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Andrew-Bassey UI, Oke DO, Okunlola MA, Morhason-Bello IO. Scoping review protocol on the perception and attitude of women on methods for collecting cervicovaginal samples for human papillomavirus testing in sub-Saharan Africa. BMJ Open 2024; 14:e085408. [PMID: 38910004 DOI: 10.1136/bmjopen-2024-085408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION Sub-Saharan Africa (SSA) regions have the highest burden of cervical cancer (CC), accounting for nearly a quarter of global mortality. Many women in SSA are reluctant to access CC screening because they are uncomfortable exposing their private parts to healthcare providers. The perception of women who have experienced self-sampling in SSA is yet to be reviewed. This scoping review will explore the literature on the perception and attitude of women towards methods of collecting cervicovaginal samples for human papillomavirus (HPV) testing in SSA. METHODS AND ANALYSIS An extensive search using the Arksey and O'Malley framework will be conducted. The search criteria will be limited to original research conducted in community or clinical settings in SSA within the last 10 years. Four databases, namely, PUBMED, Cochrane, African Journals Online and Google Scholar, will be searched. Two independent persons (UIAB and DOO) will screen the titles and abstracts and later full texts using population, intervention, comparison and outcome criteria. IOMB will serve as a tiebreaker whenever there is no agreement on the choice of eligibility criteria. The screening process will be presented using Preferred Reporting Items for Systematic Reviews and Meta-Analyses for the scoping review flow format. The descriptive analysis of eligible studies for scoping reviews will be summarised. We will describe themes of attitude and perception covering pain, embarrassment, privacy and comfortability, willingness to self-sample, anxiety and confidence. ETHICS AND DISSEMINATION This is a scoping review protocol and does not require ethical approval. Findings from this review will be disseminated through peer-reviewed publications, the production of policy briefs, and presentations at local and international conferences.
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Affiliation(s)
- Uduak Ima Andrew-Bassey
- Pan African University Life and Earth Sciences Institute (including Health and Agriculture), Ibadan, Oyo State, Nigeria
- Centre for Medical Informatics and Professional Development, Ibadan, Nigeria
| | - Deborah Olamiposi Oke
- Department of Epidemiology and Medical Statistics,College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- HPV Research Consortium, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Michael A Okunlola
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Imran O Morhason-Bello
- HPV Research Consortium, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, University of Ibadan College of Medicine, Ibadan, Nigeria
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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Lovane L, Tulsidás S, Carrilho C, Karlsson C. PD-L1 expression in squamous cervical carcinomas of Mozambican women living with or without HIV. Sci Rep 2024; 14:12974. [PMID: 38839923 PMCID: PMC11153591 DOI: 10.1038/s41598-024-63595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
Programmed death-ligand 1 (PD-L1) is overexpressed in squamous cervical cancer (SCC) and can be used for targeted immunotherapy. The highest mortality rates of SCC are reported in sub-Saharan Africa, where Human immunodeficiency virus (HIV) prevalence is high. In Mozambique most SCC patients present at advanced stages. Thus, there is a need to introduce new treatment options. However, immunocompromised patients were frequently excluded in previous clinical trials. Our aim was to determine if PD-L1 expression in SCC is as prevalent among women living with HIV (WLWH) as among other patients. 575 SCC from Maputo Central Hospital were included. HIV status was available in 266 (46%) cases PD-L1 expression was scored through tumour proportion score (TPS) and combined positive score (CPS). PD-L1 was positive in 20.1% of the cases (n = 110), TPS (score ≥ 25%) and in 26.3% (n = 144), CPS (score ≥ 1). Stratifying according to the HIV status, WLWH were TPS positive in 16.7%, compared to 20.9%, p = 0.43, and concerning CPS 21.1% versus 28.7%, p = 0.19, respectively. PD-L1 status was not influenced by stage, Ki-67 or p16, CD8 expression influenced only CPS status. Our data indicates that the documented effect of PD-L1 therapy on SCC should be confirmed in randomized clinical trials in an HIV endemic milieu.
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Affiliation(s)
- Lucília Lovane
- Pathology Department, Maputo Central Hospital, Maputo, Mozambique.
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
| | - Satish Tulsidás
- Medical Oncology Service, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Pathology Department, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Christina Karlsson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Gebreegziabher ZA, Semagn BE, Kifelew Y, Abebaw WA, Tilahun WM. Cervical cancer screening and its associated factors among women of reproductive age in Kenya: further analysis of Kenyan demographic and health survey 2022. BMC Public Health 2024; 24:741. [PMID: 38459446 PMCID: PMC10921781 DOI: 10.1186/s12889-024-18148-y] [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: 09/10/2023] [Accepted: 02/19/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Although cervical cancer screening is one of the most effective strategies to reduce the incidence and mortality of cervical cancer, the percentage of cervical cancer screening in low- and middle-income counties is low. In Kenya, the current nationwide prevalence and associated factors for the detection of cervical cancer is unknown. Therefore, this study aimed to assess the prevalence and associated factors for the detection of cervical cancer screening among women of reproductive age in Kenya using the Kenyan Demographic and Health Survey 2022. METHODS This study used the most recent Kenyan Demographic and Health Survey data (2022) with a total weighted sample of 16,901 women. A mixed effects logistic regression analysis was performed and in the multivariable analysis, variables with a p-value below 0.05 were considered statistically significant. The strength of the association was evaluated using adjusted odds ratios along with their corresponding 95% confidence intervals. RESULTS The prevalence of cervical cancer screening in Kenya was 16.81%(95% CI: 16.24, 17.38%). Having a history of abortion (AOR = 1.33, 95% CI: 1.171.50, 1.43), using modern contraceptive methods (AOR = 1.57, 95% CI: 1.25, 1.95), media exposure (AOR = 1.31, 95%CI: 1.03, 1.65), primary education (AOR = 1.56, 95%CI: 1.09, 2.22), secondary education (AOR = 21.99, 95% CI: 1.1.38, 2.87), higher education (AOR = 2..50, 95% CI: 1.71, 3.65), visiting health facility within the past 12 months (AOR = 1.61, 95%CI: 1.46, 1.79), positive HIV status (AOR: 3.50, 95% CI: 2.69, 4.57), being from a community with a higher proportion of educated individuals (AOR = 1.37, 95%CI: 1.13, 1.65) and being from a community with high proportion of poor individuals (AOR = 0.72, 9 5%CI: 0.60-0.87)) were significantly associated with cervical cancer screening. CONCLUSION In Kenya, the prevalence of cervical cancer screening was found to be low. A history of abortion, use of modern contraceptives, exposure to the media, visits to health facilities in the past 12 months, HIV status, level of education, community educational level, and community wealth were identified as significant associated factors for cervical cancer screening. Therefore, it is recommended to implement targeted public health interventions that focus on these identified factors to improve the adoption of cervical cancer screening in Kenya.
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Affiliation(s)
- Zenebe Abebe Gebreegziabher
- Department of Epidemiology and Biostatistics, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Birhan Ewunu Semagn
- Department of Public Health, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Yitagesu Kifelew
- Department of Statistics, College of Natural and Computational Science, Oda Bultum University, Chiro, Ethiopia
| | - Wondwosen Abey Abebaw
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Lin Y, Yang Q. Mechanism of gemcitabine combined with lobaplatin in interventional treatment of locally advanced cervical cancer. Anticancer Drugs 2024; 35:209-217. [PMID: 37948339 DOI: 10.1097/cad.0000000000001551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
In order to investigate the mechanism of gemcitabine combined with lobaplatin in the interventional treatment of locally advanced cervical cancer (LACC), 90 patients with LACC were divided into control group (oxaliplatin + gemcitabine) and experimental group (lobaplatin + gemcitabine) according to different perfusion drugs and embolization drugs, 45 cases in each group. They were treated with arterial chemotherapy and arterial embolization. Postoperative recurrence, metastasis, and survival, as well as changes in serum vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) levels before and after treatment were observed in both groups. The results showed that the recurrence rate of cervical cancer at 0.5, 1, 2, 3, 4, and 5 years after operation in the experimental group was significantly lower than that in the control group, P < 0.05; there was no significant difference in the postoperative cervical cancer metastasis rate, P > 0.05. Before treatment, the serum VEGF in the experimental group and the control group were (642.76 ± 216.67) ng/L and (626.30 ± 275.43) ng/L, respectively, and MMP-9 were (580.61 ± 194.12) ng/L and (575.28 ± 202.55) ng/L, respectively. After treatment, the serum VEGF levels in the experimental group and the control group were (429.24 ± 132.69) ng/L and (554.63 ± 178.11) ng/L, respectively, and MMP-9 levels were (357.60 ± 123.11) ng/L and (461.83 ± 144.45) ng/L, respectively. There was no significant difference in the serum VEGF and MMP-9 levels between the two groups before treatment ( P > 0.05); after treatment, the serum VEGF and MMP-9 levels in the experimental group were significantly lower than those in the control group, P < 0.05. Therefore, gemcitabine combined with lobaplatin interventional therapy can improve the cure rate of LACC by reducing VEGF and MMP-9 levels in the serum of patients.
