51
|
Ammoun R, Wami WM, Otieno P, Schultsz C, Kyobutungi C, Asiki G. Readiness of health facilities to deliver non-communicable diseases services in Kenya: a national cross-sectional survey. BMC Health Serv Res 2022; 22:985. [PMID: 35918710 PMCID: PMC9344761 DOI: 10.1186/s12913-022-08364-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Non-communicable diseases (NCDs) account for an estimated 71% of all global deaths annually and nearly 80% of these deaths occur in low- and middle-income countries. This study aimed to assess the readiness of existing healthcare systems at different levels of health care in delivering NCDs management and prevention services in Kenya. Methods A cross-sectional survey of 258 facilities was conducted between June 2019 and December 2020 using multistage sampling, examining facility readiness based on the availability of indicators such as equipment, diagnostic capacity, medicines and commodities, trained staff and guidelines for NCDs management. Readiness scores were calculated as the mean availability of tracer items expressed as a percentage and a cut-off threshold of ≥ 70% was used to classify facilities as “ready” to manage NCDs. Descriptive and bivariate analyses were performed to assess the readiness of facilities by type, level, and location settings. Logistic regressions were used to identify factors associated with the readiness of facilities to provide disease-specific services. Results Of the surveyed facilities, 93.8% offered chronic respiratory disease (CRD) diagnosis and/or management services, 82.2% diabetes mellitus, 65.1% cardiovascular disease (CVD), and only 24.4% cervical cancer screening services. The mean readiness scores for diabetes mellitus (71%; 95% CI: 67–74) and CVD (69%; 95% CI: 66–72) were relatively high. Although CRD services were reportedly the most widely available, its mean readiness score was low (48%; 95% CI: 45–50). The majority of facilities offering cervical cancer services had all the necessary tracer items available to provide these services. Modeling results revealed that private facilities were more likely to be “ready” to offer NCDs services than public facilities. Similarly, hospitals were more likely “ready” to provide NCDs services than primary health facilities. These disparities in service readiness extended to the regional and urban/rural divide. Conclusions Important gaps in the current readiness of facilities to manage NCDs in Kenya at different levels of health care were revealed, showing variations by disease and healthcare facility type. A collective approach is therefore needed to bridge the gap between resource availability and population healthcare needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08364-w.
Collapse
Affiliation(s)
- Rita Ammoun
- Faculty of Médicine, Limoges Université, 2 Rue du Docteur Marcland, 87025, LIMOGES CEDEX, France
| | - Welcome Mkhululi Wami
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya. .,Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands.
| | - Peter Otieno
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya
| | - Constance Schultsz
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Catherine Kyobutungi
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya.,Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya.,Department of Women's and Children's Health (KBH), Karolinka Institutet, Tomtebodavägen 18A, 171 77, Solna, Sweden
| |
Collapse
|
52
|
Auxiliary classification of cervical cells based on multi-domain hybrid deep learning framework. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
53
|
Lemma D, Aboma M, Girma T, Dechesa A. Determinants of utilization of cervical cancer screening among women in the age group of 30–49 years in Ambo Town, Central Ethiopia: A case-control study. PLoS One 2022; 17:e0270821. [PMID: 35830438 PMCID: PMC9278774 DOI: 10.1371/journal.pone.0270821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Globally, cervical cancer is the second most common and the leading cause of death in women in low-income countries. It is one of the potentially preventable cancers, and an effective screening program can result in a significant reduction in the morbidity and mortality associated with this cancer; however, evidence showed that only a small percentage of the women were screened. As a result, predictors of cervical cancer screening usage among women in Ambo town, central Ethiopia, were identified in this study. Method Unmatched, a community-based case-control study was conducted among 195 randomly sampled women in the age group of 30–49 years in Ambo town from February 1 to March 30, 2020. Data was collected using an interviewer-administered questionnaire. Descriptive, bivariate, and multivariable binary logistic regression analysis was done using SPSS. Results A total of 195 study participants, sixty-five cases and one hundred thirty controls, participated in this study, making a response rate of 100%. Being in the age group of 30–34 years old (AOR = 0.2; 95% CI: 0.06–0.7), being Para five and above (AOR = 4.5; 95% CI: 1.4–14.1), modern contraceptive utilization (AOR = 5.4; 95% CI: 1.8–16.3) and having high-level knowledge regarding cervical cancer screening and its predisposing factors (AOR = 5.9; 95% CI: 2–17) were significantly associated with the utilization of cervical cancer screening. Conclusion The age of women, parity, use of modern contraception, and level of knowledge regarding cervical cancer screening and its predisposing factors were the determinants of the utilization of cervical cancer screening among women. As a result, the media, the health bureau, and health professionals should advocate raising awareness about cervical cancer and its preventative methods, which are primarily focused on screening.
Collapse
Affiliation(s)
- Dereje Lemma
- Ambo University College of Medicine and Health Sciences, Ambo, Ethiopia
| | - Mecha Aboma
- Ambo University College of Medicine and Health Sciences, Ambo, Ethiopia
- * E-mail: ,
| | - Teka Girma
- Ambo University College of Medicine and Health Sciences, Ambo, Ethiopia
| | - Abebe Dechesa
- Ambo University College of Medicine and Health Sciences, Ambo, Ethiopia
| |
Collapse
|
54
|
Omoyeni O, Tsoka-Gwegweni J. Knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, South Africa. Pan Afr Med J 2022; 42:188. [PMID: 36212930 PMCID: PMC9508371 DOI: 10.11604/pamj.2022.42.188.26172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/01/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION cervical cancer continues to be a major cause of morbidity and mortality among women in the developing world. Despite the national cervical cancer screening programme, findings show low levels of knowledge and practices of cervical cancer screening among rural women in South Africa (SA). The purpose of this study was to determine the knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, SA. METHODS an observational cross-sectional study was performed. The study was conducted at three rural clinics. A systematic sampling technique was used to select 283 women, aged 18-65 years. Data were collected using a standardised structured self-administered questionnaire. Data were analysed using descriptive and analytic statistics. RESULTS findings showed a high level of awareness of cervical cancer (93.3%, n=264) and the Pap smear test (95.1%, n=269). Knowledge of cervical cancer-associated factors, symptoms, screening methods and treatment was poor (28.0%, n=79). An overwhelming majority (81.8%, n=231) displayed a positive attitude towards cervical cancer screening. The practice of cervical cancer screening was fairly good (66.8%, n=189). The results showed that socio-demographics were not statistically significantly associated with knowledge of cervical cancer and cervical cancer screening. CONCLUSION despite the inadequate knowledge of women, attitudes towards cervical cancer and screening were generally positive. Health care practitioners are encouraged to focus not only on creating awareness but also on improving knowledge so as women will not only undergo screening but appreciate the importance of cervical cancer screening.
Collapse
Affiliation(s)
- Oluwatosin Omoyeni
- Department of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Joyce Tsoka-Gwegweni
- Department of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa,,Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa,Corresponding author: Joyce Tsoka-Gwegweni, Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| |
Collapse
|
55
|
Musekiwa A, Moyo M, Mohammed M, Matsena-Zingoni Z, Twabi HS, Batidzirai JM, Singini GC, Kgarosi K, Mchunu N, Nevhungoni P, Silinda P, Ekwomadu T, Maposa I. Mapping Evidence on the Burden of Breast, Cervical, and Prostate Cancers in Sub-Saharan Africa: A Scoping Review. Front Public Health 2022; 10:908302. [PMID: 35784211 PMCID: PMC9246362 DOI: 10.3389/fpubh.2022.908302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCancer remains a major public health problem, especially in Sub-Saharan Africa (SSA) where the provision of health care is poor. This scoping review mapped evidence in the literature regarding the burden of cervical, breast and prostate cancers in SSA.MethodsWe conducted this scoping review using the Arksey and O'Malley framework, with five steps: identifying the research question; searching for relevant studies; selecting studies; charting the data; and collating, summarizing, and reporting the data. We performed all the steps independently and resolved disagreements through discussion. We used Endnote software to manage references and the Rayyan software to screen studies.ResultsWe found 138 studies that met our inclusion criteria from 2,751 studies identified through the electronic databases. The majority were retrospective studies of mostly registries and patient files (n = 77, 55.8%), followed by cross-sectional studies (n = 51, 36.9%). We included studies published from 1990 to 2021, with a sharp increase from 2010 to 2021. The quality of studies was overall satisfactory. Most studies were done in South Africa (n = 20) and Nigeria (n = 17). The majority were on cervical cancer (n = 93, 67.4%), followed by breast cancer (67, 48.6%) and the least were on prostate cancer (48, 34.8%). Concerning the burden of cancer, most reported prevalence and incidence. We also found a few studies investigating mortality, disability-adjusted life years (DALYs), and years of life lost (YLL).ConclusionsWe found many retrospective record review cross-sectional studies, mainly in South Africa and Nigeria, reporting the prevalence and incidence of cervical, breast and prostate cancer in SSA. There were a few systematic and scoping reviews. There is a scarcity of cervical, breast and prostate cancer burden studies in several SSA countries. The findings in this study can inform policy on improving the public health systems and therefore reduce cancer incidence and mortality in SSA.
Collapse
Affiliation(s)
- Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- *Correspondence: Alfred Musekiwa
| | - Maureen Moyo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mohanad Mohammed
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Zvifadzo Matsena-Zingoni
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jesca Mercy Batidzirai
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Kabelo Kgarosi
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nobuhle Mchunu
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Portia Nevhungoni
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Patricia Silinda
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Theodora Ekwomadu
- Department of Biological Sciences, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
56
|
Bray F, Parkin DM. Cancer in sub-Saharan Africa in 2020: a review of current estimates of the national burden, data gaps, and future needs. Lancet Oncol 2022; 23:719-728. [PMID: 35550275 DOI: 10.1016/s1470-2045(22)00270-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND With the cancer burden rising in sub-Saharan Africa, countries in the region need surveillance systems to measure the magnitude of the problem and monitor progress in cancer control planning. Based on the national estimates built from data provided by cancer registries in sub-Saharan Africa, we summarise key patterns of the regional burden and argue for investments in locally produced data. METHODS To present national estimates of the cancer incidence and mortality burden in sub-Saharan Africa countries, new cancer cases and deaths were extracted from International Agency for Research on Cancers' GLOBOCAN database for the year 2020. Given weak vital statistics systems, almost all of the information on the cancer burden in sub-Saharan Africa was derived from population-based cancer registries. Of the 48 countries included in GLOBOCAN (national populations must be larger than 150 000 inhabitants in 2020), relatively recent cancer registry data (up to 2019) were directly used to produce national incidence estimates in 25 countries, while the absence of such data for 16 meant that estimates were based on data from neighbouring countries. Tables and figures present the estimated numbers of new cases and deaths, as well as age-standardised (incidence or mortality) rates per 100 000 person-years and the cumulative risk of developing or dying from cancer before the age of 75 years. FINDINGS 801 392 new cancer cases and 520 158 cancer deaths were estimated to have occurred in sub-Saharan Africa in 2020. Cancers of the breast (129 400 female cases) and cervix (110 300 cases) were responsible for three in ten of the cancers diagnosed in both sexes. Breast and cervical cancer were the most common cancers, ranking first in 28 and 19 countries, respectively. In men, prostate cancer led in terms of incidence (77 300 cases), followed by liver cancer (24 700 cases) and colorectal cancer (23 400 cases). Prostate cancer was the leading incident cancer in men in 40 sub-Saharan Africa countries. The risk of a woman in sub-Saharan Africa developing cancer by the age of 75 years was 14·1%, with breast cancer (4·1%) and cervical cancer (3·5%) responsible for half of this risk. For men, the corresponding cumulative incidence was lower (12·2%), with prostate cancer responsible for a third of this risk (4·2%). Cervical cancer was the leading form of cancer death among women in 27 countries, followed by breast cancer (21 countries). Prostate cancer led as the most common type of cancer death in 26 countries, with liver cancer ranking second (11 countries). INTERPRETATION The estimates indicate substantial geographical variations in the major cancers in sub-Saharan Africa. Rational cancer control planning requires capacity to be built for data production, analysis, and interpretation within the countries themselves. Cancer registries provide important information in this respect and should be prioritised for sustainable investment in the region. FUNDING None.
