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Mascarenhas M, Alencoão I, Carinhas MJ, Martins M, Cardoso P, Mendes F, Fernandes J, Ferreira J, Macedo G, Zulmira Macedo R. Artificial Intelligence and Colposcopy: Automatic Identification of Cervical Squamous Cell Carcinoma Precursors. J Clin Med 2024; 13:3003. [PMID: 38792544 PMCID: PMC11122610 DOI: 10.3390/jcm13103003] [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: 03/29/2024] [Revised: 04/21/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Proficient colposcopy is crucial for the adequate management of cervical cancer precursor lesions; nonetheless its limitations may impact its cost-effectiveness. The development of artificial intelligence models is experiencing an exponential growth, particularly in image-based specialties. The aim of this study is to develop and validate a Convolutional Neural Network (CNN) for the automatic differentiation of high-grade (HSIL) from low-grade dysplasia (LSIL) in colposcopy. Methods: A unicentric retrospective study was conducted based on 70 colposcopy exams, comprising a total of 22,693 frames. Among these, 8729 were categorized as HSIL based on histopathology. The total dataset was divided into a training (90%, n = 20,423) and a testing set (10%, n = 2270), the latter being used to evaluate the model's performance. The main outcome measures included sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and the area under the receiving operating curve (AUC-ROC). Results: The sensitivity was 99.7% and the specificity was 98.6%. The PPV and NPV were 97.8% and 99.8%, respectively. The overall accuracy was 99.0%. The AUC-ROC was 0.98. The CNN processed 112 frames per second. Conclusions: We developed a CNN capable of differentiating cervical cancer precursors in colposcopy frames. The high levels of accuracy for the differentiation of HSIL from LSIL may improve the diagnostic yield of this exam.
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Affiliation(s)
- Miguel Mascarenhas
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (M.M.); (P.C.); (G.M.)
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Inês Alencoão
- Department of Gynecology, Centro Materno-Infantil do Norte Dr. Albino Aroso (CMIN), Santo António University Hospital, Largo da Maternidade Júlio Dinis, 4050-061 Porto, Portugal; (I.A.); (M.J.C.); (R.Z.M.)
| | - Maria João Carinhas
- Department of Gynecology, Centro Materno-Infantil do Norte Dr. Albino Aroso (CMIN), Santo António University Hospital, Largo da Maternidade Júlio Dinis, 4050-061 Porto, Portugal; (I.A.); (M.J.C.); (R.Z.M.)
| | - Miguel Martins
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (M.M.); (P.C.); (G.M.)
| | - Pedro Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (M.M.); (P.C.); (G.M.)
| | - Francisco Mendes
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (M.M.); (P.C.); (G.M.)
| | - Joana Fernandes
- Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-065 Porto, Portugal; (J.F.); (J.F.)
| | - João Ferreira
- Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-065 Porto, Portugal; (J.F.); (J.F.)
| | - Guilherme Macedo
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (M.M.); (P.C.); (G.M.)
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Rosa Zulmira Macedo
- Department of Gynecology, Centro Materno-Infantil do Norte Dr. Albino Aroso (CMIN), Santo António University Hospital, Largo da Maternidade Júlio Dinis, 4050-061 Porto, Portugal; (I.A.); (M.J.C.); (R.Z.M.)
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Muslin C. Addressing the burden of cervical cancer for Indigenous women in Latin America and the Caribbean: a call for action. Front Public Health 2024; 12:1376748. [PMID: 38807996 PMCID: PMC11130434 DOI: 10.3389/fpubh.2024.1376748] [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: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
Cervical cancer, primarily caused by human papillomavirus (HPV) infection, poses a significant global health challenge. Due to higher levels of poverty and health inequities, Indigenous women worldwide are more vulnerable to cervical cancer than their non-Indigenous counterparts. However, despite constituting nearly 10% of the population in Latin America and the Caribbean (LAC), the true extent of the burden of cervical cancer among Indigenous people in this region remains largely unknown. This article reviews the available information on cervical cancer incidence and mortality, as well as HPV infection prevalence, among Indigenous women in LAC. The limited existing data suggest that Indigenous women in this region face a heightened risk of cervical cancer incidence and mortality compared to non-Indigenous women. Nevertheless, a substantial knowledge gap persists that must be addressed to comprehensively assess the burden of cervical cancer among Indigenous populations, especially through enhancing cancer surveillance across LAC countries. Numerous structural, social and cultural barriers hindering Indigenous women's access to HPV vaccination and cervical cancer screening worldwide have been identified and are reviewed in this article. The discussion highlights the critical role of culturally sensitive education, community engagement, and empowerment strategies in overcoming those barriers. Drawing insights from the success of targeted strategies in certain high-income countries, the present article advocates for research, policies and healthcare interventions tailored to the unique context of LAC countries.
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Affiliation(s)
- Claire Muslin
- One Health Research Group, Faculty of Health Sciences, Universidad de las Américas, Quito, Ecuador
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Li J, Lai H, Qin H, Zhou D, Zhao Y, Sheng X. Current status of high-risk HPV infection and correlation with multiple infections in cervical lesions in Western Guangzhou. Front Med (Lausanne) 2024; 11:1252073. [PMID: 38695017 PMCID: PMC11061398 DOI: 10.3389/fmed.2024.1252073] [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: 07/14/2023] [Accepted: 04/01/2024] [Indexed: 05/04/2024] Open
Abstract
Objective This study aims to investigate the current status of multiple HPV infection and its association with cervical lesions in the western region of Guangzhou. Methods A retrospective analysis of clinical data from cervical cancer screening patients was conducted. The patients were grouped based on HPV genotypes and cervical pathology results to explore the prevalence of high-risk HPV infection and its relationship with cervical lesions in the western region of Guangzhou. The study also analyzed the relationship between high-risk HPV infection and cervical lesions among different age groups. Results A total of 13,060 patients were included in the study, with an overall infection rate of 18.46% (2,411/13,060). Among them, the infection rate of HPV genotype 16 was 14.14% (341/2,411), HPV genotype 18 was 5.23% (126/2,411), and other 12 high-risk HPV genotypes accounted for 71.96% (1,735/2,411). When comparing the incidence of HSIL+ (high-grade squamous intraepithelial lesion or worse) among different HPV genotypes, the results showed that the HPV 16 infection group (47.50%) had a higher incidence than the HPV 18 infection group (25.40%) and the other 12 high-risk HPV genotypes group (15.97%; P < 0.05). In the multiple infection groups, the pathogenicity rates were 63.64% (7/11) for the 16+18 HPV infection group, 42.97% (55/128) for the 16+other 12 high-risk HPV genotypes infection group, 26.79% (15/56) for the 18+other 12 high-risk HPV genotypes infection group, and 57.14% (8/14) for the 16+18+other 12 high-risk HPV genotypes infection group. These rates were significantly different compared to the single infection group (P <0.01). Although there was no statistically significant difference in the incidence of cervical cancer between the HPV 16 infection group and the HPV 18 infection group, both groups had a higher incidence compared to the group with other 12 high-risk HPV genotypes infection (P < 0.05). Further analysis suggests that the severity of cervical lesions is not associated with the number of high-risk HPV infections, i.e., the severity of cervical lesions is unrelated to multiple HPV infections but is instead related to the pathogenicity of the HPV genotypes. The infection rate and multiple HPV infection rate of women under 35 years old were higher than those of women aged 35 and above (20% vs. 17.1%; 2% vs. 1.3%; P < 0.05). Moreover, the pathogenicity rate of HSIL+ among high-risk HPV infection increased with age. Conclusions In the western region of Guangzhou, the overall infection rate of high-risk HPV is 18.46%. The severity of cervical lesions is unrelated to multiple HPV infections. The fundamental reason is the distinct pathogenicity of different HPV genotypes. The HSIL+ pathogenicity rates, from high to low, are in sequence for HPV 16, HPV 18, and the other 12 HPV types.
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Affiliation(s)
- Jianqi Li
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - He Lai
- Department of Obstetrics and Gynecology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Honglei Qin
- Laboratory for Gynecologic Oncology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dongmei Zhou
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yang Zhao
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiujie Sheng
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Li X, Xiang F, Zhao Y, Li Q, Gu Q, Zhang X, Chen Z, Zhang M, Wang J, Liu R, Kang X, Wu R. Detection of cervical high-grade squamous intraepithelial lesions and assessing diagnostic performance of colposcopy among women with oncogenic HPV. BMC Womens Health 2023; 23:411. [PMID: 37542333 PMCID: PMC10403922 DOI: 10.1186/s12905-023-02538-2] [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: 04/03/2023] [Accepted: 07/12/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND HPV screening tests may improve cervical cancer risk stratification and better guide decisions about follow-up with colposcopy/biopsy. This study aimed to estimate the risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) among women with oncogenic HPV types and evaluate the performance of colposcopy in the diagnosis of histologic CIN2 + at Putuo Hospital, Shanghai, China. METHODS This cross-sectional survey was conducted from February 2020 to December 2022 among women who were referred to colposcopy. Women with high-risk (HR) HPV-positive, cytology testing and colposcopy-directed biopsy were included. RESULTS Univariate and multivariate analysis indicated that high-grade colposcopic impression ((OR, 17.61%, 95%CI: 11.54-26.85%) was associated with the highest risk for detecting CIN2+, followed by HSIL + cytology (OR, 6.90%, 95%CI: 3.56-13.37%) and HPV16/18 positive (OR, 2.91%, 95%CI: 2.12-3.99%). Overall, CIN2 + was detected in 14.6% of 2007 women. HPV16/18 had higher CIN2 + risks than other HR-HPV genotypes (30.1% vs. 10.2%, P<0.001). Among women with low-grade cytology, 24.1% had CIN2+, and the risks for HPV16/18 (58.2%) were higher than for other HR-HPV(16.8%). For those with high-grade cytology, there was no significant difference between HPV groups ( 75.0% vs. 72.9%, P > 0.05). The diagnostic performance of colposcopy in diagnosis of CIN2 + by senior and junior colposcopists was comparable. CONCLUSIONS The results indicated that referral to colposcopy is recommended in managing women with HR-HPV positive, and colposcopic impressions provide key clues for identification CIN2+.
