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Mwenda V, Murage D, Kilonzo C, Bor JP, Njiri P, Osiro L, Nyangasi M, Arbyn M, Tummers P, Temmerman M. Baseline assessment of cervical cancer screening and treatment capacity in 25 counties in Kenya, 2022. Front Oncol 2024; 14:1371529. [PMID: 39015502 PMCID: PMC11249718 DOI: 10.3389/fonc.2024.1371529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/18/2024] [Indexed: 07/18/2024] Open
Abstract
Background Cervical cancer is the leading cause of cancer deaths among women in Kenya. In the context of the Global strategy to accelerate the elimination of cervical cancer as a public health problem, Kenya is currently implementing screening and treatment scale-up. For effectively tracking the scale-up, a baseline assessment of cervical cancer screening and treatment service availability and readiness was conducted in 25 priority counties. We describe the findings of this assessment in the context of elimination efforts in Kenya. Methods The survey was conducted from February 2021 to January 2022. All public hospitals in the target counties were included. We utilized healthcare workers trained in preparation for the scale-up as data collectors in each sub-county. Two electronic survey questionnaires (screening and treatment; and laboratory components) were used for data collection. All the health system building blocks were assessed. We used descriptive statistics to summarize the main service readiness indicators. Results Of 3,150 hospitals surveyed, 47.6% (1,499) offered cervical cancer screening only, while 5.3% (166) offered both screening and treatment for precancer lesions. Visual inspection with acetic acid (VIA) was used in 96.0% (1,599/1,665) of the hospitals as primary screening modality and HPV testing was available in 31 (1.0%) hospitals. Among the 166 hospitals offering treatment for precancerous lesions, 79.5% (132/166) used cryotherapy, 18.7% (31/166) performed thermal ablation and 25.3% (42/166) performed large loop excision of the transformation zone (LLETZ). Pathology services were offered in only 7.1% (17/238) of the hospitals expected to have the service (level 4 and above). Only 10.8% (2,955/27,363) of healthcare workers were trained in cervical cancer screening and treatment; of these, 71.0% (2,097/2,955) were offering the services. Less than half of the hospitals had cervical cancer screening and treatment commodities at time of survey. The main health system strength was presence of multiple screening points at hospitals, but frequent commodity stock-outs was a key weakness. Conclusion Training, commodities, and diagnostic services are major gaps in the cervical cancer program in Kenya. To meet the 2030 elimination targets, the national and county governments should ensure adequate financing, training, and service integration, especially at primary care level.
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Affiliation(s)
- Valerian Mwenda
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - David Murage
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
- Field Epidemiology and Laboratory Program, Ministry of Health, Nairobi, Kenya
| | - Catherine Kilonzo
- Field Epidemiology and Laboratory Program, Ministry of Health, Nairobi, Kenya
| | - Joan-Paula Bor
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Patricia Njiri
- Noncommunicable Disease Program, Clinton Health Access Initiative, Nairobi, Kenya
| | - Lance Osiro
- Noncommunicable Disease Program, Clinton Health Access Initiative, Nairobi, Kenya
| | - Mary Nyangasi
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Philippe Tummers
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
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Eva FN, Khan MAS, Islam T, Monisha UK, Meem NES, Hossain MA, Goutam A, Zerin T, Alam N, Nath R, Sifat S, Sultana S, Sultana MS, Saha SK, Sarker NE, Rahman ML, Nabi MH, Hawlader MDH. Awareness of HPV vaccine and its socio-demographic determinants among the parents of eligible daughters in Bangladesh: A nationwide study. Heliyon 2024; 10:e30897. [PMID: 38778954 PMCID: PMC11109798 DOI: 10.1016/j.heliyon.2024.e30897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Background Vaccination against Human papillomavirus (HPV) is recommended to avoid HPV infections and its associated diseases, including cervical cancer. However, there is no awareness study among Bangladeshi population. Hence, this nationwide study was conducted to explore HPV vaccine awareness and its determinants among parents of eligible adolescent girls. Methods This study was conducted among the parents of daughters aged 9-15 years from 42 out of 64 randomly selected districts of Bangladesh between June 28 to August 2, 2023. A multistage sampling method was used to enroll 2151 study participants from all eight divisions of Bangladesh. A semi-structured questionnaire was used for face-to-face interviews in this study. The statistical software Stata (Version 17) was used for statistical analyses. Results The average age of the participants was 38.18 (±5.86) years. Only 22.32 % of the participants were aware of the HPV vaccine. Every additional year of age increased the likelihood of being aware of the HPV vaccine by 3 % (AOR: 1.03; 95%CI: 1.00-1.06). Participants residing in the urban area had 3.56 times higher odds of awareness than rural and semi-urban people. Businessmen and housewives had 60 % (AOR: 0.40; 95 % CI: 0.22-0.69) and 77 % (AOR: 0.23; 95 % CI: 0.16-0.33) lower odds in comparison to job holders. The lower-income group exhibited significantly higher odds of awareness (AOR: 0.25, 95%CI: 0.16-0.39) compared to the middle and the higher-income group. Participants who never went through routine health check-ups had 77 % lower odds of being aware than those who availed of regular routine check-ups (AOR: 0.23; 95%CI: 0.16-0.34). Conclusion Awareness of the HPV vaccine among the general population of Bangladesh is very low. Age, residence, occupation, monthly income, and routine medical check-ups were associated with HPV vaccine awareness. A nationwide awareness campaign would increase this awareness level among the Bangladeshi population, especially among the parents of daughters.