Collapse
Affiliation(s)
- Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
| | - D Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
| |
Collapse
|
57
|
Sharma R, Aashima, Nanda M, Fronterre C, Sewagudde P, Ssentongo AE, Yenney K, Arhin ND, Oh J, Amponsah-Manu F, Ssentongo P. Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020. Front Public Health 2022; 10:839835. [PMID: 35548083 PMCID: PMC9082420 DOI: 10.3389/fpubh.2022.839835] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/10/2022] [Indexed: 01/22/2023] Open
Abstract
Objective Cancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries. Methods The estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles. Results In Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 - 1.3 million] and 711,429 [611,604 - 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa. Conclusion High cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.
Collapse
Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Aashima
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Mehak Nanda
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Claudio Fronterre
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom
| | | | - Anna E. Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Kelsey Yenney
- Washington State University Elson S. Floyd College of Medicine, Seattle, WA, United States
| | - Nina D. Arhin
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - John Oh
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | | | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
- Center for Neural Engineering, The Pennsylvania State University, State College, PA, United States
| |
Collapse
|
58
|
Sharma R, Aashima, Nanda M, Fronterre C, Sewagudde P, Ssentongo AE, Yenney K, Arhin ND, Oh J, Amponsah-Manu F, Ssentongo P. Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020. Front Public Health 2022; 10:839835. [PMID: 35548083 PMCID: PMC9082420 DOI: 10.3389/fpubh.2022.839835 10.3389/fpubh.2022.839835/full#:~:text=we%20examined%20the%20burden%20of,29)%20to%20711%2c000%20in%202020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective Cancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries. Methods The estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles. Results In Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 - 1.3 million] and 711,429 [611,604 - 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa. Conclusion High cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.
Collapse
Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Aashima
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Mehak Nanda
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Claudio Fronterre
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom
| | | | - Anna E. Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States,Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Kelsey Yenney
- Washington State University Elson S. Floyd College of Medicine, Seattle, WA, United States
| | - Nina D. Arhin
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - John Oh
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | | | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States,Center for Neural Engineering, The Pennsylvania State University, State College, PA, United States,*Correspondence: Paddy Ssentongo
| |
Collapse
|
59
|
Sharma R, Aashima, Nanda M, Fronterre C, Sewagudde P, Ssentongo AE, Yenney K, Arhin ND, Oh J, Amponsah-Manu F, Ssentongo P. Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020. Front Public Health 2022; 10:839835. [PMID: 35548083 PMCID: PMC9082420 DOI: 10.3389/fpubh.2022.839835 10.3389/fpubh.2022.839835/full] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Cancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries. METHODS The estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles. RESULTS In Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 - 1.3 million] and 711,429 [611,604 - 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa. CONCLUSION High cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.
Collapse
Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Aashima
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Mehak Nanda
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Claudio Fronterre
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom
| | | | - Anna E. Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States,Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Kelsey Yenney
- Washington State University Elson S. Floyd College of Medicine, Seattle, WA, United States
| | - Nina D. Arhin
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - John Oh
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | | | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States,Center for Neural Engineering, The Pennsylvania State University, State College, PA, United States,*Correspondence: Paddy Ssentongo
| |
Collapse
|
60
|
Sharma R, Aashima, Nanda M, Fronterre C, Sewagudde P, Ssentongo AE, Yenney K, Arhin ND, Oh J, Amponsah-Manu F, Ssentongo P. Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020. Front Public Health 2022; 10:839835. [PMID: 35548083 PMCID: PMC9082420 DOI: 10.3389/fpubh.2022.839835+10.3389/fpubh.2022.839835/full#:~:text=we%20examined%20the%20burden%20of,29)%20to%20711%2c000%20in%202020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE Cancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries. METHODS The estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles. RESULTS In Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 - 1.3 million] and 711,429 [611,604 - 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa. CONCLUSION High cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.
Collapse
Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Aashima
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Mehak Nanda
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Claudio Fronterre
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom
| | | | - Anna E. Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States,Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Kelsey Yenney
- Washington State University Elson S. Floyd College of Medicine, Seattle, WA, United States
| | - Nina D. Arhin
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - John Oh
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | | | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States,Center for Neural Engineering, The Pennsylvania State University, State College, PA, United States,*Correspondence: Paddy Ssentongo
| |
Collapse
|
61
|
Li K, Xu H, Wang S, Qin P, Liang B. Disparities in the increases of cervical cancer incidence rates: observations from a city-wide population-based study. BMC Cancer 2022; 22:419. [PMID: 35428279 PMCID: PMC9013161 DOI: 10.1186/s12885-022-09531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background Globally cervical cancer incidence rate has been declining continuously. However, an unfavorable trend has been observed in China during the past decades, and the underlying reasons remain unclear. We hereby explore the recent trends of cervical cancer incidence, as well as the underlying determinants using data from Guangzhou, one of biggest cities in China. Methods City-wide cancer registration data were obtained from the Guangzhou Center for Disease Prevention and Control from 2004 to 2018. We used the Joinpoint regression models to estimate the average annual percentage change (AAPC) of age-standardized and age-specific incidence rates by regions and by histological subtype. Age-period-cohort models were applied to analyze the period and birth cohort effects on the time trends. Results The age-standardized rates (ASRs) of cervical cancer incidence increased at an annual rate of 2.1% [95% confidence interval (CI): 1.0%-3.2%] during 2004–2018. The largest increase in ASRs was found for rural regions, with AAPC of 6.6% [95% CI: 3.7%-9.5%], followed by the suburbs (2.2% [95% CI: 1.0%-3.4%]), while there was no statistically significant increase in urban regions. The ASRs of adenocarcinoma increased faster than those of the squamous cell carcinoma (AAPC = 6.53% [95% CI: 5.0%-8.1%] versus 1.79% [95% CI: 0.8%-2.8%]). A downward trend in urban regions was found in the 20–49 age group, whereas an upward trend was found in the 50 + age group, especially in rural regions. An inverted V-shape was found for cohort effects, with the peak varied by regions, i.e., peaked in the 1966 and 1971 birth cohort in the urban and suburb regions, respectively. Period effects kept increasing during the study period. Conclusions We systematically examine the disparities in the increases of cervical cancer incidence rates using city-wide data from Guangzhou. Extensive efforts are warranted to address the large urban–rural disparities in cervical cancer prevention. The combined strategies of vaccination, screening, and health education should be reinforced and locally customized.
Collapse
|
62
|
Stojanovic MM, Rancic NK, Andjelković Apostolović MR, Ignjatović AM, Stojanovic DR, Mitic Lakusic VR, Ilic MV. Temporal Changes in Incidence Rates of the Most Common Gynecological Cancers in the Female Population in Central Serbia. Medicina (B Aires) 2022; 58:medicina58020306. [PMID: 35208629 PMCID: PMC8880439 DOI: 10.3390/medicina58020306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Objectives: There were 1,335,503 newly diagnosed cases of the most common gynecological cancers in women (cervical, uterine and ovarian cancer) worldwide in 2020. The main objective of this paper was to assess temporal changes in incidence rates of the most common gynecological cancers and to determine the age group with the greatest increase in incidence in the Serbian female population in the period 2003–2018. Material and Methods: Trends and annual percentage change (APC) of the incidence rate with corresponding 95% confidence intervals (CI) were calculated by Joinpoint regression analysis. The trend was considered to be significantly increasing (positive change) or decreasing (negative change) when the p-value was below 0.05 (p < 0.05). Results: The total number of newly registered cancer cases from 2003 to 2018 was 35,799. There was a significant increase of age standardized rate (ASR) for all cancer incidences in women from 2012 to 2018 with APC 6.9% (95% CI from 0.9 to 13.3, p = 0.028) and for uterine cancer during the 2014–2018 period with APC of 16.8% (95% CI: from 4.0 to 31.1, p = 0.014), as well as for ovarian cancer incidence in the 2012–2018 period with APC of 12.1% (95% CI: from 6.7 to 17.8, p < 0.001). A non-significant decrease of ASRs of incidence for cervical cancer was determined from 2003 to 2015 with APC of −0.22% (95% CI: from −3.4 to 3.1, p = 0.887) and a non-significant increase of ASRs incidence from 2015 to 2018 with APC of 14.21% (95% CI: from −13.3 to 50.5, p = 0.311). The most common gynecological cancers were present in all age groups and only ovarian cancer was registered in the youngest age group (0–4 years). Cervical cancer showed a typical increase after the age of 30, with peak incidence in women aged 40–44 and 65–69 years. The increased incidence trend regarding age for cervical cancer (y = 1.3966x + 0.3765, R2 = 0.3395), uterine cancer (y = 1.7963x − 5.4688, R2 = 0.5063) and ovarian cancer (y = 1.0791x − 0.8245, R2 = 0.5317) is statistically significant. Conclusion: Based on our presented results, a significant increase of incidence trend for the most common gynecological cancers in the Serbian female population from 2012 to 2018 was determined. There has been a significant increase in the incidence of uterine cancer from 2014 up to 2018, as well as for ovarian cancer from 2012 up to 2018, while cervical cancer showed a non-significant decrease of incidence trend from 2003 until 2015 and then a non-significant increase. In women below 20 years of age, ovarian cancer was significantly more prevalent, while cervical cancer was significantly more prevalent in the age groups 20–39 and 40–59 years. In the age group of 60–79, uterine cancer had a significantly higher incidence than the other two cancers. Measures of primary prevention, such as vaccination of children against Human Papilloma Virus and screening measures of secondary prevention, for the female population aged 25 to 64 years of age are needed, as well as educating females about healthy lifestyles via media and social networks to help prevent the most common gynecological cancers.
Collapse
Affiliation(s)
- Miodrag M. Stojanovic
- Faculty of Medicine Nis, University of Nis, 18000 Nis, Serbia; (M.M.S.); (M.R.A.A.); (A.M.I.); (D.R.S.); (M.V.I.)
- Institute for Public Health Nis, 18000 Nis, Serbia
| | - Natasa K. Rancic
- Faculty of Medicine Nis, University of Nis, 18000 Nis, Serbia; (M.M.S.); (M.R.A.A.); (A.M.I.); (D.R.S.); (M.V.I.)
- Institute for Public Health Nis, 18000 Nis, Serbia
- Correspondence:
| | - Marija R. Andjelković Apostolović
- Faculty of Medicine Nis, University of Nis, 18000 Nis, Serbia; (M.M.S.); (M.R.A.A.); (A.M.I.); (D.R.S.); (M.V.I.)
- Institute for Public Health Nis, 18000 Nis, Serbia
| | - Aleksandra M. Ignjatović
- Faculty of Medicine Nis, University of Nis, 18000 Nis, Serbia; (M.M.S.); (M.R.A.A.); (A.M.I.); (D.R.S.); (M.V.I.)