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Affiliation(s)
- Xiaoxiao Li
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fenfen Xiang
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yunzhi Zhao
- Department of Obstetrics and Gynecology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Li
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qing Gu
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinpei Zhang
- Department of Obstetrics and Gynecology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zixi Chen
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengzhe Zhang
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Wang
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rongrong Liu
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiangdong Kang
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Rong Wu
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Suba EJ, Donnelly AD, Duong DV, Gonzalez Mena LE, Neethling GS, Thai NV. WHO should adjust its global strategy for cervical cancer prevention. BMJ Glob Health 2023; 8:bmjgh-2023-012031. [PMID: 37308263 DOI: 10.1136/bmjgh-2023-012031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023] Open
Affiliation(s)
- Eric J Suba
- Global Cervical Cancer Prevention Project, San Francisco, California, USA
- Visiting Scholar, Tuskegee University National Center for Bioethics in Research and Health Care, Tuskegee, Alabama, USA
| | | | - Dang Van Duong
- Institute of Cancer Research Cooperation and Community Health Development, Hue City, Viet Nam
| | | | - Greta S Neethling
- Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Nguyen Van Thai
- Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Viet Nam
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Qin D, Bai A, Xue P, Seery S, Wang J, Mendez MJG, Li Q, Jiang Y, Qiao Y. Colposcopic accuracy in diagnosing squamous intraepithelial lesions: a systematic review and meta-analysis of the International Federation of Cervical Pathology and Colposcopy 2011 terminology. BMC Cancer 2023; 23:187. [PMID: 36823557 PMCID: PMC9951444 DOI: 10.1186/s12885-023-10648-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Colposcopy is an important tool in diagnosing cervical cancer, and the International Federation of Cervical Pathology and Colposcopy (IFCPC) issued the latest version of the guidelines in 2011. This study aims to systematically assess the accuracy of colposcopy in predicting low-grade squamous intraepithelial lesions or worse (LSIL+) / high-grade squamous intraepithelial lesions or worse (HSIL+) under the 2011 IFCPC terminology. METHODS We performed a systematic review and meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for studies about the performance of colposcopy in diagnosing cervical intraepithelial neoplasia under the new IFCPC colposcopy terminology from PubMed, Embase, Web of Science and the Cochrane database. Data were independently extracted by two authors and an overall diagnostic performance index was calculated under two colposcopic thresholds. RESULTS Totally, fifteen articles with 22,764 participants in compliance with the criteria were included in meta-analysis. When colposcopy was used to detect LSIL+, the combined sensitivity and specificity were 0.92 (95% CI 0.88-0.95) and 0.51 (0.43-0.59), respectively. When colposcopy was used to detect HSIL+, the combined sensitivity and specificity were 0.68 (0.58-0.76) and 0.93 (0.88-0.96), respectively. CONCLUSION In accordance with the 2011 IFCPC terminology, the accuracy of colposcopy has improved in terms of both sensitivity and specificity. Colposcopy is now more sensitive with LSIL+ taken as the cut-off value and is more specific to HSIL+. These findings suggest we are avoiding under- or overdiagnosis both of which impact on patients' well-being.
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Affiliation(s)
- Dongxu Qin
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Anying Bai
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Peng Xue
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Samuel Seery
- grid.9835.70000 0000 8190 6402Faculty of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, LA1 4YW UK
| | - Jiaxu Wang
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Maria Jose Gonzalez Mendez
- grid.411971.b0000 0000 9558 1426School of Public Health, Dalian Medical University, Dalian, 116044 Liaoning China
| | - Qing Li
- grid.469593.40000 0004 1777 204XDiagnosis and Treatment for Cervical Lesions Center, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, 518028 China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Vikraman SM, Khanna D, Dandpat A. Cervical cancer elimination in indian context: Moving from barriers to facilitators. Cancer 2022; 128:4041-4046. [PMID: 36239011 DOI: 10.1002/cncr.34486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It has been 46 years since the launch of cancer control programs in India and yet the recent National Family Health Survey (fifth round, 2019-2021) has reported that just 1.9% of women aged 30-49 years have ever undergone cervical cancer screening. The cost of delayed diagnosis of cervical cancer and its treatment is overwhelming, and the rural population takes the worst hit. It is the need of the hour that the Indian health system and policymakers identify the barriers and facilitators for cervical cancer early detection and provide pragmatic solutions so that the targets of cervical cancer elimination can be achieved in a timely manner.
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Affiliation(s)
- Saraswathy M Vikraman
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Center and Homi Bhabha Cancer Hospital, Tata Memorial Centers, Varanasi, Uttar Pradesh, India
| | - Divya Khanna
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Center and Homi Bhabha Cancer Hospital, Tata Memorial Centers, Varanasi, Uttar Pradesh, India
| | - Abhishek Dandpat
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Center and Homi Bhabha Cancer Hospital, Tata Memorial Centers, Varanasi, Uttar Pradesh, India
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Wilkin T, Chen H, Sahasrabuddhe V, Matining R, Mngqibisa R, Chinula L, Mbilizi Y, Magure T, Omoz-Oarhe AE, Rassool M, Riviere C, Bhosale R, Godbole S, Naranjo R, Coombs R, Michelow P, Godfrey C, Firnhaber C. A Randomized Clinical Trial of Human Papillomavirus Test-and-Treat as Compared to Cytology-Based Screening for Prevention of Cervical Cancer Among Women With Human Immunodeficiency Virus: AIDS Clinical Trials Group Protocol A5282. Clin Infect Dis 2022; 75:1280-1288. [PMID: 35294524 PMCID: PMC9555836 DOI: 10.1093/cid/ciac213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cytology-based cervical cancer screening followed by confirmation and treatment of biopsy-proven high-grade squamous intraepithelial lesions (bHSIL) is difficult to implement in resource-constrained settings. We hypothesized that high-risk human papillomavirus (hrHPV) testing followed by immediate cryotherapy of women with hrHPV (HPV screen-and-treat) may improve outcomes. METHODS Randomized, open-label, phase 2, multinational clinical trial enrolling women with human immunodeficiency virus (HIV) age 18 or older with cervical hrHPV and having no cervical lesions or lesions appropriate for cryotherapy. Women were randomized to immediate cryotherapy (Arm A) or cytology-based screening (Arm B). For Arm A, cervical biopsies were obtained followed by cervical cryotherapy, and in Arm B, women with abnormal cytology underwent colposcopy followed by loop electroexcision procedure (LEEP) if bHSIL was detected. Women were followed through 30 months. The primary outcome was time to bHSIL detected from Month 6 through study completion. RESULTS In total, 288 women (145 in Arm A, 143 in Arm B) were randomized: median age 35 years, 84% on antiretroviral therapy, median CD4 501 cells/mm3. In Arm A, 39 (27%) of women had bHSIL at entry, and in Arm B, 88 (62%) had abnormal cytology, 22 (15%) were diagnosed with bHSIL, 12 (8%) underwent LEEP. In follow-up, 30 (21%) and 31 (22%) developed bHSIL; time to bHSIL was similar between arms (P=.94). The prevalence of hrHPV at Month 6 was similar between arms (61% and 70%, P=.13). CONCLUSIONS HPV test-and-treat was not associated with improved bHSIL outcomes as compared to cytology-based screening. More effective treatment options are required to improve outcomes from screen-and-treat programs. CLINICAL TRIALS REGISTRATION NCT01315363.
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Affiliation(s)
- Timothy Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Huichao Chen
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA
| | | | - Roy Matining
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Rosie Mngqibisa
- Durban International Clinical Research Site, Enhancing care Foundation, King Edward Hospital, Durban, South Africa
| | - Lameck Chinula
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - Tsitsi Magure
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | | | - Mohammed Rassool
- Clinical HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Cynthia Riviere
- Clinical Research Department, Les Centres GHESKIO, Port-au-Prince, Haiti
| | - Rhamesh Bhosale
- Department of Obstetrics and Gynecology, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Sheela Godbole
- Division of Epidemiology, ICMR-National AIDS Research Unit, Pune, India
| | - Reena Naranjo
- Public Health & Scientific Research, Social & Scientific Systems, Inc, A DLH Holdings Company, Silver Spring, Maryland, USA
| | - Robert Coombs
- Departments of Laboratory Medicine & Pathology and Medicine, University of Washington, Seattle, Washington, USA
| | - Pamela Michelow
- National Health Laboratory Service, Johannesburg, South Africa
| | - Catherine Godfrey
- Office of the Global AIDS Coordinator, Department of State, Washington D.C., USA
| | - Cynthia Firnhaber
- Division of Infectious Disease, Department of Medicine, University of Colorado Medical School, Aurora, Colorado, USA
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Ma JH, You SF, Xue JS, Li XL, Chen YY, Hu Y, Feng Z. Computer-aided diagnosis of cervical dysplasia using colposcopic images. Front Oncol 2022; 12:905623. [PMID: 35992807 PMCID: PMC9389460 DOI: 10.3389/fonc.2022.905623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Backgroundcomputer-aided diagnosis of medical images is becoming more significant in intelligent medicine. Colposcopy-guided biopsy with pathological diagnosis is the gold standard in diagnosing CIN and invasive cervical cancer. However, it struggles with its low sensitivity in differentiating cancer/HSIL from LSIL/normal, particularly in areas with a lack of skilled colposcopists and access to adequate medical resources.Methodsthe model used the auto-segmented colposcopic images to extract color and texture features using the T-test method. It then augmented minority data using the SMOTE method to balance the skewed class distribution. Finally, it used an RBF-SVM to generate a preliminary output. The results, integrating the TCT, HPV tests, and age, were combined into a naïve Bayes classifier for cervical lesion diagnosis.Resultsthe multimodal machine learning model achieved physician-level performance (sensitivity: 51.2%, specificity: 86.9%, accuracy: 81.8%), and it could be interpreted by feature extraction and visualization. With the aid of the model, colposcopists improved the sensitivity from 53.7% to 70.7% with an acceptable specificity of 81.1% and accuracy of 79.6%.Conclusionusing a computer-aided diagnosis system, physicians could identify cancer/HSIL with greater sensitivity, which guided biopsy to take timely treatment.
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Affiliation(s)
| | | | | | | | | | - Yan Hu
- *Correspondence: Zhen Feng, ; Yan Hu,
| | - Zhen Feng
- *Correspondence: Zhen Feng, ; Yan Hu,
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Pimple SA, Pahwa V, Mishra GA, Anand KV, Pathuthara S, Biswas SK. Screening for Early Detection of Cervical Cancer in Women Living with HIV in Mumbai, India - Retrospective Cohort Study from a Tertiary Cancer Center. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Introduction Women living with human immunodeficiency virus (HIV) have an increased risk of persistent human papillomavirus infection (HPV) of developing cervical cancer precursors and are, therefore, considered at higher risk for cervical cancer. Despite the higher risk, screening for cervical cancer is extremely low among HIV-positive women in India.