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Affiliation(s)
- Yang Lin
- Department of Oncology, Chongqing North Kuanren Hospital
| | - Qiaoli Yang
- Department of Radiology, Chongqing Maternal and Child Health Hospital, Chongqing, China
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Zewdie A, Shitu S, Kebede N, Gashaw A, Eshetu HB, Eseyneh T, Kasahun AW. Determinants of late-stage cervical cancer presentation in Ethiopia: a systematic review and meta-analysis. BMC Cancer 2023; 23:1228. [PMID: 38097989 PMCID: PMC10720221 DOI: 10.1186/s12885-023-11728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/08/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Behind breast, colorectal, and lung cancers, cervical cancer is the fourth most common cancer affecting females. Despite, it is a preventable form of cancer both the incidence and mortality figures reflect it as a major reproductive health problem. Late-stage cervical cancer diagnosis is associated with complicated clinical presentation which can result in short survival time and increased mortality. Several factors contribute to the late-stage presentation of cervical cancer patients. In Ethiopia nationally summarized evidence on the level and the factors contributing to late-stage cervical cancer diagnosis is scarce. Therefore, this systematic review and meta-analysis aimed to assess the pooled prevalence of late-stage cervical cancer diagnosis and its determinants in Ethiopia. METHOD A systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Embase, Google Scholar, and African Online Journal to retrieve eligible articles. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among studies. Funnel plot and Egger's regression test were done to assess publication bias. RESULT Overall, 726 articles were retrieved and finally 10 articles were included in this review. The pooled prevalence of late-stage cervical cancer diagnosis in Ethiopia was 60.45% (95%CI; 53.04%-67.85%). Poor awareness about cervical cancer and its treatment (AOR = 1.55, 95% CI: (1.03 - 2.33, longer delay to seek care (AOR = 1.02, 95% CI: (1.01 - 1.03)) and rural residence (AOR = 2.07, 95% CI:( 1.56 - 2.75)) were significantly associated to late-stage diagnosis. CONCLUSION In Ethiopia, six in every ten cervical cancer cases are diagnosed at the late stage of the disease. Poor awareness about cervical cancer and its treatment, long patient delay to seek care, and rural residence were positively associated with late-stage diagnosis. Therefore intervention efforts should be made to improve public awareness about cervical cancer, minimize patient delay to seek care, and expand screening services specifically in the rural residing segment of the population to detect the disease early and improve survival.
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Affiliation(s)
- Amare Zewdie
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
| | - Solomon Shitu
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Anteneh Gashaw
- Department of Midwifery, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behaviour, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO.Box.196, Gondar, Ethiopia
| | - Tenagnework Eseyneh
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Abebaw Wasie Kasahun
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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Christensen AJ, Mwayi J, Mbabazi J, Juncker M, Kallestrup P, Kraef C. Fighting cervical cancer in Africa: a cross-sectional study on prevalence and risk factors for precancerous lesions in rural Uganda. Public Health 2023; 225:87-95. [PMID: 37922591 DOI: 10.1016/j.puhe.2023.09.023] [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: 05/15/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To identify risk factors for precancerous cervical lesions and factors associated with treatment delay among women in the rural Busoga Region, Uganda. STUDY DESIGN A retrospective cross-sectional study from a regional cervical cancer screening program and from cervical cancer patients enrolled in a region-wide palliative care program. METHODS Logistic regression analysis was conducted to assess risk factors for screening positive for precancerous lesions. In a separate analysis, factors associated with treatment delay were assessed among women enrolled in the palliative care program. RESULTS Three thousand nine hundred forty-six women were included from the screening program and 334 from the palliative care program. In total, 7.6% of screening participants had precancerous lesions. Within Busoga Region, the highest positivity rate was found in Bugweri and Namayingo Districts. Abnormal vaginal bleeding (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI] 1.15-2.21; p = 0.005) and older age at first menstrual period (aOR 1.08; 95% CI 1.01-1.16; p = 0.03) were associated with having a precancerous lesion. Among palliative care patients, a history of previous contact with the health care system was associated with a delay in enrolment (≥12 months from first symptom presentation until commencement in palliative care; aOR 5.23; 95% CI 1.16-36.54; p = 0.047). CONCLUSIONS The results underline an unmet need for broad-scale cervical cancer screening focusing on all women in the reproductive age. Abnormal bleeding was the only substantial risk factor for precancerous lesions, indicating that specific algorithms to identify high-risk populations may not be applicable in this population. Increased awareness, resources, and funding are still necessary to achieve global cervical cancer elimination.
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Affiliation(s)
| | - J Mwayi
- Rays of Hope Hospice Jinja, Uganda
| | | | | | - P Kallestrup
- Department of Public Health, Aarhus University, Denmark; Danish Non-Communicable-Disease Alliance, Denmark
| | - C Kraef
- Department of Infectious Diseases, Rigshospitalet Copenhagen, Denmark; Heidelberg Institute of Global Health, University of Heidelberg, Germany; Centre of Excellence for Health, Immunity and Infections (CHIP), Copenhagen University Hospital - Rigshospitalet, Denmark
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Kabukye JK, Namugga J, Mpamani CJ, Katumba A, Nakatumba-Nabende J, Nabuuma H, Musoke SS, Nankya E, Soomre E, Nakisige C, Orem J. Implementing Smartphone-Based Telemedicine for Cervical Cancer Screening in Uganda: Qualitative Study of Stakeholders' Perceptions. J Med Internet Res 2023; 25:e45132. [PMID: 37782541 PMCID: PMC10580134 DOI: 10.2196/45132] [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: 01/01/2023] [Revised: 04/03/2023] [Accepted: 07/27/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND In Uganda, cervical cancer (CaCx) is the commonest cancer, accounting for 35.7% of all cancer cases in women. The rates of human papillomavirus vaccination and CaCx screening remain low. Digital health tools and interventions have the potential to improve different aspects of CaCx screening and control in Uganda. OBJECTIVE This study aimed to describe stakeholders' perceptions of the telemedicine system we developed to improve CaCx screening in Uganda. METHODS We developed and implemented a smartphone-based telemedicine system for capturing and sharing cervical images and other clinical data, as well as an artificial intelligence model for automatic analysis of images. We conducted focus group discussions with health workers at the screening clinics (n=27) and women undergoing screening (n=15) to explore their perceptions of the system. The focus group discussions were supplemented with field observations and an evaluation survey of the health workers on system usability and the overall project. RESULTS In general, both patients and health workers had positive opinions about the system. Highlighted benefits included better cervical visualization, the ability to obtain a second opinion, improved communication between nurses and patients (to explain screening findings), improved clinical data management, performance monitoring and feedback, and modernization of screening service. However, there were also some negative perceptions. For example, some health workers felt the system is time-consuming, especially when it had just been introduced, while some patients were apprehensive about cervical image capture and sharing. Finally, commonplace challenges in digital health (eg, lack of interoperability and problems with sustainability) and challenges in cancer screening in general (eg, arduous referrals, inadequate monitoring and quality control) also resurfaced. CONCLUSIONS This study demonstrates the feasibility and value of digital health tools in CaCx screening in Uganda, particularly with regard to improving patient experience and the quality of screening services. It also provides examples of potential limitations that must be addressed for successful implementation.
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Affiliation(s)
- Johnblack K Kabukye
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
- Uganda Cancer Institute, Kampala, Uganda
| | - Jane Namugga
- Uganda Cancer Institute, Kampala, Uganda
- Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda
| | | | - Andrew Katumba
- Department of Electrical Engineering, Makerere University, Kampala, Uganda
| | | | - Hanifa Nabuuma
- Department of Electrical Engineering, Makerere University, Kampala, Uganda
| | - Stephen Senkomago Musoke
- Global Programs for Research and Training, University of California San Francisco, Kampala, Uganda
| | | | - Edna Soomre
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
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Hobenu KA, Naab F. A qualitative exploration of the spiritual wellbeing of women with advanced cervical cancer in Ghana. Int J Palliat Nurs 2023; 29:434-444. [PMID: 37757810 DOI: 10.12968/ijpn.2023.29.9.434] [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] [Indexed: 09/29/2023]
Abstract
BACKGROUND Spiritual wellbeing is one of the most important aspects of human health, alongside physical, psychological and social factors. Religiosity/spirituality can play a critical role in the lives of people experiencing life-threatening illnesses, such as cervical cancer. Most women with cervical cancer in Africa, including Ghana, are diagnosed at the advanced stage. These women lean on their spiritual connections for strength during their illness. Despite the fact that numerous studies have been conducted on the relevance of religiosity/spirituality in the experience of cancer in other jurisdictions, the same cannot be said about Ghana. The study aims to fill this gap in the literature. AIM To explore the spiritual wellbeing of women diagnosed with advanced cervical cancer in Ghana. METHOD A qualitative explorative design was employed, with purposive sampling used to recruit 15 women with advanced cervical cancer from a cancer treatment centre of a teaching hospital in Ghana. Individual face-to-face interviews, lasting between 45-90 minutes, were used to gather information. Interviews were audio taped with participants' consent. Data were analysed using thematic content analysis. FINDINGS The following sub-themes were identified within one overarching theme of the spiritual wellbeing of women with advanced cervical cancer: the meaning of illness and acceptance; a sense of hope and religiosity; uncertainty; and the will to live. CONCLUSION Many participants believed they were bewitched, and the devil was responsible for their cervical cancer. Healthcare providers should adopt a multi-disciplinary approach and widen their care strategies to include spirituality, to enhance the treatment outcomes of women living with advanced cervical cancer.