- Institute for Public Health Nis, 18000 Nis, Serbia
| | - Dijana R. Stojanovic
- Faculty of Medicine Nis, University of Nis, 18000 Nis, Serbia; (M.M.S.); (M.R.A.A.); (A.M.I.); (D.R.S.); (M.V.I.)
| | | | - Mirko V. Ilic
- Faculty of Medicine Nis, University of Nis, 18000 Nis, Serbia; (M.M.S.); (M.R.A.A.); (A.M.I.); (D.R.S.); (M.V.I.)
| |
Collapse
|
63
|
Amponsah-Dacosta E, Blose N, Nkwinika VV, Chepkurui V. Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services? Front Public Health 2022; 10:799984. [PMID: 35174123 PMCID: PMC8841655 DOI: 10.3389/fpubh.2022.799984] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/07/2022] [Indexed: 12/17/2022] Open
Abstract
Compared to other regions of the world, sub-Saharan Africa has made limited progress in the implementation and performance of nationwide human papillomavirus (HPV) vaccination programmes. Without urgent intervention, this will serve to undermine cervical cancer elimination efforts in this region. The primary intent of this narrative review is to highlight the programmatic successes and challenges of the school-based HPV vaccination programme in South Africa since its inception in 2014, with the aim of contributing to the evidence base needed to accelerate implementation and improve programme performance in other sub-Saharan African countries. As of 2020, the proportion of adolescent girls aged 15 years who had received at least one dose of the HPV vaccine at any time between ages 9–14 years was 75%, while 61% had completed the full recommended two-dose schedule. This gives some indication of the reach of the South African HPV vaccination programme over the past 6 years. Despite this, vaccine coverage and dose completion rates have persistently followed a downward trend, slowing progress toward attaining global elimination targets. There is evidence suggesting that declining public demand for the HPV vaccine may be a result of weakening social mobilization over time, inadequate reminder and tracking systems, and vaccine hesitancy. Another concern is the disproportionate burden of HPV and HIV co-infections among adolescent girls and young women in South Africa, which predisposes them to early development of invasive cervical cancer. Moving forward, national policy makers and implementers will have to explore reforms to current age eligibility criteria and vaccine dose schedules, as well as implement strategies to support vaccine uptake among populations like out-of-school girls, girls attending private schools, and HIV positive young women. Additional opportunities to strengthen the South African HPV vaccination programme can be achieved by scaling up the co-delivery of other adolescent health services such as comprehensive sexual and reproductive health and rights education, deworming, and health screening. This calls for reinforcing implementation of the integrated school health policy and leveraging existing adolescent health programmes and initiatives in South Africa. Ultimately, establishing tailored, adolescent-centered, integrated health programmes will require guidance from further operational research.
Collapse
Affiliation(s)
- Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- *Correspondence: Edina Amponsah-Dacosta ;
| | - Ntombifuthi Blose
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Varsetile Varster Nkwinika
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Virological Pathology, South African Vaccination and Immunisation Centre (SAVIC), Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Viola Chepkurui
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
64
|
Fu M, Pei Y, Lu F, Jiang H, Bi Y, Cheng J, Qin J. Identification of Potential Hub Genes and miRNA-mRNA Pairs Related to the Progression and Prognosis of Cervical Cancer Through Integrated Bioinformatics Analysis. Front Genet 2022; 12:775006. [PMID: 35003215 PMCID: PMC8727538 DOI: 10.3389/fgene.2021.775006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
In recent years, the incidence and mortality of cervical cancer have increased worldwide. At the same time, increasing data have confirmed that miRNA-mRNA plays a positive or negative regulatory role in many cancers. This study attempted to screen effective miRNA-mRNA in the progression of cervical cancer, and to study the mechanism of miRNA-mRNA in the progression of cervical cancer. The expression profile data of GSE7410, GSE 63514, GSE 86100 and TCGA-CESC were downloaded, and 34 overlapping differentially expressed genes (22 up-regulated and 12 down-regulated) and 166 miRNAs (74 down-regulated and 92 up-regulated) were screened through limma package. Then, miR-197-3p/TYMS pairs were obtained by PPI, functional enrichment, Kaplan-Meier plotter analysis, Cox univariate and multivariate analysis, risk modeling, WGCNA, qPCR and dual-luciferase experiments. The results showed that TYMS was an independent prognostic factor of cervical cancer, and its expression level was negatively correlated with cervical cancer tissue grade (TMN), tumor grade, age, microsatellite stability and tumor mutation load, and positively correlated with methyl expression in DNMT1, DNMT2, DNMT3A and DNMT3B. Functional experiments showed that TYMS knockout could promote the proliferation, migration and invasion of HeLa cells and reduce apoptosis. Overexpression of TYMS showed the opposite trend, miR-197-3p was negatively correlated with the expression of TYMS. MiR-197-3p inhibitor reversed the effect of si-TYMS on the proliferation of HeLa cells. In conclusion, these results reveal that TYMS plays a very important role in the prognosis and progression of cervical cancer, and has the potential to be thought of as cervical cancer biomarkers. At the same time, miR-197-3p/TYMS axis can regulate the deterioration of cervical cancer cells, which lays a foundation for the molecular diagnosis and treatment of cervical cancer.
Collapse
Affiliation(s)
- Mingxu Fu
- Department of Obstetrics and Gynecology, Shanghai Fourth People 's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yongyan Pei
- School of Medicine and Chemical Engineering, Guangdong Pharmaceutical University, Guangzhou, China
| | - Fang Lu
- Department of Obstetrics and Gynecology, Shanghai Fourth People 's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Huici Jiang
- Department of Obstetrics and Gynecology, Shanghai Fourth People 's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yingying Bi
- Department of Obstetrics and Gynecology, Shanghai Fourth People 's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiajing Cheng
- Department of Obstetrics and Gynecology, Shanghai Fourth People 's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jinlong Qin
- Department of Obstetrics and Gynecology, Shanghai Fourth People 's Hospital, School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
65
|
Yao H, Yan C, Qiumin H, Li Z, Jiao A, Xin L, Hong L. Epidemiological Trends and Attributable Risk Burden of Cervical Cancer: An Observational Study from 1990 to 2019. Int J Clin Pract 2022; 2022:3356431. [PMID: 36263235 PMCID: PMC9546700 DOI: 10.1155/2022/3356431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/29/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cervical cancer, especially in underdeveloped areas, poses a great threat to human health. In view of this, we stratified the age and social demographic index (SDI) based on the epidemiological development trend and attributable risk of cervical cancer in countries and regions around the world. METHODS According to the data statistics of the global burden of disease database (GBD) in the past 30 years, we adopted the annual percentage change (EAPCs) to evaluate the incidence trend of cervical cancer, that is, incidence rate, mortality, and disability adjusted life expectancy (DALY). Meanwhile, we investigated the potential influence of SDI on cervical cancer's epidemiological trends and relevant risk factors for cervical cancer-related mortality. RESULTS In terms of incidence rate and mortality, the high SDI areas were significantly lower than those of low SDI areas. The incidence and mortality in women aged 20 to 39 were relatively stable, whereas an upward trend existed in patients aged 40 to 59. The global cervical cancer incidence rate increased from 335642 in 1990 to 565541 in 2019 (an increase of 68.50%, with an average annual growth rate of 2.28%), while the age-standardized incidence rate (ASIR) showed a slight downward trend of 14.91/100000 people (95% uncertainty interval [UI], 13.37-17.55) in 1990 to 13.35/100,000 persons (95% UI, 11.37-15.03) in 2019. The number of annual deaths at a global level increased constantly and there were 184,527 (95% UI, 164,836-218,942) deaths in 1990 and 280,479 (95% UI, 238,864-313,930) deaths in 2019, with an increase of 52.00%(average annual growth rate: 1.73%). The annual age-standardized disability adjusted annual life rate showed a downward trend (decline range: 0.95%, 95% confidence interval [CI], from -1.00% to - 0.89%). In addition, smoking and unsafe sex were the main attributable hazard factors in most GBD regions. CONCLUSIONS In the past three decades, the increase in the global burden of cervical cancer is mainly concentrated in underdeveloped regions (concentrated in low SDI). On the contrary, in countries with high sustainable development index, the burden of cervical cancer tends to be reduced. Alarmingly, ASIR in areas with low SDI is on the rise, which suggests that policy makers should pay attention to the allocation of public health resources and focus on the prevention and treatment of cervical cancer in underdeveloped areas, so as to reduce its incidence rate, mortality, and prognosis.
Collapse
Affiliation(s)
- Hu Yao
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
- Department of Obstetrics and Gynecology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei 434020, China
| | - Chen Yan
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - He Qiumin
- Department of Obstetrics and Gynecology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei 434020, China
| | - Zhou Li
- Department of Obstetrics and Gynecology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei 434020, China
| | - Ai Jiao
- Department of Urinary Surgery, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei 434020, China
| | - Li Xin
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Li Hong
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| |
Collapse
|
66
|
Wang W, Kothari S, Baay M, Garland SM, Giuliano AR, Nygård M, Velicer C, Tota J, Sinha A, Skufca J, Verstraeten T, Sundström K. Real-world impact and effectiveness assessment of the quadrivalent HPV vaccine: a systematic review of study designs and data sources. Expert Rev Vaccines 2021; 21:227-240. [PMID: 34845951 DOI: 10.1080/14760584.2022.2008243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vaccine effectiveness and impact studies are typically observational, generating evidence after vaccine launch in a real-world setting. For human papillomavirus (HPV) vaccination studies, the variety of data sources and methods used is pronounced. Careful selection of study design, data capture and analytical methods can mitigate potential bias in such studies. AREAS COVERED We systematically reviewed the different study designs, methods, and data sources in published evidence (1/2007-3/2020), which assessed the quadrivalent HPV vaccine effectiveness and impact on cervical/cervicovaginal, anal, and oral HPV infections, anogenital warts, lesions in anus, cervix, oropharynx, penis, vagina or vulva, and recurrent respiratory papillomatosis. EXPERT OPINION The rapid growth in access to real-world data allows global monitoring of effects of different public health interventions, including HPV vaccination programs. But the use of data which are not collected or organized to support research also underscore a need to develop robust methodology that provides insight of vaccine effects and consequences of different health policy decisions. To achieve the WHO elimination goal, we foresee a growing need to evaluate HPV vaccination programs globally. A critical appraisal summary of methodology used will provide timely guidance to researchers who want to initiate research activities in various settings.
Collapse
Affiliation(s)
- Wei Wang
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Smita Kothari
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
| | - Suzanne M Garland
- Department Obstetrics and Gynaecology, University of Melbourne, Centre Women's Infectious Diseases Research, Royal Women's Hospital, and Infection & Immunity Murdoch Children's Research Institute, Parkville, Australia
| | - Anna R Giuliano
- Center for Immunizaton and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Christine Velicer
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Joseph Tota
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Anushua Sinha
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Jozica Skufca
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
| | | | - Karin Sundström
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
67
|
Kabukye JK, Kakungulu E, Keizer ND, Cornet R. Digital health in oncology in Africa: A scoping review and cross-sectional survey. Int J Med Inform 2021; 158:104659. [PMID: 34929545 DOI: 10.1016/j.ijmedinf.2021.104659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/09/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Low- and middle-income countries, especially in Africa, face a growing cancer burden. Adoption of digital health solutions has the potential to improve cancer care delivery and research in these countries. However, the extent of implementation and the impact of digital health interventions across the cancer continuum in Africa have not been studied. AIMS To describe the current landscape of digital health interventions in oncology in Africa. METHODS We conducted a scoping literature review and supplemented this with a survey. Following the PRISMA for Scoping Reviews guidelines, we searched literature in PubMed and Embase for keywords and synonyms for cancer, digital health, and African countries, and abstracted data using a structured form. For the survey, participants were delegates of the 2019 conference of the African Organization for Research and Training in Cancer. RESULTS The literature review identified 57 articles describing 40 digital health interventions or solutions from 17 African countries, while the survey included 111 respondents from 18 African countries, and these reported 25 different digital health systems. Six articles (10.5%) reported randomized controlled trials. The other 51 articles (89.5%) were descriptive or quasi-experimental studies. The interventions mostly targeted cancer prevention (28 articles, 49.1%) or diagnosis and treatment (23 articles, 40.4%). Four articles (7.0%) targeted survivorship and end of life, and the rest were cross-cutting. Cervical cancer was the most targeted cancer (25 articles, 43.9%). Regarding WHO classification of digital interventions, most were for providers (35 articles, 61.4%) or clients (13, 22.8%), while the others were for data services or cut across these categories. The interventions were mostly isolated pilots using basic technologies such as SMS and telephone calls for notifying patients of their appointments or results, or for cancer awareness; image capture apps for cervical cancer screening, and tele-conferencing for tele-pathology and mentorship. Generally positive results were reported, but evaluation focused on structure and process measures such as ease of use, infrastructure requirements, and acceptability of intervention; or general benefits e.g. supporting training and mentorship of providers, communication among providers and clients, and improving data collection and management. No studies evaluated individualized clinical outcomes, and there were no interventions in literature for health system managers although the systems identified in the survey had such functionality, e.g. inventory management. The survey also indicated that none of the digital health systems had all the functionalities for a comprehensive EHR, and major barriers for digital health were initial and ongoing costs, resistance from clinical staff, and lack of fit between the EHR and the clinical workflows. CONCLUSION Digital health interventions in oncology in Africa are at early maturity stages but promising. Barriers such as funding, fit between digital health tools and clinical workflows, and inertia towards technology, shall need to be addressed to allow for advancement of digital health solutions to support all parts of the cancer continuum. Future research should investigate the impact of digital health solutions on long-term cancer outcomes such as cancer mortality, morbidity and quality of life.