Objectives Given the limited usefulness of cytology-based screening programs, the current study retrospectively evaluated the comparative performance of visual inspection with 5% acetic acid (VIA), conventional cytology, and human papillomavirus (HPV) testing among HIV-positive women attending the cancer screening clinic at the tertiary cancer center.
Materials and Methods Retrospective analysis of 291 HIV-positive women attending cervical cancer screening services in a tertiary cancer center in Mumbai was undertaken. All underwent simultaneous screening with VIA, Pap cytology, and HPV DNA testing, followed by diagnostic colposcopy and histopathology. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to detect cervical intraepithelial neoplasia (CIN) 2/3 on histology were estimated.
Results The screen positivity rate for cervical cancer screening by VIA, high-risk HPV DNA, and Pap cytology was 35.7, 34.4, and 6.2% respectively. At the CIN2+ disease threshold, the sensitivity, specificity, PPV, and NPV estimates were 80.00% (59.30–93.17), 68.42% (62.46–73.96), 19.23% (15.46–23.67), 97.33% (94.30–98.77) for VIA; 80.00% (68.78–97.45), 70.68% (64.81–76.08), 22.00% (18.22–26.32), 98.43% (95.58–99.45) for HPV DNA; and 64.00% (42.52–82.03), 98.12% (95.67–99.39), 76.19% (56.13–88.89), 96.67% (94.50–98.00) for cytology (HSIL cutoff).
Conclusion The diagnostic performance of VIA and HPV DNA was comparable and better than cytology indicating that VIA as a cost-effective cervical cancer screening test can be incorporated within the services under sexually transmitted diseases /HIV testing and counseling centers within the country.
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Affiliation(s)
- Sharmila A. Pimple
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vandita Pahwa
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gauravi A. Mishra
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kavita V. Anand
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Saleem Pathuthara
- Department of Microbiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sanjay K. Biswas
- Department of Microbiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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11
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Bai A, Wang J, Li Q, Seery S, Xue P, Jiang Y. Assessing colposcopic accuracy for high-grade squamous intraepithelial lesion detection: a retrospective, cohort study. BMC Womens Health 2022; 22:9. [PMID: 35012523 PMCID: PMC8751223 DOI: 10.1186/s12905-022-01592-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/31/2021] [Indexed: 01/03/2023] Open
Abstract
Background Inappropriate management of high-grade squamous intraepithelial lesions (HSIL) may be the result of an inaccurate colposcopic diagnosis. The aim of this study was to assess colposcopic performance in identifying HSIL+ cases and to analyze the associated clinical factors. Methods Records from 1130 patients admitted to Shenzhen Maternal and Child Healthcare Hospital from 12th January, 2018 up until 30th December, 2018 were retrospectively collected, and included demographics, cytological results, HPV status, transformation zone type, number of cervical biopsy sites, colposcopists’ competencies, colposcopic impressions, as well as histopathological results. Colposcopy was carried out using 2011 colposcopic terminology from the International Federation of Cervical Pathology and Colposcopy. Logistic regression modelling was implemented for uni- and multivariate analyses. A forward stepwise approach was adopted in order to identify variables associated with colposcopic accuracy. Histopathologic results were taken as the comparative gold standard. Results Data from 1130 patient records were collated and analyzed. Colposcopy was 69.7% accurate in identifying HSIL+ cases. Positive predictive value, negative predictive value, sensitivity and specificity of detecting HSIL or more (HSIL+) were 35.53%, 64.47%, 42.35% and 77.60%, respectively. Multivariate analysis highlighted the number of biopsies, cytology, and transformation zone type as independent factors. Age and HPV subtype did not appear to statistically correlate with high-grade lesion/carcinoma. Conclusion Evidence presented here suggests that colposcopy is only 69.7% accurate at diagnosing HSIL. Even though not all HSIL will progress into cancer it is considered pre-cancerous and therefore early identification will save lives. The number of biopsies, cytology and transformation zone type appear to be predictors of misdiagnosis and therefore should be considered during clinical consultations and by way of further research.
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Affiliation(s)
- Anying Bai
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jiaxu Wang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qing Li
- Diagnosis and Treatment for Cervical Lesions Center, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, 518028, China
| | - Samuel Seery
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YW, UK
| | - Peng Xue
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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12
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Comparative assessment of test characteristics of cervical cancer screening methods for implementation in low-resource settings. Prev Med 2022; 154:106883. [PMID: 34785209 DOI: 10.1016/j.ypmed.2021.106883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 12/31/2022]
Abstract
Cervical cancer disproportionately affects low-resource settings. Papanicolaou, human papillomavirus (HPV), and visual inspection of cervix with acetic acid (VIA) testing, each with different characteristics, will reduce cervical cancer burden. We conducted a critical literature review using PubMed, Cochrane, WHO, and grey literature from 1994 to 2020. We examined efficacy, harms, and comparative effectiveness of screening methods by age, human immunodeficiency virus, provider characteristics, and assessed implementation challenges in low-resource settings. Comprehensive data on utility and efficacy of screening tests indicates that each screening has strengths and shortcomings but all confer acceptable performance. HPV and VIA appear more promising. Primary HPV test-and-treat, self-testing, and co-testing have been studied but data on triage plans, cost, support system, implementation and sustainability is unclear in low-resource settings. HPV testing could help target subgroups of older or higher risk women. VIA offers local capacity-building and scalability. Quality VIA technique after HPV testing is still required to guide post-screening treatments. VIA competencies decline gradually with current standard trainings. Stationary cervicography improves VIA quality but isn't scalable. Affordable smartphones eliminate this barrier, enhance training through mentorship, and advance continuing education and peer-to-peer training. Smartphone-based VIA facilitates cervical image storage for patient education, health promotion, record-keeping, follow-up care, remote expert support, and quality control to improve VIA reliability and reproducibility and reduce mis-diagnoses and burden to health systems. Rather than ranking screening methods using test characteristics alone in study or higher-resource settings, we advocate for scalable strategies that maximize reliability and access and reduce cost and human resources.
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13
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Dsouza JP, Van den Broucke S, Pattanshetty S, Dhoore W. The application of health behavior theories to promote cervical cancer screening uptake. Public Health Nurs 2021; 38:1039-1079. [PMID: 34231254 DOI: 10.1111/phn.12944] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND While cervical cancer is a major cause of mortality, its progress and survival rate can be improved through screening. Yet despite their wide availability, women's participation in cervical cancer screening (CCS) programs is often suboptimal, especially in low- and middle-income countries. Besides demographic and organizational characteristics, screening uptake is influenced by psychological factors, most of which are included in health behavior theories. This systematic review compared different health behavior theories in terms of their capacity to explain CCS uptake and inform CCS promotion campaigns. METHODS A comprehensive search and analysis of published intervention and non-intervention (observational) studies that applied at least one health behavior theory to CCS participation. RESULTS After quality screening, 48 observational and 21 intervention studies were identified that applied the Health Belief Model (HBM), Theory of Reasoned Action (TRA), Theory of Planned Behaviour (TPB), Transtheoretical model (TTM), Social-ecological Model (SEM), and/or Theory of Triadic Influence (TTI) to CCS. The HBM was most frequently used to explain behavior, whereas the TPB was better at explaining screening intentions. Tailored intervention studies focusing on all theoretical constructs were most effective in modifying perceptions and increasing CCS uptake. CONCLUSIONS Despite their inconsistent use, health behavior theories can explain CCS intentions and behavior and contribute to the development of targeted interventions to promote screening uptake.
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Affiliation(s)
| | - Stephan Van den Broucke
- Faculty of Psychology and Educational Sciences, Université Catholique de Louvain, Louvain, Belgium
| | - Sanjay Pattanshetty
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - William Dhoore
- Faculty of Public Health, Université Catholique de Louvain, Louvain, Belgium
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14
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Téguété I, Tounkara FK, Diawara B, Traoré S, Koné D, Bagayogo A, Sissoko A, Traoré CB. A population-based combination strategy to improve the cervical cancer screening coverage rate in Bamako, Mali. Acta Obstet Gynecol Scand 2021; 100:794-801. [PMID: 33560520 DOI: 10.1111/aogs.14119] [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] [Received: 10/28/2020] [Accepted: 02/08/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cervical cancer screening coverage rate is <5% in Sub-Saharan Africa and <2% in French- speaking African countries. In 2016, we implemented strategies to improve cervical cancer screening in Bamako, the "Weekend70 program". The present study objectives are to determine the effect of this program on women's participation in cervical cancer screening in Bamako, and to estimate the cervical cancer screening coverage rate in Bamako. MATERIAL AND METHODS From 1 January 2016 to 31 July 2020, we conducted an operational research by developing several strategies to improve the cervical cancer screening coverage rate among adolescents and women ≥15 years old in Bamako, Mali. The strategies consisted of awareness-raising activities, strengthening of screening practices in healthcare facilities and cost-free cervical cancer screening during the weekend. Descriptive statistics were presented. The cervical cancer coverage rate was calculated by dividing the number of women screened by the total number of women ≥20 years old, based on Mali demographic data. RESULTS The total number of women screened was 289 924. Residents from Bamako represented 91.9% (266 436/289 924) vs 8.1% (23 488/289 924) who lived outside Bamako. The mean age was 33.2 (± 11.5) years old. Around 46.1% of participants attending the cervical cancer screening were between 30 and 49 years old (World Health Organization prioritized target age for cervical cancer screening). Women ≥60 years old represented <5%. Cervical cancer screening participation increased significantly, from <800 women screened per week before the implementation of the program to a peak of 4100 women screened per week during the "Weekend70 program". Overall, the cervical cancer screening coverage rates at the end of the study among women ≥20 years old was 47.3%, and 56.9% in the WHO target population. CONCLUSION In an impoverished context, a multi-component strategy significantly increases cervical cancer screening participation.
