (HPV) among young adults – a cross-sectional study

Background. Human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases and is incriminated in a large proportion of cervical, oral and other genital cancers. HPV vaccination was first introduced in 2004 in women, but recently there have been debates about extending the vaccination programme to men. Objective. To measure the knowledge and awareness of human papillomavirus infection among young adults. Subjects and method. The participants are medical students, selected from a larger sample, who completed an anonymous web-based survey measuring awareness and knowledge of HPV infection. The subsample contains 169 students in the age range 18-20 years old, with 32.5% men, who had fully completed the survey. Results. Overall, 70.4% of the sample had heard about HPV before. The awareness of HPV was similar between women (74.6%) and men (61.8%) (p=0.089), but was higher with seniority in medical studies (p=0.020). Among those who had heard about HPV before, while only 4.2% had been HPV vaccinated, 71% knew that the prevention of cervical cancer was possible through HPV vaccination. The highest knowledge score was 18 (out of 23), with a median of 11. The most missed answers were related to questions regarding the types of HPV included in the tetravalent vaccine (12/119 correct answers), and other types of cancer where HPV is incriminated (18/119 correct answers). Conclusions. Our survey indicates that medical students have poor knowledge of HPV and low HPV vaccination rates. These have important implications in prevention strategy. Increasing knowledge about the implications of HPV infection may encourage primary and secondary cervical cancer prevention programs.

Human papillomavirus and cervical cancer.

Cervical cancer is by far the most common HPV-related disease. About 99.7% of cervical cancer cases are caused by persistent genital high-risk human papillomavirus (HPV) infection. Worldwide, cervical cancer is one of the most common cancer in women with an estimated 528,000 new cases reported in 2012. Most HPV infections clear spontaneously but persistent infection with the oncogenic or high-risk types may cause cancer of the oropharynx and anogenital regions. The virus usually infects the mucocutaneous epithelium and produces viral particles in matured epithelial cells and then causes a disruption in normal cell-cycle control and the promotion of uncontrolled cell division leading to the accumulation of genetic damage. There are currently two effective prophylactic vaccines against HPV infection, and these comprise of HPV types 16 and 18, and HPV types 6, 11, 16 and 18 virus-like particles. HPV testing in the secondary prevention of cervical cancer is clinically valuable in triaging low-grade cytological abnormalities and is also more sensitive than cytology as a primary screening. If these prevention strategies can be implemented in both developed and developing countries, many thousands of lives could be saved.

Medroxyprogesterone Acetate Prevention of Cervical Cancer through Progesterone Receptor in a Human Papillomavirus Transgenic Mouse Model

Cervical dysplastic lesions called cervical intraepithelial neoplasias (CINs) need be treated to prevent cervical cancer. Currently available surgical procedures are effective, but the development of noninvasive treatment is warranted. In human papillomavirus transgenic mice engineered to express human papillomavirus type 16 E6 and E7, short-term treatment with 17β-estradiol induces CINs that progress to cervical cancer if the treatment is continued. In the present study, this mouse model was used to determine whether medroxyprogesterone acetate (MPA), a progestin drug, is chemopreventive. Human papillomavirus transgenic mice bearing CIN lesions were treated with MPA plus 17β-estradiol. Unlike control mice treated with 17β-estradiol alone, cervical cancer was absent in the MPA-treated mice. This observation suggests that MPA prevented CIN from progressing to invasive cancer. MPA was associated with inhibited cell proliferation and the promotion of apoptosis in CIN lesions. Confirming the role of the progesterone receptor, the preventive effect of MPA was absent in human papillomavirus transgenic mice in which the expression of progesterone receptor was genetically ablated. These results suggest that MPA is efficient in treating progesterone receptor–positive CIN lesions. These findings provide the basis for a biomarker-driven clinical trial of the secondary prevention of cervical cancer.

A roadmap for a comprehensive control of cervical cancer in Poland: integration of available solutions into current practice in primary and secondary prevention.