Collapse
Affiliation(s)
- Johnblack K Kabukye
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands; Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda.
| | - Edward Kakungulu
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| | - Nicolette de Keizer
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| |
Collapse
|
68
|
Zibako P, Tsikai N, Manyame S, Ginindza TG. Knowledge, attitude and practice towards cervical cancer prevention among mothers of girls aged between 9 and 14 years: a cross sectional survey in Zimbabwe. BMC Womens Health 2021; 21:426. [PMID: 34930221 PMCID: PMC8691087 DOI: 10.1186/s12905-021-01575-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer (CC) morbidity and mortality is still high in developing countries like Zimbabwe. Treatment for CC is out of reach for many women, hence the need to maximise on prevention which mainly includes screening and administering human papillomavirus (HPV) vaccine. Knowledge about CC prevention is a prerequisite for utilisation of all the available options for CC prevention, yet little is known about its levels and the corresponding attitudes and practices on cancer prevention methods within the society.
Methods A cross sectional survey was done to assess knowledge, attitude and practice (KAP) on CC prevention among mothers of girls aged between 9 and 14 years in Zimbabwe as well as factors explaining the KAP. Four hundred and six mothers participate. Descriptive and inferential statistics (binary logistic regression and Chi-Square test of association) were applied to determine participant characteristics with KAP using STATA version 16 software. Findings Overall KAP of cervical cancer prevention is in a poor state. The knowledge was poor with 24% being able to say CC is caused by HPV; the attitude is negative with 58% being of the opinion that CC is caused by witchcraft and it is a death sentence, while the bad practices of relying only on traditional means were being practiced. Factors associated with knowledge are: not having medical aid (odds: 0.17, 95%CI: 0.05–0.59, p = 0.005) and high levels of education (secondary level odds: 4.20; 95%CI: 2.25–7.84 p < 0.001 and tertiary odds: 7.75; 95%CI: 2.04–29.45, p-value: 0.003 compared to primary education). Attitude towards CC management was driven by levels of education (secondary level odds: 0.39, 95%CI: 0.20–0.78, p = 0.007 and tertiary odds: 0.12, 95%CI: 0.04–0.33, p < 0.001), the same factor increases odds of good practice (secondary odds: 3.78, 95%CI: 1.99–7.18, p < 0.001 and tertiary odds: 3.78, 95%CI: 1.99–7.18, p < 0.001). On the other hand, HPV vaccine knowledge was also very moderate (with majority of mothers not knowing the right age of vaccination; vaccine acceptability was high (90%), but uptake was very low (8% had their daughter vaccinated). Conclusion KAP about CC prevention was poor with factors necessary for improvement of KAP identified as education, medical insurance coverage. Making health education easily accessible in schools, primary health facilities and various media platforms will help to address the myths on causes of CC and how it can be treated. Health education and availability of free screening services and free vaccine will improve CC prevention out outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01575-z.
Collapse
|
69
|
Desai S, Zhu MJ, Lapidos-Salaiz I. Cervical cancer prevention: Human papillomavirus testing as primary screening. Cancer 2021; 128:939-943. [PMID: 34767263 DOI: 10.1002/cncr.34006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/09/2022]
Abstract
Low- and middle-income countries carry a high burden of preventable cervical cancer cases and deaths. Because human papillomavirus DNA-based testing is increasingly becoming the preferred method of screening for cervical cancer prevention, this commentary discusses next steps and key considerations for its expansion.
Collapse
Affiliation(s)
- Shreya Desai
- US Agency for International Development, Washington, DC
| | | | | |
Collapse
|
70
|
Mbuya W, Held K, Mcharo RD, Haule A, Mhizde J, Mnkai J, Mahenge A, Mwakatima M, Sembo M, Mwalongo W, Agrea P, Hoelscher M, Maboko L, Saathoff E, Geisenberger O, Rwegoshora F, Torres L, Koup RA, Kroidl A, Chachage M, Geldmacher C. Depletion of Human Papilloma Virus E6- and E7-Oncoprotein-Specific T-Cell Responses in Women Living With HIV. Front Immunol 2021; 12:742861. [PMID: 34759925 PMCID: PMC8573218 DOI: 10.3389/fimmu.2021.742861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cervical cancer - caused by persistent High Risk Human Papilloma Virus (HR HPV) infections - is the second most common cancer affecting women globally. HIV infection increases the risk for HPV persistence, associated disease progression and malignant cell transformation. We therefore hypothesized that this risk increase is directly linked to HIV infection associated dysfunction or depletion of HPV-oncoprotein-specific T-cell responses. Methods The 2H study specifically included HIV+ and HIV- women with and without cervical lesions and cancer to analyze HPV oncogene-specific T cell responses in relation to HPV infection, cervical lesion status and HIV status. Oncoprotein E6 and E7 specific T-cell responses were quantified for the most relevant types HPV16, 18 and 45 and control antigens (CMV-pp65) and M.tb-PPD in 373 women, using fresh peripheral blood mononuclear cells in an IFN-γ release ELISpot assay. Results Overall, systemic E6- and E7-oncoprotein-specific T-cell responses were infrequent and of low magnitude, when compared to CMV-pp65 and M.tb-PPD (p < 0.001 for all HR HPV types). Within HIV negative women infected with either HPV16, 18 or 45, HPV16 infected women had lowest frequency of autologous-type-E6/E7-specific T-cell responses (33%, 16/49), as compared to HPV18 (46% (6/13), p = 0.516) and HPV45 (69% (9/13), p = 0.026) infected women. Prevalent HPV18 and 45, but not HPV16 infections were linked to detectable oncoprotein-specific T-cell responses, and for these infections, HIV infection significantly diminished T-cell responses targeting the autologous infecting genotype. Within women living with HIV, low CD4 T-cell counts, detectable HIV viremia as well as cancerous and precancerous lesions were significantly associated with depletion of HPV oncoprotein-specific T-cell responses. Discussion Depletion of HPV-oncoprotein-specific T-cell responses likely contributes to the increased risk for HR HPV persistence and associated cancerogenesis in women living with HIV. The low inherent immunogenicity of HPV16 oncoproteins may contribute to the exceptional potential for cancerogenesis associated with HPV16 infections.
Collapse
Affiliation(s)
- Wilbert Mbuya
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania.,Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Kathrin Held
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Ruby D Mcharo
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Antelmo Haule
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Jacklina Mhizde
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Jonathan Mnkai
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Anifrid Mahenge
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Maria Mwakatima
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Margareth Sembo
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Wolfram Mwalongo
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Peter Agrea
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Leonard Maboko
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania.,Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, Tanzania
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Otto Geisenberger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - France Rwegoshora
- Pathology Department, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Liset Torres
- Pathology Department, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Richard A Koup
- Vaccine Research Centre, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Mkunde Chachage
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania.,Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,Microbiology and Immunology Department, University of Dar es Salaam -Mbeya College of Health and Allied Sciences (UDSM-MCHAS), Mbeya, Tanzania
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| |
Collapse
|
71
|
Akokuwebe ME, Idemudia ES, Lekulo AM, Motlogeloa OW. Determinants and levels of cervical Cancer screening uptake among women of reproductive age in South Africa: evidence from South Africa Demographic and health survey data, 2016. BMC Public Health 2021; 21:2013. [PMID: 34740352 PMCID: PMC8571865 DOI: 10.1186/s12889-021-12020-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/30/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cervical cancer (CC) is the cancer with the most incidents and the leading cause of cancer mortality among women in South Africa. CC screening is one of the most cost-effective control approaches for the disease burden. This study assessed the determinants and individual-level indicators of cervical cancer screening uptake among women of reproductive age in South Africa. METHODS We analyzed data from the 2016 South Africa Demographic Health Survey. Our analysis focused on 5903 women (15-49 years). We conducted Chi-square test for bivariate analysis, and multivariate binary logistics regression was used to analyze independent association between individual-level factors and women who have had Pap smear testing. Statistical significance was set at p < 0.05. RESULTS The mean age at cervical cancer screening uptake among women in South Africa was 40.8 years (SD 18.6, range 15-95 years). A majority of the women (39.3%) were aged 45 years and above and 54.6% of them resides in urban settlements. About 35.4% of women (n = 2098) have had a Pap smear test, with 66.5% of them who had a Pap smear test resides in Western Cape province. The proportion of women who had a Pap smear test was significantly higher among those with higher educational attainment (68.7%, p = 0.000), in the rich wealth index (50.1%, p = 0.000), and those with health insurance cover (60.3%, p = 0.000). Pap smear testing was found to be more prevalent among women aged 45+ years, were in the white population group, had higher education, were divorced, and had health insurance cover. The predominance of Pap smear test was 14% higher among women who are working in the professional/formal sector (AOR; 1.38, 95% CI; 1.14-1.69). The uptake of Pap smear test was also higher among women aged 35-44 years. CONCLUSIONS The prevalence of cervical cancer uptake is substantially low among women aged 15-24 years in South Africa and shows a degree of between-provinces differences. Therefore, heath educational interventions aimed at increasing the uptake of cervical cancer screening services in South Africa are critically needed.
Collapse
Affiliation(s)
- Monica Ewomazino Akokuwebe
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
| | - Erhabor Sunday Idemudia
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
| | - Abiel M. Lekulo
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
| | - Ogone Warona Motlogeloa
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
| |
Collapse
|
72
|
He WQ, Li C. Recent global burden of cervical cancer incidence and mortality, predictors, and temporal trends. Gynecol Oncol 2021; 163:583-592. [PMID: 34688503 DOI: 10.1016/j.ygyno.2021.10.075] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/29/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUNDS This study investigated the global incidence and mortality of cervical cancer, its predictors, the temporal trend by country and age. METHODS Data from Global Cancer Observatory 2020 for 185 countries was used to estimate current cervical cancer incidence and mortality and their associations with predictors by linear regression analysis. Estimated age-standardized rates (ASR) and average annual percentage changes (AAPC) from cancer registries for up to 53 countries through 2018 were used for trend analysis by joinpoint regression. RESULTS Wide variations in cervical cancer were observed globally with the highest rates of incidence and mortality in East Africa (ASR, 40.1 and 28.6). The incidence and mortality of cervical cancer were positively associated with human papillomavirus, human immunodeficiency virus infection and negatively associated with cervical cancer screening coverage. In the most recent 5 years, reduction of incidence and mortality was found from 22 (AAPC, -11.2 to -0.5) and 27 countries (-21.5 to -0.3). Increase of incidence and mortality was found from 13 (1.7 to 6.5) and 5 (0.3 to 1.8) countries. Comparing to women aged above 50 years, increasing incidence were additionally found among women under age 50 years from 9 countries (ranging from 0.2 in Denmark to 3.8 in Sweden). CONCLUSIONS While most countries with cancer registry have shown reduction in cervical cancer incidence and mortality, the increasing incidence among younger women from some developed countries warrants further implementation of effective cancer screening.
