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Rajaraman P, Anderson BO, Basu P, Belinson JL, Cruz AD, Dhillon PK, Gupta P, Jawahar TS, Joshi N, Kailash U, Kapambwe S, Katoch VM, Krishnan S, Panda D, Sankaranarayanan R, Selvam JM, Shah KV, Shastri S, Shridhar K, Siddiqi M, Sivaram S, Seth T, Srivastava A, Trimble E, Mehrotra R. Recommendations for screening and early detection of common cancers in India. Lancet Oncol 2015; 16:e352-61. [PMID: 26149887 DOI: 10.1016/s1470-2045(15)00078-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 12/16/2022]
Abstract
Cancers of the breast, uterine cervix, and lip or oral cavity are three of the most common malignancies in India. Together, they account for about 34% of more than 1 million individuals diagnosed with cancer in India each year. At each of these cancer sites, tumours are detectable at early stages when they are most likely to be cured with standard treatment protocols. Recognising the key role that effective early detection and screening programmes could have in reducing the cancer burden, the Indian Institute for Cytology and Preventive Oncology, in collaboration with the US National Cancer Institute Center for Global Health, held a workshop to summarise feasible options and relevant evidence for screening and early detection of common cancers in India. The evidence-based recommendations provided in this Review are intended to act as a guide for policy makers, clinicians, and public health practitioners who are developing and implementing strategies in cancer control for the three most common cancers in India.
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Affiliation(s)
- Preetha Rajaraman
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA.
| | - Benjamin O Anderson
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Partha Basu
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Jerome L Belinson
- Preventive Oncology International and Department of Surgery, Women's Health Institute, Lerner School of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Anil D' Cruz
- Department of Head and Neck Services, Tata Memorial Hospital, Mumbai, India
| | - Preet K Dhillon
- Centre for Control of Chronic Conditions, Public Health Foundation of India, Gurgaon, India
| | - Prakash Gupta
- Healis-Sekhsaria Institute for Public Health, Navi Mumbai, India
| | | | - Niranjan Joshi
- Healthcare Technology Innovation Centre, IIT Madras Research Park, Chennai, India
| | - Uma Kailash
- Institute of Cytology and Preventive Oncology, Noida, India
| | - Sharon Kapambwe
- Africa Centre of Excellence for Women's Cancer Control, Centre for Infectious Disease Research, Lusaka, Zambia
| | | | - Suneeta Krishnan
- Women's Global Health Imperative, Research Triangle Institute International, San Francisco, CA, USA
| | - Dharitri Panda
- Institute of Cytology and Preventive Oncology, Noida, India
| | - R Sankaranarayanan
- Early Detection & Prevention Section and Screening Group, International Agency for Research on Cancer, Lyon, France
| | | | - Keerti V Shah
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Surendra Shastri
- Department of Preventive Oncology, Tata Memorial Center, Mumbai, India
| | - Krithiga Shridhar
- Centre for Control of Chronic Conditions, Public Health Foundation of India, Gurgaon, India
| | | | - Sudha Sivaram
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Tulika Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Edward Trimble
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Ravi Mehrotra
- Institute of Cytology and Preventive Oncology, Noida, India
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152
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Haworth RJ, Margalit R, Ross C, Nepal T, Soliman AS. Knowledge, attitudes, and practices for cervical cancer screening among the Bhutanese refugee community in Omaha, Nebraska. J Community Health 2015; 39:872-8. [PMID: 25060231 DOI: 10.1007/s10900-014-9906-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cervical cancer is the second most common cause of cancer mortality among women with the vast majority of patients in developing countries. Bhutanese refugees in the United States are from South Central Asia, the 4th leading region of the world for cervical cancer incidence. Over the past few years, Bhutanese refugees have increased significantly in Nebraska. This study evaluates current knowledge of cervical cancer and screening practices among the Bhutanese refugee women in Omaha, Nebraska. The study aimed to investigate cervical cancer and screening knowledge and perceptions about the susceptibility and severity of cervical cancer and perceived benefits and barriers to screening. Self-administered questionnaires and focus groups based on the Health Belief Model were conducted among 42 healthy women from the Bhutanese refugee community in Omaha. The study revealed a significant lack of knowledge in this community regarding cervical cancer and screening practices, with only 22.2 % reporting ever hearing of a Pap test and 13.9 % reporting ever having one. Only 33.3 % of women were in agreement with their own perceived susceptibility to cervical cancer. Women who reported ever hearing about the Pap test tended to believe more strongly about curability of the disease if discovered early than women who never heard about the test (71.4 vs. 45.0 %, for the two groups. respectively). Refugee populations in the United States are in need for tailored cancer education programs especially when being resettled from countries with high risk for cancer.
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Affiliation(s)
- Rebecca J Haworth
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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153
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Wang B, He M, Chao A, Engelgau MM, Saraiya M, Wang L, Wang L. Cervical Cancer Screening Among Adult Women in China, 2010. Oncologist 2015; 20:627-34. [PMID: 25956407 PMCID: PMC4571778 DOI: 10.1634/theoncologist.2014-0303] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 02/06/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cervical cancer is one of the most commonly diagnosed cancers among women in China. The World Health Organization (WHO) recommends routine screening for cervical cancer, and the WHO Global Monitoring Framework suggests that every nation monitors cervical cancer screening. However, little information is available on cervical cancer screening behavior among women in China. METHODS We used data from the 2010 China Chronic Disease and Risk Factor Surveillance System that included 51,989 women aged 18 years and older. We report the proportion of women who reported ever having had a Papanicolaou (Pap) test, stratified by sociodemographic characteristics and geographic region. Multivariable logistic regression modeling was performed to adjust for potential confounders. RESULTS Overall, 21% of 51,989 women reported having ever had a Pap test. The highest proportion was reported among women aged 30-39 years (30.1%, 95% confidence interval, 26.8%-33.4%). In all geographic regions, women in rural areas were consistently less likely than women in urban areas to report having had a Pap test. Among women who reported ever having a Pap test, 82% reported having the most recent test in the past 3 years. Factors associated with reporting ever having a test were being aged 30-49 years, higher education, being married, and having urban health insurance. CONCLUSION Our results indicate that screening programs need to be strengthened along with a more intense focus on specific demographic groups. National cervical cancer screening guidelines and comprehensive implementation strategies are needed to make screening services available and accessible to all women. IMPLICATIONS FOR PRACTICE This study is the largest nationwide and population-based assessment of self-reported history of Pap test for cervical cancer screening in China. This article describes cervical cancer screening behavior among women and examines key demographic and geographic factors. Only one fifth of Chinese women reported having ever had a Pap test for cervical cancer screening. The results highlight the urgent need to develop national cervical cancer screening guidelines and strategies that make screening services widely available, accessible, and acceptable to all women, especially to those who reside in rural areas and those with no health insurance.
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Affiliation(s)
- Baohua Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Minfu He
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ann Chao
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael M Engelgau
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Saraiya
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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154
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Campos NG, Castle PE, Wright TC, Kim JJ. Cervical cancer screening in low-resource settings: A cost-effectiveness framework for valuing tradeoffs between test performance and program coverage. Int J Cancer 2015; 137:2208-19. [PMID: 25943074 DOI: 10.1002/ijc.29594] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 03/20/2015] [Accepted: 04/21/2015] [Indexed: 12/16/2022]
Abstract
As cervical cancer screening programs are implemented in low-resource settings, protocols are needed to maximize health benefits under operational constraints. Our objective was to develop a framework for examining health and economic tradeoffs between screening test sensitivity, population coverage and follow-up of screen-positive women, to help decision makers identify where program investments yield the greatest value. As an illustrative example, we used an individual-based Monte Carlo simulation model of the natural history of human papillomavirus (HPV) and cervical cancer calibrated to epidemiologic data from Uganda. We assumed once in a lifetime screening at age 35 with two-visit HPV DNA testing or one-visit visual inspection with acetic acid (VIA). We assessed the health and economic tradeoffs that arise between (i) test sensitivity and screening coverage; (ii) test sensitivity and loss to follow-up (LTFU) of screen-positive women; and (iii) test sensitivity, screening coverage and LTFU simultaneously. The decline in health benefits associated with sacrificing HPV DNA test sensitivity by 20% (e.g., shifting from provider- to self-collection of specimens) could be offset by gains in coverage if coverage increased by at least 20%. When LTFU was 10%, two-visit HPV DNA testing with 80-90% sensitivity was more effective and more cost-effective than one-visit VIA with 40% sensitivity and yielded greater health benefits than VIA even as VIA sensitivity increased to 60% and HPV test sensitivity declined to 70%. As LTFU increased, two-visit HPV DNA testing became more costly and less effective than one-visit VIA. Setting-specific data on achievable test sensitivity, coverage, follow-up rates and programmatic costs are needed to guide decision making for cervical cancer screening.