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Affiliation(s)
- Ibrahima Téguété
- Department of Gynecology and Obstetrics, Gabriel Touré Teaching Hospital, Bamako, Mali
| | - Fatoumata K Tounkara
- Department of Social and Preventive Medicine, Laval University, Quebec, Canada.,Population Health and Optimal Health Practices Axis, Research Center of CHU of Quebec-Laval University, Quebec, Canada
| | - Broulaye Diawara
- Department of Gynecology and Obstetrics, Gabriel Touré Teaching Hospital, Bamako, Mali
| | - Sidy Traoré
- Department of Gynecology and Obstetrics, Gabriel Touré Teaching Hospital, Bamako, Mali
| | | | - Aliou Bagayogo
- Direction of Reproductive Health and General Direction of Health, Ministry of Health, Bamako, Mali
| | | | - Cheick B Traoré
- Department of Anatomy - Pathology, Point G Teaching Hospital, Bamako, Mali
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15
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Kirubarajan A, Leung S, Li X, Yau M, Sobel M. Barriers and facilitators for cervical cancer screening among adolescents and young people: a systematic review. BMC Womens Health 2021; 21:122. [PMID: 33757512 PMCID: PMC7989022 DOI: 10.1186/s12905-021-01264-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/14/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Though cervical cancer is one of the leading causes of cancer-related death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening as this population has historically been under-screened. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines. The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening (CCS) among adolescents and young people globally. METHODS We conducted a systematic review following PRISMA guidelines of three key databases: Medline-OVID, EMBASE, and CINAHL. Supplementary searches were done through ClinicialTrials.Gov and Scopus. Databases were examined from 1946 until the date of our literature searches on March 12th 2020. We only examined original, peer-reviewed literature. Articles were excluded if they did not specifically discuss CCS, were not specific to individuals under the age of 35, or did not report outcomes or evaluation. All screening, extraction, and synthesis was completed in duplicate with two independent reviewers. Outcomes were summarized descriptively. Risk of bias for individual studies was graded using an adapted rating scale based on the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. RESULTS Of the 2177 original database citations, we included 36 studies that met inclusion criteria. The 36 studies included a total of 14,362 participants, and around half (17/36, 47.2%) of studies specifically targeted students. The majority of studies (31/36, 86.1%) discussed barriers and facilitators to Pap testing specifically, while one study analyzed self-sampling (1/36, 2.8%), one study targeted HPV DNA testing (1/36, 2.8%), and the remainder (4/36, 11.1%) were not specified. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and systemic barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. CONCLUSION There are unique barriers and facilitators that affect CCS rates in adolescents and young people. Health systems and healthcare providers worldwide should address the challenges for this unique population.
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Affiliation(s)
- Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Shannon Leung
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
| | - Xinglin Li
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
| | - Matthew Yau
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mara Sobel
- Department of Obstetrics and Gynecology, Sinai Health System, Toronto, ON, Canada
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16
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Joshi S, Muwonge R, Kulkarni V, Lucas E, Kulkarni S, Kand S, Mandolkar M, Baig M, Wankhede S, Surwase K, Pardeshi D, Basu P, Rengaswamy S. Mobile Screening Unit (MSU) for the Implementation of the 'Screen and Treat' Programme for Cervical Cancer Prevention In Pune, India. Asian Pac J Cancer Prev 2021; 22:413-418. [PMID: 33639655 PMCID: PMC8190336 DOI: 10.31557/apjcp.2021.22.2.413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/19/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES We are reporting the evaluation of an opportunistic point of care cervical cancer screening initiative in Pune, India using a mobile screening unit (MSU). METHODS We conducted 290 cervical cancer screening outreach clinics in the MSU. Screening was performed by trained nurses/ health care providers using visual inspection with 5% acetic acid (VIA). Screen positive women when eligible were treated by thermal ablation during the same sitting. Women with large lesions not eligible for treatment with thermal ablation were referred for colposcopy and treatment. RESULTS A total of 10, 925 women were screened between Nov 2016 and June 2019 in 290 outreach clinics in the MSU. The overall screen positivity was 6.6% (95% CI 6.1, 7.0) with a declining trend over time. A total of 304/717 (42.4%, 95% CI 38.7, 46.1) women received treatment with thermal ablation. About 3.6% (11/304) reported minor side effects and 1.6% (5/304) reported lower abdominal pain and all of them subsided after treatment. Among the 413 women who were advised colposcopy, only 84 (20.33%) women underwent the procedure. Of these 84 women, 64 (76.19%) had normal colposcopy/ histopathology, 7 (8.33%) had CIN1, 2 (2.38%) had CIN 2, 9 (10.71%) had CIN 3 disease and 2 (2.38%) women were diagnosed with invasive cancer. CONCLUSION MSUs are useful for providing cervical cancer screening services, using the 'screen and treat' strategy. Thermal ablation is safe in the field clinics. Additional efforts are needed to improve the compliance for referral of those with large lesions requiring additional visits.
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Affiliation(s)
- Smita Joshi
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Richard Muwonge
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, WHO, Lyon, France.
| | - Vinay Kulkarni
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Eric Lucas
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, WHO, Lyon, France.
| | - Sanjeevani Kulkarni
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Seema Kand
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Mahesh Mandolkar
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Mufid Baig
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Sudhakar Wankhede
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Kavita Surwase
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Dilip Pardeshi
- Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India.
| | - Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, WHO, Lyon, France.
| | - Sankaranarayanan Rengaswamy
- Research Triangle Institute, International-India, Commercial Tower, Pullman Hotel Aerocity, New Delhi, India.
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17
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Yu Y, Ma J, Zhao W, Li Z, Ding S. MSCI: A multistate dataset for colposcopy image classification of cervical cancer screening. Int J Med Inform 2020; 146:104352. [PMID: 33360117 DOI: 10.1016/j.ijmedinf.2020.104352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 11/05/2020] [Accepted: 11/21/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cervical cancer is the second most common female cancer globally, and it is vital to detect cervical cancer with low cost at an early stage using automated screening methods of high accuracy, especially in areas with insufficient medical resources. Automatic detection of cervical intraepithelial neoplasia (CIN) can effectively prevent cervical cancer. OBJECTIVES Due to the deficiency of standard and accessible colposcopy image datasets, we present a dataset containing 4753 colposcopy images acquired from 679 patients in three states (acetic acid reaction, green filter, and iodine test) for detection of cervical intraepithelial neoplasia. Based on this dataset, a new computer-aided method for cervical cancer screening was proposed. METHODS We employed a wide range of methods to comprehensively evaluate our proposed dataset. Hand-crafted feature extraction methods and deep learning methods were used for the performance verification of the multistate colposcopy image (MSCI) dataset. Importantly, we propose a gated recurrent convolutional neural network (C-GCNN) for colposcopy image analysis that considers time series and combined multistate cervical images for CIN grading. RESULTS The experimental results showed that the proposed C-GCNN model achieves the best classification performance in CIN grading compared with hand-crafted feature extraction methods and classic deep learning methods. The results showed an accuracy of 96.87 %, a sensitivity of 95.68 %, and a specificity of 98.72 %. CONCLUSION A multistate colposcopy image dataset (MSCI) is proposed. A CIN grading model (C-GCNN) based on the MSCI dataset is established, which provides a potential method for automated cervical cancer screening.
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Affiliation(s)
- Yao Yu
- The School of Management, Hefei University of Technology, China
| | - Jie Ma
- The First Affiliated Hospital of USTC, China
| | | | - Zhenmin Li
- The School of Microelectronics, Hefei University of Technology, China
| | - Shuai Ding
- The School of Management, Hefei University of Technology, China.
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18
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Rahatgaonkar V, Uchale P, Oka G. Comparative Study of Smart Scope® Visual Screening Test with Naked Eye Visual Screening and Pap Test. Asian Pac J Cancer Prev 2020; 21:3509-3515. [PMID: 33369446 PMCID: PMC8046303 DOI: 10.31557/apjcp.2020.21.12.3509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Cervical cancer is a major contributor to mortality and morbidity in women. Naked eye visual screening (NE test) and Pap test are commonly used for cervical cancer screening. Both tests have inherent limitations like low sensitivity (Pap test) and subjectivity in interpretation, lack of permanent record and overestimation (NE test). Here, Smart Scope® visual screening test (SS test) was compared with NE and Pap tests. Smart Scope® is a small, hand-held device that captures cervical images attached to a tablet to store data. Objective: To compare SS test with Pap and NE tests. Study Design: This prospective observational study was conducted at a tertiary care hospital in India, over 16 months. A total of 509 women in the age group of 25 to 65 years were included in the study as per the inclusion criteria. All the participants underwent Pap test, NE test and SS test. Screen positives on any one test were advised colposcopy and biopsy. Results: Out of 154 screen-positive women, 49 visited for follow-up colposcopy-guided biopsy. Nine incidental biopsies of screen-negative women were included in the data. Thus, statistical analysis was carried out based on 58 available histopathology results. Out of 58 biopsies, 8 were normal, 30 were benign lesions, 18 were precancerous and 2 were cancerous lesions. SS test was found to have a sensitivity and NPV of 100% each, PPV of 45.4% and a specificity of 36.8%. Sensitivity and specificity of NE test was 90% and 39.5% respectively, PPV was 43.9% and NPV was 88.2%. Pap smear had a sensitivity of 25% and specificity of 84.2%, PPV of 45.5% and NPV of 68.08%. Conclusion: SS test has great potential to be a primary screening test in low-resource settings due to its better sensitivity and NPV as compared to NE and Pap tests.
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Affiliation(s)
- Veena Rahatgaonkar
- Department of Gynecology, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
| | - Pooja Uchale
- Department of Research, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
| | - Gauri Oka
- Department of Research, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
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19
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Gottschlich A, Rivera-Andrade A, Bevilacqua K, Murchland AR, Isak E, Alvarez CS, Ogilvie G, Carey TE, Prince M, Dean M, Mendoza-Montano C, Meza R. Using self-collection HPV testing to increase engagement in cervical cancer screening programs in rural Guatemala: a longitudinal analysis. BMC Public Health 2020; 20:1406. [PMID: 32933512 PMCID: PMC7493167 DOI: 10.1186/s12889-020-09478-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022] Open
Abstract
Background Cervical cancer is a leading cause of death in low- and middle-income countries. Self-collection testing for human papillomavirus (HPV) is an alternative form of cervical cancer screening that can be completed privately and at home. Understanding how the use of HPV testing influences follow-up care in low-resourced settings is crucial before broad implementation. This study aimed to identify if access to self-collection HPV testing impacts participation in established cervical cancer screening programs among women in two rural communities in Guatemala. Methods A cohort of 956 women was recruited in 2016 and followed for 2 years for the HPV Multiethnic Study (HPV MES). At baseline, women answered a questionnaire assessing cervical cancer screening history and were offered self-collection HPV testing. Women were re-contacted yearly to determine receipt of additional screening. Statistical changes in screening behavior before and throughout study participation, stratified by self-collection status, were assessed using McNemar pair tests for proportions. Alluvial plots were constructed to depict changes in individual screening behavior. The odds of changes in Pap-compliance (screened in past 3 years), given collection status, were assessed using multivariate logistic regressions. Results Reported screening rates increased 2 years after enrollment compared to rates reported for the 3 years before study entry among women who collected a sample (19.1% increase, p < 0.05), received results of their test (22.1% increase, p < 0.05), and received positive (24.2% increase, p < 0.1) or negative results (21.7% increase, p < 0.05). However, most increases came from one community, with minimal changes in the other. The adjusted odds of becoming Pap compliant were higher for women who collected a sample vs. did not (OR: 1.48, 95% CI: 0.64, 3.40), received their result vs. did not (OR: 1.29, 95% CI: 0.52, 3.02), and received a positive result vs. negative (OR: 2.43, 95% CI: 0.63, 16.10). Conclusions Participation in self-collection HPV testing campaigns may increase likelihood of involvement in screening programs. However, results varied between communities, and reporting of screening histories was inconsistent. Future work should identify what community-specific factors promote success in HPV testing programs and focus on improving education on existing cervical cancer interventions.