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Affiliation(s)
- Fahima Nasrin Eva
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Md Abdullah Saeed Khan
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
- National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, 1212, Bangladesh
| | - Tariful Islam
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Umme Kulsum Monisha
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
- Mandy Dental College & Hospital, Dhaka, 1209, Bangladesh
| | - Nur-E-Safa Meem
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Mohammad Ali Hossain
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
- Ibn Sina Medical College Hospital, Kallyanpur, Dhaka, 1216, Bangladesh
| | - Arpita Goutam
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Tahmina Zerin
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Nishat Alam
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Rima Nath
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Shamma Sifat
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Sayla Sultana
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Mosammat Sadeka Sultana
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Sumit Kumar Saha
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Naifa Enam Sarker
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Public Health Promotion and Development Society (PPDS), Dhaka, 1205, Bangladesh
| | - Mohammad Lutfor Rahman
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, 1000, Bangladesh
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Nessa A, Hossain MS, Uddin SMN, Islam MR, Khan MAH, Azad AK. Electronic aggregated data collection on cervical cancer screening in Bangladesh since 2014: what the data tells us? BMC Public Health 2024; 24:270. [PMID: 38263029 PMCID: PMC10804837 DOI: 10.1186/s12889-023-17545-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION To reduce the high prevalence of cervical cancers among the Bangladeshi women, the Government of Bangladesh established a national cervical cancer screening programme in 2005 for women aged 30 to 60 years. The District Health Information System Version 2 (DHIS2) based electronic aggregated data collection system is used since the year 2013. This study summarises data from the year 2014 to 2022 to assess the effectiveness of the electronic data collection system in understanding the outcome of the screening programme. METHODS This is a descriptive study based on secondary data extracted in MS Excel from the DHIS2-based electronic repository of the national cervical cancer screening programme of Bangladesh. The respondents were women aged 30-60 years, screened for cervical cancer using VIA (Visual Inspection of cervix with Acetic acid) method in 465 government health facilities. The data were collected on the participants' residential location, month and year of screening, name and type of health facilities performing VIA, and VIA screening results. RESULTS The national screening programme reported a total 3.36 million VIA tests from 465 government hospitals in 8 years (2014 to 2022). The national average VIA-positivity rate was 3.6%, which varied from 1.4 to 9.5% among the districts. This national screening programme witnessed an exponential growth, year after year, with 83.3% increase in VIA test from 2014 to 2022. The primary and the secondary care hospitals were the highest collective contributors of VIA tests (86.2%) and positive cases (77.8%). The VIA-positivity rates in different hospital types varied widely, 7.0% in the medical university hospital, 5.7% in the medical college hospitals, 3.9% in the district/general hospitals, and 3.0% in the upazila health complexes. CONCLUSIONS A national cervical cancer screening programme using VIA method and a DHIS2-based electronic data collection backbone, is effective, sustainable, and useful to understand the screening coverage, VIA positivity rate and geographic distribution of the participants and case load to initiate policy recommendations and actions. Decentralization of the screening programme and more efforts at the primary and secondary care level is required to increase screening performances.