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Affiliation(s)
- Nicole G Campos
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA
| | - Philip E Castle
- Global Coalition against Cervical Cancer, Arlington, VA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Thomas C Wright
- Department of Pathology and Cell Biology, Columbia University Medical Center, NY
| | - Jane J Kim
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA
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155
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Thulaseedharan JV, Malila N, Esmy PO, Muwonge R, Hakama M, Sankaranarayanan R. Risk of invasive cancer among women visually screened and colposcopy triaged by trained nurses in rural South India. Int J Gynaecol Obstet 2015; 129:104-8. [PMID: 25661324 DOI: 10.1016/j.ijgo.2014.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/11/2014] [Accepted: 01/22/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate the long-term risk of cervical cancer among women screened by visual inspection with acetic acid (VIA) and to evaluate the benefit of additional colposcopy triage in rural south India. METHODS A retrospective analysis was conducted among 31 343 women who had undergone VIA at Dindigul district, India between January 1, 2000, and August 5, 2003, as part of a randomized screening trial. Women with positive VIA test results were offered colposcopy triage by trained nurses. Cervical cancer incidence data during follow-up (January 1, 2000, to December 31, 2012) were obtained from a regional cancer registry. RESULTS Among 3021 screen-positive women free of cancer at baseline, 2974 women underwent colposcopy; colposcopic abnormalities suggestive of precancerous lesions were detected among 2792 of these women (93.9%). Compared with the women with negative VIA screening results, the hazard ratio (HR) of cervical cancer during follow-up among the VIA-positive women without colposcopic abnormalities was 6.5 (95% confidence interval [CI], 1.6-27.1). The risk was similar among VIA-positive women with colposcopic abnormalities but without histological confirmation (HR5.2; 95% CI, 1.9-14.6). CONCLUSION The high risk of cancer among women without colposcopic abnormalities who tested positive by VIA suggested that screening without triage is potentially effective.
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Affiliation(s)
- Jissa V Thulaseedharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India; School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland
| | - Nea Malila
- School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland; Finnish Cancer Registry, Pieni Roobertinkatu, Helsinki, Finland
| | - Pulikottil O Esmy
- Christian Fellowship Community Health Centre, Ambilikkai, Tamil Nadu, India
| | - Richard Muwonge
- Screening Group, International Agency for Research on Cancer, Lyon, France.
| | - Matti Hakama
- School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland; Finnish Cancer Registry, Pieni Roobertinkatu, Helsinki, Finland
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156
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Parham GP, Mwanahamuntu MH, Kapambwe S, Muwonge R, Bateman AC, Blevins M, Chibwesha CJ, Pfaendler KS, Mudenda V, Shibemba AL, Chisele S, Mkumba G, Vwalika B, Hicks ML, Vermund SH, Chi BH, Stringer JSA, Sankaranarayanan R, Sahasrabuddhe VV. Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia. PLoS One 2015; 10:e0122169. [PMID: 25885821 PMCID: PMC4401717 DOI: 10.1371/journal.pone.0122169] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/07/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Very few efforts have been undertaken to scale-up low-cost approaches to cervical cancer prevention in low-resource countries. METHODS In a public sector cervical cancer prevention program in Zambia, nurses provided visual-inspection with acetic acid (VIA) and cryotherapy in clinics co-housed with HIV/AIDS programs, and referred women with complex lesions for histopathologic evaluation. Low-cost technological adaptations were deployed for improving VIA detection, facilitating expert physician opinion, and ensuring quality assurance. Key process and outcome indicators were derived by analyzing electronic medical records to evaluate program expansion efforts. FINDINGS Between 2006-2013, screening services were expanded from 2 to 12 clinics in Lusaka, the most-populous province in Zambia, through which 102,942 women were screened. The majority (71.7%) were in the target age-range of 25-49 years; 28% were HIV-positive. Out of 101,867 with evaluable data, 20,419 (20%) were VIA positive, of whom 11,508 (56.4%) were treated with cryotherapy, and 8,911 (43.6%) were referred for histopathologic evaluation. Most women (87%, 86,301 of 98,961 evaluable) received same-day services (including 5% undergoing same-visit cryotherapy and 82% screening VIA-negative). The proportion of women with cervical intraepithelial neoplasia grade 2 and worse (CIN2+) among those referred for histopathologic evaluation was 44.1% (1,735/3,938 with histopathology results). Detection rates for CIN2+ and invasive cervical cancer were 17 and 7 per 1,000 women screened, respectively. Women with HIV were more likely to screen positive, to be referred for histopathologic evaluation, and to have cervical precancer and cancer than HIV-negative women. INTERPRETATION We creatively disrupted the 'no screening' status quo prevailing in Zambia and addressed the heavy burden of cervical disease among previously unscreened women by establishing and scaling-up public-sector screening and treatment services at a population level. Key determinants for successful expansion included leveraging HIV/AIDS program investments, and context-specific information technology applications for quality assurance and filling human resource gaps.
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Affiliation(s)
- Groesbeck P. Parham
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of Zambia, Lusaka, Zambia
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- International Agency for Research on Cancer, Lyon, France
| | - Mulindi H. Mwanahamuntu
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of Zambia, Lusaka, Zambia
| | - Sharon Kapambwe
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of Zambia, Lusaka, Zambia
| | | | - Allen C. Bateman
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Meridith Blevins
- Vanderbilt University, Nashville, Tennessee, United States of America
| | - Carla J. Chibwesha
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Krista S. Pfaendler
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of California, Irvine, Irvine, California, United States of America
| | | | | | | | | | | | - Michael L. Hicks
- Michigan Cancer Institute, Pontiac, Michigan, United States of America
| | - Sten H. Vermund
- Vanderbilt University, Nashville, Tennessee, United States of America
| | - Benjamin H. Chi
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jeffrey S. A. Stringer
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Vikrant V. Sahasrabuddhe
- Vanderbilt University, Nashville, Tennessee, United States of America
- National Cancer Institute, Bethesda, Maryland, United States of America
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Abstract
Cervical cancer is on the declining trend in India according to the population-based registries; yet it continues to be a major public health problem for women in India. Multifactorial causation, potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. This paper attempts to review the available knowledge regarding the epidemiology and pattern of cervical cancer; types of HPV (human papilloma virus) prevalent among cervical cancer patients and among women in general, high-risk groups such as commercial sex workers, and HIV (human immunodeficiency virus)-positive women; and the role of the national program on cancer in control efforts. The peak age of incidence of cervical cancer is 55-59 years, and a considerable proportion of women report in the late stages of disease. Specific types of oncogenic HPV-16, 18 have been identified in patients with cervical cancer. Other epidemiological risk factors are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness. A multipronged approach is necessary which can target areas of high prevalence identified by registries with a combination of behavior change communication exercises and routine early screening with VIA. Sensitizing the people of the area, including menfolk, is necessary to increase uptake levels. Vaccination against types 16 and 18 can also be undertaken after taking into confidence all stakeholders, including the parents of adolescent girls. Preventing and treating cervical cancer and reducing the burden are possible by targeting resources to the areas with high prevalence.
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Affiliation(s)
- Aswathy Sreedevi
- Community Medicine, AIMS, Kochi, Amrita Vishwa Vidyapeetham, Kerala, India
| | - Reshma Javed
- Community Medicine, AIMS, Kochi, Amrita Vishwa Vidyapeetham, Kerala, India
| | - Avani Dinesh
- Community Medicine, AIMS, Kochi, Amrita Vishwa Vidyapeetham, Kerala, India
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158
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Martin CE, Tergas AI, Wysong M, Reinsel M, Estep D, Varallo J. Evaluation of a single-visit approach to cervical cancer screening and treatment in Guyana: feasibility, effectiveness and lessons learned. J Obstet Gynaecol Res 2015; 40:1707-16. [PMID: 24888938 DOI: 10.1111/jog.12366] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 12/02/2013] [Indexed: 11/29/2022]
Abstract
AIM To evaluate a cervical cancer prevention project in Guyana utilizing visual inspection with acetic acid (VIA) and immediate cryotherapy in a single-visit approach; and to identify lessons learned to inform the improvement of cervical cancer prevention programs in Guyana and other low-resource settings. METHODS Service records from January 2009 to June 2012 were analyzed for 18 cervical cancer prevention sites across Guyana. Records included women's HIV status, data on visual inspection with acetic acid screening and treatment status for women's initial and 1-year follow-up screenings, provider training and retention. A process evaluation was conducted in 2011 to identify programmatic strengths and interventions for integration, scale-up and sustainability. RESULTS During the 42-month interval, 21,597 new screenings were performed, reaching 95% of HIV(+) women enrolled in care and 17% of women aged 25-49 years in Guyana. The VIA(+) rate was 13% (n = 2806); 85% of women eligible for cryotherapy received immediate treatment. Half of VIA(+) women treated with cryotherapy or loop electrosurgical excision procedure returned for a 1-year follow-up screening (n = 1027); 95% were VIA(-) at the second screening. Non-physician providers were more likely to continue offering services than physicians. Most programmatic challenges were related to systemic rather than technical/clinical issues. CONCLUSION The single-visit approach-based program is feasible, effective, and when scaled up, likely to have an impact on overall incidence of cervical cancer. Services can be shifted to non-physicians for scale-up of high-quality cervical cancer prevention services nationally. To ensure sustainability and expansion, support structures should be prioritized.