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Affiliation(s)
- Anna Gottschlich
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA. .,, Vancouver, Canada.
| | - Alvaro Rivera-Andrade
- Institute of Nutrition of Central America and Panama-INCAP, Guatemala City, Guatemala
| | - Kristin Bevilacqua
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Audrey R Murchland
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ergest Isak
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Christian S Alvarez
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Gina Ogilvie
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Thomas E Carey
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA.,Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Michael Dean
- Laboratory of Translational Genomics, Division of Cancer, Epidemiology and Genetics, National Cancer Institute, Gaithersburg, MD, USA
| | | | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Visual Inspection with Acetic Acid Versus Papanicolaou Test in Cervical Cancer Screening. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00438-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tekalegn Y, Aman R, Woldeyohannes D, Sahiledengle B, Degno S. Determinants of VIA Positivity Among Women Screened for Cervical Precancerous Lesion in Public Hospitals of Oromia Region, Ethiopia: Unmatched Case-Control Study. Int J Womens Health 2020; 12:587-596. [PMID: 32801936 PMCID: PMC7398741 DOI: 10.2147/ijwh.s256821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Globally, cervical cancer is the fourth most frequent cancer among women. An estimated 570,000 cases of cervical cancer representing 6.6% of all female cancers were reported in the year 2018. Approximately, 90% of deaths from cervical cancer occurred in low- and middle-income countries. Screening cervical cancer at an early stage and providing access to effective treatment can significantly improve the likelihood of survival. Hence, this study aimed to assess the determinants of visual inspection of cervix with acetic acid (VIA) positivity among women screened in public hospitals of Oromia region, Ethiopia. Methods A hospital-based un-matched case-control study was conducted in Oromia region, Ethiopia. Cases were women who have a positive result for the VIA test, and controls were women with a negative result. An interviewer-administered questionnaire was used to collect the data. Multiple binary logistic regressions were conducted to assess the determinants of VIA positivity. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported to describe the strength of associations. Statistical significance was declared at a p-value <0.05. Results A total of 74 cases and 148 controls were included in this study. The mean age of cases and controls was 40.5 ± 13.3 years and 37.1 ± 11.9 years, respectively. Women with parity of four or more children had two times higher odds being positive for VIA test compared to their counterparts (AOR: 2.1, 95% CI: 1.3–4.0). Women with a history of post-coital bleeding had three times higher odds of VIA positivity compared to their counterparts (AOR: 3.3, 95% CI: 1.2–8.0). History of sexually transmitted infection (AOR: 1.9, 95% CI: 1.1–3.5), having multiple sexual partners (AOR: 3.2, 95% CI: 1.2–8.0), and history of smoking (AOR: 8.9, 95% CI: 1.6–48.0) were also found to be determinants of VIA positivity. Conclusion This study found that women with parity greater than four children, post-coital bleeding, history of sexually transmitted infections, having multiple sexual partners, and history of smoking were significantly associated with VIA positivity. Women with the mentioned characteristics should be encouraged to have a close follow-up for the screening. Additionally, awareness creation activities on the identified risk factors are strongly recommended for all women.
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Affiliation(s)
- Yohannes Tekalegn
- School of Health Science, Department of Public Health, Madda Walabu University, Goba Referral Hospital, Goba, Ethiopia
| | - Rameto Aman
- School of Health Science, Department of Public Health, Madda Walabu University, Goba Referral Hospital, Goba, Ethiopia
| | - Demelash Woldeyohannes
- School of Health Science, Department of Public Health, Madda Walabu University, Goba Referral Hospital, Goba, Ethiopia
| | - Biniyam Sahiledengle
- School of Health Science, Department of Public Health, Madda Walabu University, Goba Referral Hospital, Goba, Ethiopia
| | - Sisay Degno
- School of Medicine, Department of Anatomy, Madda Walabu University, Goba Referral Hospital, Goba, Ethiopia
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Meeta M, Digumarti L, Agarwal N, Vaze N, Shah R, Malik S. Clinical Practice Guidelines on Menopause: *An Executive Summary and Recommendations: Indian Menopause Society 2019-2020. J Midlife Health 2020; 11:55-95. [PMID: 33281418 PMCID: PMC7688016 DOI: 10.4103/jmh.jmh_137_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Meeta Meeta
- Gynecologist, Co-Director and Chief Consultant, Tanvir Hospital, Hyderabad, Telangana, India
| | - Leela Digumarti
- Gynecologist, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Visakhapatnam, Andhra Pradesh, India
| | - Neelam Agarwal
- Obs Gynae, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nirmala Vaze
- Consultant Obstetrician/Gynaecologist, Counselar Breast, Gynae Cancer & Menopause, Nagpur, India
| | - Rashmi Shah
- Gynecologist, Ex Senior Deputy Director, National Institute for Research in Reproductive Health (ICMR), Mumbai, India
| | - Sonia Malik
- Gynecologist, Director and HOD, Southend Fertility & IVF Centre, New Delhi, India
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Pérula de Torres LA, Moscosio Cuevas JI, Bartolomé Moreno C, Martín-Carrillo P, Martín-Rabadán M, Jiménez García C. [Knowledge, conduct and attitude before the European Code against Cancer by health professionals of primary care]. Aten Primaria 2020; 52:67-76. [PMID: 30630633 PMCID: PMC7025965 DOI: 10.1016/j.aprim.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To decide if Primary Care (PC) professionals know the European Code against Cancer (CECC) and if this relates to practice the recommendations with themselves and with their patients. DESIGN descriptive, observational study. SETTING Spanish Health Centers. PARTICIPANTS Health professionals. INTERVENTIONS self-administered questionnaire. MAIN MEASUREMENTS cancer protective and risk factors, screening for colorectal, breast, cervix and prostate cancer, level of knowledge of the ECAC. RESULTS 1734 participants (10.5%), mean age 47.4 years (SD: 8.6), 71.5% female. 50.0% do not know the CECC; tutors (OR=1.61), assigned to the PAPPS (OR=1.51) and who have been working in AP for more time (OR=2.62) are the ones who know it most. 7.2% smoke and 79.1% drink alcohol. 64.1% presented normal weight and 19% performed physical activity. They avoid exposing themselves to the sun 52.7% and use protectors 53.8%. 85.2% have never had a colorectal screening, 11% never had a cytology, and 12% had a mammogram. There is a relationship between knowing the CECC and smoking (P<.001), overweight/obesity (P=.024), physical activity (P=.003), meat intake (P<.001), mammography (P<.001), cytology (P=.022), PSA (P=.045), as well as the promotion of their advice among patients. CONCLUSIONS The CECC is unknown by half of the AP professionals. The practice of its recommendations is uneven, with the prevalence of low smoking, and sun protection a little extended behavior. Those who know him are the ones who most practice his recommendations.
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Affiliation(s)
- Luis Angel Pérula de Torres
- Unidad Docente de Medicina Familiar y Comunitaria de Córdoba, Distrito Sanitario Córdoba y Guadalquivir, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Grupo de Evaluación y mejora del PAPPS (semFYC), Córdoba, España.
| | - Jose Ignacio Moscosio Cuevas
- Unidad Docente de Medicina Familiar y Comunitaria de Córdoba, Distrito Sanitario Córdoba y Guadalquivir, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Grupo de Evaluación y mejora del PAPPS (semFYC), Córdoba, España
| | - Cruz Bartolomé Moreno
- Unidad Docente de Medicina Familiar y Comunitaria Sector Zaragoza I, Grupo de Cáncer del PAPPS, Zaragoza, España
| | - Pilar Martín-Carrillo
- Centro de Salud de Yébenes. Grupo de evaluación y mejora del PAPPS (semFYC), Madrid, España
| | - María Martín-Rabadán
- Centro de Salud Can Misses. Grupo de Evaluación y mejora del PAPPS (semFYC), Ibiza, España
| | - Celia Jiménez García
- Distrito Sanitario de Atención Primaria Córdoba y Guadalquivir, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, España
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Shikha S, Smita J, Nayanjeet C, Ruchi P, Parul S, Uma M, Shubhra T, Phillip G, Pritpal M. Experience of a 'Screen and treat' program for secondary prevention of cervical cancer in Uttar Pradesh, India. J Obstet Gynaecol Res 2019; 46:320-327. [PMID: 31814247 DOI: 10.1111/jog.14162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/10/2019] [Indexed: 01/22/2023]
Abstract
AIM Considering the burden of cervical cancer in India, innovative approaches are needed to improve coverage of cervical cancer screening. METHODS From May 2014 to January 2017, we implemented a project in 10 cities in Uttar Pradesh, India using World Health Organization-recommended 'screen and treat' approach for cervical cancer prevention. We involved private practitioners (obstetricians and gynecologists and general practitioners) in these cities to provide affordable cervical cancer screening to women mobilized by our community health workers. A pilot phase was implemented in three cities during May 2014 and December 2015 and the project was scaled-up to additional seven cities between January 2016 and January 2017. RESULTS A total of 100 836 women aged between 30 and 60 years were screened with visual inspection with acetic acid (VIA) of which 5477 (5.4%, 95% confidence interval (CI) 5.29, 5.57) were VIA positive. Treatment with cryotherapy was given to 3735 (68.2%, 95% CI 66.96, 69.43) women. In the three cities that piloted the program, VIA positivity rates significantly declined from 6.6% (95% CI 6.31, 6.84) to 4.0% (95% CI 3.82, 4.24) during the scale-up phase (P < 0.0001) and the rates of cryotherapy significantly increased from 66.8% (95% CI 64.78, 68.77) to 76.7% (95% CI 74.42, 78.96) (P < 0.0001). CONCLUSION We observed a significant decline in the VIA positivity rates during the scale-up phase in the three cities that participated in the pilot phase. We have reported successful engagement of private practitioners to provide affordable cervical cancer screening and it is possible to replicate it in other states in India as well.