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Affiliation(s)
| | - Florence Naab
- Department of Maternal and Child Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana
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Olwal CO, Fabius JM, Zuliani-Alvarez L, Eckhardt M, Kyei GB, Quashie PK, Krogan NJ, Bouhaddou M, Bediako Y. Network modeling suggests HIV infection phenocopies PI3K-AKT pathway mutations to enhance HPV-associated cervical cancer. Mol Omics 2023; 19:538-551. [PMID: 37204043 PMCID: PMC10524288 DOI: 10.1039/d3mo00025g] [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] [Indexed: 05/20/2023]
Abstract
Women coinfected with human immunodeficiency virus type 1 (HIV-1) and human papillomavirus (HPV) are six times as likely to develop invasive cervical carcinoma compared to those without HIV. Unlike other HIV-associated cancers, the risk of cervical cancer development does not change when HPV/HIV coinfected women begin antiretroviral therapy, suggesting HIV-associated immune suppression is not a key driver of cervical cancer development in coinfected women. Here, we investigated whether the persistent secretion of inflammatory factors in HIV-positive patients on antiretroviral therapy could enhance cancer signaling in HPV-infected cervical cells via endocrine mechanisms. We integrated previously reported HIV-induced secreted inflammatory factors (Hi-SIFs), HIV and HPV virus-human protein interactions, and cervical cancer patient genomic data using network propagation to understand the pathways underlying disease development in HPV/HIV coinfection. Our results pinpointed the PI3K-AKT signaling pathway to be enriched at the interface between Hi-SIFs and HPV-host molecular networks, in alignment with PI3K pathway mutations being prominent drivers of HPV-associated, but HIV independent, cervical cancer development. Furthermore, we experimentally stimulated cervical cells with 14 Hi-SIFs to assess their ability to activate PI3K-AKT signaling. Strikingly, we found 8 factors (CD14, CXCL11, CXCL9, CXCL13, CXCL17, AHSG, CCL18, and MMP-1) to significantly upregulate AKT phosphorylation (pAKT-S473) relative to a phosphate buffered saline control. Our findings suggest that Hi-SIFs cooperate with HPV infection in cervical cells to over-activate PI3K-AKT signaling, effectively phenocopying PI3K-AKT pathway mutations, resulting in enhanced cervical cancer development in coinfected women. Our insights could support the design of therapeutic interventions targeting the PI3K-AKT pathway or neutralizing Hi-SIFs in HPV/HIV coinfected cervical cancer patients.
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Affiliation(s)
- Charles Ochieng' Olwal
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana.
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Jacqueline M Fabius
- The J. David Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
- The Cancer Cell Map Initiative, San Francisco and La Jolla, CA, USA
| | - Lorena Zuliani-Alvarez
- The J. David Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
- The Cancer Cell Map Initiative, San Francisco and La Jolla, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA, USA.
| | - Manon Eckhardt
- The J. David Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA, USA.
| | - George Boateng Kyei
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
- University of Ghana Medical Centre, University of Ghana, Accra, Ghana
| | - Peter Kojo Quashie
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana.
| | - Nevan J Krogan
- The J. David Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
- The Cancer Cell Map Initiative, San Francisco and La Jolla, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA, USA.
| | - Mehdi Bouhaddou
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
- Institute for Quantitative and Computational Biosciences (QCBio), University of California, Los Angeles, LA, USA
- Department of Microbiology, Immunology, and Molecular Genetics (MIMG), University of California, Los Angeles, LA, USA.
- Molecular Biology Institute, University of California, Los Angeles, LA, USA
| | - Yaw Bediako
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana.
- Yemaachi Biotech, Accra, Ghana
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Dickson KS, Boateng ENK, Acquah E, Ayebeng C, Addo IY. Screening for cervical cancer among women in five countries in sub-saharan Africa: analysis of the role played by distance to health facility and socio-demographic factors. BMC Health Serv Res 2023; 23:61. [PMID: 36670402 PMCID: PMC9862532 DOI: 10.1186/s12913-023-09055-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cervical cancer significantly affects women in Sub-Saharan Africa (SSA). However, limited studies have concentrated on cervical screening behaviour among women in SSA. This study aimed to assess the interplay of distance to health facilities and socio-demographic factors with cervical screening behaviour among women in five SSA countries. METHODS The study was based on pooled data of 40,555 women included in Demographic and Health Surveys (DHS) conducted between 2013 to 2021. Proportions and logistic regression models were used in assessing the interplay of distance to health facilities and socio-demographic factors with cervical screening behaviour. RESULTS Approximately, 7.9% of women that saw the distance to a health facility as a big problem, tested for cervical cancer compared to 13.5% who indicated that distance to a health facility is not a big problem. More women in urban areas, with a higher level of education, of richest wealth index, aged 40-44 years and using contraceptives who also indicated that distance to a health facility was a big problem tested for cervical cancer compared to those in rural areas with no education, of poorest wealth index, aged 15-19 years and not using contraceptives. Education, age, contraceptive use, frequent exposure to mass media and Sexual Transmitted Infections (STI) had a significant relationship with testing for cervical cancer. CONCLUSION The prevalence of cervical cancer screening was low in the five SSA countries largely due to distance barriers and was also significantly influenced by education, age, contraceptive use, frequent exposure to mass media, and STI status. To improve the screening for cervical cancer and its associated benefits in the five SSA countries, there is a need for policymakers, clinicians and public health workers to channel more commitment and efforts to addressing the barriers identified in this study.
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Affiliation(s)
- Kwamena S. Dickson
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer N. K. Boateng
- grid.413081.f0000 0001 2322 8567Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana
| | - Evelyn Acquah
- grid.449729.50000 0004 7707 5975Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Castro Ayebeng
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Isaac Y. Addo
- grid.1005.40000 0004 4902 0432Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
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11
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Vilares AT, Ciabattoni R, Cunha TM, Félix A. Cervical cancer in Cape Verde: reappraisal upon referral to a tertiary cancer centre. Ecancermedicalscience 2022; 16:1471. [PMID: 36819824 PMCID: PMC9934889 DOI: 10.3332/ecancer.2022.1471] [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: 07/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Cervical cancer (CC) is the first cause of cancer-related deaths among Cape Verdean women. The absence of a national screening programme and a lack of dedicated cancer treatment facilities contribute to its high mortality rate. In an effort to improve the prognosis of these women, a health cooperation agreement was established between Portugal and Cape Verde (CV), allowing their evacuation to Portuguese hospitals. Our aim was to characterise CC among CV women, and to assess the response given to these patients in Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), so that their treatment and follow-up protocols can be optimised and overall prognosis improved. Methods Retrospective evaluation of women diagnosed with CC in CV that underwent therapy in IPOLFG between 2013 and 2020. Risk factors, demographic and tumour characteristics, treatment and outcomes were reviewed. Results Fifty-eight patients were included. Squamous cell carcinoma was the most frequent (91.5%) histological type. HPV DNA was present in 25 out of 26 samples.The agreement rate between the pathology analysis performed in CV and in Portugal was high (87.9%); however, the agreement regarding the FIGO stage was low (15.5%). This may be explained by both the time interval between diagnosis and treatment (around 6 months) and by the absence of resources to accurately stage the disease in CV. In IPOLFG, 77.6% of patients received combined chemo-radiotherapy. Post-treatment follow-up varied widely, due to disease-related and bureaucratic issues. Eighteen patients developed cancer-related complications and/or cancer-related death. The survival rate and median overall survival (OS) in our cohort were of 89.7% and 73.2 months, respectively. Conclusions Although most women had advanced-stage disease, the OS in our cohort was better than what has been reported for other African countries, probably because state-of-the-art treatment, frequently not accessible in those countries, was offered to all patients.
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Affiliation(s)
- Ana Teresa Vilares
- Department of Radiology, Centro Hospitalar Universitário de São João, Porto 4200-319, Portugal,Medical School, University of Porto, Porto 4200-319, Portugal,https://orcid.org/0000-0001-7375-491X
| | - Riccardo Ciabattoni
- Azienda Sanitaria Universitaria Giuliano-Isontina, Dipartimento Universitario di Scienze Mediche Chirurgiche e Sperimentali, Università degli Studi di Trieste, Trieste 34148, Italy,https://orcid.org/0000-0003-4555-6128
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon 1099-023, Portugal,https://orcid.org/0000-0003-2411-0207
| | - Ana Félix
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon 1099-023, Portugal,NOVA Medical School, NMS, Universidade NOVA de Lisboa, Lisbon, Portugal,https://orcid.org/0000-0002-2653-2262
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12
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Friebel-Klingner TM, Bazzett-Matabele L, Ramogola-Masire D, Monare B, Ralefala TB, Seiphetlheng A, Ramontshonyana G, Vuylsteke P, Mitra N, Wiebe DJ, Rebbeck TR, McCarthy AM, Grover S. Distance to Multidisciplinary Team Clinic in Gaborone, Botswana, and Stage at Cervical Cancer Presentation for Women Living With and Without HIV. JCO Glob Oncol 2022; 8:e2200183. [PMID: 36395437 PMCID: PMC10166426 DOI: 10.1200/go.22.00183] [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: 05/26/2022] [Revised: 07/20/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Cervical cancer is the leading cause of cancer death for women in Botswana. Barriers in access to cancer care can lead to later stages at diagnosis and increased mortality. This study evaluated access, defined as travel time from a patient's residential village to a multidisciplinary team clinic in Gaborone, with stage of cervical cancer at presentation. In addition, because of the high HIV prevalence in Botswana, we explored the association between travel time and HIV status. METHODS Eligible patients with cervical cancer presenting to the multidisciplinary team between 2015 and 2020 were included. Data were abstracted from questionnaires and hospital records. Google Maps was used to calculate travel time. Multinomial regression was used to examine travel time and cancer stage, and multivariable logistic regression was used to investigate travel time and HIV status. RESULTS We identified 959 patients with cervical cancer of which 70.1% were women living with HIV. The median travel time was approximately 2 hours. Using a reference group of stage I disease and a travel time of < 1 hour, the odds of presenting with stage II increased for patients traveling 3-5 hours (adjusted odds ratio [OR], 2.00; 95% CI, 1.14 to 3.52) and > 5 hours (OR, 2.19; 95% CI, 1.15 to 4.19). There were no significant associations for stage III. For stage IV disease, the odds were increased for patients traveling 3-5 hours (OR, 2.93; 95% CI, 1.26 to 6.79) and > 5 hours (adjusted OR, 4.05; 95% CI, 1.62 to 10.10). In addition, the odds of patients presenting living with HIV increased with increasing travel time (trend test = 0.004). CONCLUSION This study identified two potential factors, travel time and HIV status, that influence access to comprehensive cervical cancer care in Botswana.