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Affiliation(s)
- Ashrafun Nessa
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
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Quang TT, Yang J, Mikhail AS, Wood BJ, Ramanujam N, Mueller JL. Locoregional Thermal and Chemical Tumor Ablation: Review of Clinical Applications and Potential Opportunities for Use in Low- and Middle-Income Countries. JCO Glob Oncol 2023; 9:e2300155. [PMID: 37625104 PMCID: PMC10581629 DOI: 10.1200/go.23.00155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/31/2023] [Accepted: 07/01/2023] [Indexed: 08/27/2023] Open
Abstract
This review highlights opportunities to develop accessible ablative therapies to reduce the cancer burden in LMICs.
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Affiliation(s)
- Tri T. Quang
- Department of Bioengineering, University of Maryland, College Park, MD
| | - Jeffrey Yang
- Department of Bioengineering, University of Maryland, College Park, MD
- Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Andrew S. Mikhail
- Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nimmi Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC
| | - Jenna L. Mueller
- Department of Bioengineering, University of Maryland, College Park, MD
- Department of OB-GYN and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD
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Sharma J, Yennapu M, Priyanka Y. Screening Guidelines and Programs for Cervical Cancer Control in Countries of Different Economic Groups: A Narrative Review. Cureus 2023; 15:e41098. [PMID: 37519623 PMCID: PMC10381098 DOI: 10.7759/cureus.41098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Screening guidelines and practices differ according to resource availability and continually update as scientific developments take place. In this article, we have reviewed screening guidelines and programs for cervical cancer prevention in selected countries belonging to different economic groups viz high income, middle income, and low income. We have selected six countries - the United States of America (USA), the United Kingdom (UK), India, South Africa, Bangladesh, and Malawi. Considerable differences are observed across the health systems. Countries with established screening guidelines complemented by organised nationwide programs or insurance practices have much better screening rates. Human Papilloma Virus (HPV) DNA testing is currently the test of choice in the majority of settings for cervical cancer screening due to its higher sensitivity (up to 90-100%) and longer screening intervals (three to five years). It is also cost-effective, less dependent on operator expertise, and suitable for all settings as compared to a Pap smear test or visual inspection with acetic acid (VIA). Self-sampling of HPV can further help to improve screening coverage by increasing opportunities of reaching to women who would otherwise not participate in screening programs. Resource-constrained countries recommend VIA-based screening in their national programs due to its low cost. The share of cervical cancer is higher in middle and low-income countries as they have lower screening coverage, compared to high-income countries. The main barriers faced in the implementation of the program in low-income countries (LICs) are pertaining to the health system, patient-specific challenges, and healthcare provider-specific challenges.
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Affiliation(s)
- Jyoti Sharma
- Council of Scientific and Industrial Research-National Institute of Science Communication and Policy Research (CSIR-NIScPR), Academy of Scientific and Innovative Research (AcSIR), New Delhi, IND
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, IND
| | - Madhavi Yennapu
- Council of Scientific and Industrial Research-National Institute of Science Communication and Policy Research (CSIR-NIScPR), Academy of Scientific and Innovative Research (AcSIR), New Delhi, IND
| | - Yamini Priyanka
- Division of Reproductive Child Health and Nutrition, Indian Council of Medical Research, New Delhi, IND
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Mittal A, Neibart SS, Kulkarni A, Anderson T, Hudson SV, Beer NL, Einstein MH, Kohler RE. Barriers and facilitators to effective cervical cancer screening in Belize: a qualitative analysis. Cancer Causes Control 2023:10.1007/s10552-023-01703-0. [PMID: 37165111 DOI: 10.1007/s10552-023-01703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/13/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Belize has among the highest cervical cancer incidence and mortality rates of Latin American and Caribbean countries. This study evaluates the perspectives of key stakeholders for cervical cancer screening in Belize and identifies the barriers and facilitators for providing equitable access to prevention services. METHODS Semi-structured interviews discussing cervical cancer screening were conducted with key stakeholders across the six districts of Belize in 2018. Interviews were transcribed, coded, and analyzed thematically; themes were organized by levels of the social-ecological model. RESULTS We conducted 47 interviews with health care providers (45%), administrators (17%), government officials (25%), and other stakeholders (13%). Majority (78%) of interviews were from the public sector. Perceived barriers to cervical cancer screening were identified across multiple levels: (1) Individual Patient: potential delays in Pap smear results and fear of a cancer diagnosis; (2) Provider: competing clinician responsibilities; (3) Organizational: insufficient space and training; (4) Community: reduced accessibility in rural areas; and (5) Policy: equipment and staffing budget limitations. The main facilitators we identified included the following: (1) at the Community level: resource-sharing between public and private sectors and dedicated rural outreach personnel; (2) at the Policy level: free public screening services and the establishment of population-based screening. CONCLUSION Despite free, publicly available cervical cancer screening in Belize, complex barriers affect access and completion of management when abnormal screening tests are identified. Provider workload, education outreach, and additional funding for training and facilities are potential areas for strengthening this program and increasing detection and management for cervical cancer control.