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Affiliation(s)
- Caitlin E Martin
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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159
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Shridhar K, Dey S, Bhan CM, Bumb D, Govil J, Dhillon PK. Cancer detection rates in a population-based, opportunistic screening model, New Delhi, India. Asian Pac J Cancer Prev 2015; 16:1953-8. [PMID: 25773793 DOI: 10.7314/apjcp.2015.16.5.1953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In India, cancer accounts for 7.3% of DALY's, 14.3% of mortality with an age-standardized incident rate of 92.4/100,000 in men and 97.4/100,000 in women and yet there are no nationwide screening programs. MATERIALS AND METHODS We calculated age-standardized and age-truncated (30-69 years) detection rates for men and women who attended the Indian Cancer Society detection centre, New Delhi from 2011-12. All participants were registered with socio-demographic, medical, family and risk factors history questionnaires, administered clinical examinations to screen for breast, oral, gynecological and other cancers through a comprehensive physical examination and complete blood count. Patients with an abnormal clinical exam or blood result were referred to collaborating institutes for further investigations and follow-up. RESULTS A total of n=3503 were screened during 2011-12 (47.8% men, 51.6% women and 0.6% children <15 years) with a mean age of 47.8 yrs (±15.1 yrs); 80.5% were aged 30-69 years and 77.1% had at least a secondary education. Tobacco use was reported by 15.8%, alcohol consumption by 11.9% and family history of cancer by 9.9% of participants. Follow-up of suspicious cases yielded 45 incident cancers (51.1% in men, 48.9% in women), consisting of 55.5% head and neck (72.0% oral), 28.9% breast, 6.7% gynecological and 8.9% other cancer sites. The age-standardized detection rate for all cancer sites was 340.8/100,000 men and 329.8/100,000 women. CONCLUSIONS Cancer screening centres are an effective means of attracting high-risk persons in low-resource settings. Opportunistic screening is one feasible pathway to address the rising cancer burden in urban India through early detection.
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Affiliation(s)
- Krithiga Shridhar
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, India E-mail :
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160
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Sankaranarayanan R, Qiao YL, Keita N. The next steps in cervical screening. WOMEN'S HEALTH (LONDON, ENGLAND) 2015; 11:201-12. [PMID: 25776294 DOI: 10.2217/whe.14.70] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cervical cancer is fourth most common cancer among women with four-fifths of the global burden in low- and middle-income countries (LMICs). Persistent infection with one of the high-risk types of human papillomaviruses (HPV), particularly HPV 16/18, is the central cause of cervical neoplasia. Progress in developing feasible, alternative screening methods in LMICs and HPV vaccines have further improved cervical cancer prevention prospects. While existing screening programs in high-income countries should be re-organized, in view of the downstream effects of national HPV vaccination programs, LMICs should introduce national programs to vaccinate single year cohorts of girls aged 9-13 years with two or three doses and screen 30-35-year-old women with HPV testing to pragmatically decrease their high disease burden.
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161
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A multicountry evaluation of careHPV testing, visual inspection with acetic acid, and papanicolaou testing for the detection of cervical cancer. Int J Gynecol Cancer 2015; 24:576-85. [PMID: 24557438 PMCID: PMC4047307 DOI: 10.1097/igc.0000000000000084] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental digital content is available in the text. Objective This study evaluates the feasibility and performance of careHPV, a novel human papillomavirus (HPV) DNA test, when used for screening women for cervical cancer in low-resource settings. Methods and Materials Clinician-collected (cervical) and self-collected (vaginal) careHPV specimens, visual inspection with acetic acid (VIA), and Papanicolaou test were evaluated among 16,951 eligible women in India, Nicaragua, and Uganda. Women with positive screening results received colposcopy and histologic follow-up as indicated. The positivity of each screening method was calculated overall, by site, and age. In addition, the clinical performance of each screening test was determined for detection of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2+) and CIN grade 3. Results Moderate or severe dysplasia or cancer (taken together as CIN2+) was diagnosed in 286 women. The positivity rate ranged between 2.4% to 19.6% for vaginal careHPV, 2.9% to 20.2% for cervical careHPV, 5.5% to 34.4% for VIA, and 2.8% to 51.8% for Papanicolaou test. Cervical careHPV was the most sensitive for CIN2+ (81.5%; 95% confidence interval [CI], 76.5–85.8) and CIN grade 3 (85.3%; 95% CI, 78.6–90.6) at all sites, followed by vaginal careHPV (69.6% and 71.3%, respectively). The sensitivity of VIA ranged from 21.9% to 73.6% and Papanicolaou test from 40.7% to 73.7%. The pooled specificities of cervical careHPV, vaginal careHPV, VIA, and Papanicolaou test were 91.6%, 90.6%, 84.2%, and 87.7%, respectively. Conclusions careHPV performed well in large multicountry demonstration studies conducted in resource-limited settings that have not previously been conducted this type of testing; its sensitivity using cervical samples or vaginal self-collected samples was better than VIA or Papanicolaou test. The feasibility of using careHPV in self-collected vaginal samples opens the possibility of increasing coverage and early detection in resource-constrained areas.
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Adjunct screening of cervical or vaginal samples using careHPV testing with Pap and aided visual inspection for detecting high-grade cervical intraepithelial neoplasia. Cancer Epidemiol 2015; 39:104-8. [DOI: 10.1016/j.canep.2014.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/28/2014] [Accepted: 11/02/2014] [Indexed: 11/20/2022]
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Fong J, Gyaneshwar R, Lin S, Morrell S, Taylor R, Brassil A, Stuart A, McGowan C. Cervical Screening Using Visual Inspection with Acetic Acid (VIA) and Treatment with Cryotherapy in Fiji. Asian Pac J Cancer Prev 2015; 15:10757-62. [DOI: 10.7314/apjcp.2014.15.24.10757] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Saquib N, Saquib J, Ioannidis JP. Does screening for disease save lives in asymptomatic adults? Systematic review of meta-analyses and randomized trials. Int J Epidemiol 2015; 44:264-77. [DOI: 10.1093/ije/dyu140] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Masukume G. Estimating the lost benefits of not implementing a visual inspection with acetic acid screen and treat strategy for cervical cancer prevention in South Africa. WIKIJOURNAL OF MEDICINE 2015. [DOI: 10.15347/wjm/2015.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ganesan S, Subbiah VN, Michael JCJ. Associated factors with cervical pre-malignant lesions among the married fisher women community at Sadras, Tamil Nadu. Asia Pac J Oncol Nurs 2015; 2:42-50. [PMID: 27981091 PMCID: PMC5123457 DOI: 10.4103/2347-5625.146223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To identify the associated factors of cervical pre-malignant lesions among the married fisher women residing in the coastal areas of Sadras, Tamil Nadu. Methods: The study was conducted in five fishermen communities under Sadras, a coastal area in Tamil Nadu, India. Two hundred and fifty married fisher women residing in the area. Quantitative descriptive approach with a cross-sectional study design was used. Data were collected using a structured interview schedule for identifying the associated factors and Pap smear test was performed for identifying the pre-malignant cervical lesions among the married fisher women. Data were analyzed using descriptive and inferential statistics. Results: Among 250 women, about six (2.4%) of them presented with pre-cancerous lesions such as atypical squamous cell of undifferentiated significance (ASCUS) — five (2%) and mild dysplasia one (0.4%). Majority of the women, about 178 (71.2%) women, had abnormal cervical findings. Statistical analysis showed a significant association of risk factors such as advanced age, lack of education, low socioeconomic status, using tobacco, multiparity, premarital sex, extramarital relationship, using cloth as sanitary napkin, etc. Conclusion: The study findings clearly show the increased vulnerable state of the fisher women for acquiring cervical cancer as they had many risk factors contributing to the same.
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Affiliation(s)
- Sornam Ganesan
- College of Nursing, Chengalpattu Medical College, Tamil Nadu, India
| | - Vasantha N Subbiah
- Department of Obstetrics and Gynecology, Chettinad Hospital and Research Institute, Tamil Nadu, India
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Abstract
Less-developed-region countries (LDCs) are seeing a rapid rise in cancer incidence owing to changing lifestyles, infections, environmental carcinogens and increasing longevity. LDCs have poor resources to deal with cancers, leading to high mortality rates. Investment in nationally implementable and sustainable cancer prevention and screening strategies would be more appropriate for LDCs. This Science and Society article outlines the burden of preventable cancers in selected LDCs and discusses evidence on cost-effective and widely implementable prevention and screening strategies.