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Affiliation(s)
- Tara M. Friebel-Klingner
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | | | | | | | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Douglas J. Wiebe
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Timothy R. Rebbeck
- Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, MA
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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13
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Friebel-Klingner TM, Iyer HS, Ramogola-Masire D, Bazzett-Matabele L, Monare B, Seiphetlheng A, Ralefala TB, Mitra N, Wiebe DJ, Rebbeck TR, Grover S, McCarthy AM. Evaluating the geographic distribution of cervical cancer patients presenting to a multidisciplinary gynecologic oncology clinic in Gaborone, Botswana. PLoS One 2022; 17:e0271679. [PMID: 35925976 PMCID: PMC9352107 DOI: 10.1371/journal.pone.0271679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/05/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE In Botswana, cervical cancer is the leading cause of cancer death for females. With limited resources, Botswana is challenged to ensure equitable access to advanced cancer care. Botswana's capital city, Gaborone, houses the only gynecologic oncology multi-disciplinary team (MDT) and the one chemoradiation facility in the country. We aimed to identify areas where fewer women were presenting to the MDT clinic for care. METHODS This cross-sectional study examined cervical cancer patients presenting to the MDT clinic between January 2015 and March 2020. Patients were geocoded to residential sub-districts to estimate age-standardized presentation rates. Global Moran's I and Anselin Local Moran's I tested the null hypothesis that presentation rates occurred randomly in Botswana. Community- and individual-level factors of patients living in sub-districts identified with higher (HH) and lower (LL) clusters of presentation rates were examined using ordinary least squares with a spatial weights matrix and multivariable logistic regression, respectively, with α level 0.05. RESULTS We studied 990 patients aged 22-95 (mean: 50.6). Presentation rates were found to be geographically clustered across the country (p = 0.01). Five sub-districts were identified as clusters, two high (HH) sub-district clusters and three low (LL) sub-district clusters (mean presentation rate: 35.5 and 11.3, respectively). Presentation rates decreased with increased travel distance (p = 0.033). Patients residing in LL sub-districts more often reported abnormal vaginal bleeding (aOR: 5.62, 95% CI: 1.31-24.15) compared to patients not residing in LL sub-districts. Patients in HH sub-districts were less likely to be living with HIV (aOR: 0.59; 95% CI: 0.38-0.90) and more likely to present with late-stage cancer (aOR: 1.78; 95%CI: 1.20-2.63) compared to patients not in HH sub-districts. CONCLUSIONS This study identified geographic clustering of cervical cancer patients presenting for care in Botswana and highlighted sub-districts with disproportionately lower presentation rates. Identified community- and individual level-factors associated with low presentation rates can inform strategies aimed at improving equitable access to cervical cancer care.
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Affiliation(s)
- Tara M. Friebel-Klingner
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Hari S. Iyer
- Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut, United States of America
| | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut, United States of America
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | | | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Douglas J. Wiebe
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Timothy R. Rebbeck
- Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Ssentongo P, McCall-Hosenfeld JS, Calo WA, Moss J, Lengerich EJ, Chinchilli VM, Ba DM. Association of human papillomavirus vaccination with cervical cancer screening: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29329. [PMID: 35839062 PMCID: PMC11132352 DOI: 10.1097/md.0000000000029329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Prophylactic vaccination and routine screening are effective at preventing most cases of cervical cancer. Globally, cervical cancer is the fourth most frequently diagnosed cancer among women. The aim of this study was to investigate the association between human papillomavirus virus (HPV) vaccination (1, 2, or 3 doses) and cervical cancer screening. METHODS PubMed (MEDLINE), Scopus, Web of Science, and Cochrane Library electronic databases were systematically searched from July 1, 2006, up to September 30, 2021. We pooled estimates using random-effects models. Heterogeneity between studies was quantified using Cochran Q test and I2 statistics. In total, 12 studies involving 2.4 million individuals were included in the meta-analysis. RESULTS In the adjusted estimates, uptake of HPV vaccination was associated with increased cervical cancer screening (pooled relative risk [RR]: 1.35; 95% confidence interval [CI]: 1.21, 1.50; n = 12). Between-study heterogeneity was large (I2 = 99%). Compared to unvaccinated, those who received 3 doses of HPV vaccine had the highest uptake of cervical cancer screening (RR: 1.85; 95% CI: 1.58, 2.17), followed by those who received 2 doses (RR: 1.34; 95% CI: 1.21, 1.47). No statistically significant association with screening was found for those who received a single dose of the HPV vaccine. CONCLUSION In this meta-analysis, uptake of HPV vaccination was associated with higher cervical cancer screening. It is plausible that vaccinated individuals are more likely to engage in preventive health behaviors. Healthcare providers should remind patients to continue with routine screening for cervical cancer regardless of their HPV vaccine status since vaccination does not protect against all HPV types.
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Affiliation(s)
- Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- College of Engineering Science and Mechanics, The Pennsylvania State University, State College, PA
| | - Jennifer S. McCall-Hosenfeld
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Department of Medicine, Penn State College of Medicine, Hershey, PA
| | - William A. Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Jennifer Moss
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA
| | - Eugene J. Lengerich
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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15
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Benider A, Bendahhou K, Sauvaget C, Mrabti H, Selmouni F, Muwonge R, Alaoui L, Lucas E, Chami Y, Abousselham L, Bennani M, Errihani H, Sankaranarayanan R, Bekkali R, Basu P. Evolution of patterns of care for women with cervical cancer in Morocco over a decade. BMC Cancer 2022; 22:479. [PMID: 35501742 PMCID: PMC9059352 DOI: 10.1186/s12885-022-09358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We conducted a Pattern-of-care (POC) study at two premier-most public-funded oncology centers in Morocco to evaluate delays in care continuum and adherence to internationally accepted treatment guidelines of cervical cancer. METHOD Following a systematic sampling method, cervical cancer patients registered at Centre Mohammed VI (Casablanca) and Institut National d'Oncologie (Rabat) during 2 months of every year from 2008 to 2017, were included in this retrospective study. Relevant information was abstracted from the medical records. RESULTS A total of 886 patients was included in the analysis; 59.5% were at stage I/II. No appreciable change in stage distribution was observed over time. Median access and treatment delays were 5.0 months and 2.3 months, respectively without any significant temporal change. Concurrent chemotherapy was administered to 57.7% of the patients receiving radiotherapy. Surgery was performed on 81.2 and 34.8% of stage I and II patients, respectively. A very high proportion (85.7%) of operated patients received post-operative radiation therapy. Median interval between surgery and initiation of radiotherapy was 3.1 months. Only 45.3% of the patients treated with external beam radiation received brachytherapy. Radiotherapy was completed within 10 weeks in 77.4% patients. An overall 5-year disease-free survival (DFS) was observed in 57.5% of the patients - ranging from 66.1% for stage I to 31.1% for stage IV. Addition of brachytherapy to radiation significantly improved survival at all stages. The study has the usual limitations of retrospective record-based studies, which is data incompleteness. CONCLUSION Delays in care continuum need to be further reduced. Increased use of chemoradiation and brachytherapy will improve survival further.
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Affiliation(s)
- Abdellatif Benider
- Centre Mohammed VI Pour Le Traitement Des Cancers, Centre Hospitalier Universitaire Ibn Rochd de Casablanca, Casablanca, Maroc
| | - Karima Bendahhou
- Registre Des Cancers de La Région du Grand Casablanca, Casablanca, Maroc
| | - Catherine Sauvaget
- Early Detection, Prevention & Infections Branch, International Agency for Research On Cancer (WHO), 150 cours Albert Thomas, 69372 Cedex 08, Lyon, France
| | - Hind Mrabti
- Institut National d'oncologie, CHU-Rabat, Rabat, Morocco
| | - Farida Selmouni
- Early Detection, Prevention & Infections Branch, International Agency for Research On Cancer (WHO), 150 cours Albert Thomas, 69372 Cedex 08, Lyon, France
| | - Richard Muwonge
- Early Detection, Prevention & Infections Branch, International Agency for Research On Cancer (WHO), 150 cours Albert Thomas, 69372 Cedex 08, Lyon, France
| | | | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research On Cancer (WHO), 150 cours Albert Thomas, 69372 Cedex 08, Lyon, France
| | - Youssef Chami
- Lalla Salma Foundation, Prevention and Treatment of Cancers, Rabat, Morocco
| | - Loubna Abousselham
- Cancer Unit, Epidemiology and Disease Control Department, Ministry of Health, Rabat, Morocco
| | - Maria Bennani
- Lalla Salma Foundation, Prevention and Treatment of Cancers, Rabat, Morocco
| | | | | | - Rachid Bekkali
- Lalla Salma Foundation, Prevention and Treatment of Cancers, Rabat, Morocco
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research On Cancer (WHO), 150 cours Albert Thomas, 69372 Cedex 08, Lyon, France.