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Affiliation(s)
- Avni Mittal
- Department of Obstetrics and Reproductive Health and Gynecology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Shane S Neibart
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Abha Kulkarni
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Taylor Anderson
- University of Queensland Ochsner Clinical School, Brisbane, QLD, Australia
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Mark H Einstein
- Department of Obstetrics and Reproductive Health and Gynecology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Racquel E Kohler
- Department of Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health , Piscataway, NJ, USA
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Luizaga CTDM, Jardim BC, Wünsch V, Eluf J, Silva GAE. Recent changes in trends of mortality from cervical cancer in Southeastern Brazil. Rev Saude Publica 2023; 57:25. [PMID: 37075421 PMCID: PMC10118416 DOI: 10.11606/s1518-8787.2023057004709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/08/2022] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To analyze the trends of cervical cancer mortality in Brazilian Southeastern states, and to compare them to Brazil and other regions between 1980 and 2020. METHODS Time series study based on data from the Sistema de Informações de Mortalidade (Brazilian Mortality Information System). Death data were corrected by proportional redistribution of deaths from ill-defined causes and cervical cancer of unspecified portion. Age-standardized and age-specific rates were calculated by screening target (25-39 years; 40-64 years) and non-target (65 years or older) age groups. Annual percentage changes (APC) were estimated by linear regression model with breakpoints. The coverage of Pap Smear exam in the Unified Health System (SUS) was evaluated between 2009 and 2020 according to age group and locality. RESULTS There were increases in corrected mortality rates both in 1980 and in 2020 in all regions, with most evident increments at the beginning of the series. There was a decrease in mortality nationwide between 1980-2020; however, the state of São Paulo showed a discrete upward trend in 2014-2020 (APC=1.237; 95%CI 0.046-2.443). Noteworthy is the trend increment in the 25-39 year-old group in all study localities, being sharper in the Southeast region in 2013-2020 (APC=5.072; 95%CI 3.971-6.185). Screening coverage rates were highest in São Paulo and lowest in Rio de Janeiro, with a consistent decline from 2012 onwards at all ages. CONCLUSIONS São Paulo is the first Brazilian state to show a reversal trend in mortality from cervical cancer. The changes in mortality patterns identified in this study point to the need for reorganization of the current screening program, which should be improved to ensure high coverage, quality, and adequate follow-up of all women with altered test results.