In Poland, cervical cancer incidence and mortality still remain considerably higher than in Western European countries or North America. Recent data indicate decreasing trends in women younger than 60 years and stable trends in older women. In this article, we identified obstacles in primary and secondary prevention of cervical cancer in Poland. We analysed local legislation, management structure and organization of cervical cancer prevention in Poland and reviewed solutions available and implemented in other European countries. The main weaknesses include: (i) very low coverage of organized screening; concurrent unregistered opportunistic screening with unknown coverage and high test consumption (ii) suboptimal quality assurance in organized screening and no external quality assurance in opportunistic screening (iii) very low coverage of human papillomavirus vaccination that is not centrally reimbursed (iv) absence of pilot evaluation of (a) interventions that may improve population coverage and (b) performance of new preventive strategies. The proposed solutions are multifaceted and involve: (i) legislative and organizational regulation of cervical cancer screening aimed at comprehensive registration of procedures, data access and quality assurance (ii) pilot testing and implementation of new ways to increase coverage of cervical cancer screening, in particular among older women (iii) pilot evaluation with possible introduction of human papillomavirus-based screening and (iv) inclusion of human papillomavirus vaccination into the reimbursed national immunization program.

Secondary cervical cancer prevention in routine prenatal care - coverage, results and lessons for the future.

Cervical cancer is the fourth most common type of cancer among women worldwide and one of the most common malignancies diagnosed in gravidas. Therefore, routine antenatal Pap smear is such an important examination. The aim of the study was to assess the prevalence of Pap smear performance during prenatal care and to determine possible factors affecting it. A self-composed questionnaire was distributed among 638 women managed in a tertiary obstetric referral center. 33 questions regarded cervical cancer prevention and risk factors. 96.9% of respondents had undergone Pap smear and 80.6% had it performed during pregnancy. For 11.5% women Pap smear in pregnancy was the first one in their life. The most common reasons for lack of Pap smear performance were: no subjective need to perform it (40.9%), no doctor's recommendation (28.6%) and lack of gynecological care (16.3%). Among professionally active women the percentage of those who had not undergone Pap smear during pregnancy was statistically higher (28.5%) than among those who were on sick leave (13.5%) (p = 0.0003). Also, younger women were at risk of less frequent participation in cervical cancer screening CONCLUSIONS: Although performance of Pap smear among surveyed patients was relatively high, there was a significant group of women who had undergone their first test during pregnancy, which makes secondary cervical cancer prevention in prenatal care a useful prophylactic strategy. Special attention should be given to younger and professionally active women.

Survey of cervical cancer and precancerous lesion prevention knowledge within community health service centers in Shanghai, China.

To study deficiencies in knowledge of the general public health-care professionals in community health service centers regarding the prevention of cervical intraepithelial neoplasia and cervical cancer. In addition, this study examined the key content of training required for primary health-care personnel to prevent cervical precancerous lesion and cervical cancer.A questionnaire was distributed among 172 medical staff personnel (the ratio of general practitioners and nurses was 1:1 in five community health service centers in Shanghai, China. This questionnaire assessed four knowledge areas of cervical cancer prevention using 10 single-choice questions.Out the 172 questionnaires distributed, 105 (61.05%) were completed correctly. No statistically significant difference in the percentage of complete correct answers among the five community health service centers was seen (P = .06). Additionally, there was no significant difference in the percentage of correct answers among the three age groups surveyed: age ≤35 years, 36–45 years, and ≥46 years (P = .12). We did find a statistically significant difference in the percentage of correct answers between general practitioners and nurses (P = .01) and between staff with master's degrees, bachelor's degrees, and associate's degrees (P = .03).General practitioners and nurses in community health service centers in Shanghai require additional education on the secondary prevention of cervical intraepithelial neoplasia and cervical cancer. The health knowledge related to human papillomavirus also needs to improve. Nurses and medical staff with lower degrees have insufficient awareness of the prevention of precancerous lesions of the cervix and cervical cancer; these two groups should be prioritized for additional training.

Сучасні підходи до скринінгу на наявність раку шийки матки

Considering the significant changes in approaches to the prevention of cervical cancer that have taken place over the past decades, the article considers the concept of primary, secondary and tertiary levels of preventive measures on cancer pathology in general, the nature and purpose of screening studies, the requirements to diagnostic tests that can be used as a screening. The modern approaches to cervical screening as a key component of secondary prevention of cervical cancer, the features of existing screening programs based on the initial determination of highly oncogenic strains of human papillomavirus virus alone and in combination with cytological research are considered in detail. Key words: cervical cancer, dysplasia, cervical intraepithelial neoplasia, human papillomavirus, screening.