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16
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Mattern J, Letendre I, Sibiude J, Pénager C, Jnifen A, Souare F, Ayel S, Nguyen T, Mandelbrot L. Diagnosis of advanced cervical cancer, missed opportunities? BMC Womens Health 2022; 22:97. [PMID: 35354463 PMCID: PMC8969332 DOI: 10.1186/s12905-022-01668-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Cervical cancer is common worldwide. Despite the existence of primary and secondary prevention strategies, the survival rate is decreasing in France due to an increasing proportion of advanced-stage cancer. Our objective was to determine the factors associated with a diagnosis of cervical cancer at advanced stages in an urban population in France. Methods A retrospective study was conducted on all consecutive records of patients diagnosed with cervical cancer between January 2006 and December 2018 in a single center in Paris. The data collected were demographic characteristics, medical and gynecological history, circumstances of diagnosis, diagnostic and therapeutic management. The patients were divided into two groups according to the FIGO 2018 stage at diagnosis: group A stages IA1 to IB2 and group B advanced stages IB3 to IVB. Results Among 96 patients who were diagnosed with cervical cancer, 25 (26%) were in group A and 71 (74%) in group B. Women in group B had less frequently received regular gynecological care than in group A (36% vs 84.2%, p < 0.001) and fewer had Pap test screening in the previous 3 years (30.4% vs 95.0%, p < 0.001). Parity greater than 3 was more frequent in group B (69.6% vs 42.9%, p = 0.031). The diagnosis was made during a routine examination or cervical smear in only 9.23% and 16.18% respectively in group B, versus 60% of cases in 45.82% of cases in group A (p < 0.001 and p = 0.003). Vaginal bleeding was observed in 85.29% in group B versus 36% in group A (p < 0.001). Histological type was squamous cell carcinoma 87.32% of group B and 56% of group A (p < 0.001). Conclusion Diagnosis of cervical cancers at advanced stages occurred mostly in women who did not benefit from the recommended screening. Universal access to screening is necessary for the prevention and early treatment of cervical cancer.
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Affiliation(s)
- Jérémie Mattern
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France.,Université de Paris, Paris, France
| | - Irène Letendre
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - Jeanne Sibiude
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France.,Université de Paris, Paris, France.,Inserm IAME 1137, Paris, France
| | - Cécile Pénager
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France.,Université de Paris, Paris, France
| | - Asma Jnifen
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - Fatoumata Souare
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - Sophie Ayel
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - Thuy Nguyen
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France. .,Université de Paris, Paris, France. .,Inserm IAME 1137, Paris, France.
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Abstract
OBJECTIVES To survey on the availability and use of primary care services in slum populations. DESIGN Retrospective, cross-sectional, household, individual and healthcare provider surveys. SETTING Seven slum sites in four countries (Nigeria, Kenya, Pakistan and Bangladesh). PARTICIPANTS Residents of slums and informal settlements. PRIMARY AND SECONDARY OUTCOME MEASURES Primary care consultation rates by type of provider and facility. RESULTS We completed 7692 household, 7451 individual adult and 2633 individual child surveys across seven sites. The majority of consultations were to doctors/nurses (in clinics or hospitals) and pharmacies rather than single-handed providers or traditional healers. Consultation rates with a doctor or nurse varied from 0.2 to 1.5 visits per person-year, which was higher than visit rates to any other type of provider in all sites except Bangladesh, where pharmacies predominated. Approximately half the doctor/nurse visits were in hospital outpatient departments and most of the remainder were to clinics. Over 90% of visits across all sites were for acute symptoms rather than chronic disease. Median travel times were between 15 and 45 min and the median cost per visit was between 2% and 10% of a household's monthly total expenditure. Medicines comprised most of the cost. More respondents reported proximity (54%-78%) and service quality (31%-95%) being a reason for choosing a provider than fees (23%-43%). Demand was relatively inelastic with respect to both price of consultation and travel time. CONCLUSIONS People in slums tend to live sufficiently close to formal doctor/nurse facilities for their health-seeking behaviour to be influenced by preference for provider type over distance and cost. However, costs, especially for medicines are high in relation to income and use rates remain significantly below those of high-income countries.
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18
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Inequity of healthcare access and use and catastrophic health spending in slum communities: a retrospective, cross-sectional survey in four countries. BMJ Glob Health 2021; 6:bmjgh-2021-007265. [PMID: 34844998 PMCID: PMC8633995 DOI: 10.1136/bmjgh-2021-007265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Tracking the progress of universal health coverage (UHC) is typically at a country level. However, country-averages may mask significant small-scale variation in indicators of access and use, which would have important implications for policy choice to achieve UHC. Methods We conducted a retrospective cross-sectional household and individual-level survey in seven slum sites across Nigeria, Kenya, Bangladesh and Pakistan. We estimated the adjusted association between household capacity to pay and report healthcare need, use and spending. Catastrophic health expenditure was estimated by five different methods. Results We surveyed 7002 households and 6856 adults. Gini coefficients were wide, ranging from 0.32 to 0.48 across the seven sites. The total spend of the top 10% of households was 4–47 times more per month than the bottom 10%. Households with the highest budgets were: more likely to report needing care (highest vs lowest third of distribution of budgets: +1 to +31 percentage points (pp) across sites), to spend more on healthcare (2.0 to 6.4 times higher), have more inpatient and outpatient visits per year in five sites (1.0 to 3.0 times more frequently), spend more on drugs per visit (1.1 to 2.2 times higher) and were more likely to consult with a doctor (1.0 to 2.4 times higher odds). Better-off households were generally more likely to experience catastrophic health expenditure when calculated according to four methods (−1 to +12 pp), but much less likely using a normative method (−60 to −80 pp). Conclusions Slums have a very high degree of inequality of household budget that translates into inequities in the access to and use of healthcare. Evaluation of UHC and healthcare access interventions targeting these areas should consider distributional effects, although the standard measures may be unreliable.
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19
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Akokuwebe ME, Idemudia ES, Lekulo AM, Motlogeloa OW. Determinants and levels of cervical Cancer screening uptake among women of reproductive age in South Africa: evidence from South Africa Demographic and health survey data, 2016. BMC Public Health 2021; 21:2013. [PMID: 34740352 PMCID: PMC8571865 DOI: 10.1186/s12889-021-12020-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/30/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cervical cancer (CC) is the cancer with the most incidents and the leading cause of cancer mortality among women in South Africa. CC screening is one of the most cost-effective control approaches for the disease burden. This study assessed the determinants and individual-level indicators of cervical cancer screening uptake among women of reproductive age in South Africa. METHODS We analyzed data from the 2016 South Africa Demographic Health Survey. Our analysis focused on 5903 women (15-49 years). We conducted Chi-square test for bivariate analysis, and multivariate binary logistics regression was used to analyze independent association between individual-level factors and women who have had Pap smear testing. Statistical significance was set at p < 0.05. RESULTS The mean age at cervical cancer screening uptake among women in South Africa was 40.8 years (SD 18.6, range 15-95 years). A majority of the women (39.3%) were aged 45 years and above and 54.6% of them resides in urban settlements. About 35.4% of women (n = 2098) have had a Pap smear test, with 66.5% of them who had a Pap smear test resides in Western Cape province. The proportion of women who had a Pap smear test was significantly higher among those with higher educational attainment (68.7%, p = 0.000), in the rich wealth index (50.1%, p = 0.000), and those with health insurance cover (60.3%, p = 0.000). Pap smear testing was found to be more prevalent among women aged 45+ years, were in the white population group, had higher education, were divorced, and had health insurance cover. The predominance of Pap smear test was 14% higher among women who are working in the professional/formal sector (AOR; 1.38, 95% CI; 1.14-1.69). The uptake of Pap smear test was also higher among women aged 35-44 years. CONCLUSIONS The prevalence of cervical cancer uptake is substantially low among women aged 15-24 years in South Africa and shows a degree of between-provinces differences. Therefore, heath educational interventions aimed at increasing the uptake of cervical cancer screening services in South Africa are critically needed.
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Affiliation(s)
- Monica Ewomazino Akokuwebe
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
| | - Erhabor Sunday Idemudia
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
| | - Abiel M. Lekulo
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
| | - Ogone Warona Motlogeloa
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
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Drokow EK, Baffour AA, Effah CY, Agboyibor C, Akpabla GS, Sun K. Building a predictive model to assist in the diagnosis of cervical cancer. Future Oncol 2021; 18:67-84. [PMID: 34729999 DOI: 10.2217/fon-2021-0767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: Cervical cancer is still one of the most common gynecologic cancers in the world. Since cervical cancer is a potentially preventive cancer, earlier detection is the most effective technique for decreasing the worldwide incidence of the illness. Materials and methods: This research presents a novel ensemble technique for predicting cervical cancer risk. Specifically, the authors introduce a voting classifier that aggregates prediction probabilities from multiple machine-learning models: logistic regression, K-nearest neighbor, decision tree, XGBoost and multilayer perceptron. Results: The average accuracy, precision, recall and f1-score of the voting classifier were 96.6, 97.4, 95.9 and 96.6, respectively. Furthermore, the voting algorithm gains average high values for all evaluation metrics (accuracy, precision, recall and f1-score). The f1-score of the algorithm is 96%, which demonstrates the robustness of the model. Conclusion: The findings suggest that the probability of having cervical cancer can be accurately predicted utilizing the voting technique.
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Affiliation(s)
- Emmanuel Kwateng Drokow
- Department of Radiation Oncology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital, Henan, China
| | - Adu Asare Baffour
- School of Information & Software Engineering, University of Electronic Science & Technology of China, 610054, China
| | | | - Clement Agboyibor
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | | | - Kai Sun
- Department of Haematology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital Henan, China
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Deressa BT, Assefa M, Tafesse E, Kantelhardt EJ, Soldatovic I, Cihoric N, Rauch D, Jemal A. Contemporary treatment patterns and survival of cervical cancer patients in Ethiopia. BMC Cancer 2021; 21:1102. [PMID: 34645407 PMCID: PMC8515694 DOI: 10.1186/s12885-021-08817-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background Cervical cancer is the second commonly diagnosed cancer and the second leading cause of cancer death in women in Ethiopia, with rates among the highest worldwide. However, there are limited data on cervical cancer treatment patterns and survival in the country. Herein, we examine treatment patterns and survival of cervical cancer patients treated in Tikur Anbessa Hospital Radiotherapy Center (TAHRC), the only hospital with radiotherapy facility in the country. Methods Women with histologically verified cervical cancer who were seen in 2014 (January 1, 2014 to December 31, 2014) at TAHRC were included. Information about clinical characteristics and treatments were extracted from the patients’ medical record files. The information on vital status was obtained from medical chart and through telephone calls. Result Among 242 patients included in the study, the median age at diagnosis was 48 years. The median waiting time for radiotherapy was 5.6 months (range 2 to 9 months). Stage migration occurred in 13% of patients while waiting for radiotherapy. Consequently, the proportion of patients with stage III or IV disease increased from 66% at first consultation to 74% at the initiation of radiotherapy. Among 151 patients treated with curative intent, only 34 (22.5%) of the patients received concurrent chemotherapy while the reaming patients received radiotherapy alone. The 5-year overall survival rate was 28.4% (20.5% in the worst-case scenario). As expected, survival was lower in patients with advanced stage at initiation of radiotherapy and in those treated as palliative care. Conclusion The survival of cervical cancer patients remains low in Ethiopia because of late presentation and delay in receipt of radiotherapy, leading to stage migration in substantial proportion of the cases. Concerted and coordinated multisectoral efforts are needed to promote early presentation of cervical cancer and to shorten the unacceptable, long waiting time for radiotherapy.