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Affiliation(s)
- Aditi Shastri
- Albert Einstein College of Medicine, Hematology-Oncology, 1300 Morris Park Avenue, Bronx, New York, New York 10461, USA
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Maseko FC, Chirwa ML, Muula AS. Client satisfaction with cervical cancer screening in Malawi. BMC Health Serv Res 2014; 14:420. [PMID: 25245860 PMCID: PMC4180310 DOI: 10.1186/1472-6963-14-420] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessing client and patient satisfaction towards a service is of programmatic importance. A study was conducted in Malawi between July and October 2013 to assess client satisfaction among women who had been screened for cervical cancer using Visual Inspection with Acetic acid test. METHODS This was a cross sectional descriptive study which was conducted in 16 out of 43 cervical cancer screening centres. A semi structured questionnaire was used for data collection. Data were analyzed using STATA version 11 for windows. Descriptive statistics were computed to summarize participant characteristics. Logistic regression was also conducted to assess the relationship between client satisfaction with the service and the independent variables. RESULTS One hundred and twenty women with a mean age of 33.7 (SD = 10.1) participated in the survey. All women reported being satisfied with the received service at the facility, with 68.33% reported to be very satisfied. All demographic characteristics such as age, marital status, level of education, with exception of distance to the nearest health facility had no statistically significant association with satisfaction at both univariate and multivariate analysis. However, previous knowledge about the cause of the disease itself, its prevention, knowledge that the disease can be cured, knowledge of clinic times, previous knowledge of the VIA screening test and the source from where they heard about cervical cancer had a statistical significant relationship with the outcome variable. Logistic regression revealed that satisfaction in this study was predicted by having an appointment before the screening with adjusted odd ratio of 5.71(95%CI: 1.75 - 18.63), having previous knowledge of the VIA test, AOR = 0.021(95% CI: 0.002-0.226) distance from the home to the health facility AOR = 0.11(95%CI: 0.02-0.65) and waiting time AOR = 0.09 with 95% CI: 0.09 - 0.83. Having an appointment had the only independent variable with a positive relationship with satisfaction. CONCLUSION Women were satisfied with the screening service. The study also showed several challenges in cervical cancer screening services which can be considered as areas of potential improvement.
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Affiliation(s)
- Fresier C Maseko
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, College of Medicine, Mahatma Gandhi Road, Private Bag 360, Chichiri, Blantyre 3, Malawi.
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Nessa A, Nahar KN, Begum SA, Anwary SA, Hossain F, Nahar K. Comparison between visual inspection of cervix and cytology based screening procedures in Bangladesh. Asian Pac J Cancer Prev 2014; 14:7607-11. [PMID: 24460341 DOI: 10.7314/apjcp.2013.14.12.7607] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer continues to be a major problem in Bangladesh with approximately 18,000 new cases annually of which over 10,000 women die from it. Visual inspection of the cervix after 3-5% acetic acid (VIA) application is a simple and easy to learn method for cervical cancer screening, although cytology-based screening is more often applied in developed countries where it has successfully reduced the prevalence of cervical cancer. OBJECTIVE To compare the efficacy of VIA and cytology-based primary methods for cervical cancer screening in Bangladesh. MATERIALS AND METHODS This hospital based comparative study was conducted at the VIA centre and Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2008 to October 2010. RESULTS Among 650 women, 74 (11.4%) were VIA+ve and 8 (1.2%) had abnormalities in their Pap smear reports. During colposcopy, 38 (7.7%) women had different grades of CIN and 4 (0.6%) had cervical cancer. The gold standard histology findings proved 20 women had CIN I, 14 had CIN II/II and 4 had cervical cancer. Among the 38 histology diagnosed abnormalities, VIA test could identify 30 abnormalities including two cervical cancers. However, Pap smear could detect only 8 cases of histological abnormalities (2 low grade and 6 had high grade lesion) and it missed all the cervical cancer cases. The sensitivity and specificity of VIA were 88.9% and 52.1%. The positive predictive value (PPV) and negative predictive value (NPV) were 41.0%, and 92.6% respectively. Moreover, the sensitivity, specificity, PPV and NPV of Pap smear were 33.3%, 95.8%, 75.0% and 79.3%, respectively. CONCLUSIONS VIA test should be used as the primary screening tool even with its low sensitivity and specificity in low resource countries like Bangladesh. False positive results may be greater, but overtreatment can be minimized by colposcopy evaluation of the VIA positive women.
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Affiliation(s)
- Ashrafun Nessa
- Gyne-oncology Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh E-mail :
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Wang SM, Hu SY, Chen F, Chen W, Zhao FH, Zhang YQ, Ma XM, Qiao YL. Clinical Evaluation of Human Papillomavirus Detection by careHPVTMTest on Physician-Samples and Self-Samples using The Indicating FTA Elute® Card. Asian Pac J Cancer Prev 2014; 15:7085-9. [DOI: 10.7314/apjcp.2014.15.17.7085] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Boppart SA, Richards-Kortum R. Point-of-care and point-of-procedure optical imaging technologies for primary care and global health. Sci Transl Med 2014; 6:253rv2. [PMID: 25210062 PMCID: PMC4370289 DOI: 10.1126/scitranslmed.3009725] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Leveraging advances in consumer electronics and wireless telecommunications, low-cost, portable optical imaging devices have the potential to improve screening and detection of disease at the point of care in primary health care settings in both low- and high-resource countries. Similarly, real-time optical imaging technologies can improve diagnosis and treatment at the point of procedure by circumventing the need for biopsy and analysis by expert pathologists, who are scarce in developing countries. Although many optical imaging technologies have been translated from bench to bedside, industry support is needed to commercialize and broadly disseminate these from the patient level to the population level to transform the standard of care. This review provides an overview of promising optical imaging technologies, the infrastructure needed to integrate them into widespread clinical use, and the challenges that must be addressed to harness the potential of these technologies to improve health care systems around the world.
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Affiliation(s)
- Stephen A Boppart
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA. Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA. Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA. Department of Internal Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Rebecca Richards-Kortum
- Department of Bioengineering, Rice University, Houston, TX 77030, USA. Department of Electrical and Computer Engineering, Rice University, Houston, TX 77030, USA
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Gard AC, Soliman AS, Ngoma T, Mwaiselage J, Kahesa C, Chamberlain RM, Harlow SD. Most women diagnosed with cervical cancer by a visual screening program in Tanzania completed treatment: evidence from a retrospective cohort study. BMC Public Health 2014; 14:910. [PMID: 25187329 PMCID: PMC4162936 DOI: 10.1186/1471-2458-14-910] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/29/2014] [Indexed: 12/01/2022] Open
Abstract
Background Visual inspection with acetic acid (VIA) to identify and treat pre-cancerous lesions is effective for cervical cancer prevention. Screening programs also facilitate screening and diagnosis of invasive cancers that must be referred for radiation therapy or chemotherapy. This study compared characteristics of women diagnosed with invasive cervical cancer by a VIA screening program who did and did not follow up for treatment and who did and did not complete treatment at the Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania. Methods We conducted a retrospective cohort study of ORCI screening referrals from the period November 2002 to June 2011. Women referred for treatment of invasive disease (n = 980) were identified from an existing database of all women attending the screening clinic during this period (n = 20,131) and matched to a dataset of all cervical cancer patients attending ORCI in this period (n = 8,240). Treatment information was abstracted from patient records of women who followed up. Records of a random sample (n = 333) of unscreened patients were reviewed for disease stage. Results Of the 980 women referred women, 829 (84.6%) sought treatment. Most of those women (82.8%) completed their prescribed radiation. Lower disease stage, having a skilled occupation, residence in Dar es Salaam, and younger age were independently associated with loss to follow-up. Higher disease stage, residence in Dar es Salaam, older age, and later year of first treatment appointment were independently associated with incomplete treatment among those who followed up. Significantly more screened women had stage 1 disease (14.0%) than unscreened women (7.8%). Conclusions Most women referred from the screening clinic completed treatment for their cancer at ORCI. Some of those lost to follow-up may have sought treatment elsewhere. In most cases, the screening clinic appears to facilitate diagnosis and treatment, rather than screening, for women with invasive cervical cancer.
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Affiliation(s)
| | - Amr S Soliman
- University of Nebraska Medical Center College of Public Health, Omaha, NE, USA.