181. Reducing The Physical And Emotional Burdens of HPV Infection Through An Integrated Primary And Secondary Cervical Cancer Prevention Texting System Initiative In A Primary Care Setting, A Pilot Study

To investigate the feasibility and efficacy of using an integrated model of mobile health education for primary and secondary cervical cancer prevention to reduce the physical and emotional burdens associated with HPV infection in a primary care setting. A proof of concept pilot study was conducted among 50 dyads of adolescent females (AF) aged 9-17 who were naive for their HPV vaccination series and their adult female guardians (AFG). Participants were recruited from the Pediatric and Adolescent clinics at Boston Medical Center (BMC), the largest safety-net hospital in New England that serves a predominantly low-income, minority population. Both AFs and AFGs completed questionnaires on HPV vaccination and cervical cancer screening (CCS). A Brief Negotiated Interview BNI was completed among vaccine-hesitant AFGs to elicit and address concerns, provide information and promote shared and well informed decision about CCS for AFG and HPV vaccine for their adolescent female daughter. Follow-up text messages were sent to all participants for nine months, which included HPV vaccine and CCS appointment scheduling and reminders, and educational information addressing their chosen HPV vaccine and Pap test related concerns. Completion of AFG's CCS and AF's HPV vaccinations was tracked through the hospital’s electronic medical record database. A feedback survey was administered at the end of the study to assess AF and AFG knowledge and behavior changes, and their attitudes and confidence about scheduling and appointment adherence for the HPV vaccine and CCS. Two-thirds of the subjects were black 37% African American and 29% Haitians/West Indies. Baseline knowledge of HPV among AFs was low. Only (21%) of AFs had heard of HPV and (28%) knew that HPV can cause cervical cancer. About 1 out of 5 (21%) knew that HPV can be passed on by genital skin-to-skin contact and only 9% knew that having sex at an early age increases the risk of getting HPV. At the end of the study, almost 9 out of 10 (86%) of AFs, had received 1 or more doses of HPV vaccine and half (50%) were HPV vaccination up to date (HPV UTD). Overall, follow-up surveys showed positive feedback on the integrated texting system as two-thirds of the AFGs reported that they strongly agreed/agreed that the text messages helped them learn more about HPV and cervical cancer. The majority of AFGs responded they strongly agreed/agreed that the WoW text messages helped remind them to both schedule (72%) and show up to their appointment (78%). The results support the value of text messaging in overcoming barriers to HPV vaccination and CCS in high risk, urban, minority populations. The integrated texting system is both feasible and effective in promoting cervical cancer prevention, which reduces the physical and emotional burdens associated with HPV infection.

Secondary prevention of cervical cancer - causes of ineffectiveness

Secondary prevention of cervical cancer - causes of ineffectiveness

CERVICAL CANCER – CAUSES AND PREVENTION OF HPV INFECTIONS IN THE OPINIONS OF YOUNG POLISH WOMEN: A CROSS-SECTIONAL SURVEY

Introduction: Cervical cancer is an important issue of gynecologic oncology. The awareness of this disease, the attitude towards HPV vaccination and cytological screening play an important role in decreasing morbidity and mortality due to cervical cancer. The aim: To assess the various aspects of knowledge regarding cervical cancer, risk factors for this disease, the role of HPV infection and the attitude to primary (vaccination) and secondary (cytological screening) prevention among young women. Materials and methods: The study was performed using CAWI method based on original questionnaire in electronic form. Online completing of the survey was voluntary and anonymous. Results: The study was conducted in a group of 2058 women aged 19-33. In total 98.4% of respondents came across the term "cervical cancer", 84.1% knew that cervical cancer could be prevented and the following were identified as the main risk factors: cervical cancer in closest relatives (85.3%) and HPV infection (81.9%). Although according to 82.0% of women HPV infection can be prevented by vaccination, only 18.4% of respondents were vaccinated. The main reason for non-vaccination was lack of knowledge about the availability of the vaccine (41.2%) and high price (32.0%). Of the unvaccinated people, 63.5% declare their will to be vaccinated in the future. Concerning secondary prevention, 98.6% of the respondents admitted that they knew the term "cytological examination", 89.0% indicated that this examination detected the presence of pre-cancerous lesions, and according to 58.4% of respondents, this test should be performed after sexual initiation. Despite the fact that 80.5% of respondents confirmed the fact of beginning sexual activity (44.4% of them had more than 1 partner), 17.1% of the respondents admitted that they didn't go to gynecologist yet. Approximately 84% of respondents believe that the amount of information on cervical cancer prophylaxis and HPV infections currently providing is insufficient. Conclusions: The basic terms regarding primary (vaccination) and secondary (prophylactic tests) prevention of cervical cancer have been widely known. However, the knowledge about specific risk factors, sexual behaviors contributing to HPV infection and, consequently, the ability to self-identify as belonging to higher risk group is insufficient. It is justified to conduct educational activities regarding the assessment of risks related to cervical cancer addressed to young women. Together with education, HPV vaccination and secondary prevention programs require financial support.