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Affiliation(s)
| | - Mathewos Assefa
- Department of Clinical Oncology, College of Health Sciences, Addis Ababa university, Addis Ababa, Ethiopia
| | - Ephrem Tafesse
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eva Johanna Kantelhardt
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany
| | - Ivan Soldatovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | - Nikola Cihoric
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Rauch
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Niyonsenga G, Gishoma D, Sego R, Uwayezu MG, Nikuze B, Fitch M, Igiraneza PC. Connaissances, utilisation et obstacles liés au dépistage du cancer du col utérin dans des hôpitaux de district de Kigali, au Rwanda. Can Oncol Nurs J 2021; 31:275-284. [PMID: 34395830 DOI: 10.5737/23688076313275284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Contexte Dans le monde, le cancer du col utérin arrive au troisième rang des cancers les plus fréquents chez les femmes, mais il passe au deuxième rang en Afrique orientale, où se trouve le Rwanda. Le dépistage périodique est un moyen de prévention efficace. Malgré cela, en Afrique, on estime que le taux de dépistage de ce cancer se situe entre 10 et 70 %. Plusieurs facteurs entravent le dépistage, surtout en Afrique subsaharienne. Au Rwanda, on recense peu d'écrits sur l'utilisation des services de dépistage et les facteurs nuisant au dépistage du cancer du col utérin. Objectif Évaluer les connaissances sur le dépistage du cancer du col utérin qu'ont les femmes fréquentant les hôpitaux de district de Kigali (au Rwanda), recenser l'utilisation de ce service et déterminer les obstacles qui empêchent d'y recourir. Méthodologie Une étude transversale descriptive a été menée, et les données ont été collectées au moyen d'un questionnaire structuré. Des questions nominales de type « oui ou non » ont mis en lumière les connaissances des femmes sur le cancer du col utérin et l'utilisation des services de dépistage. Pour cerner les obstacles au dépistage, nous avons utilisé des questions de type « échelle de Likert ». Ces données ont ensuite fait l'objet d'une analyse statistique descriptive et déductive. La sélection des répondantes s'est faite par échantillonnage aléatoire systématique depuis la base de données des patientes fréquentant les services gynécologiques de trois hôpitaux de district de Kigali (Rwanda). Résultats Au total, 329 femmes ont répondu au sondage. La moitié d'entre elles (n = 165) connaissaient bien le dépistage du cancer du col utérin. Le pourcentage de dépistage se situe à 28,3 %. Nous avons décelé un lien entre l'utilisation du dépistage et une bonne connaissance du sujet (P = 0,000, r = -0,392) ainsi que certains facteurs démographiques (P = 0,000). Parmi les obstacles qui concourent à restreindre l'accès au dépistage, nous avons relevé des obstacles individuels (méconnaissance de l'existence des services de dépistage), géographiques (milieu rural) et liés au système de santé et aux prestataires de soins (campagnes de sensibilisation déficientes, attitudes négatives des prestataires de soins envers les patientes et longs délais d'attente). Conclusion Dans les hôpitaux de district étudiés de Kigali (Rwanda), on constate un faible pourcentage de dépistage du cancer du col utérin causé par plusieurs obstacles. Il est donc fortement recommandé d'engager une campagne d'information permanente sur ce cancer et son dépistage. Enfin, il est crucial que les prestataires de soins qualifiés encouragent les femmes à se soumettre au dépistage, et qu'ils s'efforcent de réduire les obstacles qui s'y rattachent.
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Affiliation(s)
| | - Darius Gishoma
- École de sciences infirmières et pratique sagefemme, Université du Rwanda, Collège de médecine et de sciences de la santé, Kigali, Rwanda
| | - Ruth Sego
- Collège des sciences infirmières Rory Meyers, Université de New York, New York, États-Unis et Faculté des sciences infirmières Bloomberg, Université de Toronto, Canada
| | - Marie Goretti Uwayezu
- École de sciences infirmières et pratique sage-femme, Université du Rwanda, Collège de médecine et de sciences de la santé, Kigali, Rwanda
| | - Bellancille Nikuze
- École de sciences infirmières et pratique sagefemme, Université du Rwanda, Collège de médecine et de sciences de la santé, Kigali, Rwanda
| | - Margaret Fitch
- École de sciences infirmières et pratique sagefemme, Université du Rwanda, Collège de médecine et de sciences de la santé, Kigali, Rwanda
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Clinical and sociodemographic factors associated with late stage cervical cancer diagnosis in Botswana. BMC WOMENS HEALTH 2021; 21:267. [PMID: 34229672 PMCID: PMC8259023 DOI: 10.1186/s12905-021-01402-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/22/2021] [Indexed: 01/22/2023]
Abstract
Background Cervical cancer is the leading cause of female cancer mortality in Botswana with the majority of cervical cancer patients presenting with late-stage disease. The identification of factors associated with late-stage disease could reduce the cervical cancer burden. This study aims to identify potential patient level clinical and sociodemographic factors associated with a late-stage diagnosis of cervical cancer in Botswana in order to help inform future interventions at the community and individual levels to decrease cervical cancer morbidity and mortality. Results There were 984 women diagnosed with cervical cancer from January 2015 to March 2020 at two tertiary hospitals in Gaborone, Botswana. Four hundred forty women (44.7%) presented with late-stage cervical cancer, and 674 women (69.7%) were living with HIV. The mean age at diagnosis was 50.5 years. The association between late-stage (III/IV) cervical cancer at diagnosis and patient clinical and sociodemographic factors was evaluated using multivariable logistic regression with multiple imputation. Women who reported undergoing cervical cancer screening had lower odds of late-stage disease at diagnosis (OR: 0.63, 95% CI 0.47–0.84) compared to those who did not report screening. Women who had never been married had increased odds of late-stage disease at diagnosis (OR: 1.35, 95% CI 1.02–1.86) compared to women who had been married. Women with abnormal vaginal bleeding had higher odds of late-stage disease at diagnosis (OR: 2.32, 95% CI 1.70–3.16) compared to those without abnormal vaginal bleeding. HIV was not associated with a diagnosis of late-stage cervical cancer. Rural women who consulted a traditional healer had increased odds of late-stage disease at diagnosis compared to rural women who had never consulted a traditional healer (OR: 1.61, 95% CI 1.02–2.55). Conclusion Increasing education and awareness among women, regardless of their HIV status, and among providers, including traditional healers, about the benefits of cervical cancer screening and about the importance of seeking prompt medical care for abnormal vaginal bleeding, while also developing support systems for unmarried women, may help reduce cervical cancer morbidity and mortality in Botswana.
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Niyonsenga G, Gishoma D, Sego R, Uwayezu MG, Nikuze B, Fitch M, Igiraneza PC. Knowledge, utilization and barriers of cervical cancer screening among women attending selected district hospitals in Kigali - Rwanda. Can Oncol Nurs J 2021; 31:266-274. [PMID: 34395829 DOI: 10.5737/23688076313266274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Cervical cancer is the third most common cancer attacking women globally, and the second in Eastern Africa where Rwanda is located. Regular screening is an effective prevention approach for cervical cancer. Despite that, the screening rate for cervical cancer in Africa is estimated between 10% and 70%, with a number of barriers. This is especially the case in sub-Saharan Africa. In Rwanda, there is limited literature on the rate of use of screening services or the barriers to cervical screening. Objective To assess knowledge, utilization, and barriers of cervical cancer screening among women attending selected district hospitals in Kigali, Rwanda. Methods A descriptive cross-sectional study with a structured questionnaire was used to collect data. Nominal 'yes' or 'no' questions were used to gather data on knowledge and utilisation of cervical cancer and its screening. Likert-type scale questions were used to identify different barriers to screening services. Data were analysed using descriptive and inferential statistics. Respondents were selected by systematic random sampling from the database of women attending gynaecology services at three district hospitals in Kigali, Rwanda. Results Three hundred and twenty-nine women responded to the survey. Half of the respondents (n = 165) had high knowledge level scores on cervical cancer screening. The cervical cancer screening rate was 28.3%. Utilization of screening was associated with knowledge (P = 0.000, r = -0.392) and selected demographic factors (P = 0.000). Individual barriers included poor knowledge on availability of screening services, community barriers included living in a rural area, and health provider and systems barriers included lack of awareness campaigns, negative attitudes of healthcare providers toward clients, and long waiting times; all barriers limit the access to screening services. Conclusion A low rate of cervical cancer screening was identified for women attending selected district hospitals in Kigali-Rwanda due to various barriers. On-going education on cervical cancer and its screening is highly recommended. It is important that trained health providers encourage their clients to have cervical cancer screening and work to reduce related barriers.