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Can visual inspection with acetic acid be used as an alternative to Pap smear in screening cervical cancer? MIDDLE EAST FERTILITY SOCIETY JOURNAL 2014. [DOI: 10.1016/j.mefs.2013.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
PURPOSE OF REVIEW In this era of healthcare reform, attention is focused on increasing the quality of care and access to services, while simultaneously reducing the cost. Economic evaluations can play an important role in translating research to evidence-based practice and policy. RECENT FINDINGS Cost-effectiveness analysis (CEA) and its utility for clinical and policy decision making among U.S. obstetricians and gynecologists is reviewed. Three case examples demonstrating the value of this methodology in decision making are considered. A discussion of the methodologic principles of CEA, the advantages, and the limitations of the methodology are presented. SUMMARY CEA can play an important role in evidence-based decision making, with value for clinicians and policy makers alike. These studies are of particular interest in the field of obstetrics and gynecology, in which uncertainty from epidemiologic or clinical trials exists, or multiple perspectives need to be considered (maternal, neonatal, and societal). As with all research, it is essential that economic evaluations are conducted according to established methodologic standards. Interpretation and application of results should occur with a clear understanding of both the value and the limitations of economic evaluations.
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Tsu VD, Jeronimo J, Anderson BO. Why the time is right to tackle breast and cervical cancer in low-resource settings. Bull World Health Organ 2014; 91:683-90. [PMID: 24101784 DOI: 10.2471/blt.12.116020] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 01/04/2023] Open
Abstract
The health concerns of women in their mid-adult years - when the prime age of reproduction has passed - have been traditionally given little or no attention by health systems and donors, despite the heavy burden that diseases such as breast and cervical cancer impose on women and their families. The risk of sexually transmitted infections that accompanies sexual relations and the risk of death and morbidity associated with pregnancy have long been recognized and have stimulated major control efforts that are finally yielding positive results. Much less attention has been focused, however, on how experiences in early life can affect women's health in adulthood. Breast and cervical cancers kill more women than any other types of cancer in all parts of the developing world. In most of Asia and Latin America and some African countries, deaths from these two forms of cancer now outnumber pregnancy-related deaths. There are five compelling reasons for focusing on these cancers now to try to reverse these epidemiologic trends: (i) the burden of breast and cervical cancer is large and is growing; (ii) effective screening and treatment are available; (iii) research is generating new knowledge; (iv) there are opportunities for synergy with other health programmes; and (v) noncommunicable diseases are the focus of much current interest.
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Affiliation(s)
- Vivien Davis Tsu
- PATH, PO Box 900922, Seattle, WA 98109, United States of America (USA)
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Chary AN, Rohloff PJ. Major challenges to scale up of visual inspection-based cervical cancer prevention programs: the experience of Guatemalan NGOs. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:307-17. [PMID: 25276590 PMCID: PMC4168631 DOI: 10.9745/ghsp-d-14-00073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/01/2014] [Indexed: 01/08/2023]
Abstract
Scale up of visual inspection with acetic acid (VIA) in Guatemala encountered major challenges, including high attrition of people trained, didactic training without hands-on skills building, lack of continued supervision, and provision of VIA alone without immediate on-site provision of cryotherapy. Background: Like many other low- and middle-income countries, Guatemala has adopted visual inspection with acetic acid (VIA) as a low-resource alternative to the Pap smear for cervical cancer screening. Nongovernmental organizations (NGOs) introduced VIA to Guatemala in 2004, and a growing number of NGOs, working both independently and in collaboration with the Guatemalan Ministry of Health, employ VIA in cervical cancer prevention programs today. While much research describes VIA efficacy and feasibility in Latin America, little is known about NGO involvement with VIA programming or experiences with VIA outside the context of clinical trials and pilot projects in the region. Methods: To explore challenges faced by NGOs implementing VIA programs in Guatemala, we conducted semi-structured interviews with 36 NGO staff members involved with 20 VIA programs as direct service providers, program administrators, and training course instructors. Additionally, we collected data through observation at 30 NGO-sponsored cervical cancer screening campaigns, 8 cervical cancer prevention conferences, and 1 week-long NGO-sponsored VIA training course. Results: Frequently highlighted challenges included staff turnover, concerns over training quality, a need for opportunities for continued supervision, and problems with cryotherapy referrals when immediate treatment for VIA-positive women was unavailable. Conclusions: Reducing staff turnover, budgeting to train replacement providers, standardizing training curricula, and offering continued supervision are key strategies to improve VIA service quality and program sustainability. Alternative training methods, such as on-the-job mentoring and course prerequisites of online learning, could help increase training time available for clinical supervision. Efforts should be made to ensure that VIA testing is coupled with immediate cryotherapy, that providers trained in VIA are also trained in cryotherapy, and that cryotherapy supplies and equipment are maintained. Where this is not possible and only VIA screening is available, referral systems must be strengthened.
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Affiliation(s)
- Anita Nandkumar Chary
- Washington University in St. Louis, School of Medicine and Department of Anthropology , St. Louis, MO. , USA
| | - Peter J Rohloff
- Harvard Medical School, Brigham and Women's Hospital , Boston, MA. , USA
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Krishnan S, Madsen E, Porterfield D, Varghese B. Advancing cervical cancer prevention in India: implementation science priorities. Oncologist 2014; 18 Suppl:13-25. [PMID: 24334478 DOI: 10.1634/theoncologist.18-s2-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cervical cancer is the leading cause of cancer mortality in India, accounting for 17% of all cancer deaths among women aged 30 to 69 years. At current incidence rates, the annual burden of new cases in India is projected to increase to 225,000 by 2025, but there are few large-scale, organized cervical cancer prevention programs in the country. We conducted a review of the cervical cancer prevention research literature and programmatic experiences in India to summarize the current state of knowledge and practices and recommend research priorities to address the gap in services. We found that research and programs in India have demonstrated the feasibility and acceptability of cervical cancer prevention efforts and that screening strategies requiring minimal additional human resources and laboratory infrastructure can reduce morbidity and mortality. However, additional evidence generated through implementation science research is needed to ensure that cervical cancer prevention efforts have the desired impact and are cost-effective. Specifically, implementation science research is needed to understand individual- and community-level barriers to screening and diagnostic and treatment services; to improve health care worker performance; to strengthen links among screening, diagnosis, and treatment; and to determine optimal program design, outcomes, and costs. With a quarter of the global burden of cervical cancer in India, there is no better time than now to translate research findings to practice. Implementation science can help ensure that investments in cervical cancer prevention and control result in the greatest impact.
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HPV detection in a self-collected vaginal swab combined with VIA for cervical cancer screening with correlation to histologically confirmed CIN. Arch Gynecol Obstet 2014; 290:1207-13. [DOI: 10.1007/s00404-014-3321-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 06/16/2014] [Indexed: 11/27/2022]
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Huchko MJ, Sneden J, Sawaya G, Smith-McCune K, Maloba M, Abdulrahim N, Bukusi EA, Cohen CR. Accuracy of visual inspection with acetic acid to detect cervical cancer precursors among HIV-infected women in Kenya. Int J Cancer 2014; 136:392-8. [PMID: 24889387 DOI: 10.1002/ijc.28996] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/15/2014] [Indexed: 01/06/2023]
Abstract
Visual inspection with acetic acid (VIA) is becoming a more widely recommended and implemented screening tool for cervical cancer prevention programs in low-resource settings. Many of these settings have a high prevalence of HIV-infected women. We carried out a cross-sectional validation study to define the sensitivity, specificity and predictive values of VIA among HIV-infected women. Women enrolled in HIV care at the Family AIDS Care and Education Services clinic in Kisumu, Kenya, were recruited for participation. All participants underwent VIA followed by colposcopy performed by a second blinded clinician. At colposcopy, lesions suspicious for cervical intraepithelial neoplasia 2 or greater (CIN2+) were biopsied. Disease status was determined by final histopathologic diagnosis in women who underwent biopsies. A satisfactory colposcopy with no lesions was considered a negative result. From October 2010 to June 2012, 1,432 women underwent VIA and colposcopy. A total of 514 (35.7%) women had a positive VIA, and 179 (12.2%) had CIN2+ confirmed by colposcopically directed biopsy. Sensitivity, specificity, positive and negative predictive values of VIA for CIN2+ were 86.6, 71.6, 30.3 and 97.4%, respectively. Specificity, but not sensitivity, increased with older age. Among older women, sensitivity was affected by CD4+ count and use of antiretroviral therapy. Although they are impacted by age and immune status, test characteristics for VIA among HIV-infected women are similar to what has been reported for general populations. Recommendations to use VIA as a screening tool should not vary by HIV status.