Ukrainian national consensus on the examination and treatment of women after primary cervical screening

This document is evidence of the uniting of the efforts of gynecologists and oncogynecologists of Ukraine in solving the problem of cervical cancer and can be considered as the first step towards the implementation of the global association program in the fight against this disease, put forward by the World Health Organization. Head of WHO Dr. Tedros Adhanom Ghebreyesus urged all countries to engage in this struggle and put an end to the suffering of cervical cancer.“Through cost-effective evidence-based interventions, including vaccination against human papillomavirus for girls, screening and treatment of precancerous lesions, improving access to diagnosis and treatment of invasive forms of cancer, we can eliminate cervical cancer as a public health problem and make it a disease of the past.” This is the purpose of the recommendations of the Ukrainian National Consensus on the examination and treatment of women after primary cervical screening, which, of course, are not final – it will be improved and supplemented by annual consensus conferences and meetings.At the same time, the fight against cancer of the cervix must be widespread. It is important to involve family doctors and pediatricians in this struggle. In this regard, is necessary to introduce the topic “Primary and secondary prevention of cervical cancer – the path to the elimination of illness” in the curricula and programs of medical faculties of higher educational institutions of III–IV accreditation levels and postgraduate education. In addition, the opportunities of social networks and the media should be widely used to raise awareness of the population in the prevention of cervical cancer and to provide scientific evidence of the possibility of preventing this disease

The new screening program to prevent cervical cancer using HPV DNA: getting the balance right in maintaining quality.

Along with the reduction in human papillomavirus (HPV) infection and cervical abnormalities as a result of the successful HPV vaccination program, Australia is adopting a new screening strategy. This involves a new paradigm moving from cervical cytological screening to molecular nucleic acid technology (NAT), using HPV DNA assays as primary screening methodology for cervical cancer prevention. These assays must strike a balance between sufficient clinical sensitivity to detect or predict high‐grade cervical intraepithelial lesions, the precursor to cervical cancer, without being too sensitive and detecting transient infection not destined for disease. Ensuring the highest quality HPV NAT is thus a priority in order to reduce the possibility of falsely negative screens and manage the risk associated with false positive HPV NAT test results. How to do this needs informed discussion and on‐going refinement of the screening algorithm. This is of relevance as more countries move to more sensitive HPV NAT tests for secondary prevention of cervical cancer and as more HPV assays become available.

Awareness and Beliefs About Cervical Cancer, the HPV Vaccine, and Cervical Cancer Screening Among Ghanaian Women with Diverse Education Levels.

Cervical cancer is the leading cause of cancer death among women in Ghana. Cost-effective tools for the primary and secondary prevention of cervical cancer, such as the Pap test, the HPV DNA test, and the HPV vaccine, are available in hospitals and clinics throughout Ghana. However, participation in cervical cancer prevention behaviors is low among Ghanaian women. Our objective was to determine if there were significant differences in cervical cancer awareness and stigmatizing beliefs about women with cervical cancer between Ghanaian women of different education levels. We surveyed 288 Ghanaian women who were at least 18years old. Data on the participants' demographic characteristics, awareness of cervical cancer, cervical cancer screening, and the HPV vaccine, beliefs about cervical cancer screening, and stigmatizing beliefs about women with cervical cancer was collected. Chi-square tests for independence and Fisher's exact test of independence were preformed to determine if education level was associated with those factors. Participation in cervical cancer screening and uptake of the HPV vaccine was significantly lower among women with less than a senior high school education. Awareness about cervical cancer, cervical cancer screening, and the HPV vaccine was lower among women with less education. Women with lower levels of education were more likely to agree with the negative statements about cervical cancer screening and stigmatizing beliefs about women with cervical cancer. Cervical cancer education interventions that are tailored for Ghanaian women with different educational levels are needed to increase awareness of and participation in cervical cancer prevention strategies.