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Affiliation(s)
| | - Beatriz Cordeiro Jardim
- Universidade do Estado do Rio de JaneiroInstituto de Medicina Social Hesio CordeiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social Hesio Cordeiro. Rio de Janeiro, RJ, Brasil
- nstituto Nacional de CâncerRio de JaneiroRJBrasilInstituto Nacional de Câncer. Rio de Janeiro, RJ, Brasil
| | - Victor Wünsch
- Fundação Oncocentro de São PauloSão PauloSPBrasilFundação Oncocentro de São Paulo. São Paulo, SP, Brasil
- Universidade de São PauloFaculdade de Saúde PúblicaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil
| | - José Eluf
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Gulnar Azevedo e Silva
- Universidade do Estado do Rio de JaneiroInstituto de Medicina Social Hesio CordeiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social Hesio Cordeiro. Rio de Janeiro, RJ, Brasil
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Hu SY, Zhao XL, Zhao FH, Wei LH, Zhou Q, Niyazi M, Liu JH, Wang CY, Li LY, Cheng XD, Duan XZ, Sauvaget C, Qiao YL, Sankaranarayanan R. Implementation of visual inspection with acetic acid and Lugol's iodine for cervical cancer screening in rural China. Int J Gynaecol Obstet 2023; 160:571-578. [PMID: 35871356 DOI: 10.1002/ijgo.14368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/08/2022] [Accepted: 07/20/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To address the value of visual inspection where HPV-based screening is not yet available, we evaluated the real-world effectiveness of visual inspection with acetic acid (VIA) and with Lugol's iodine (VILI) as a primary screening method for cervical cancer in rural China. METHODS A total of 206 133 women aged 30-59 years received two rounds of VIA/VILI screening for cervical cancer in 2006-2010. Women with positive screening results underwent colposcopy and direct biopsy, and were treated if cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was diagnosed. Clinical effectiveness of VIA/VILI was evaluated by process and outcome measures. RESULTS The VIA/VILI positivity rate, biopsy rate and detection rate of CIN2+ in the second round were significantly lower than in the first round. The 2-year cumulative detection rate of CIN2+ varied from 0.53% to 0.90% among the four cohorts initiated in 2006, 2007, 2008, and 2009. The first round of screening detected 60%-83% of CIN2, 70%-86% of CIN3, and 88%-100% of cervical cancer. Over 92% of CIN2+ were found at the early stage. CONCLUSION Multiple rounds of visual inspection with continuous training and quality assurance could act as a temporary substitutional screening method for cervical cancer in resource-restricted settings.
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Affiliation(s)
- Shang-Ying Hu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Lian Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang-Hui Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Hui Wei
- Peking University People's Hospital, Beijing, China
| | - Qi Zhou
- Chongqing University Cancer Hospital, Chongqing, China
| | - Mayinuer Niyazi
- People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Ji-Hong Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Chun-Yan Wang
- Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China
| | - Long-Yu Li
- Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Xiao-Dong Cheng
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | | | - Catherine Sauvaget
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - You-Lin Qiao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Goel B, Desouza A, Sehgal A, Dubey S. Looking Beyond VIA to Improve Cervical Cancer Screening in Low Resource Settings. J Obstet Gynaecol India 2022; 72:503-508. [PMID: 36506901 PMCID: PMC9732159 DOI: 10.1007/s13224-022-01674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background The two prongs for cervical cancer prevention are vaccination for primary prevention and effective screening for preinvasive and early invasive disease. Until human papilloma virus DNA testing can be provided in low resource settings, screening with VIA is the most feasible option. Various innovative methods have been used to improve the diagnostic accuracy of visual inspection with acetic acid (VIA). This study explores one such option. Method We modified VIA (VIA-Md) by using a magnifying lens mounted with battery operated light emitting devices (LEDs) to study the acetowhite areas on the cervix. The peak wavelength of the light from the LEDs was in the bluish white range. The results of VIA and VIA-Md were compared using colposcopy directed biopsy as the reference standard. Result The study was conducted in 273 eligible women. The sensitivity of VIA and VIA-Md for detecting CIN2 + lesions were 57.1% and 100% respectively. The specificity of VIA and VIA-Md were 99.2% and 89.5%; and p values using the colposcopy directed biopsy as the reference standard were 0.000 and 0.018 respectively. However, VIA-Md was also effective in identifying 21 out of the total 32 cases of chronic cervicitis identified by colposcopy directed biopsy. Conclusion VIA-Md appears to be a highly sensitive test for detection of CIN2 + lesions. However, because of concerns regarding lower specificity, VIA-Md can be used simultaneously with VIA as an effective tool for triaging women who need to be kept under close surveillance or who might benefit from local ablative therapy.
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Affiliation(s)
- Bharti Goel
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital (GMCH), Sector - 32, Chandigarh, India
| | - Argyia Desouza
- Department of Obstetrics and Gynaecology, K.S Hegde Medical Academy, Mangaluru, India
| | - Alka Sehgal
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital (GMCH), Sector - 32, Chandigarh, India
| | - Sunita Dubey
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital (GMCH), Sector - 32, Chandigarh, India
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Vikraman SM, Khanna D, Dandpat A. Cervical cancer elimination in indian context: Moving from barriers to facilitators. Cancer 2022; 128:4041-4046. [PMID: 36239011 DOI: 10.1002/cncr.34486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It has been 46 years since the launch of cancer control programs in India and yet the recent National Family Health Survey (fifth round, 2019-2021) has reported that just 1.9% of women aged 30-49 years have ever undergone cervical cancer screening. The cost of delayed diagnosis of cervical cancer and its treatment is overwhelming, and the rural population takes the worst hit. It is the need of the hour that the Indian health system and policymakers identify the barriers and facilitators for cervical cancer early detection and provide pragmatic solutions so that the targets of cervical cancer elimination can be achieved in a timely manner.