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Affiliation(s)
- Megan J Huchko
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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Lin CQ, Chen F, Liu B, Zhang YZ, Cui XL, Li AM, Zhang WH, Chen W, Chang I, Sivasubramaniam P, Zhu J, Qiao YL. A parallel study of careHPV and Hybrid Capture 2 human papillomavirus DNA testing for cervical cancer screening in rural China. J Virol Methods 2014; 202:73-8. [DOI: 10.1016/j.jviromet.2014.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 03/01/2014] [Accepted: 03/04/2014] [Indexed: 11/16/2022]
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Affiliation(s)
- Eric J Suba
- Kaiser Permanente Medical Center, San Francisco, CA 94115, USA.
| | - Stephen S Raab
- Memorial University of Newfoundland Saint John's, Newfoundland, Canada
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Sankaranarayanan R, Esmy PO, Rajkumar R, Muwonge R, Swaminathan R. Cervical cancer mortality in India - Authors' reply. Lancet 2014; 383:1804-5. [PMID: 24856024 DOI: 10.1016/s0140-6736(14)60878-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Pulikkottil Okkuru Esmy
- Christian Fellowship Community Health Center, Ambilikkai, Dindigul District, Tamil Nadu, India
| | - Rajamanickam Rajkumar
- Community Medicine, Meenakshi Medical College and Research Institute, Enathur, Kanchipuram, Tamil Nadu, India
| | - Richard Muwonge
- International Agency for Research on Cancer, 69008 Lyon, France
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Ben Khaial F, Bodalal Z, Elramli A, Elkhwsky F, Eltaguri A, Bendardaf R. Cervical cancer in north-eastern Libya: 2000-2008. J OBSTET GYNAECOL 2014; 34:523-6. [PMID: 24800833 DOI: 10.3109/01443615.2014.914478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Libya is a country with a low population, listed under the EMRO. Using registers and patient records from a major primary oncology clinic, data was gathered from Libyan cervical cancer patients and various parameters were studied across 9 years. Out of 4,090 female cancer cases during the study period, 1.8% were cervical cancer (n = 74). The average age of presentation was 53 years, with most of the cases (60%, n = 44) being premenopausal. Approximately 65% (n = 48) of cervical cancer patients are diagnosed at later stages (i.e. stages III and IV). The majority of these cases are squamous cell carcinoma (83.8%, n = 62), while 16.2% (n = 12) were found to be adenocarcinoma. Patients with squamous cell carcinoma presented at later stages more often than those with adenocarcinoma. Human papilloma virus was strongly implicated in cervical cancer, with 94% (n = 63) of those who were tested being positive for HPV-16 (82.5%, n = 52) and HPV-18 (12.7%, n = 8). Diagnosis was most frequently made through biopsy (97.3%, n = 72) as opposed to Pap smears (2.7%, n = 2). Most Libyan patients were put through chemotherapy (75%, n = 55) and triple therapy (surgery with combined chemotherapy and radiotherapy) was the most common (38%, n = 28) modality of treatment. Comparisons were made between Libya and other nations, either in the developed world or neighbouring countries. The major problem of cervical cancer in Libya is delayed presentation and hence, all the recommendations focus on increased awareness for the populace, implementation of a national cancer control plan and a national screening programme.
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Affiliation(s)
- F Ben Khaial
- Family and Community Medicine, Faculty of Medicine, Benghazi University , Benghazi , Libya
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186
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Interval from loop electrosurgical excision procedure to pregnancy and pregnancy outcomes. Obstet Gynecol 2014; 123:886. [PMID: 24785621 DOI: 10.1097/aog.0000000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sullivan R, Badwe RA, Rath GK, Pramesh CS, Shanta V, Digumarti R, D'Cruz A, Sharma SC, Viswanath L, Shet A, Vijayakumar M, Lewison G, Chandy M, Kulkarni P, Bardia MR, Kumar S, Sarin R, Sebastian P, Dhillon PK, Rajaraman P, Trimble EL, Aggarwal A, Vijaykumar DK, Purushotham AD. Cancer research in India: national priorities, global results. Lancet Oncol 2014; 15:e213-22. [DOI: 10.1016/s1470-2045(14)70109-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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189
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Foliaki S, Brewer N, Pearce N, Snijders PJF, Meijer CJLM, Waqatakirewa L, Clifford GM, Franceschi S. Prevalence of HPV infection and other risk factors in a Fijian population. Infect Agent Cancer 2014; 9:14. [PMID: 24891876 PMCID: PMC4040509 DOI: 10.1186/1750-9378-9-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/20/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cancer is among the leading contributors to morbidity and mortality in the Pacific, but the magnitude of the problem and the potential for prevention have not been comprehensively studied. Over the past decade, cervical cancer has been the most common cancer among women in Fiji with an age standardised cervical cancer incidence rate of 51 per 100,000. This rate is among the highest in the South Pacific region and in the world. This high cervical cancer incidence rate is likely linked to the low cervical screening rate, but it points also to the possibility of a high burden of human papillomavirus (HPV) infection. METHODS We conducted a population-based survey in Fiji to provide information on human papillomavirus (HPV) prevalence, and the distribution of individual HPV types in a Fijian health-sub-district. We included 1,261 women aged between 16 and 64 years. A general primer GP5+/6+ mediatedpolymerase chain reaction (PCR) assay was used for HPV testing of 44 HPV types. RESULTS The crude HPV prevalence in 1,244 women with an adequate HPV sample was 24.0% (95% confidence interval (CI), 21.7-26.4%) and the corresponding age standardised prevalence was 25.5% (95% CI, 23.1-28.1%). The prevalence of high-risk HPV types was 13.6% (95% CI, 11.8-15.6%). Among 1,192 women with adequate cytological results, 13 (1.1%) showed cervical abnormalities, the majority of which were high-grade intraepithelial lesions or worse. HPV prevalence declined from 35.8% in women aged <25 years to 18.6% in those aged 55-64 years of age. After adjustment, the only variables significantly associated with HPV-positivity were age (ranging from odds ratio (OR) 0.57 (95% CI, 0.36-0.89) for 25-34 year-old-women to OR 0.43 (95% CI, 0.20-0.89) for 55-64 year-old-women) and 'husband's extramarital sexual relationships' (OR 1.69; 95% CI, 1.17-2.34). CONCLUSION These findings on HPV provide key information for future policy decisions on the most appropriate methods of cervical cancer prevention in Fiji and in the Pacific region.
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Affiliation(s)
- Sunia Foliaki
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Naomi Brewer
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Neil Pearce
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
- London School of Hygiene & Tropical Medicine, London, UK
| | - Peter JF Snijders
- Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Chris JLM Meijer
- Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Ezechi OC, Petterson KO, Gbajabiamila TA, Idigbe IE, Kuyoro O, Ujah IAO, Ostergren PO. Predictors of default from follow-up care in a cervical cancer screening program using direct visual inspection in south-western Nigeria. BMC Health Serv Res 2014; 14:143. [PMID: 24678898 PMCID: PMC3986612 DOI: 10.1186/1472-6963-14-143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 03/27/2014] [Indexed: 11/24/2022] Open
Abstract
Background Increasingly evidence is emerging from south East Asia, southern and east Africa on the burden of default to follow up care after a positive cervical cancer screening/diagnosis, which impacts negatively on cervical cancer prevention and control. Unfortunately little or no information exists on the subject in the West Africa sub region. This study was designed to determine the proportion of and predictors and reasons for default from follow up care after positive cervical cancer screen. Method Women who screen positive at community cervical cancer screening using direct visual inspection were followed up to determine the proportion of default and associated factors. Multivariate logistic regression was used to determine independent predictors of default. Results One hundred and eight (16.1%) women who screened positive to direct visual inspection out of 673 were enrolled into the study. Fifty one (47.2%) out of the 108 women that screened positive defaulted from follow-up appointment. Women who were poorly educated (OR: 3.1, CI: 2.0 – 5.2), or lived more than 10 km from the clinic (OR: 2.0, CI: 1.0 – 4.1), or never screened for cervical cancer before (OR: 3.5, CI:3:1–8.4) were more likely to default from follow-up after screening positive for precancerous lesion of cervix . The main reasons for default were cost of transportation (48.6%) and time constraints (25.7%). Conclusion The rate of default was high (47.2%) as a result of unaffordable transportation cost and limited time to keep the scheduled appointment. A change from the present strategy that involves multiple visits to a “see and treat” strategy in which both testing and treatment are performed at a single visit is recommended.