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Affiliation(s)
| | - Darius Gishoma
- School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Ruth Sego
- Rory Meyer's College of Nursing, New York University, New York, USA and the Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Marie Goretti Uwayezu
- School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Bellancille Nikuze
- School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Margaret Fitch
- School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
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Ba DM, Ssentongo P, Musa J, Agbese E, Diakite B, Traore CB, Wang S, Maiga M. Prevalence and determinants of cervical cancer screening in five sub-Saharan African countries: A population-based study. Cancer Epidemiol 2021; 72:101930. [PMID: 33756434 DOI: 10.1016/j.canep.2021.101930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide, with an estimate of 570,000 new cases and about 311,000 deaths annually. Low-resource countries, including those in sub-Saharan Africa, have the highest-burden with an estimate of 84 % of all cervical cancers. This study examines the prevalence and socio-demographic-economic factors associated with cervical cancer screening in sub-Saharan Africa. METHODS A weighted population-based cross-sectional study using Demographic and Health Surveys data. We used available data on cervical cancer screening between 2011 and 2018 from the Demographic and Health Surveys for five sub-Saharan African countries (Benin, Ivory Coast, Kenya, Namibia, and Zimbabwe). The study population included women of childbearing age, 21-49 years (n = 28,976). We fit a multivariable Poisson regression model to identify independent factors associated with cervical cancer screening. RESULTS The overall weighted prevalence of cervical cancer screening was 19.0 % (95 % CI: 18.5 %-19.5 %) ranging from 0.7 % in Benin to 45.9 % in Namibia. Independent determinants of cervical cancer screening were: older age (40-49 years) adjusted prevalence ratio (aPR) = 1.77 (95 % CI: 1.64, 1.90) compared with younger age (21-29 years), secondary/higher education (aPR = 1.51, 95 CI: 1.28-1.79) compared with no education, health insurance (aPR = 1.53, 95 % CI: 1.44-1.61) compared with no insurance, and highest socioeconomic status (aPR = 1.39, 95 % CI: 1.26-1.52) compared with lowest. CONCLUSION The prevalence of cervical cancer screening is substantially low in sub-Saharan Africa countries and shows a high degree of between-country variation. Interventions aimed at increasing the uptake of cervical cancer screening in sub-Saharan Africa are critically needed.
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Affiliation(s)
- Djibril M Ba
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States.
| | - Paddy Ssentongo
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States
| | - Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Nigeria; Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, IL 60611, USA
| | - Edeanya Agbese
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States
| | - Brehima Diakite
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Cheick Bougadari Traore
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Steve Wang
- Mobile Imaging Innovations, Inc., Evanston, IL, United States
| | - Mamoudou Maiga
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali; Northwestern University, Department of Biomedical Engineering, Evanston, IL, United States; Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, IL 60611, USA
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Raimi IO, Kopaopa BG, Mugivhisa LL, Lewu FB, Amoo SO, Olowoyo JO. An appraisal of documented medicinal plants used for the treatment of cancer in Africa over a twenty-year period (1998–2018). J Herb Med 2020. [DOI: 10.1016/j.hermed.2020.100371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Nnabugwu II, Okoronkwo IL, Nnabugwu CA. Lower urinary tract symptoms in men: challenges to early hospital presentation in a resource-poor health system. BMC Urol 2020; 20:87. [PMID: 32620103 PMCID: PMC7333413 DOI: 10.1186/s12894-020-00651-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background The point at which men seek medical care for lower urinary tract symptoms (LUTS) varies between individuals. Presentation to hospital with complications beyond LUTS appears prevalent in our setting. The aim of this survey is to assess from the community perspective in southeast Nigeria, the challenges to early presentation for medical evaluation for LUTS by men. Methods A questionnaire-based cross-sectional survey of randomly-selected men ≥40 years. The questionnaire captured respondent’s age; presence, duration and severity of LUTS; access to health information; wealth-index; and when (and why) medical care for LUTS was sought. Analysis was with SPSS® version 20. Results In all, responses from 1319 men (mean age 54.2 ± 10.2 years) are analysed. Of these, 267 report LUTS: 58.4% (156) report moderate to severe LUTS and 51.7% (138) are yet to seek medical care. As regards seeking medical care, all the men reporting LUTS of 3 months, 35.7% of 126 men reporting moderate LUTS, and 20.0% of 30 men reporting severe LUTS are yet to seek medical care. LUTS being non-bothersome (not financial constraint) is the most prevalent reason for not seeking medical care early. Delay is encouraged by limited access to health information (OR 3.10; p < 0.001), but discouraged by literacy (OR 0.86; p < 0.001) and aging (OR 0.93; p = 0.002). Conclusion From the community perspective, the prevalent challenge to seeking medical care for LUTS early is absence of bother. Empowering men through formal education and researched health information will influence positively the time that LUTS in men is appreciated as bothersome.
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Affiliation(s)
- Ikenna I Nnabugwu
- Department of Surgery, College of Medicine, University of Nigeria Ituku-Ozalla, Enugu, PMB 01129, Nigeria.
| | - Ijeoma L Okoronkwo
- Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Chinwe A Nnabugwu
- Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria Enugu Campus, Enugu, Nigeria
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Jedy-Agba E, Joko WY, Liu B, Buziba NG, Borok M, Korir A, Masamba L, Manraj SS, Finesse A, Wabinga H, Somdyala N, Parkin DM. Trends in cervical cancer incidence in sub-Saharan Africa. Br J Cancer 2020; 123:148-154. [PMID: 32336751 PMCID: PMC7341858 DOI: 10.1038/s41416-020-0831-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/17/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cervical cancer is the second most common cancer and the leading cause of cancer death in women in sub-Saharan Africa (SSA). METHODS Trends in the incidence of cervical cancer are examined for a period of 10-25 years in 10 population-based cancer registries across eight SSA countries (Gambia, Kenya, Malawi, Mauritius, Seychelles, South Africa, Uganda and Zimbabwe). A total of 21,990 cases of cervical cancer were included in the analyses. RESULTS Incidence rates had increased in all registries for some or all of the periods studied, except for Mauritius with a constant annual 2.5% decline. Eastern Cape and Blantyre (Malawi) registries showed significant increases over time, with the most rapid being in Blantyre (7.9% annually). In Kampala (Uganda), a significant increase was noted (2.2%) until 2006, followed by a non-significant decline. In Eldoret, a decrease (1998-2002) was followed by a significant increase (9.5%) from 2002 to 2016. CONCLUSION Overall, cervical cancer incidence has been increasing in SSA. The current high-level advocacy to reduce the burden of cervical cancer in SSA needs to be translated into support for prevention (vaccination against human papillomavirus and population-wide screening), with careful monitoring of results through population-based registries.
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Affiliation(s)
- Elima Jedy-Agba
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria.
| | - Walburga Yvonne Joko
- Clinical Trials Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Biying Liu
- African Cancer Registry Network, Prama House, 267 Banbury Road, Oxford, UK
| | | | - Margaret Borok
- Zimbabwe National Cancer Registry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Anne Korir
- Nairobi Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Leo Masamba
- University of Malawi College of Medicine and Queen Elizabeth Central Hospital Cancer Unit, Blantyre, Malawi
| | - Shyam Shunker Manraj
- Mauritius National Cancer Registry, Mauritius Institute of Health, Pamplemousses, Mauritius
| | - Anne Finesse
- Seychelles National Cancer Registry, Ministry of Health, Victoria, Seychelles
| | - Henry Wabinga
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nontuthuzelo Somdyala
- Eastern Cape Cancer Registry, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Donald Maxwell Parkin
- Clinical Trials Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- International Agency for Research on Cancer, Lyon, France
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Chambuso R, Ramesar R, Kaambo E, Murahwa AT, Abdallah MO, De Sousa M, Denny L, Williamson AL, Gray CM. Age, absolute CD4 count, and CD4 percentage in relation to HPV infection and the stage of cervical disease in HIV-1-positive women. Medicine (Baltimore) 2020; 99:e19273. [PMID: 32118737 PMCID: PMC7478573 DOI: 10.1097/md.0000000000019273] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A subgroup of women who are co-infected with human immunodeficiency virus type 1 (HIV-1) and human papillomavirus (HPV), progress rapidly to cervical disease. We characterized HPV genotypes within cervical tumor biopsies, assessed the relationships of cervical disease stage with age, HIV-1 status, absolute CD4 count, and CD4 percentage, and identified the predictive power of these variables for cervical disease stage in a cohort of South African women.We recruited 181 women who were histologically diagnosed with cervical disease; 87 were HIV-1-positive and 94 were HIV-1-seronegative. Colposcopy-directed tumor biopsies were confirmed by histology and used for genomic DNA extraction. The Roche Linear Array HPV genotyping test was used for HPV genotyping. Peripheral whole blood was used for HIV-1 rapid testing. Fully automated FC500MPL/CellMek with PanLeucogate (PLG) was used to determine absolute CD4 count, CD4 percentage, and CD45 count. Chi-squared test, a logistic regression model, parametric Pearson correlation, and ROC curves were used for statistical analyses. We used the Benjamini-Horchberg test to control for false discovery rate (FDR, q-value). All tests were significant when both P and q were <.05.Age was a significant predictor for invasive cervical cancer (ICC) in both HIV-1-seronegative (P < .0001, q < 0.0001) and HIV-1-positive women (P = .0003, q = 0.0003). Sixty eight percent (59/87) of HIV-1-positive women with different stages of cervical disease presented with a CD4 percentage equal or less than 28%, and a median absolute CD4 count of 400 cells/μl (IQR 300-500 cells/μl). Of the HIV-1-positive women, 75% (30/40) with ICC, possessed ≤28% CD4 cells vs 25% (10/40) who possessed >28% CD4 cells (both P < .001, q < 0.001). Furthermore, 70% (28/40) of women with ICC possessed CD4 count >350 compared to 30% (12/40) who possessed CD4 count ≤ 350 (both P < .001, q < 0.001).Age is an independent predictor for ICC. In turn, development of ICC in HIV-1-positive women is independent of the host CD4 cells and associates with low CD4 percentage regardless of absolute CD4 count that falls within the normal range. Thus, using CD4 percentage may add a better prognostic indicator of cervical disease stage than absolute CD4 count alone.