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Affiliation(s)
- Saraswathy M Vikraman
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Center and Homi Bhabha Cancer Hospital, Tata Memorial Centers, Varanasi, Uttar Pradesh, India
| | - Divya Khanna
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Center and Homi Bhabha Cancer Hospital, Tata Memorial Centers, Varanasi, Uttar Pradesh, India
| | - Abhishek Dandpat
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Center and Homi Bhabha Cancer Hospital, Tata Memorial Centers, Varanasi, Uttar Pradesh, India
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11
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Silva GAE, Alcantara LLDM, Tomazelli JG, Ribeiro CM, Girianelli VR, Santos ÉC, Claro IB, Almeida PFD, Lima LDD. [Evaluation of cervical cancer control actions within Brazil and its regions based on data recorded in the Brazilian Unified National Health System]. CAD SAUDE PUBLICA 2022; 38:e00041722. [PMID: 35894365 DOI: 10.1590/0102-311xpt041722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/06/2022] [Indexed: 11/22/2022] Open
Abstract
This study analyzes the performance of screening and diagnosis tests for cervical cancer among women aged 25 to 64 years, as well as the delay for the initiation of treatment within Brazil and in its geographic regions, from 2013 to 2020. Information on populational procedures and estimates was obtained from the information systems of the Brazilian Unified National Health System and the Brazilian National Supplementary Health Agency. We calculated the coverage indicators of the Pap smear, the percentages of altered cytopathological and histopathological tests, and the percentage of women diagnosed with cervical cancer with over 60 days of treatment. There was great variation in the coverage of the Pap smear test among the Brazilian regions with a downward trend from 2013, which was aggravated from 2019 to 2020. The number of altered cytopathological tests was 40% lower than estimated, and the difference between the recorded number of cancer diagnoses and the estimated number of patients was below 50%. The percentage of women diagnosed with invasive cervical cancer, who started treatment after 60 days, ranged from 50% in the South to 70% in the North Region with a decrease from 2018. In 2020, there was a decrease in the number of screening and follow-up tests, reducing the proportion of women delayed in starting treatment in the North, Southeast, and South regions. The decline in screening coverage and inadequate follow-up of women with altered results indicate the need to improve early detection strategies for the disease and establish mechanisms for constant evaluation and monitoring of actions.
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Affiliation(s)
- Gulnar Azevedo E Silva
- Instituto de Medicina Social Hesio Cordeiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | | | - Vania Reis Girianelli
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Édnei Cesar Santos
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Itamar Bento Claro
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
| | | | - Luciana Dias de Lima
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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12
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Luu T. Reduced Cancer Screening Due to Lockdowns of the COVID-19 Pandemic: Reviewing Impacts and Ways to Counteract the Impacts. Front Oncol 2022; 12:955377. [PMID: 35965514 PMCID: PMC9372444 DOI: 10.3389/fonc.2022.955377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has created disruptions in health services in general and cancer screening and diagnostic services in particular, leading to diminished cancer screening participation rates. This paper aims to seek insights into impacts that the pandemic has had on cancer screening, impacts that reduced cancer screening may have in the long run, and how to address such impacts. The paper demonstrates that reduced cancer screening in the pandemic is likely to result in enhanced demands for cancer screening in the new normal, enhanced demands for resources to address such demands, and poor prognosis due to stage migration of cancer diseases. Some measures are recommended for counteracting these impacts.