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Affiliation(s)
| | - Joshi Smita
- Department of Preventive Oncology, Prayas, Pune, India
| | | | - Pathak Ruchi
- Population Services International, New Delhi, Prayas, Pune
| | - Saxena Parul
- Population Services International, New Delhi, Prayas, Pune
| | - Mahajan Uma
- Independent Consultant Statistician, Pune, India
| | | | - George Phillip
- Population Services International, New Delhi, Prayas, Pune
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Pimple SA, Mishra GA. Optimizing high risk HPV-based primary screening for cervical cancer in low- and middle-income countries: opportunities and challenges. ACTA ACUST UNITED AC 2019; 71:365-371. [DOI: 10.23736/s0026-4784.19.04468-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Egede J, Ajah L, Ibekwe P, Agwu U, Nwizu E, Iyare F. Comparison of the Accuracy of Papanicolaou Test Cytology, Visual Inspection With Acetic Acid, and Visual Inspection With Lugol Iodine in Screening for Cervical Neoplasia in Southeast Nigeria. J Glob Oncol 2019; 4:1-9. [PMID: 30241249 PMCID: PMC6223424 DOI: 10.1200/jgo.17.00127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose This study aimed to compare the accuracy of Papanicolaou test cytology, visual inspection with 5% acetic acid (VIA), and visual inspection with Lugol iodine (VILI) in the detection of premalignant and malignant lesions of the cervix. Materials and Methods This was a cross-sectional comparative study of 200 consenting participants at the Federal Teaching Hospital, Abakaliki over a 6-month period. All the participants had Papanicolaou test cytology. Subsequently, they were classified into two groups of 100 each through systematic random sampling: group 1 had VIA and group 2 had VILI. Thereafter, all the participants had cervical punch biopsy at the 6 and 12 o’clock cervical positions. Cervical punch biopsy was also done on the suspicious lesions of the cervix irrespective of their positions. The tests of validity of the three methods were calculated using the histology of the biopsy specimen as the gold standard. P value ≤ .05 was considered to be statistically significant. Results Among the VIA group, 19 (19%) had cervical epithelial abnormalities on Papanicolaou test cytology, and VIA was positive in 14 (14%). Histology results showed cervical neoplasia in 15 (15%) of the participants. Among the VILI group, 15 (15%) had cervical epithelial abnormalities on Papanicolaou test cytology, and VILI was positive in 19 (19%). Histology results showed cervical neoplasia in 15 (15%) of the participants. There was no significant difference in overall accuracy of Papanicolaou test cytology, VIA, and VILI. The overall accuracy of the Papanicolaou test cytology plus VIA was significantly more than Papanicolaou test cytology alone. Conclusion VIA or VILI can be used as a stand-alone cervical cancer screening test when compared with Papanicolaou test cytology, particularly in resource-limited settings. VIA can also complement Papanicolaou test cytology.
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Affiliation(s)
- John Egede
- John Egede, Perpetus Ibekwe, Uzoma Agwu, Emmanuel Nwizu, and Festus Iyare, Federal Teaching Hospital, Abakaliki, Ebonyi State; and Leonard Ajah, University of Nigeria, Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
| | - Leonard Ajah
- John Egede, Perpetus Ibekwe, Uzoma Agwu, Emmanuel Nwizu, and Festus Iyare, Federal Teaching Hospital, Abakaliki, Ebonyi State; and Leonard Ajah, University of Nigeria, Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
| | - Perpetus Ibekwe
- John Egede, Perpetus Ibekwe, Uzoma Agwu, Emmanuel Nwizu, and Festus Iyare, Federal Teaching Hospital, Abakaliki, Ebonyi State; and Leonard Ajah, University of Nigeria, Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
| | - Uzoma Agwu
- John Egede, Perpetus Ibekwe, Uzoma Agwu, Emmanuel Nwizu, and Festus Iyare, Federal Teaching Hospital, Abakaliki, Ebonyi State; and Leonard Ajah, University of Nigeria, Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
| | - Emmanuel Nwizu
- John Egede, Perpetus Ibekwe, Uzoma Agwu, Emmanuel Nwizu, and Festus Iyare, Federal Teaching Hospital, Abakaliki, Ebonyi State; and Leonard Ajah, University of Nigeria, Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
| | - Festus Iyare
- John Egede, Perpetus Ibekwe, Uzoma Agwu, Emmanuel Nwizu, and Festus Iyare, Federal Teaching Hospital, Abakaliki, Ebonyi State; and Leonard Ajah, University of Nigeria, Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
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Elliott T, Kohler RE, Monare B, Moshashane N, Ramontshonyana K, Muthoga C, Wynn A, Howett R, Luckett R, Morroni C, Ramogola-Masire D. Performance of vaginal self-sampling for human papillomavirus testing among women living with HIV in Botswana. Int J STD AIDS 2019; 30:1169-1176. [PMID: 31558129 PMCID: PMC7179768 DOI: 10.1177/0956462419868618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In Botswana, where HIV prevalence remains high, cervical cancer is the leading cause of cancer deaths in women. Multiple organizations recommend high-risk human papillomavirus (hr-HPV) testing as a screening tool, however, high coverage may not be feasible with provider-collected samples. We conducted the first assessment of self- versus provider-collected samples for hr-HPV testing in HIV-positive women in Botswana and report prevalence of hr-HPV and histological outcomes. Methods: We recruited HIV-positive women ≥25 years attending an HIV clinic in Gaborone. Self- and provider-collected samples from participants were tested for hr-HPV using Cepheid GeneXpert. Women testing positive for any hr-HPV returned for colposcopy. We used unweighted κ statistics to determine hr-HPV agreement. Results: Thirty-one (30%) of 103 women tested positive for any hr-HPV. The most common genotypes were HPV 31/33/35/52/58. Overall agreement between self- and provider-collected samples for any hr-HPV was 92% with a κ of 0.80. Ten of the 30 hr-HPV positive women attending colposcopy had CIN 2+ (33%). Conclusions: In this HIV-positive population, hr-HPV prevalence was 30%, with excellent agreement between self and provider samples. Self-sampling may play an important role in screening programs in high HIV burden settings with limited resources like Botswana.
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Affiliation(s)
| | - Racquel E Kohler
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Botswana Harvard Aids Institute Partnership, Gaborone, Botswana
| | | | | | | | | | - Adriane Wynn
- Botswana UPenn Partnership, Gaborone, Botswana
- University of California, San Diego, CA, USA
| | | | - Rebecca Luckett
- Botswana Harvard Aids Institute Partnership, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Chelsea Morroni
- Botswana UPenn Partnership, Gaborone, Botswana
- Botswana Harvard Aids Institute Partnership, Gaborone, Botswana
- Liverpool School of Tropical Medicine, Liverpool, UK
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Rady HA, Gaber Z, Agamia A, Melies M. A Study of Sensitivity of Visual Inspection of the Cervix with Acetic Acid in Cervical Cancer Screening. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mishra GA, Pimple SA, Gupta SD. Evaluation of cytology as secondary triage in visual inspection after application of 4% acetic acid-based cervical cancer screening program. South Asian J Cancer 2019; 8:102-107. [PMID: 31069189 PMCID: PMC6498705 DOI: 10.4103/sajc.sajc_50_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context (Background): Visual-based screening techniques are low cost and have good sensitivity. Hence, they appear promising for primary screening in low-resource settings. However, to reduce referrals for diagnostic colposcopy, there is need to triage these screen-positive women with test with good specificity. Aims: The study aims to evaluate the performance of cytology as triage for visual inspection after application of 4% acetic acid (VIA) screen-positive women. Settings and Design: Community-based cervical cancer screening using VIA was implemented among socioeconomically disadvantaged women in Mumbai, India. Methods: Cytology was performed on screen-positive women. All primarily screen-positive women underwent colposcopy. Directed biopsies were obtained among women with positive findings on colposcopy. The gold standard used for final disease status was histopathology or negative colposcopy. Statistical Analysis Used: Test characteristics of cytology as triage test. Results: Among the 138,383 population, 16,424 eligible women were screened with VIA. 785 (4.78%) women were VIA positive and 580 women participated in triage with cytology. The sensitivity and specificity of cytology at threshold of atypical squamous cells of undetermined significance in detecting ≥cervical intraepithelial neoplasia (CIN) 2 were 75.0 and 94.7, respectively. The positive and negative predictive values of cytology as triage test were 23.1 and 99.4, respectively, and the false positivity and false negativity rates were 5.34 and 25.0, respectively. Conclusion: Cytology triage with VIA can reduce referrals for colposcopy to 4.97% of original referrals but may miss around 25%, of high-grade CIN. The substantial reduction in referrals has special implication for low-resource settings, wherein compliance to referral and availability of diagnostic facilities are poor.
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Affiliation(s)
- Gauravi A Mishra
- Department of Preventive Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sharmila A Pimple
- Department of Preventive Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Subhadra D Gupta
- Department of Preventive Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Vahedpoor Z, Behrashi M, Khamehchian T, Abedzadeh-Kalahroudi M, Moravveji A, Mohmadi-Kartalayi M. Comparison of the diagnostic value of the visual inspection with acetic acid (VIA) and Pap smear in cervical cancer screening. Taiwan J Obstet Gynecol 2019; 58:345-348. [DOI: 10.1016/j.tjog.2019.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 10/26/2022] Open
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Sudhalkar N, Rathod NP, Mathews A, Chopra S, Sriram H, Shrivastava SK, Goda JS. Potential role of cancer stem cells as biomarkers and therapeutic targets in cervical cancer. Cancer Rep (Hoboken) 2019; 2:e1144. [PMID: 32721115 PMCID: PMC7941515 DOI: 10.1002/cnr2.1144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Eradicating cancer stem cells (CSCs) that are termed as the "beating heart" of various malignant tumors, including cervical cancer, holds great importance in cancer therapeutics. CSCs not only confer chemo-radio resistance but also play an important role in tumor metastasis and thereby pose a potential barrier for the cure of cervical cancer. Cervical cancer, a common malignancy among females, is associated with high morbidity and mortality rates, and the study on CSCs residing in the niche is promising. RECENT FINDINGS Biomarker approach to screen the cervical CSCs has gained impetus since the past decade. Progress in identification and characterization of the stem cell biomarkers has led to many insights. For the diagnostic purpose, several biomarkers like viral (HPV16), stem cell markers, transcription factors (viz, SOX2, OCT 4, and c-Myc), and CSC surface markers (viz, ALDH1 and CD44) have been identified. The research so far has been directed to study the CSC stemness and demonstrates various gene expression signatures in cervical CSCs. Such studies hold a potential to improve diagnostic accuracy and predict therapeutic response and clinical outcome in patients. CONCLUSIONS Stem cell biomarkers have been validated and their therapeutic targets are being developed as "strategies to improve therapeutic ratio in personalized medicine." This review gives a brief overview of the cervical CSC biomarkers, their current and future diagnostic, prognostic, and therapeutic potential.