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Affiliation(s)
- Ramadhani Chambuso
- MRC Unit for Genomic and Precision Medicine, Division of Human Genetics, Department of Pathology
- Department of Gynaecology, Morogoro Regional Referral Hospital, Morogoro, Tanzania
| | - Raj Ramesar
- MRC Unit for Genomic and Precision Medicine, Division of Human Genetics, Department of Pathology
- Division of Human Genetics
| | - Evelyn Kaambo
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences
- Department of Biochemistry and Medical Microbiology, University of Namibia School of Medicine, Windhoek, Namibia
| | | | - Mohammed O.E. Abdallah
- MRC Unit for Genomic and Precision Medicine, Division of Human Genetics, Department of Pathology
- Department of Gynaecology, Morogoro Regional Referral Hospital, Morogoro, Tanzania
| | - Michelle De Sousa
- Department of Obstetrics and Gynaecology, Victoria Wynberg Hospital, Cape Town
- South African Medical Research Council, Clinical Gynaecological Cancer Research Centre
| | - Lynette Denny
- South African Medical Research Council, Clinical Gynaecological Cancer Research Centre
- Department of Obstetrics and Gynaecology
| | - Anna-Lise Williamson
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences
- South African Medical Research Council, Clinical Gynaecological Cancer Research Centre
| | - Clive M. Gray
- Division of Immunology, Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
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Kizub DA, Zujewski J, Gralow JR, Ndoh K, Soko U, Dvaladze AL. Patient Advocacy Approaches to Improving Care for Breast and Cervical Cancer in East and Southern Africa. JCO Glob Oncol 2020; 6:49-55. [PMID: 32031438 PMCID: PMC6998024 DOI: 10.1200/jgo.19.00219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Breast and cervical cancer are the most common cancers among women in East and Southern Africa, where mortality remains high because of late diagnosis and limited access to treatment. We explored local approaches to breast and cervical cancer advocacy to identify the most pressing issues and opportunities for increasing the impact of civil society activities in the region. METHODS Focus group discussions were conducted with participants of the 2016 Women's Empowerment Cancer Advocacy Network (WE CAN) Summit in Nairobi, Kenya. Discussions were audio-recorded, transcribed, coded, and analyzed for emergent themes. Results were presented to participants of 2019 WE CAN summit for cross-validation. RESULTS Four focus group discussions were conducted with 50 participants. Thirty-six (70%) identified as advocates, 30 (59%) as cancer survivors, 14 (27%) as nongovernmental organization representatives, 13 (25%) as researchers, 4 (8%) as clinicians, and 6 (8%) as policymakers. Although most participants focused on cancer awareness and screening/early detection, some noted that treatment was often unavailable and advocated for a broader strategy to improving access to care. Challenges to designing and implementing such a strategy included knowledge gaps in addressing late diagnosis and access to care, difficulty collaborating with like-minded organizations, approaching policymakers, and addressing treatment financing. Cancer coalitions, although rare, were crucial to building collaborations with ministries of health, policymakers, and international organizations that advanced breast and cervical cancer care. CONCLUSION Participants indicated that they would benefit from additional training about resource-appropriate best practices for improving breast and cervical cancer care and outcomes. Coalition-building and collaborations, including with oncologists and other medical professionals involved in cancer care, were crucial to leveraging limited resources, sharing lessons learned, and developing local solutions to common challenges.
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Affiliation(s)
| | | | - Julie R. Gralow
- University of Washington, Seattle, WA
- Seattle Cancer Care Alliance, Seattle, WA
| | | | - Udie Soko
- Zambia Cancer Society, Lusaka, Zambia
| | - Allison L. Dvaladze
- University of Washington, Seattle, WA
- Seattle Cancer Care Alliance, Seattle, WA
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Oliveira NPDD, Santos Siqueira CAD, Lima KYND, de Camargo Cancela M, Souza DLBD. Association of cervical and breast cancer mortality with socioeconomic indicators and availability of health services. Cancer Epidemiol 2019; 64:101660. [PMID: 31877471 DOI: 10.1016/j.canep.2019.101660] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/26/2019] [Accepted: 12/13/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Analyze cervical and breast cancer mortality in Brazil and its relationship with socioeconomic population indicators and availability of health services in the period 2011-2015. METHODS An ecological study is presented herein. Mortality data were extracted from the Mortality Information System, based on ICD-10, per area of residence and age group, for the period 2011-2015. Socioeconomic variables were extracted from the Brazilian Human Development Atlas, and the National Register of Health Facilities (CNES) provided data on the density of physicians and health services. Statistical analysis was carried out using the Chi-squared test and Poisson regression, with robust variance and 95 % confidence level. RESULTS The median age-standardized mortality rates for cervical and breast cancers were, respectively, 5.95 (± 3.97) and 10.65 (± 3.12) per 100,000 women. High cervical cancer mortality rates presented a statistically significant association with GINI Index (p=0.000) and Human Development Index - HDI (p=0.030). High breast cancer mortality rates were positively associated with the variables "number of general physicians per 100,000 inhabitants" (p = 0.005) and "Number of licensed oncology centers per 1,000,000 inhabitants" (p = 0.002). CONCLUSION The importance of organization and equity in the access to health services is highlighted herein, enabling the reorientation of public policies aimed at the minimization of health disparities.
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Affiliation(s)
- Nayara Priscila Dantas de Oliveira
- Graduate Program in Collective Health - Federal University of Rio Grande do Norte, UFRN, Public Health Department, Graduate Program in Public Health, 1787 Senador Salgado Filho Ave., 59010-000, Lagoa Nova, Natal, RN, Brazil
| | - Camila Alves Dos Santos Siqueira
- Graduate Program in Collective Health - Federal University of Rio Grande do Norte, UFRN, Public Health Department, Graduate Program in Public Health, 1787 Senador Salgado Filho Ave., 59010-000, Lagoa Nova, Natal, RN, Brazil
| | - Kálya Yasmine Nunes de Lima
- Graduate Program in Collective Health - Federal University of Rio Grande do Norte, UFRN, Public Health Department, Graduate Program in Public Health, 1787 Senador Salgado Filho Ave., 59010-000, Lagoa Nova, Natal, RN, Brazil
| | - Marianna de Camargo Cancela
- Division of Population Research, National Cancer Institute (INCA), Division of Population Research, 125 Marques de Pombal Street, 20230-240, Sandra, Center, Rio de Janeiro, RJ, Brazil
| | - Dyego Leandro Bezerra de Souza
- Department of Collective Health, Graduate Program in Collective Health, Federal University of Rio Grande do Norte, UFRN, Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Brazil; Public Health Department, Graduate Program in Public Health,1787 Senador Salgado Filho Ave., 59010-000, Lagoa Nova, Natal, RN, Brazil.
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Socio-demographic Characteristics and Use of Pap Smear for Cervical Cancer Screening Among Women of Eastern Part of India. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Dunyo P, Effah K, Udofia EA. Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study. BMC Public Health 2018; 18:1156. [PMID: 30285699 PMCID: PMC6171232 DOI: 10.1186/s12889-018-6065-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022] Open
Abstract
Background Cervical cancer is the leading and most common female cancer among women in Ghana. Although there are screening methods to detect premalignant lesions for treatment, screening coverage in Ghana is 2.8% and late presentation of cases complicates treatment efforts. This study examined the sociodemographic, clinical and histological characteristics associated with late presentation of cervical cancer cases attending Gynecological Oncology care at Catholic Hospital, Battor. Methods One hundred and fifty-seven medical records of confirmed cases of cervical cancer reporting to the Outpatient Obstetrics and Gynecology Department between 2012 and 2016 were reviewed. Relevant data were retrieved using abstraction forms. Socio demographic variables investigated were level of education attained, marital status, National Health Insurance Scheme membership, employment status, place of residence and distance from hospital. Clinical variables included intermenstrual/postmenopausal bleeding, previous screening history, previous smoking history, age at menarche and number of children. Histological variables included subtypes of tumour and characteristics of tumour. Pearson’s chi-square test and logistic regression analysis were used to determine correlates of late stage at presentation with cervical cancer. Sensitivity analysis was performed to assess the effect of missing data. Results Approximately two-thirds (65.97%) of the cases presented in advanced stages of cervical cancer. Level of education, age at menarche and previous screening history were included in a regression model and adjusted for age. Age at menarche (n = 66) was eliminated from the model after sensitivity analysis. Among the remaining variables, only previous screening history was predictive of late stage at presentation of cervical cancer cases. Previously unscreened cases of cervical cancer were nearly four times more likely to present late, compared to those who had been screened previously (OR 3.91; 95% CI 1.43–10.69). No association was observed with sociodemographic and histological characteristics. Conclusion Lack of previous screening was associated with late presentation of cervical cancer at Catholic Hospital, Battor. Efforts to promote early cervical cancer screening should be intensified and future studies may explore an association with age at menarche. Electronic supplementary material The online version of this article (10.1186/s12889-018-6065-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Priscilla Dunyo
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kofi Effah
- Obstetric and Gynecological Department/Cervical Cancer Screening and Training Center, Catholic Hospital, Battor, Ghana
| | - Emilia Asuquo Udofia
- Department of Community Health, School of Public Health, University of Ghana, Legon, Accra, Ghana.
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