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13
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Zhang L, Carvalho AL, Mosquera I, Wen T, Lucas E, Sauvaget C, Muwonge R, Arbyn M, Weiderpass E, Basu P. An international consensus on the essential and desirable criteria for an 'organized' cancer screening programme. BMC Med 2022; 20:101. [PMID: 35317783 PMCID: PMC8941752 DOI: 10.1186/s12916-022-02291-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND High variability in the definition and interpretation of organized cancer screening needs to be addressed systematically. Moreover, the relevance of the current practice of categorizing screening programmes dichotomously into organized or non-organized needs to be revisited in the context of considerable heterogeneity that exists in the delivery of cancer screening in the real world. We aimed to identify the essential and desirable criteria for organized cancer screening that serve as a charter of best practices in cancer screening. METHODS We first did a systematic review of literature to arrive at an exhaustive list of criteria used by various publications to describe or define organized cancer screening, based on which, a consolidated list of criteria was generated. Next, we used a Delphi process comprising of two rounds of online surveys to seek agreement of experts to categorize each criterion into essential, desirable, or neither. Consensus was considered to have been achieved based on a predetermined criterion of agreement from at least 80% of the experts. The outcomes were presented before the experts in a virtual meeting for feedbacks and clarifications. RESULTS A total of 32 consolidated criteria for an organized screening programme were identified and presented to 24 experts from 20 countries to select the essential criteria in the Delphi first round. Total 16 criteria were selected as essential with the topmost criteria (based on the agreement of 96% of experts) being the availability of a protocol/guideline describing at least the target population, screening intervals, screening tests, referral pathway, management of positive cases and a system being in place to identify the eligible populations. In the second round of Delphi, the experts selected eight desirable criteria out of the rest 16. The most agreed upon desirable criterion was existence of a specified organization or a team responsible for programme implementation and/or coordination. CONCLUSIONS We established an international consensus on essential and desirable criteria, which screening programmes would aspire to fulfil to be better-organized. The harmonized criteria are a ready-to-use guide for programme managers and policymakers to prioritize interventions and resources rather than supporting the dichotomous and simplistic approach of categorizing programmes as organized or non-organized.
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Affiliation(s)
- Li Zhang
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Tianmeng Wen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Eric Lucas
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | | | - Partha Basu
- International Agency for Research on Cancer, Lyon, France.
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14
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Abstract
Since the publication of the 2018 FIGO Cancer Report, giant strides have been made in the global effort to reduce the burden of cervical cancer, with the World Health Organization (WHO) rolling out a global strategy for cervical cancer elimination, aiming for implementation by 2030. In over 130 countries, including low- and middle-income countries, HPV vaccination is now included in the national program. Screening has seen major advances with wider implementation of HPV testing. These interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. FIGO's revised staging of cervical cancer (2018) has been widely implemented and retrospective analyses of data based on the new staging have been published. Minimally invasive surgery has been shown to be disadvantageous in women with cervical cancer. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and GynecologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Daisuke Aoki
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
| | - Daya Nand Sharma
- Department of Radiation OncologyAll India Institute of Medical SciencesNew DelhiIndia
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15
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Basu P, Lucas E, Zhang L, Muwonge R, Murillo R, Nessa A. Leveraging vertical COVID-19 investments to improve monitoring of cancer screening programme - A case study from Bangladesh. Prev Med 2021; 151:106624. [PMID: 34023359 PMCID: PMC9755639 DOI: 10.1016/j.ypmed.2021.106624] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 02/06/2023]
Abstract
Cancer screening programs from majority of the low- and middle-income countries (LMICs) report screening coverage as the only performance indicator, and that too measured through population-based sample surveys. Such information is unreliable and has very little value in assessing programmatic quality and impact. Regular monitoring of key process and outcome indicators based on data collected through a robust information system is essential to ensure quality of a screening programme. Fragmented health systems, limited resources and absence of a culture of systematic evaluation are the major hindrances for most of the LMICs to build electronic information systems to manage screening. The COVID-19 pandemic has created an impetus for the countries to customize the freely available District Health Information Software (DHIS2) to collect electronic data to track the outbreaks and manage containment measures. In the present article we present Bangladesh as an exemplar LMIC that has a (DHIS2) based integrated health information system gradually upgraded to collect individual data of the participants to the national cervical cancer screening program. Such efforts paid rich dividends as the screening program was switched from opportunistic to a population-based one. Moreover, the electronic system could report impact of the pandemic on cancer screening on a monthly basis. The aggregate number of women screened in the year 2020 was 14.1% less compared to 2019. The monthly rate of screening during peak of the outbreak was only 5.1% of the previous year. The rate rapidly recovered as the program intensified screening in the hard-to-reach regions less affected by the pandemic and expanded the outreach services. Other LMICs may emulate Bangladesh example. Customizing the information system developed for pandemic surveillance to collect cancer screening data will help them build back the screening programs better.