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Affiliation(s)
- Niyati Sudhalkar
- Department of Radiation Oncology, ACTREC, Tata Memorial CentreHomi Bhaba National InstituteKharghar, Navi MumbaiIndia
| | - Nidul P. Rathod
- Department of Radiation Oncology, ACTREC, Tata Memorial CentreHomi Bhaba National InstituteKharghar, Navi MumbaiIndia
| | - Ashwathi Mathews
- Department of Radiation Oncology, ACTREC, Tata Memorial CentreHomi Bhaba National InstituteKharghar, Navi MumbaiIndia
| | - Supriya Chopra
- Department of Radiation Oncology, ACTREC, Tata Memorial CentreHomi Bhaba National InstituteKharghar, Navi MumbaiIndia
| | - Harshini Sriram
- Department of Radiation Oncology, ACTREC, Tata Memorial CentreHomi Bhaba National InstituteKharghar, Navi MumbaiIndia
| | - Shyam K. Shrivastava
- Department of Radiation Oncology, ACTREC, Tata Memorial CentreHomi Bhaba National InstituteKharghar, Navi MumbaiIndia
| | - Jayant S. Goda
- Department of Radiation Oncology, ACTREC, Tata Memorial CentreHomi Bhaba National InstituteKharghar, Navi MumbaiIndia
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Umuago IJ, Obiebi IP, Eze GU, Zini M, Okoacha I. Bridging the gap in health systems through task-sharing: A model of PHC workers’ competency for cervical screening. JOURNAL OF CANCER RESEARCH AND PRACTICE 2018. [DOI: 10.1016/j.jcrpr.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Marzo-Castillejo M, Vela-Vallespín C, Bellas-Beceiro B, Bartolomé-Moreno C, Melús-Palazón E, Vilarrubí-Estrella M, Nuin-Villanueva M. Recomendaciones de prevención del cáncer. Actualización PAPPS 2018. Aten Primaria 2018; 50 Suppl 1:41-65. [PMID: 29866358 PMCID: PMC6837141 DOI: 10.1016/s0212-6567(18)30362-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mercè Marzo-Castillejo
- Especialista en Medicina Familiar y Comunitaria y especialista en Medicina Preventiva y Salud Pública, Unitat de Suport a la Recerca de Costa de Ponent, IDIAP Jordi Gol, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Barcelona
| | - Carmen Vela-Vallespín
- Especialista en Medicina Familiar y Comunitaria, EAP Riu Nord i Riu Sud, Santa Coloma de Gramenet, SAP Barcelona Nord i Maresme-ICS, Unitat Docent Metropolitana Nord, Barcelona
| | - Begoña Bellas-Beceiro
- Especialista en Medicina Familiar y Comunitaria, Complejo Hospitalario Universitario de Canarias y Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Servicio Canario de Salud, Santa Cruz de Tenerife
| | - Cruz Bartolomé-Moreno
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Goya de Zaragoza y Unidad Docente de Medicina Familiar y Comunitaria Sector Zaragoza I, Servicio Aragonés de Salud, Zaragoza
| | - Elena Melús-Palazón
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Actur Oeste, Zaragoza, y Unidad Docente de Medicina Familiar y Comunitaria Sector Zaragoza I, Servicio Aragonés de Salud, Zaragoza
| | - Mercè Vilarrubí-Estrella
- Especialista en Medicina Familiar y Comunitaria, Servicio de Gestión Clínica y Sistemas de Información, Dirección de Atención Primaria, Servicio Navarro de Salud, Pamplona
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Musa J. The Need for Societal Investment to Improve Cervical Cancer Outcomes in Nigeria: A commentary. Afr J Reprod Health 2017; 21:17-23. [PMID: 29624947 DOI: 10.29063/ajrh2017/v21i4.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Although cervical cancer is a preventable cancer with a well-known natural history, it remains a huge burden in developing countries of sub-Saharan Africa where organized cervical cancer screening services are lacking. Developed countries that have invested on providing organized screening programs have made substantial progress in reducing both incidence and mortality due to cervical cancer. Implementing evidence-based interventions such as human papillomavirus (HPV) vaccination of young girls, early detection and treatment of premalignant conditions of the cervix through conventional Pap cytology, HPV screening or visual aided inspection with acetic acid could significantly reduce incidence of new cases at population level. Societal investment for such preventive services and provision of effective treatment for those diagnosed at early stages will yield economic benefits in reducing premature deaths of women at the prime of their productive lives. From a societal perspective, this should be a priority area for national investment towards the achievement of sustainable development in Nigeria and similar settings in Africa.
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Ali S, Skirton H, Clark MT, Donaldson C. Integrative review of cervical cancer screening in Western Asian and Middle Eastern Arab countries. Nurs Health Sci 2017; 19:414-426. [PMID: 29058371 DOI: 10.1111/nhs.12374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 07/12/2017] [Accepted: 07/20/2017] [Indexed: 01/21/2023]
Abstract
Population-based screening programs have resulted in minimizing mortality and morbidity from cervical cancer. The aim of this integrative review was to explore the factors influencing access of women from Western Asian and Middle Eastern Arab countries to cervical cancer screening. A systematic search for studies conducted in Arab countries in those regions, and published in English between January 2002 and January 2017, was undertaken. Thirteen papers were selected and subjected to quality appraisal. A three step analysis was used, which involved a summary of the evidence, analysis of both quantitative and qualitative data, and integration of the results in narrative form. Few population-based cervical cancer screening programs had been implemented in the relevant countries, with low knowledge of, and perceptions about, cervical screening among Arab women, the majority of whom are Muslim. Factors affecting the uptake of cervical cancer screening practices were the absence of organized, systematic programs, low screening knowledge among women, healthcare professionals' attitudes toward screening, pain and embarrassment, stigma, and sociocultural beliefs. Policy changes are urgently needed to promote population-based screening programs. Future research should address the promotion of culturally-sensitive strategies to enable better access of Arab Muslim women to cervical cancer screening.
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Affiliation(s)
- Suhailah Ali
- School of Nursing and Midwifery, Plymouth University, Plymouth, UK.,College of Nursing, Kirkuk University, Kirkuk, Iraq
| | - Heather Skirton
- School of Nursing and Midwifery, Plymouth University, Plymouth, UK
| | - Maria T Clark
- School of Nursing, University of Birmingham, Edgbaston, UK
| | - Craig Donaldson
- School of Biomedical and Healthcare Sciences, Plymouth University, Plymouth, UK
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Jahic M, Jahic E, Mulavdic M, Hadzimehmedovic A. Difference Between Cryotherapy and Follow Up Low Grade Squamous Lesion of Cervix Uteri. Med Arch 2017; 71:280-283. [PMID: 28974850 PMCID: PMC5585814 DOI: 10.5455/medarh.2017.71.280-283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/05/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cervical cancer can be successfully prevented by effective treatment. AIM Analyse of success of cryotherapy in LSIL and ASCUS. MATERIALS ET METHODS In retrospective study between January 2016 to March 2017, 3244 PAP test were analysed. 257 patients who had been diagnosed with LSIL and ASCUS from PAP smear were divided in two groups: women who had HPV positive, colposcopic positive and cytologic finding of LSIL or ASCUS treathed with cryotherapy and women with LSIL, ASCUS and negative colposcopy. χ2 test was used for statistical analysis of data. RESULTS Analysis of 3244 PAP smears showed negative for intraepithelial lesion or malignancy (NILM) in 90,10% (N-2923), and abnormal in 9,8% (N-321) of women. ASCUS was found in 4,8% (N-156) and ASC-H in 0,2% (N-6), LSIL in 3,1% (N-101), HSIL in 0,64% (N-21). The average age of patients with ASCUS lesion was 41 ± 12 years. After cryotherapy, HSIL had progression in 1,5% (N-1), persistence in 6,3% (N-4) and regression in 91,7% (N-58). Progression occured in 10,5% (N-4) of HSIL, persistence in 52,6% (N-20) and regression in 36,7% (N-14) in 38 women with LSIL lesion after repeated PAP test. Progression occured in 8% (N-10) of LSIL and 4% HSIL (N-5), persistence in 58% (N-72) and regression in 29,8% (N-37) in 124 women with ASCUS lesion after treatment and repeated PAP test. Difference in progression lesions in HSIL between women with cryotherapy (1,5%) and follow-up (10,5%) after LSIL is not significant, but progression to CIN II occured after cryotherapy. CIN III or cervical cancer was not found. CONCLUSION Cryotherapy prevents progression of LSIL in HSIL and in cervical cancer. Because of that cryotherapy is successful method in prevention of cervical cancer.