Collapse
Affiliation(s)
- Wen-Qiang He
- School of Population Health, UNSW Sydney, Sydney 2052, Australia.
| | - Chenxi Li
- School of Population Health, UNSW Sydney, Sydney 2052, Australia
| |
Collapse
|
73
|
Xu HF, Liu Y, Luo YL, Zhao DM, Jia MM, Chen PP, Li MJ, Sun XA, Liu SZ, Sun XB, Zhang SK. The Risk Stratification for Cervical Cancer and Precursors of Domestic HPV Testing With HPV 16/18 Genotyping in Women With NILM Cytology in CentralChina: A Cohort Study. Front Oncol 2021; 11:716762. [PMID: 34671550 PMCID: PMC8521162 DOI: 10.3389/fonc.2021.716762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the clinical performance and utility for risk stratification of DH3 HPV assay in women (≥30 years) with NILM cytology. Methods A prospective cohort was established in Central China between November 8 to December 14, 2016 which consisted of 2180 women aging 30-64 years with NILM cytology. At baseline, all women were screened using DH3 HPV assay. HPV 16/18 positive women would be assigned to colposcopy and biopsied if necessary. Then, hr-HPV positive women without CIN2+ lesions would be followed up by cytology every 12 months for two years. In the 3rd year of follow up, all women that were not biopsy proven CIN2+ would be called back and screened by cytology again. In follow-up period, women with ASC-US and above were referred to colposcopy and biopsied if clinically indicated. CIN2+ was the primary endpoint in analysis. The clinical performance and utility for risk stratification of DH3 HPV assay were assessed by SPSS 22.0 and SAS 9.4. Results Of 2180 qualified women, the prevalence of hr-HPV was 8.5% (185/2180), 45(2.1%) were HPV 16/18 positive. The clinical performance for HPV16/18 was 91.7% for sensitivity, 98.4% for specificity, respectively against CIN2+ detection at baseline. In four years of study, the corresponding rates of HPV 16/18 were 51.5% and 98.7%, respectively. The cumulative absolute risk for the development of CIN2+ was as high as 37.8% for HPV 16/18 positive women, followed by hr-HPV positive (14.6%), other hr-HPV positive (11.0%) and HPV negative (0.3%) in three years. The relative risk was 125.6 and 3.4 for HPV 16/18 positive group when compared with HPV negative and other hr-HPV positive group, respectively. Conclusions DH3 HPV assay demonstrated excellent clinical performance against CIN2+ detection in cervical cancer screening and utility of risk stratification by genotyping to promote scientific management of women with NILM cytology.
Collapse
Affiliation(s)
- Hui-Fang Xu
- Department of Cancer Epidemiology, Henan International Joint Laboratory of Cancer Prevention, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Zhengzhou, China
| | - Yin Liu
- Department of Cancer Epidemiology, Henan International Joint Laboratory of Cancer Prevention, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Zhengzhou, China
| | - Yan-Lin Luo
- Department of Gynecology and Oncology, Henan International Joint Laboratory of Cancer Prevention, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Zhengzhou, China
| | - Dong-Mei Zhao
- Department of Pathology, Henan International Joint Laboratory of Cancer Prevention, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Zhengzhou, China
| | - Man-Man Jia
- Department of Gynecology and Oncology, Henan International Joint Laboratory of Cancer Prevention, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Zhengzhou, China
| | - Pei-Pei Chen
- Department of Cancer Epidemiology, Henan International Joint Laboratory of Cancer Prevention, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Zhengzhou, China
| | - Meng-Jie Li
- Department of Cancer Epidemiology, Henan International Joint Laboratory of Cancer Prevention, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Zhengzhou, China
| | - Xing-Ai Sun
- Department of Cancer Epidemiology, Henan International Joint Laboratory of Cancer Prevention, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Zhengzhou, China
| | - Shu-Zheng Liu
- Department of Cancer Epidemiology, Henan International Joint Laboratory of Cancer Prevention, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Zhengzhou, China
| | - Xi-Bin Sun
- Department of Cancer Epidemiology, Henan International Joint Laboratory of Cancer Prevention, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Zhengzhou, China
| | - Shao-Kai Zhang
- Department of Cancer Epidemiology, Henan International Joint Laboratory of Cancer Prevention, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Zhengzhou, China
| |
Collapse
|
74
|
Njuguna DW, Mahrouseh N, Isowamwen OV, Varga O. Knowledge, Attitude and Practice of Main Stakeholders towards Human Papilloma Virus Infection and Vaccination in Mombasa and Tana-River Counties in Kenya: A Qualitative Study. Vaccines (Basel) 2021; 9:1099. [PMID: 34696206 PMCID: PMC8538985 DOI: 10.3390/vaccines9101099] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 01/17/2023] Open
Abstract
Following a successful Human Papilloma Virus (HPV) vaccination pilot in 2013-2015 in Kitui county, Kenya introduced the HPV vaccine in October 2019 with a goal to immunize approximately 800,000 girls annually against HPV. Our study assessed the knowledge, attitudes, and practice of affected groups towards HPV infection and vaccination in two counties of Kenya. Semi-structured interviews from children aged between nine and thirteen years and key informants comprising of parents, head teachers, community leaders and health workers involved in HPV vaccination in health facilities from Mombasa and Tana-River counties were conducted. Content was analyzed thematically and coded for emerging themes using the QRS Nvivo 12 Plus (QRS International, Doncaster, Australia) software package. From our findings, a significant proportion of participants, especially children, have limited knowledge of the subject. Vaccination of boys was opposed by most participants. Parents and the community members are not in favor of HPV vaccination, as compared to the other groups. A similar pattern of inadequate knowledge and strongly opposed attitudes was observed in Tana-River and Mombasa. Active community involvement in primary prevention strategies may promote the uptake of the vaccine which can be achieved by robust awareness, modifying the negative beliefs about HPV vaccine and encouraging the perceptibility of HPV vaccination.
Collapse
Affiliation(s)
- Diana Wangeshi Njuguna
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.W.N.); (N.M.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.W.N.); (N.M.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | | | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.W.N.); (N.M.)
- Office for Supported Research Groups, Eötvös Loránd Research Network, 1052 Budapest, Hungary
| |
Collapse
|
75
|
Spayne J, Hesketh T. Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators. BMJ Open 2021. [PMID: 34475188 DOI: 10.1136/bmjopen‐2021‐052016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mortality rates from cervical cancer demonstrate deep inequality in health between richer and poorer populations. Over 310 000 women died of this preventable disease in 2018, mostly in low-income and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunisation against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunisation strategies. OBJECTIVES The aim of this study is to evaluate the status of HPV vaccination coverage from nationally reported indicators and to estimate global coverage in a single year cohort of vaccine-eligible girls. DESIGN This study provides quantitative population-level estimates of important global health indicators. Using data from the Global Cancer Observatory and WHO/UNICEF, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorised by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global HPV immunisation coverage is calculated and its impact on cervical cancer mortality estimated. RESULTS Incidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high-income countries, coverage varies widely. In upper-middle-income countries, there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunisation coverage for 2018 is estimated at 12.2%. Of the global cohort of 61 million 15-year-old girls in 2018, 7000 are likely to die from cervical cancer, almost all in LMICs. CONCLUSIONS Countries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunisation. For all but the richest, affordability remains a barrier.
Collapse
Affiliation(s)
- Jacqueline Spayne
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Institute for Global Health, University College London, London, UK
| | - Therese Hesketh
- Institute for Global Health, University College London, London, UK
- Centre for Global Health, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| |
Collapse
|
76
|
Abstract
BACKGROUND Mortality rates from cervical cancer demonstrate deep inequality in health between richer and poorer populations. Over 310 000 women died of this preventable disease in 2018, mostly in low-income and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunisation against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunisation strategies. OBJECTIVES The aim of this study is to evaluate the status of HPV vaccination coverage from nationally reported indicators and to estimate global coverage in a single year cohort of vaccine-eligible girls. DESIGN This study provides quantitative population-level estimates of important global health indicators. Using data from the Global Cancer Observatory and WHO/UNICEF, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorised by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global HPV immunisation coverage is calculated and its impact on cervical cancer mortality estimated. RESULTS Incidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high-income countries, coverage varies widely. In upper-middle-income countries, there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunisation coverage for 2018 is estimated at 12.2%. Of the global cohort of 61 million 15-year-old girls in 2018, 7000 are likely to die from cervical cancer, almost all in LMICs. CONCLUSIONS Countries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunisation. For all but the richest, affordability remains a barrier.
Collapse
Affiliation(s)
- Jacqueline Spayne
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Institute for Global Health, University College London, London, UK
| | - Therese Hesketh
- Institute for Global Health, University College London, London, UK
- Centre for Global Health, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| |
Collapse
|
77
|
Jeudin P, Abebe T, Butler R, Hooi D, Watt A, Capo-Chichi CD, George S, Ragin C, McFarlane Anderson N, Schlumbrecht M. Human Papilloma Virus Distribution Across the African Diaspora. JCO Glob Oncol 2021; 7:1206-1208. [PMID: 34314227 PMCID: PMC8457790 DOI: 10.1200/go.21.00151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Understanding the distribution of human papilloma virus (HPV) subtypes in limited-resource settings is imperative for cancer prevention strategies in these regions. The objective of our study is to compare the prevalence of cervical HPV genotypes in women across the African diaspora.