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Townsend JS, Stormo AR, Roland KB, Buenconsejo-Lum L, White S, Saraiya M. Current cervical cancer screening knowledge, awareness, and practices among U.S. affiliated pacific island providers: opportunities and challenges. Oncologist 2014; 19:383-93. [PMID: 24668335 DOI: 10.1634/theoncologist.2013-0340] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cervical cancer is a leading cause of cancer mortality in nearly all U.S. Affiliated Pacific Island Jurisdictions (USAPIJ); however, most jurisdictions are financially and geographically limited in their capacity to deliver routine screening. METHODS We conducted a cross-sectional survey of 72 health care providers from five of the six USAPIJ in 2011 to assess knowledge, beliefs, practices, and perceived barriers regarding routine cervical cancer screening. We compared the responses of providers from jurisdictions that were funded by the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) with those that were not funded. RESULTS Most providers reported cervical cancer prevention as a priority in their clinical practices (90.3%) and use the Papanicolaou test for screening (86.1%). Many providers reported knowledge of screening guidelines (76.4%); however, more than half reported that annual screening is most effective (56.9%). Providers in non-NBCCEDP-funded jurisdictions reported greater acceptance of visual inspection with acetic acid (93.9%) and self-sampling for human papillomavirus testing (48.5%) compared with NBCCEDP-funded jurisdictions (15.4% and 30.8% respectively). Providers from non-NBCCEDP-funded jurisdictions reported inadequate technological resources for screening women (42.4%), and approximately 25% of providers in both groups believed that screening was cost-prohibitive. CONCLUSION Although cervical cancer screening is a priority in clinical practice, beliefs about annual screening, costs associated with screening, and varying levels of support for alternative screening tests pose barriers to providers throughout the USAPIJ. Further exploration of using evidence-based, lower cost, and sustainable screening technologies is warranted in addition to emphasizing timely follow-up of all positive cases.
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Affiliation(s)
- Julie S Townsend
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Atlanta, Georgia, USA; Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
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Castle PE, Qiao YL, Zhao FH, Chen W, Valdez M, Zhang X, Kang LN, Bansil P, Paul P, Bai P, Peck R, Li J, Chen F, Jeronimo J. Clinical determinants of a positive visual inspection after treatment with acetic acid for cervical cancer screening. BJOG 2014; 121:739-46. [PMID: 24575872 DOI: 10.1111/1471-0528.12646] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- PE Castle
- Global Cancer Initiative; Chestertown MD USA
| | - Y-L Qiao
- Cancer Institute and Hospital; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - F-H Zhao
- Cancer Institute and Hospital; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - W Chen
- Cancer Institute and Hospital; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | | | - X Zhang
- Cancer Institute and Hospital; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - L-N Kang
- Cancer Institute and Hospital; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | | | | | - P Bai
- Cancer Institute and Hospital; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | | | - J Li
- Cancer Institute and Hospital; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - F Chen
- Cancer Institute and Hospital; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
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Shastri SS, Mittra I, Mishra GA, Gupta S, Dikshit R, Singh S, Badwe RA. Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India. J Natl Cancer Inst 2014; 106:dju009. [PMID: 24563518 DOI: 10.1093/jnci/dju009] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer mortality among women in India. Because Pap smear screening is not feasible in India, we need to develop effective alternatives. METHODS A cluster-randomized controlled study was initiated in 1998 in Mumbai, India, to investigate the efficacy of visual inspection with acetic acid (VIA) performed by primary health workers in reducing cervical cancer mortality. Four rounds of cancer education and VIA screening were conducted at 24-month intervals in the screening group, whereas cancer education was offered once at entry to the control group. The study was planned for 16 years to include four screening rounds followed by four monitoring rounds. We present results after 12 years of follow-up. Poisson regression method was used to calculate the rate ratios (RRs); two-sided χ(2) was used to calculate the probability. RESULTS We recruited 75360 women from 10 clusters in the screening group and 76178 women from 10 comparable clusters in the control group. In the screening group, we achieved 89% participation for screening and 79.4% compliance for diagnosis confirmation. The incidence of invasive cervical cancer was 26.74 per 100000 (95% confidence interval [CI] = 23.41 to 30.74) in the screening group and 27.49 per 100000 (95% CI = 23.66 to 32.09) in the control group. Compliance to treatment for invasive cancer was 86.3% in the screening group and 72.3% in the control group. The screening group showed a statistically significant 31% reduction in cervical cancer mortality (RR = 0.69; 95% CI = 0.54 to 0.88; P = .003). CONCLUSIONS VIA screening by primary health workers statistically significantly reduced cervical cancer mortality. Our study demonstrates the efficacy of an easily implementable strategy that could prevent 22000 cervical cancer deaths in India and 72600 deaths in resource-poor countries annually.
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Affiliation(s)
- Surendra S Shastri
- Affiliations of authors: Tata Memorial Centre, Parel, Mumbai, India (SSS, IM, GAM, SG, RD, RAB); Novartis Pharmaceuticals UK Limited, PharmaOps Horsham, West Sussex, UK (SS)
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Dartell MA, Rasch V, Iftner T, Kahesa C, Mwaiselage JD, Junge J, Gernow A, Ejlersen SF, Munk C, Kjaer SK. Performance of visual inspection with acetic acid and human papillomavirus testing for detection of high-grade cervical lesions in HIV positive and HIV negative Tanzanian women. Int J Cancer 2014; 135:896-904. [PMID: 24391021 DOI: 10.1002/ijc.28712] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 12/12/2013] [Indexed: 11/09/2022]
Abstract
The aim of this cross sectional study was to assess type distribution of human papillomavirus (HPV) among HIV positive and HIV negative women who underwent cervical cancer screening, and to examine the ability of visual inspection with acetic acid (VIA), the standard detection method in Tanzania, and HPV-testing to detect cytologically diagnosed high grade lesions or cancer (HSIL+). Women from different areas in Tanzania were invited by public announcement to cervical cancer screening organized by Ocean Road Cancer Institute (Dar-es-Salaam). A total of 3,767 women were enrolled. Women underwent gynecological examination with collection of cervical cells for conventional cytological examination, and swab for HPV-DNA detection (Hybrid-Capture2) and genotyping (LiPAv2 test). Subsequently VIA was performed. The participants were also tested for HIV. HPV16, HPV52 and HPV18 were the three most common HR HPV types among women with HSIL+ cytology with prevalences of 42.9, 35.7 and 28.6%, respectively, in HIV positive women which was higher than among HIV negative women (30.2, 21.9 and 16.7%). A total of 4.5% of the women were VIA positive, and VIA showed a low sensitivity compared to HPV-testing for detection of HSIL+. The sensitivity of VIA varied with staff VIA experience, HIV status and age. Vaccines including HPV16, HPV52 and HPV18 will likely reduce the number of HSIL+ cases independently of HIV status. The frequency of HSIL+ was high among HIV positive women, emphasizing the importance of establishing a screening program which also reaches HIV positive women. Our results highlight the importance of continuous training of staff performing VIA, and also point to the need for other screening methods such as HPV-testing at low cost.
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Affiliation(s)
- Myassa Arkam Dartell
- Department of International Health, Public Health Institute, University of Copenhagen, Denmark; Unit of Virus Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
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Feasibility of community-based careHPV for cervical cancer prevention in rural Thailand. J Low Genit Tract Dis 2014; 17:315-9. [PMID: 23422644 DOI: 10.1097/lgt.0b013e31826b7b70] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess the safety, acceptability and feasibility of primary human papillomavirus (HPV) testing for cervical cancer prevention at the community level in a low-resource setting. MATERIALS AND METHODS After training a technician to run specimens on the careHPV unit, the study team traveled to a different village each day in rural Roi-et Province, Thailand. Women were tested for HPV using self-swab, followed by careHPV testing. Those with positive result were assessed immediately by visual inspection with acetic acid. Women positive for HPV and visual inspection with acetic acid were offered cryotherapy. Safety was determined by monitoring adverse events. Exit surveys assessed acceptability and feasibility. Feasibility was also assessed by measuring testing and triage throughputs. RESULTS Technician training required 2.5 days to achieve competency. A total of 431 women were screened in 14 days, with an average of 31 women screened daily. No adverse events were reported. Women deemed the program overwhelmingly acceptable: 90.5% reported that they would take the self-swab again, 71.3% preferred the self-swab to a clinician swab. The program was also feasible: 99.8% of eligible women agreed to testing, 94.8% returned for same-day follow-up, and women only spent 30 to 50 minutes of their total time with the program from screening to results. CONCLUSIONS Cervical cancer prevention programs based on self-swab HPV testing could be safe, acceptable, feasible, and effective at the community level in low-resource settings.
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Belinson JL, Wang G, Qu X, Du H, Shen J, Xu J, Zhong L, Yi J, Yi X, Wu R. The development and evaluation of a community based model for cervical cancer screening based on self-sampling. Gynecol Oncol 2014; 132:636-42. [PMID: 24440471 DOI: 10.1016/j.ygyno.2014.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To develop and implement a community based model for cervical cancer prevention that allows the communities to manage the screening and the healthcare system to focus resources on evaluation and management of the positives. METHODS Using self-sampling and the concepts founded in Community Based Participatory Research (CBPR), we progressively developed a model to efficiently reach the women, especially rural communities; and collect the volume of samples needed to support high throughput centralized low cost per case processing. RESULTS 8382 eligible women, ages 35 to 59, in 130 rural communities participated. The screening was organized by the local government administration and conducted by the community leaders (CLs). The model used was progressively designed through detailed assessment of key elements at 6 decision points in 26 workshops that were used to train the CLs and the local promoters. The communities were able to accurately conduct the screening; in the final model a local medical worker conducted a 50-minute workshop featuring instructional posters and structured role-play. A manual and a workshop DVD were created for distribution to and implementation by local governments. The average callback rate was 84.3%, without involvement of the local doctors in the management of the positives. CONCLUSION An efficient community based model capable of massive screening events was developed. We believe that the callback rate will be further improved when local doctors are trained in the management of the positives. Many elements impact coverage and further research is needed to define the influence of the identified key variables.