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Affiliation(s)
- Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France.
| | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Li Zhang
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Richard Muwonge
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Raul Murillo
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France; Centro Javerinao de Oncología - Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Ashrafun Nessa
- Department of Obstetrics and Gynecology, Bangabandhu Sheikh, Mujib Medical University, Shahbag, Dhaka, Bangladesh
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16
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Villain P, Carvalho AL, Lucas E, Mosquera I, Zhang L, Muwonge R, Selmouni F, Sauvaget C, Basu P. Cross-sectional survey of the impact of the COVID-19 pandemic on cancer screening programs in selected low- and middle-income countries: Study from the IARC COVID-19 impact study group. Int J Cancer 2021; 149:97-107. [PMID: 33533501 PMCID: PMC8014228 DOI: 10.1002/ijc.33500] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
We conducted a study to document the impact of COVID-19 pandemic on cancer screening continuum in selected low- and middle-income countries (LMICs). LMICs having an operational cancer control plan committed to screen eligible individuals were selected. Managers/supervisors of cancer screening programs were invited to participate in an online survey and subsequent in-depth interview. Managers/supervisors from 18 programs in 17 countries participated. Lockdown was imposed in all countries except Brazil. Screening was suspended for at least 30 days in 13 countries, while diagnostic-services for screen-positives were suspended in 9 countries. All countries except Cameroon, Bangladesh, India, Honduras and China managed to continue with cancer treatment throughout the outbreak. The participants rated service availability compared to pre-COVID days on a scale of 0 (no activities) to 100 (same as before). A rating of ≤50 was given for screening services by 61.1%, diagnostic services by 44.4% and treatment services by 22.2% participants. At least 70% participants strongly agreed that increased noncompliance of screen-positive individuals and staff being overloaded or overwhelmed with backlogs would deeply impact screening programs in the next 6 months at least. Although many of the LMICs were deficient in following the "best practices" to minimize service disruptions, at least some of them made significant efforts to improve screening participation, treatment compliance and program organization. A well-coordinated effort is needed to reinitiate screening services in the LMICs, starting with a situational analysis. Innovative strategies adopted by the programs to keep services on-track should be mutually shared.
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Affiliation(s)
| | | | - Eric Lucas
- International Agency for Research on Cancer, Lyon, France
| | | | - Li Zhang
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
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17
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Nessa A, Uddin SM, Azad AK. Initiation of Population-Based Cervical and Breast Cancer Screening in Bangladesh. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00550-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Bhatla N, Meena J, Kumari S, Banerjee D, Singh P, Natarajan J. Cervical Cancer Prevention Efforts in India. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021; 19:41. [PMID: 34095455 PMCID: PMC8170054 DOI: 10.1007/s40944-021-00526-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose Cervical cancer is one of the leading cancers among women in India. Its prevention and control require a concerted effort to improve awareness among women regarding primary and secondary prevention strategies as well as access to care for treatment and palliation. A focused strategy is important to reach the World Health Organization’s targets for cervical cancer elimination, due to be completed by 2030. Methods Currently available literature was reviewed regarding cervical cancer prevention strategies in India including various national programmes and other initiatives on the part of government, non-governmental organizations and professional organizations. Their applicability to the present situation was assessed. Results National programmes need to build on success stories of various states and neighbouring countries as well as to audit the performance. Strengthening of cancer registries and improvement of linkages between different healthcare levels with incorporation of task-shifting, adding digital technology and supporting programmes that promote women’s welfare and health will also provide synergy to cancer control programmes. In the current pandemic era, HPV self-sampling can be an ideal method for screening. The development of an affordable, point-of-care HPV test is urgently needed to facilitate its introduction in low- and middle-income countries. HPV vaccination efforts need to be speeded up. Conclusion Scaling up of cervical cancer prevention with inclusion of widespread HPV vaccination and primary HPV test should be the new standard of care.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Sarita Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Dipanwita Banerjee
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Prerana Singh
- Department of Obstetrics and Gynaecology, Maa Janki Hospital and Research Center, Muzaffarpur, Bihar 842002 India
| | - Jayashree Natarajan
- Department of Gynaecologic Oncology, Cancer Institute (WIA) Adyar, Chennai, Tamil Nadu 600020 India
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