Collapse
Affiliation(s)
- Patricia Jeudin
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, MI.,African Caribbean Cancer Consortium, Philadelphia, PA
| | - Tamrat Abebe
- African Caribbean Cancer Consortium, Philadelphia, PA.,Department of Microbiology, Immunology & Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Raleigh Butler
- African Caribbean Cancer Consortium, Philadelphia, PA.,Department of Obstetrics & Gynecology, University of the West Indies, Nassau, Bahamas
| | - Desiree Hooi
- African Caribbean Cancer Consortium, Philadelphia, PA.,Department of Pathology, VU University Medical Center, Amsterdam, Netherlands Antilles
| | - Angela Watt
- African Caribbean Cancer Consortium, Philadelphia, PA.,Department of Basic Medical Sciences, University of West Indies, Mona, Jamaica
| | - Callinice D Capo-Chichi
- African Caribbean Cancer Consortium, Philadelphia, PA.,Division of Molecular Biomarkers in Cancer and Nutrition, University of Aborney-Calavi, Cotonou, Benin
| | - Sophia George
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, MI.,African Caribbean Cancer Consortium, Philadelphia, PA
| | - Camille Ragin
- African Caribbean Cancer Consortium, Philadelphia, PA.,Cancer Prevention and Control Program at Fox Chase Cancer Center-Temple Health, Philadelphia, PA
| | - Normal McFarlane Anderson
- African Caribbean Cancer Consortium, Philadelphia, PA.,Department of Basic Medical Sciences, University of West Indies, Mona, Jamaica
| | - Matthew Schlumbrecht
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, MI.,African Caribbean Cancer Consortium, Philadelphia, PA
| |
Collapse
|
78
|
Mumba JM, Kasonka L, Owiti OB, Andrew J, Lubeya MK, Lukama L, Kasempa C, Msadabwe SC, Kalinda C. Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia. Gynecol Oncol Rep 2021; 37:100784. [PMID: 34095422 PMCID: PMC8165546 DOI: 10.1016/j.gore.2021.100784] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 01/07/2023] Open
Abstract
Expedited diagnostic processes for all suspected cervical cancer cases remain essential in the effort to improve clinical outcomes of the disease. However, in some developing countries like Zambia, there is paucity of data that assesses factors influencing diagnostic and treatment turnaround time (TAT) and other metrics vital for quality cancer care. We conducted a retrospective hospital-based study at the Cancer Diseases Hospital (CDH) for cervical cancer cases presenting to the facility between January 2014 and December 2018. Descriptive statistics were used to summarize demographic characteristics while a generalized linear model of the negative binomial was used to assess determinants of overall TAT. Our study included 2121 patient case files. The median age was 49 years (IQR: ±17) and most patients (n = 634, 31%) were aged between 41 and 50 years. The International Federation of Gynaecology and Obstetrics (FIGO) Cancer stage II (n = 941, 48%) was the most prevalent while stage IV (n = 103, 5.2%) was the least. The average diagnostic TAT in public laboratories was 1.48 (95%CI: 1.21-1.81) times longer than in private laboratories. Furthermore, referral delay was 55 days (IQR: 24-152) and the overall TAT (oTAT) was 110 days (IQR: 62-204). The age of the patient, HIV status, stage of cancer and histological subtype did not influence oTAT while marital status influenced oTAT. The observed longer oTAT may increase irreversible adverse health outcomes among cervical cancer patients. There is a need to improve cancer care in Zambia through improved health expenditure especially in public health facilities.
Collapse
Affiliation(s)
- Jane Mwamba Mumba
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110, Ridgeway, Lusaka, Zambia
- Ndola Teaching Hospital, Department of Obstetrics and Gynaecology, Broadway Road, Postal Agency Ndola, Ndola, Zambia
| | - Lackson Kasonka
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110, Ridgeway, Lusaka, Zambia
- Women and Newborn Hospital-University Teaching Hospitals, Nationalist Road, P/Bag RWX1 Ridgeway, Lusaka, Zambia
| | - Okola Basil Owiti
- Hasselt University, Faculty of Science, Campus Diepenbeek, Agoralaan Building D, 3590 Diepenbeek, Belgium
| | - John Andrew
- Hasselt University, Faculty of Science, Campus Diepenbeek, Agoralaan Building D, 3590 Diepenbeek, Belgium
| | - Mwansa Ketty Lubeya
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110, Ridgeway, Lusaka, Zambia
- Women and Newborn Hospital-University Teaching Hospitals, Nationalist Road, P/Bag RWX1 Ridgeway, Lusaka, Zambia
| | - Lufunda Lukama
- Ndola Teaching Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Broadway Road, Postal Agency Ndola, Ndola, Zambia
- University of KwaZulu-Natal, College of Health Sciences., Nelson R Mandela School of Medicine, Durban 4001, South Africa
| | - Charlotte Kasempa
- Cancer Diseases Hospital, Nationalist Road, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia
| | - Susan C. Msadabwe
- Cancer Diseases Hospital, Nationalist Road, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia
- Zambia College of Medicine and Surgery, Levy Mwanawasa Medical University, Great East Campus, Box 33991, Lusaka, Lusaka
| | - Chester Kalinda
- University of Namibia, Faculty of Agriculture, Engineering and Science, School of Science, Katima Mulilo Campus, Winele Road, Private Bag 1096, Ngweze, Katima Mulilo, Namibia
- University of KwaZulu-Natal, Howard College Campus, College of Health Sciences, School of Public Health and Nursing, Desmond Clarence Building, Durban 4001, South Africa
| |
Collapse
|
79
|
Vodicka E, Nonvignon J, Antwi-Agyei KO, Bawa J, Clark A, Pecenka C, LaMontagne DS. The projected cost-effectiveness and budget impact of HPV vaccine introduction in Ghana. Vaccine 2021; 40 Suppl 1:A85-A93. [PMID: 34303563 DOI: 10.1016/j.vaccine.2021.07.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cervical cancer is responsible for around one-quarter of all cancer deaths among Ghanaian women. Between 2013 and 2015, Ghana conducted a pilot of HPV vaccination among 10-14-year-old girls in four regions; however, the country has yet to introduce the vaccine nationally. This study projected the cost-effectiveness and budget impact of adding HPV vaccination into Ghana's national immunization program. METHODS We used a proportional outcomes model (UNIVAC, version 1.4) to evaluate the cost-effectiveness of introduction with bivalent (Cervarix™) and quadrivalent (Gardasil®) vaccines from government and societal perspectives. Vaccine introduction was modeled to start in 2022 and continue over ten birth cohorts using a combined delivery strategy of school (80%) and community outreach (20%). We modeled vaccination in a single age cohort of 9-year-old girls vs. a multi-age cohort of 9-year-old girls (routine) and 10-14-year-old girls (one-time campaign) compared to no vaccination. Health outcomes included cervical cancer cases, hospitalizations, deaths, and disability-adjusted life years (DALYs). We applied a discount rate of 3% to costs and outcomes. All monetary units are reported in USD 2018. RESULTS National HPV vaccination in Ghana was projected to be cost-effective compared to no vaccination in all scenarios evaluated. The most cost-effective and dominant strategy was vaccination among 9-year-old girls, plus a one-time campaign among 10-14-year-old with the bivalent vaccine ($158/DALY averted from the government perspective; 95% credible range: $19-$280/DALY averted). Projected average annual costs of the vaccine program ranged from $11.2 to $15.4 M, depending on strategy. This represents 11-15% of the estimated total immunization costs for 2022 ($100,857,875 based on Ghana's comprehensive Multi-Year Plan for Immunization, 2020-2024). DISCUSSION Our model suggests that introducing HPV vaccination would be cost-effective in Ghana under any strategy when willingness-to-pay is at least 40% GDP per capita ($881). Inclusion of a one-time catch-up campaign is shown to create greater value for money than routine immunization alone but would incur greater program costs.
Collapse
Affiliation(s)
| | - Justice Nonvignon
- University of Ghana, Department of Health Policy, Planning and Management, P.O Box LG 78, Legon, Accra, Ghana
| | | | - John Bawa
- PATH-Ghana, 14a Ameda Street, Roman Ridge, Accra, Ghana
| | - Andrew Clark
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Clint Pecenka
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98109, USA
| | | |
Collapse
|
80
|
Rafferty H, Sturt AS, Phiri CR, Webb EL, Mudenda M, Mapani J, Corstjens PLAM, van Dam GJ, Schaap A, Ayles H, Hayes RJ, van Lieshout L, Hansingo I, Bustinduy AL. Association between cervical dysplasia and female genital schistosomiasis diagnosed by genital PCR in Zambian women. BMC Infect Dis 2021; 21:691. [PMID: 34273957 PMCID: PMC8286581 DOI: 10.1186/s12879-021-06380-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Female genital schistosomiasis (FGS) is a neglected tropical gynaecological disease that affects millions of women in sub-Saharan Africa (SSA). FGS is caused by Schistosoma haematobium, a parasitic carcinogen involved in the pathogenesis of squamous cell carcinoma of the bladder. Cervical cancer incidence and mortality are highest in SSA, where pre-cancerous cervical dysplasia is often detected on screening with visual inspection with acetic acid (VIA). There are no studies evaluating the association between VIA positivity and FGS diagnosed by genital PCR. METHODS Women were recruited from the Bilharzia and HIV (BILHIV) study in Zambia a community-based study comparing genital self-sampling to provider obtained cervicovaginal-lavage for the diagnosis of FGS in women aged 18-31. FGS was defined as positive Schistosoma DNA from any genital PCR. Urogenital schistosomiasis diagnostics included urine circulating anodic antigen, urine microscopy and portable colposcopy. Participants were offered cervical cancer screening using VIA at Livingstone Central Hospital. Associations of PCR confirmed FGS and other diagnostics with VIA positivity were assessed using multivariable logistic regression. RESULTS VIA results were available from 237 BILHIV participants. A positive Schistosoma PCR in any genital specimen was detected in 14 women (5.9%), 28.6% (4/14) of these women had positive VIA compared to 9.0% without PCR evidence of schistosome infection (20/223). Schistosoma PCR positivity in any genital specimen was strongly associated with VIA positivity (OR: 6.08, 95% CI: 1.58-23.37, P = 0.02). CONCLUSIONS This is the first study to find an association between FGS and positive VIA, a relationship that may be causal. Further longitudinal studies are needed.
Collapse
Affiliation(s)
- H Rafferty
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - A S Sturt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - E L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - M Mudenda
- Livingstone Central Hospital, Livingstone, Zambia
| | - J Mapani
- Livingstone Central Hospital, Livingstone, Zambia
| | - P L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - G J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - H Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Zambart, Lusaka, Zambia
| | - R J Hayes
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - L van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - I Hansingo
- Livingstone Central Hospital, Livingstone, Zambia
| | - A L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| |
Collapse
|
81
|
Kiros M, Mesfin Belay D, Getu S, Hailemichael W, Esmael A, Andualem H, Geteneh A. Prevalence and Determinants of Pre-Cancerous Cervical Lesion and Human Papillomavirus Among HIV-Infected and HIV-Uninfected Women in North-West Ethiopia: A Comparative Retrospective Cross-Sectional Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:719-725. [PMID: 34234573 PMCID: PMC8254534 DOI: 10.2147/hiv.s310905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022]
Abstract
Background The poor socio-economic status, underdeveloped health care system, and the high HIV/AIDS burden have potentially increased the incidence of cervical cancer in sub-Saharan Africa (SSA) including Ethiopia. Studies on the magnitude of pre-cancerous cervical lesion and human papillomavirus (HPV) among HIV-infected women are still limited, particularly in the current study setting. Thus, we determined the prevalence of pre-cancerous cervical lesion and HPV among HIV-infected women in comparison with HIV-uninfected women at Debre Tabor Comprehensive Specialized Hospital (DTCSH), North-West Ethiopia. Methods Hospital-based comparative retrospective cross-sectional study was conducted among 546 women from July 2018 to January 2020 at DTCSH. All records during the study period were collected using a structured checklist. Epi data version 4.02 and SPSS version 25.0 were used for data entry and analysis, respectively. Results The overall prevalence of pre-cancerous cervical lesion among 546 women was 8.8%. The prevalence of pre-cancerous cervical lesion was comparable between HIV-infected (9.3%) and HIV-uninfected women (8.6%) (p = 0.859). Age >45 years old, widowed marital status, multiparous (women ≥ 5 childbirths), and educational status were independent contributing factors of a pre-cancerous cervical lesion. Regarding HPV prevalence, among 109 screened women, 7 (6.4%) were positive for both HPV 16 and 18 strains. Conclusion HIV infection was not statistically correlated with the magnitude of pre-cancerous cervical lesion (p = 0.859). Women in the study setting developed pre-cancerous cervical lesions irrespective of their HIV status. Hence, we recommend routine screening of women for pre-cancerous cervical lesion and HPV infection regardless of their HIV status for early management and prevention of associated morbidity and/or mortality.