Opportunities and challenges for human papillomavirus vaccination in cancer.

The discovery of genotype 16 as the prototype oncogenic human papillomavirus (HPV) initiated a quarter century of laboratory and epidemiological studies that demonstrated their necessary, but not sufficient, aetiological role in cervical and several other anogenital and oropharyngeal cancers. Early virus-induced immune deviation can lead to persistent subclinical infection that brings the risk of progression to cancer. Effective secondary prevention of cervical cancer through cytological and/or HPV screening depends on regular and widespread use in the general population, but coverage is inadequate in low-resource settings. The discovery that the major capsid antigen L1 could self-assemble into empty virus-like particles (VLPs) that are both highly immunogenic and protective led to the licensure of several prophylactic VLP-based HPV vaccines for the prevention of cervical cancer. The implementation of vaccination programmes in adolescent females is underway in many countries, but their impact critically depends on the population coverage and is improved by herd immunity. This Review considers how our expanding knowledge of the virology and immunology of HPV infection can be exploited to improve vaccine technologies and delivery of such preventive strategies to maximize reductions in HPV-associated disease, including incorporation of an HPV vaccine covering oncogenic types within a standard multitarget paediatric vaccine.

Clinical efficacy of p16/Ki-67 dual-stained cervical cytology in secondary prevention of cervical cancer.

Cervical cancer is the third most common malignant neoplasm in women worldwide. HPV infection is the necessary factor for the cancer to develop. HPV DNA can be integrated into the genome of squamous epithelium and cause transcription of the viral oncoproteins and development of invasive cancer within 15-20 years. We assessed ICC co-expression of p16/Ki-67 proteins in smears collected from the uterine cervix and the association between p16/Ki-67 co-expression and cytologic and histologic results. Samples were collected from 93 women using liquid based cytology (LBC). Two microscopic slides were prepared: for Papanicolaou staining and ICC staining. Biopsy samples were collected from 43 women. Diagnosis of CIN 2+ was the endpoint of the study. p16/Ki-67 positive cells were found in women with: 1) a cytology result of ASC-US (3.59%), LSIL (2.22%), ASC-H (21.92%), HSIL (33.18%), SCC (72.22%) or NILM (3.44%); 2) a histopathologic result of CIN 1 (2.13%), CIN 2 (19.93%), CIN 3 (23.22%), SCC (69.72%) or normal histology (7.58%). p16/Ki-67 dual staining can increase the efficiency of screening methods and indicate women in whom further diagnostic procedures are required or those with extremely low risk of cancer. Sparing protocols will have a significant role in women of reproductive age.

Prevalence and sociodemographic correlates of cervicovaginal human papillomavirus (HPV) carriage in a cross-sectional, multiethnic, community-based female Asian population

ObjectivesCervical cancer is a largely preventable disease, and the strategic implementation of a cervical cancer prevention programme is partly dependent on the impact of human papillomavirus (HPV) infection interpreted within...

Optimizing secondary prevention of cervical cancer: Recentadvances and future challenges.

Although human papillomavirus (HPV) vaccines offer enormous promise for the ultimate control and possible elimination of cervical cancer, barriers to uptake and coverage of the vaccine both in high- and low/middle-income settings mean that advances in secondary prevention continue to be essential to prevent unnecessary deaths and suffering from cervical cancer for decades to come. While cytology (the Pap smear) has reduced cervical cancer incidence and prevalence in jurisdictions where it has been systematically implemented in population-based programs-mainly in high-income settings-limitations inherent to this method, and to program delivery, leave many women still vulnerable to cervical cancer. Recent evidence has confirmed that screening based on HPV testing prevents more invasive cervical cancer and precancerous lesions, and offers innovative options such as self-collection of specimens to improve screening uptake broadly. In this paper, we review key advances, future opportunities, and ongoing challenges for secondary prevention of cervical cancer using HPV-based testing.

Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Clinical Practice Guideline

(Abstracted from J Global Oncol 2017; DOI:10.1200/JGO.2016.006577) The aim of the guideline was to provide global resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer, while accounting for wide variations in resource levels and health systems. These are the first cervical cancer screening guidelines that offer recommendations tailored to resource availability in the settings where women live.