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Affiliation(s)
- Jerome L Belinson
- Preventive Oncology International, Cleveland Heights, OH, USA; The Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Guixiang Wang
- Dept of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Xinfeng Qu
- Preventive Oncology International, Cleveland Heights, OH, USA
| | - Hui Du
- Dept of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Jingjing Shen
- Dept of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
| | | | - Liqun Zhong
- The Maternity and Child Health Hospital, Heshan, Guangdong, PR China
| | - Ji Yi
- BGI Shenzhen, Shenzhen, PR China
| | - Xin Yi
- BGI Shenzhen, Shenzhen, PR China
| | - Ruifang Wu
- Dept of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
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Abstract
Asia accounts for 60% of the world population and half the global burden of cancer. The incidence of cancer cases is estimated to increase from 6.1 million in 2008 to 10.6 million in 2030, due to ageing and growing populations, lifestyle and socioeconomic changes. Striking variations in ethnicity, sociocultural practices, human development index, habits and dietary patterns are reflected in the burden and pattern of cancer in different regions. The existing and emerging cancer patterns and burden in different regions of Asia call for political recognition of cancer as an important public health problem and for balanced investments in public and professional awareness. Prevention as well as early detection of cancers leads to both better health outcomes and considerable savings in treatment costs. Cancer health services are still evolving, and require substantial investment to ensure equitable access to cancer care for all sections of the population. In this review, we discuss the changing burden of cancer in Asia, along with appropriate management strategies. Strategies should promote healthy ageing via healthy lifestyles, tobacco and alcohol control measures, hepatitis B virus (HBV) and human papillomavirus (HPV) vaccination, cancer screening services, and vertical investments in strengthening cancer healthcare infrastructure to improve equitable access to services.
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Affiliation(s)
| | - Kunnambath Ramadas
- Regional Cancer Centre, PO Box 2417, Trivandrum 695011, Kerala State, India
| | - You-lin Qiao
- Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Godfrey CC, Michelow PM, Godard M, Sahasrabuddhe VV, Darden J, Firnhaber CS, Wetherall NT, Bremer J, Coombs RW, Wilkin T. Improving diagnostic capability for HPV disease internationally within the NIH-NIAID Division of AIDS Clinical Trial Networks. Am J Clin Pathol 2013; 140:881-9. [PMID: 24225757 DOI: 10.1309/ajcpibis19qiyhjy] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To evaluate an external quality assurance (EQA) program for the laboratory diagnosis of human papillomavirus (HPV) disease that was established to improve international research capability within the Division of AIDS at the National Institute of Allergy and Infectious Disease-supported Adult AIDS Clinical Trials Group network. METHODS A three-component EQA scheme was devised comprising assessments of diagnostic accuracy of cytotechnologists and pathologists using available EQA panels, review of quality and accuracy of clinical slides from local sites by an outside expert, and HPV DNA detection using a commercially available HPV test kit. RESULTS Seven laboratories and 17 pathologists in Africa, India, and South America participated. EQA scores were suboptimal for EQA proficiency testing panels in three of seven laboratories. There was good agreement between the local laboratory and the central reader 70% of the time (90% confidence interval, 42%-98%). Performance on the College of American Pathologists' HPV DNA testing panel was successful in all laboratories tested. CONCLUSIONS The prequalifying EQA round identified correctable issues that will improve the laboratory diagnosis of HPV-related cervical disease at the participating international study sites and will provide a mechanism for ongoing education and continuous quality improvement.
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Affiliation(s)
- Catherine C. Godfrey
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Pamela M. Michelow
- Cytology Unit, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Mandana Godard
- Johns Hopkins University, Patient Safety Monitoring in International Laboratories (SMILE), Baltimore, MD
| | - Vikrant V. Sahasrabuddhe
- Vanderbilt Institute for Global Health and Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Cynthia S. Firnhaber
- Clinical HIV Research Unit, Faculty of Health Sciences, Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa
- Right to Care, Johannesburg, South Africa
| | - Neal T. Wetherall
- HJF-DAIDS, a Division of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | | | - Robert W. Coombs
- Departments of Laboratory Medicine and Medicine, University of Washington, Seattle, WA
| | - Timothy Wilkin
- Division of Infectious Diseases, Weill Cornell Medical College, New York, NY
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Comparing Papanicolau smear, visual inspection with acetic acid and human papillomavirus cervical cancer screening methods among HIV-positive women by immune status and antiretroviral therapy. AIDS 2013; 27:2909-19. [PMID: 23842133 DOI: 10.1097/01.aids.0000432472.92120.1b] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A rigorous comparison of cervical cancer screening methods utilizing data on immune status, antiretroviral therapy (ART) and colposcopy-directed biopsy has not been performed among HIV-positive women. METHODS Between June and November 2009, 500 HIV-positive women were enrolled at an HIV treatment clinic in Nairobi, Kenya, and underwent Papanicolau (Pap) smear, visual inspection with acetic acid (VIA), human papillomavirus (HPV) and colposcopy-directed biopsy (gold standard). Positive Pap smear (ASCUS+, LSIL+, HSIL+), VIA, HPV and their combinations were compared with CIN2/3+. Sensitivity, specificity and AUC (sensitivity and 1-specificity) were compared using pairwise tests and multivariate logistic regression models that included age, CD4⁺ cell count and ART duration. RESULTS Of 500 enrolled, 498 samples were collected. On histology, there were 172 (35%) normal, 186 (37%) CIN1, 66 (13%) CIN2, 47 (9%) CIN3 and 27 (5%) indeterminate. Pap (ASCUS+) was the most sensitive screening method (92.7%), combination of both Pap (HSIL+) and VIA positive was the most specific (99.1%) and Pap (HSIL+) had the highest AUC (0.85). In multivariate analyses, CD4⁺ cell count of 350 cells/μl or less was associated with decreased HPV specificity (P = 0.002); ART duration of less than 2 years was associated with decreased HPV (P = 0.01) and VIA (P = 0.03) specificity; and age less than 40 years was associated with increased VIA sensitivity (P < 0.001) and decreased HPV specificity (P = 0.005). CONCLUSION Pap smear is a robust test among HIV-positive women regardless of immune status or ART duration. Results should be cautiously interpreted when using HPV among those younger, immunosuppressed or on ART less than 2 years, and when using VIA among those aged 40 years or more.
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Krishnan S, Madsen E, Porterfield D, Varghese B. Advancing cervical cancer prevention in India: implementation science priorities. Oncologist 2013; 18:1285-97. [PMID: 24217555 PMCID: PMC3868423 DOI: 10.1634/theoncologist.2013-0292] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/04/2013] [Indexed: 12/31/2022] Open
Abstract
Cervical cancer is the leading cause of cancer mortality in India, accounting for 17% of all cancer deaths among women aged 30 to 69 years. At current incidence rates, the annual burden of new cases in India is projected to increase to 225,000 by 2025, but there are few large-scale, organized cervical cancer prevention programs in the country. We conducted a review of the cervical cancer prevention research literature and programmatic experiences in India to summarize the current state of knowledge and practices and recommend research priorities to address the gap in services. We found that research and programs in India have demonstrated the feasibility and acceptability of cervical cancer prevention efforts and that screening strategies requiring minimal additional human resources and laboratory infrastructure can reduce morbidity and mortality. However, additional evidence generated through implementation science research is needed to ensure that cervical cancer prevention efforts have the desired impact and are cost-effective. Specifically, implementation science research is needed to understand individual- and community-level barriers to screening and diagnostic and treatment services; to improve health care worker performance; to strengthen links among screening, diagnosis, and treatment; and to determine optimal program design, outcomes, and costs. With a quarter of the global burden of cervical cancer in India, there is no better time than now to translate research findings to practice. Implementation science can help ensure that investments in cervical cancer prevention and control result in the greatest impact.
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Affiliation(s)
- Suneeta Krishnan
- RTI International, Research Triangle Park, North Carolina, USA
- St. John's Research Institute, Bangalore, India
| | - Emily Madsen
- RTI International, Research Triangle Park, North Carolina, USA
| | - Deborah Porterfield
- RTI International, Research Triangle Park, North Carolina, USA
- Department of Social Medicine, School of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Beena Varghese
- St. John's Research Institute, Bangalore, India
- Public Health Foundation of India, New Delhi, India
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