Collapse
Affiliation(s)
- Mulugeta Kiros
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demeke Mesfin Belay
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sisay Getu
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wasihun Hailemichael
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ahmed Esmael
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Henok Andualem
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alene Geteneh
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| |
Collapse
|
82
|
Okoye JO, Ofodile CA, Adeleke OK, Obioma O. Prevalence of high-risk HPV genotypes in sub-Saharan Africa according to HIV status: a 20-year systematic review. Epidemiol Health 2021; 43:e2021039. [PMID: 34044477 PMCID: PMC8510839 DOI: 10.4178/epih.e2021039] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/25/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This review assessed the rate of high-risk human papillomavirus (HPV) infection among women living in sub-Saharan Africa. It also determined the prevalence of high-risk HPV (hrHPV) among human immunodeficiency virus (HIV) seropositive (HIV+) and seronegative (HIV-) women in sub-Saharan Africa, pre-2010 and post-2010. METHODS In this systematic review, Google Scholar, PubMed Central, and Embase were searched to identify cohort and case-control studies that investigated the relationship between HIV and HPV infection. The database searches yielded 17 studies published between 1999 and 2018. RESULTS In the general population, the prevalence of any HPV/multiple HPV infections was higher among HIV+ (53.6/22.6%) than among HIV- women (26.5/7.3%) with odds ratios of 3.22 and 3.71, respectively (95% confidence interval, 3.00 to 3.42 and 2.39 to 5.75, p<0.001). The prevalent HPV genotypes among HIV+ and HIV- women diagnosed with invasive cervical cancer (ICC) were HPV-16/18 and HPV-45. The prevalence of HPV-16, HPV-18, and HPV-45 was lower in 1999-2010 (3.8, 1.7, and 0.8%, respectively) than in 2011-2018 (19.1, 6.0, and 3.6%, respectively). Among women diagnosed with ICC, HIV+ women had a higher prevalence of HPV-56, HPV-31, and HPV-51 (7.3, 5.3, and 3.3%, respectively) than HIV- women (1.3, 2.2, and 0.4%, p<0.001, p=0.050, and p=0.013, respectively). CONCLUSIONS The prevalence of HPV infection, multiple HPV infections, and non-vaccine HPV types were higher among HIV+ women than among HIV- women in sub-Saharan Africa. Although HIV infection influences the distribution of HPV types, this study suggests that cervical cancer incidence in sub-Saharan Africa is primarily driven by the prevalence of vaccine hrHPVs, especially HPV-16 and HPV-18.
Collapse
Affiliation(s)
- Jude Ogechukwu Okoye
- Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Chukwudi Amaechi Ofodile
- Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi, Nigeria
| | | | - Okechi Obioma
- Department of Medical Laboratory Science, Abia State University, Uturu, Nigeria
| |
Collapse
|
83
|
Parham GP, Mathieu KM, YouYou TG, Hicks ML, Henry-Tillman R, Mutombo A, Anaclet MM, Sylvain MK, Pinder L, Hicks MM, Kanda L, Kanda M. Establishing women's cancer care services in a fragile, conflict and violence affected ecosystem in Africa. Ecancermedicalscience 2021; 15:1231. [PMID: 34221114 PMCID: PMC8225336 DOI: 10.3332/ecancer.2021.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The majority of the world's poorest women (income < $1.90/day) reside in fragile, conflict and violence (FCV)-affected countries, like the Democratic Republic of the Congo. Health services in these settings have traditionally focused on immediate relief efforts, communicable diseases and malnutrition. Recent data suggests there is need to widen the focus to include cancer, as its incidence and mortality rates are rising. METHODS Employing competency-based learning strategies, Congolese health professionals were trained to perform same-day cervical cancer screening and treatment of precancerous lesions of the cervix; same-day clinical breast examination and breast ultrasound diagnostics; surgical treatment of invasive cancers of the breast and cervix; and infusion of cytotoxic chemotherapy. Outpatient breast and cervical cancer care clinics, a chemotherapy suite and surgical theatres were outfitted with equipment and supplies. RESULTS Combining local and regional hands-on training seminars with wise infrastructure investments, a team of US and Zambian oncology experts successfully implemented a clinical service platform for women's cancers in a private sector health facility in the Democratic Republic of the Congo. CONCLUSION We forged a novel partnership between oncology health professionals from Africa and its Diaspora, international philanthropic organisations, a cancer medicine access initiative and an established African cancer centre to build women's cancer services in a FVC-affected African setting.
Collapse
Affiliation(s)
- Groesbeck Preer Parham
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- https://orcid.org/0000-0001-5922-5990
| | - Kabongo Mukuta Mathieu
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Tankoy Gombo YouYou
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Michael L Hicks
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- St Mary Mercy Cancer Center, 36475 Five Mile Rd, Livonia, MI 48154, USA
- St Joseph Mercy Oakland Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48324, USA
- McLaren Macomb Medical Center, 1000 Harrington Blvd, Mount Clemens, MI 48043, USA
- https://orcid.org/0000-0002-1819-155X
| | - Ronda Henry-Tillman
- Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham St, Slot #725, Little Rock, AR 72205, USA
- https://orcid.org/0000-0002-1782-9523
| | - Alex Mutombo
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mukanya Mpalata Anaclet
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mulumba Kapuku Sylvain
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Leeya Pinder
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
- https://orcid.org/0000-0002-8929-7810
| | - Maya M Hicks
- Howard University College of Medicine, 520 W St NW, Washington, DC 20059, USA
- https://orcid.org/0000-0002-1993-3367
| | - Louis Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Mirielle Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| |
Collapse
|
84
|
Bukirwa P, Wabinga H, Nambooze S, Amulen PM, Joko WY, Liu B, Parkin DM. Trends in the incidence of cancer in Kampala, Uganda, 1991 to 2015. Int J Cancer 2021; 148:2129-2138. [PMID: 33129228 DOI: 10.1002/ijc.33373] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023]
Abstract
Trends in the incidence of cancer in the population of Kyadondo County, Uganda-which comprises the city of Kampala and a peri-urban hinterland-are presented for a period of 25 years (1991-2015) based on data collected by the Kampala Cancer Registry. Incidence rates have risen overall-age-adjusted rates are some 25% higher in 2011 to 2015 compared with 1991 to 1995. The biggest absolute increases have been in cancers of the prostate, breast and cervix, with rates of some 100% (prostate), 70% (breast) and 45% (cervix) higher in 2010 to 2015 than in 1991 to 1995. There were also increases in the incidence of cancers of the esophagus and colon-rectum (statistically significant in men), while the incidence of liver cancer-the fifth most common in this population-increased until 2007, and subsequently declined. By far the most commonly registered cancer over the 25-year period was Kaposi sarcoma, but the incidence has declined, consistent with the decreasing population-prevalence of HIV. Non-Hodgkin lymphomas, also AIDS-related, increased in incidence until 2006/2007 and then declined-possibly as a result of availability of antiretroviral therapy. The trends reflect the changing lifestyles of this urban African population, as well as the consequences of the epidemic of HIV/AIDS and the availability of treatment with ARVs. At the same time, it highlights the fact that the decreases in cancer of the cervix observed in high and upper-middle income countries are not a consequence of changes in lifestyle, but demand active intervention through screening (and, in the longer term, vaccination).
Collapse
Affiliation(s)
- Phiona Bukirwa
- Department of Pathology, Makerere University Medical School, Kampala, Uganda
- Kampala Cancer Registry, Makerere University Medical School, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, Makerere University Medical School, Kampala, Uganda
- Kampala Cancer Registry, Makerere University Medical School, Kampala, Uganda
| | - Sarah Nambooze
- Kampala Cancer Registry, Makerere University Medical School, Kampala, Uganda
| | - Phoebe Mary Amulen
- Kampala Cancer Registry, Makerere University Medical School, Kampala, Uganda
| | | | - Biying Liu
- African Cancer Registry Network, Oxford, UK
| | - Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
85
|
Parkin DM, Chingonzoh T, Vuma S, Liu B, Chokunonga E, Ndlovu N, Borok M. Changes in the Incidence of Cancer in Bulawayo, Zimbabwe over a 50-Year Period. Cancer Epidemiol Biomarkers Prev 2021; 30:867-873. [PMID: 33619023 DOI: 10.1158/1055-9965.epi-20-0669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/14/2020] [Accepted: 02/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The cancer registry of Bulawayo (Zimbabwe) operated for 15 years in the preindependence period (1963-77), and was restarted in 2011. This allows comparison of incidence of cancers over a period of almost 50 years. METHODS Age-standardized rates, with SEs, were calculated for 1963-1972 and 2011-2015. Detailed results are presented for those cancers for which there was a significant (P < 0.05) change in the rates between the two periods. RESULTS There were declines in the rates of those cancers previously known to be common in East and Southern Africa (esophagus, liver, bladder), and the emergence of cancers associated with "westernization" of lifestyles (breast, prostate, large bowel). Cancers related to infection with HIV-AIDS (Kaposi sarcoma, non-Hodgkin lymphoma, eye cancers) have come to comprise a much larger proportion of the total burden, and cancer of the cervix (also AIDS-related) has shown a large increase in incidence-as elsewhere in sub-Saharan Africa (SSA). More surprising is the decline in cancer of the lung-formerly very high, but by 2011-2015, despite little change in the prevalence of smoking, rates were low-close to the average for SSA. This may relate, in part, to a decline in the numbers of miners, and ex-miners, residing in the city. CONCLUSIONS The changes in incidence are largely explained by differences in past exposure to environmental risk factors. IMPACT Few datasets from SSA can document temporal changes in the cancer epidemic on the continent. There are some anticipated observations, as well as unexpected findings meriting further investigation.
Collapse
Affiliation(s)
- Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
- African Cancer Registry Network, Prama House, Oxford, United Kingdom
- International Agency for Research on Cancer, Lyon, France
| | | | - Samkeliso Vuma
- Radiotherapy Centre, Mpilo Central Hospital, Bulawayo, Zimbabwe
| | - Biying Liu
- African Cancer Registry Network, Prama House, Oxford, United Kingdom
| | - Eric Chokunonga
- Zimbabwe National Cancer Registry, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - Ntokozo Ndlovu
- Zimbabwe National Cancer Registry, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
- Radiotherapy Centre, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - Margaret Borok
- Zimbabwe National Cancer Registry, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| |
Collapse
|
86
|
Jaquet A, Boni S, Tchounga B, Comoe K, Tanon A, Horo A, Diomandé I, Didi-Kouko Coulibaly J, Ekouevi DK, Adoubi I. Changes in HIV-Related Cervical Cancer Over a Decade in Côte d'Ivoire. JCO Glob Oncol 2021; 7:782-789. [PMID: 34043415 PMCID: PMC8457855 DOI: 10.1200/go.21.00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/22/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Major improvements have occurred in access to invasive cervical cancer (ICC) screening in HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associated with HIV infection in women with ICC in Côte d'Ivoire. METHODS A repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d'Ivoire, through the 2009-2011 and 2018-2020 periods. Women diagnosed with ICC were systematically tested for HIV. Demographics, ICC risk factors, cancer stage (International Federation of Gynecology and Obstetrics), and HIV characteristics were collected through questionnaires. Characteristics of HIV-related ICC were compared between the periods, and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariable logistic model. RESULTS During the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed with estimated HIV prevalence of 24.5% and 21.9% (P = .53), respectively. In HIV-infected women, access to antiretroviral treatment increased from 2.8% to 73.8% (P < 10-4) and median CD4 cell count from 285 (IQR, 250-441) to 492 (IQR, 377-833) cells/mm3 (P = .03). In women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (International Federation of Gynecology and Obstetrics I or II stage) (adjusted OR, 2.2 [95% CI, 1.1 to 4.4]) and with ICC diagnosis through a systematic screening (adjusted OR, 10.5 [95% CI, 2.5 to 45.5]). CONCLUSION Despite a persistently high proportion of HIV-related ICC over time in Côte d'Ivoire, HIV was associated with less advanced clinical stage at ICC diagnosis. Recent improvements in ICC screening services across HIV clinics might explain this association and support their implementation across non-HIV health facilities.
Collapse
Affiliation(s)
- Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Simon Boni
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Programme PACCI /site ANRS Abidjan, Abidjan, Cote d'Ivoire
| | - Boris Tchounga
- Programme PACCI /site ANRS Abidjan, Abidjan, Cote d'Ivoire
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Kouassi Comoe
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Service de cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Service des Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Service de Gynécologie obstétrique, CHU de Yopougon, Université Félix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - Isidore Diomandé
- Service anatomopathologie, Centre Hospitalier Universitaire (CHU) Cocody, Abidjan, Cote d'Ivoire
| | | | - Didier K. Ekouevi
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
- Université de Lomé, Département de Santé Publique, Lomé, Togo
| | - Innocent Adoubi
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Service de cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| |
Collapse
|
87
|
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71:209-249. [PMID: 33538338 DOI: 10.3322/caac.21660] [Citation(s) in RCA: 48886] [Impact Index Per Article: 16295.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023] Open
Abstract
This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.
Collapse
Affiliation(s)
- Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Mathieu Laversanne
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
88
|
Ngcobo N, Jaca A, Iwu-Jaja CJ, Mavundza E. Reflection: burden of cervical cancer in Sub-Saharan Africa and progress with HPV vaccination. Curr Opin Immunol 2021; 71:21-26. [PMID: 33857884 DOI: 10.1016/j.coi.2021.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Abstract
In Sub-Saharan (SSA) cervical cancer is the leading cause of cancer deaths amongst women. The region carries the greatest burden, with 24.55% of the global mortality from cervical cancer. Reports indicate an increasing challenge of cervical cancer in SSA. HPV vaccination with its well-established effectiveness provides hope for cancer control in SSA. Following an initial delay in HPV vaccine uptake in SSA, 18 countries mostly in Eastern and Southern Africa, had a national programme by 2020. Vaccination coverage data show that high populated countries have lower coverage figures. Furthermore, high coverage of demonstration projects may not be achieved in the national rollout. In conclusion, whilst there is significant progress with the rollout of HPV vaccination programme in SSA, some countries in West Africa should be prioritised. Experiences of early adopters should be reviewed to guide other countries to achieve and sustain high coverage.
Collapse
Affiliation(s)
| | - Anelisa Jaca
- South African Medical Research Council, South Africa
| | | | | |
Collapse
|
89
|
Piñeros M, Saraiya M, Baussano I, Bonjour M, Chao A, Bray F. The role and utility of population-based cancer registries in cervical cancer surveillance and control. Prev Med 2021; 144:106237. [PMID: 33678223 PMCID: PMC7957339 DOI: 10.1016/j.ypmed.2020.106237] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 02/09/2023]
Abstract
Population-based cancer registries (PBCR) are vital to the assessment of the cancer burden and in monitoring and evaluating national progress in cervical cancer surveillance and control. Yet the level of their development in countries exhibiting the highest cervical cancer incidence rates is suboptimal, and requires considerable investment if they are to document the impact of WHO global initiative to eliminate cervical cancer as a public health problem. As a starting point we propose a comprehensive cancer surveillance framework, positioning PBCR in relation to other health information systems that are required across the cancer control continuum. The key concepts of PBCR are revisited and their role in providing a situation analysis of the scale and profile of the cancer-specific incidence and survival, and their evolution over time is illustrated with specific examples. Linking cervical cancer data to screening and immunization information systems enables the development of a comprehensive set of measures capable of assessing the short- and long-term achievements and impact of the initiative. Such data form the basis of national and global estimates of the cancer burden and permit comparisons across countries, facilitating decision-making or triggering cancer control action. The initiation and sustainable development of PBCR must be an early step in the scale-up of cervical cancer control activities as a means to ensure progress is successfully monitored and appraised.
Collapse
Affiliation(s)
- Marion Piñeros
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France.
| | - Mona Saraiya
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Iacopo Baussano
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Maxime Bonjour
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France; University "Claude Bernard" Lyon 1, Faculté de Médecine, Lyon, France
| | - Ann Chao
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
90
|
Rotimi SO, Rotimi OA, Salhia B. A Review of Cancer Genetics and Genomics Studies in Africa. Front Oncol 2021; 10:606400. [PMID: 33659210 PMCID: PMC7917259 DOI: 10.3389/fonc.2020.606400] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022] Open
Abstract
Cancer is the second leading cause of death globally and is projected to overtake infectious disease as the leading cause of mortality in Africa within the next two decades. Cancer is a group of genomic diseases that presents with intra- and inter-population unique phenotypes, with Black populations having the burden of morbidity and mortality for most types. At large, the prevention and treatment of cancers have been propelled by the understanding of the genetic make-up of the disease of mostly non-African populations. By the same token, there is a wide knowledge gap in understanding the underlying genetic causes of, and genomic alterations associated with, cancer among black Africans. Accordingly, we performed a review of the literature to survey existing studies on cancer genetics/genomics and curated findings pertaining to publications across multiple cancer types conducted on African populations. We used PubMed MeSH terms to retrieve the relevant publications from 1990 to December 2019. The metadata of these publications were extracted using R text mining packages: RISmed and Pubmed.mineR. The data showed that only 0.329% of cancer publications globally were on Africa, and only 0.016% were on cancer genetics/genomics from Africa. Although the most prevalent cancers in Africa are cancers of the breast, cervix, uterus, and prostate, publications representing breast, colorectal, liver, and blood cancers were the most frequent in our review. The most frequently reported cancer genes were BRCA1, BRCA2, and TP53. Next, the genes reported in the reviewed publications’ abstracts were extracted and annotated into three gene ontology classes. Genes in the cellular component class were mostly associated with cell part and organelle part, while those in biological process and molecular function classes were mainly associated with cell process, biological regulation, and binding, and catalytic activity, respectively. Overall, this review highlights the paucity of research on cancer genomics on African populations, identified gaps, and discussed the need for concerted efforts to encourage more research on cancer genomics in Africa.
Collapse
Affiliation(s)
- Solomon O Rotimi
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Department of Biochemistry, Covenant University, Ota, Nigeria
| | - Oluwakemi A Rotimi
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Department of Biochemistry, Covenant University, Ota, Nigeria
| | - Bodour Salhia
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Norris Comprehensive Cancer Centre, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
91
|
Erem AS, Appiah-Kubi A, Konney TO, Amo-Antwi K, Bell SG, Johnson TRB, Johnston C, Tawiah Odoi A, Lawrence ER. Gynecologic Oncology Sub-Specialty Training in Ghana: A Model for Sustainable Impact on Gynecologic Cancer Care in Sub-Saharan Africa. Front Public Health 2020; 8:603391. [PMID: 33344404 PMCID: PMC7744480 DOI: 10.3389/fpubh.2020.603391] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022] Open
Abstract
African women have double the risk of dying from cancer than women in high-income countries. In Ghana, most women with gynecological malignancies present with advanced-stage disease when treatment is less effective. Barriers to improved cancer outcomes include the availability of cancer screening, affordability of treatment, and access to gynecologic oncology specialists. In response to a paucity of gynecologic oncology providers, an in-country fellowship training program was established at Komfo Anokye Teaching Hospital (KATH) in 2013. Historically, Ghanaian resident physicians were sent to other countries for fellowship training and were unlikely to repatriate. The establishment of an in-country training program not only addresses the challenge of "brain drain," but also builds local capacity in gynecologic oncology education and emphasizes culturally relevant and accessible healthcare. The four-years gynecologic oncology fellowship program at KATH was developed as part of a longitudinal multi-decade partnership between the University of Michigan and academic medical centers in Ghana. The fellowship trains obstetricians and gynecologists to provide subspecialist clinical and surgical care to patients with gynecologic malignancies. Fellows collaborate with the radiation, oncology and pathology departments, participate in monthly inter-institutional tumor board meetings, conduct research, advise on health policy issues, and train subsequent cohorts. This fellowship is representative of emerging twenty-first-century trends in which subspecialty training programs in low-income countries are strengthened by international collaborations. Providing specialized training in gynecologic oncology can help develop and maintain resources that will improve clinical outcomes for women in low-resources settings.
Collapse
Affiliation(s)
- Anna Sarah Erem
- Saba University School of Medicine, The Bottom, Saba, Netherlands
| | - Adu Appiah-Kubi
- Department of Obstetrics and Gynaecology, University of Health and Allied Sciences, Ho, Ghana.,Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana
| | - Thomas Okpoti Konney
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana.,Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwabena Amo-Antwi
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana
| | - Sarah G Bell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| | - Timothy R B Johnson
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| | - Carolyn Johnston
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| | - Alexander Tawiah Odoi
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana.,Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
92
|
Omonisi AE, Liu B, Parkin DM. Population-Based Cancer Registration in Sub-Saharan Africa: Its Role in Research and Cancer Control. JCO Glob Oncol 2020; 6:1721-1728. [PMID: 33180635 PMCID: PMC7713579 DOI: 10.1200/go.20.00294] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Abidemi Emmanuel Omonisi
- Department of Anatomic Pathology, Ekiti State University, Ado-Ekiti, Nigeria
- Ekiti Cancer Registry, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Biying Liu
- African Cancer Registry Network, Oxford, United Kingdom
| | - Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
93
|
New-Aaron M, Meza JL, Goedert MH, Kibusi SM, Mkhoi ML, Mayengo CD, Charles J, Shabani S, Musil KM, Cheney A, Sumba S. Cervical Cancer Screening among Women Receiving Antiretroviral Therapy in a Resource-Limited Environment. Asian Pac J Cancer Prev 2020; 21:2035-2045. [PMID: 32711430 PMCID: PMC7573407 DOI: 10.31557/apjcp.2020.21.7.2035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Cervical cancer is among the most prevalent cancer among women worldwide and women living with HIV are at increased risk, especially in a resource-limited environment. Objective: This study aimed to determine levels of awareness, knowledge, uptake, and willingness to screen for cervical cancer among women receiving care in an HIV clinic at Dodoma Regional Referral Hospital (DRRH), Tanzania. Methods: Data were collected for a period of three weeks from July 21 to August 11, 2017 using a mobile phone data collection App. A total of 421 Women aged 18-50 years old were included in the study. Results: Majority of the women interviewed (n=306, 73%) were aware of cervical cancer. Among those who were aware, 84% (n=257) did not recall ever being screened for cervical cancer, and majority had a poor knowledge of cervical cancer. Educational level completed (p=0.01), income per month (p=0.02), age group (p<0.0001), and area of residence (p<0.0001) were all significantly associated to awareness of cervical cancer. Most of the women who have never screened (n=231, 91%) expressed willingness to be screened. Prior uptake of cervical cancer screening was associated with number of live births (p=0.001) and area of residence (p=0.04). And Willingness to screen was significantly associated with age groups (p=0.03) and the number of live births (p=0.03). Moreover, we found that younger age and urban residence was positively associated with awareness and uptake of cervical cancer screening. Willingness was found to decrease as age increased. Conclusion: The study found that despite older women’s higher risk of cervical cancer, those who indicated willingness to screen were younger. Additional education, health promotion, and integration of cervical cancer screening services is needed to improve cervical cancer awareness and screening uptake at the HIV clinic.
Collapse
Affiliation(s)
- Moses New-Aaron
- Department of Environmental Health, Occupational Health and Toxicology, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jane L Meza
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Martha H Goedert
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Stephen M Kibusi
- College of Health Sciences, Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Mkhoi L Mkhoi
- University of Dodoma, College of Health Sciences, Department of Microbiology and Immunology, Dodoma, Tanzania
| | - Caroline Damian Mayengo
- Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania.,Dodoma Regional Referral Hospital, Dodoma, Tanzania
| | | | | | - Kelsie M Musil
- Department of Environmental Health, Occupational Health and Toxicology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Anlan Cheney
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | |
Collapse
|