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Affiliation(s)
- Mahira Jahic
- Private Gynecology Ordination, Dr Mahira Jahic” Tuzla, Tuzla, Bosnia and Herzegovina
- University of Tuzla, Faculty of Medicine Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
| | - Elmir Jahic
- Private Gynecology Ordination, Dr Mahira Jahic” Tuzla, Tuzla, Bosnia and Herzegovina
- Cardiovascular Clinic, University Clinical Centar Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
| | - Mirsada Mulavdic
- University of Tuzla, Faculty of Medicine Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
- Polyclinic of Laboratory diagnostic, Department of Microbiology, University Clinical Centar Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
| | - Azra Hadzimehmedovic
- University of Tuzla, Faculty of Medicine Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
- Clinic for Gynecology and Obctetrics, University Clinical Centar Tuzla, Tuzla, Tuzla, Bosnia and Herzegovina
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Awua AK, Wiredu EK, Afari EA, Tijani AS, Djanmah G, Adanu RMK. A tailored within-community specimen collection strategy increased uptake of cervical cancer screening in a cross-sectional study in Ghana. BMC Public Health 2017; 18:80. [PMID: 28764756 PMCID: PMC5540566 DOI: 10.1186/s12889-017-4631-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/26/2017] [Indexed: 11/26/2022] Open
Abstract
Background The implementation of cervical cancer screening strategies has reported different rates of success in different countries due to population specific factors that limit women’s participation. We report observations and the development of a community-based specimen collection strategy which resulted from interactions with women in the study communities, following an initial low response to a hospital based cervical cancer screening strategy. Method Women were recruited by a house survey and invited to report at a hospital either within a week or after a week for self and health-personnel specimen collections. However, due to the very low response and subsequent interactions with the women of the communities, another strategy was developed that required recruited women report at a central location within their respective communities for specimen collections at times that did not interfere with their daily routines. Results For specimen collection, of the 156 participants who opted to report after a week at the hospital, 60 (38.5%) reported. Of the 118 participants who opted to report within 1 week at the hospital, 55 (46.6%) reported. Of the 103 participants were invited to report at a specified location within the community, 98 (95.1%) reported. An overall response rate of 60.4% was attained. Almost 89.7% (226 of 253) of the women performed both self and health personnel sample collection. Conclusion The community-based strategy with self-specimen collection and HPV testing holds great potential for increasing women’s participation in cervical cancer screening in Ghana as compared to the hospital based strategy. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4631-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adolf K Awua
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana. .,Cellular and Clinical Research Centre, Radiological and Medical Sciences Research Institute, GAEC, Accra, Ghana.
| | - Edwin K Wiredu
- University of Health and Allied Sciences, Ho, Ghana.,Department of Pathology, School of Biomedical and Allied Health Science, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - Edwin A Afari
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Ahmad S Tijani
- Akuse Government Hospital, Ghana Health Service, Akuse, Ghana
| | - Gabriel Djanmah
- Akuse Government Hospital, Ghana Health Service, Akuse, Ghana
| | - Richard M K Adanu
- Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Islam RM, Billah B, Hossain MN, Oldroyd J. Barriers to Cervical Cancer and Breast Cancer Screening Uptake in Low-Income and Middle-Income Countries: A Systematic Review. Asian Pac J Cancer Prev 2017; 18:1751-1763. [PMID: 28749101 PMCID: PMC5648375 DOI: 10.22034/apjcp.2017.18.7.1751] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Cervical cancer (CCa) and breast cancer (BCa) are the two leading cancers in women worldwide. Early detection and education to promote early diagnosis and screening of CCa and BCa greatly increases the chances for successful treatment and survival. Screening uptake for CCa and BCa in low and middle - income countries (LMICs) is low, and is consequently failing to prevent these diseases. We conducted a systematic review to identify the key barriers to CCa and BCa screening in women in LMICs. Methods: We performed a systematic literature search using Ovid MEDLINE, EMBASE, PsycINFO, SCOPUS, CINHAL Plus, and Google scholar to retrieve all English language studies from inception to 2015. This review was done in accordance with the PRISMA-P guidelines. Results: 53 eligible studies, 31 CCa screening studies and 22 BCa screening studies, provided information on 81,210 participants. We found fewer studies in low-income and lower - middle - income countries than in upper - middle - income countries. Lack of knowledge about CCa and BCa, and understanding of the role of screening were the key barriers to CCa and BCa screening in LMICs. Factors that are opportunities for knowledge acquisition, such as level of education, urban living, employment outside the home, facilitated CCa and BCa screening uptake in women in LMICs. Conclusions: Improvements to CCa and BCa screening uptake in LMICs must be accompanied by educational interventions which aim to improve knowledge and understanding of CCa and BCa and screening to asymptomatic women. It is imperative for governments and health policy makers in LMICs to implement screening programmes, including educational interventions, to ensure the prevention and early detection of women with CCa and BCa. These programmes and policies will be an integral part of a comprehensive population-based CCa and BCa control framework in LMICs.
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Affiliation(s)
- Rakibul M Islam
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
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Suba EJ, Ortega RE, Mutch DG. Unethical randomised controlled trial of cervical screening in India: US Freedom of Information Act disclosures. BMJ Glob Health 2017; 2:e000177. [PMID: 28589014 DOI: 10.1136/bmjgh-2016-000177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/17/2017] [Accepted: 02/22/2017] [Indexed: 11/03/2022] Open
Abstract
A randomised controlled trial conducted in Mumbai, India, compared invasive cervical cancer rates among women offered cervical screening with invasive cervical cancer rates among women offered no-screening. The US Office for Human Research Protections determined the Mumbai trial was unethical because informed consent was not obtained from trial participants. Reportedly, cervical screening in the Mumbai trial reduced invasive cervical cancer mortality rates, but not invasive cervical cancer incidence rates. Documents obtained through the US Freedom of Information Act disclose that the US National Cancer Institute funded the Mumbai trial from 1997 to 2015 to study 'visual inspection/downstaging' tests. However, 'visual inspection/downstaging' tests had been judged unsatisfactory for cancer control before the Mumbai trial began. 'Visual inspection/downstaging' tests failed to reduce invasive cervical cancer incidence rates in Mumbai because 'visual inspection/downstaging' tests, by design, failed to detect preinvasive cervical lesions. None of the 151 538 Mumbai trial participants, in either the intervention or control arms, received cervical screening tests that detected preinvasive cervical lesions. Because of missing/discrepant clinical staging data, it is uncertain whether 'visual inspection/downstaging' tests actually reduced invasive cervical cancer mortality rates in Mumbai. Documents obtained through the US Freedom of Information Act disclose that US National Cancer Institute leaders avoided accountability by making false and misleading statements to Congressional oversight staff. Our findings contradict assurances given to President Barack Obama that regulations pertaining to global health research supported by the US government adequately protect human participants from unethical treatment. US National Cancer Institute leaders should develop policies to compensate victims of unethical global health research. All surviving Mumbai trial participants should finally receive cervical screening tests that detect preinvasive cervical lesions.
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Affiliation(s)
- Eric J Suba
- Kaiser Permanente Medical Center, San Francisco, California, USA
| | | | - David G Mutch
- Washington University School of Medicine, Saint Louis, Missouri, USA
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Mboumba Bouassa RS, Prazuck T, Lethu T, Jenabian MA, Meye JF, Bélec L. Cervical cancer in sub-Saharan Africa: a preventable noncommunicable disease. Expert Rev Anti Infect Ther 2017; 15:613-627. [PMID: 28440679 DOI: 10.1080/14787210.2017.1322902] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Infections caused by high-risk human papillomavirus (HPV) are responsible for 7.7% of cancers in developing countries, mainly cervical cancer. This disease is steadily increasing in sub-Saharan Africa, with more than 75,000 new cases and 50,000 deaths yearly, further increased by HIV infection. Areas covered: The current status of cervical cancer associated with HPV in sub-Saharan Africa has been systematically revised. The main issues discussed here are related to the public health burden of cervical cancer in sub-Saharan Africa and predictions for the coming decades, including molecular epidemiology and determinants of HPV infection in Africa, and promising prevention measures currently being evaluated in Africa. Expert commentary: By the year 2030, cervical cancer will kill more than 443,000 women yearly worldwide, most of them in sub-Saharan Africa. The increase in the incidence of cervical cancer in Africa could counteract the progress made by African women in reducing maternal mortality and longevity. Nevertheless, cervical cancer is a potentially preventable noncommunicable disease, and intervention strategies to eliminate cervical cancer as a public health concern should be urgently implemented.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- a Laboratoire de virologie, hôpital Européen Georges Pompidou , Assistance Publique-Hôpitaux de Paris , France.,b Department of Immunology, INSERM U970 , Université Paris Descartes, Sorbonne Paris-Cité , Paris , France
| | - Thierry Prazuck
- c Service des Maladies Infectieuses et Tropicales , Centre Hospitalier Régional Orléans La Source , Orléans , France
| | - Thérèse Lethu
- d Department of health and well-being , Global Health Objectives , Geneva , Switzerland
| | - Mohammad-Ali Jenabian
- e Departement des Sciences Biologiques et Centre de recherche BioMed , Universite du Quebec a Montreal (UQAM) , Montreal , QC , Canada
| | - Jean-François Meye
- f Service de Gynécologie Obstétrique, Centre Hospitalo-Universitaire d'Angondjé, Libreville et Faculté de Médecine de Libreville , Université des Sciences de la Santé , Libreville , Gabon
| | - Laurent Bélec
- a Laboratoire de virologie, hôpital Européen Georges Pompidou , Assistance Publique-Hôpitaux de Paris , France.,b Department of Immunology, INSERM U970 , Université Paris Descartes, Sorbonne Paris-Cité , Paris , France
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Xu T, Zhang H, Xin C, Kim E, Long LR, Xue Z, Antani S, Huang X. Multi-feature based Benchmark for Cervical Dysplasia Classification Evaluation. PATTERN RECOGNITION 2017; 63:468-475. [PMID: 28603299 PMCID: PMC5464748 DOI: 10.1016/j.patcog.2016.09.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cervical cancer is one of the most common types of cancer in women worldwide. Most deaths due to the disease occur in less developed areas of the world. In this work, we introduce a new image dataset along with expert annotated diagnoses for evaluating image-based cervical disease classification algorithms. A large number of Cervigram® images are selected from a database provided by the US National Cancer Institute. For each image, we extract three complementary pyramid features: Pyramid histogram in L*A*B* color space (PLAB), Pyramid Histogram of Oriented Gradients (PHOG), and Pyramid histogram of Local Binary Patterns (PLBP). Other than hand-crafted pyramid features, we investigate the performance of convolutional neural network (CNN) features for cervical disease classification. Our experimental results demonstrate the effectiveness of both our hand-crafted and our deep features. We intend to release this multi-feature dataset and our extensive evaluations using seven classic classifiers can serve as the baseline.
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Affiliation(s)
- Tao Xu
- Computer Science and Engineering Department, Lehigh University, Bethlehem, PA, USA
| | - Han Zhang
- Department of Computer Science, Rutgers University, Piscataway, NJ, USA
| | - Cheng Xin
- Computer Science and Engineering Department, Lehigh University, Bethlehem, PA, USA
| | - Edward Kim
- Computing Sciences Department, Villanova University, Villanova, PA, USA
| | - L. Rodney Long
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Zhiyun Xue
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Sameer Antani
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Xiaolei Huang
- Computer Science and Engineering Department, Lehigh University, Bethlehem, PA, USA
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Visual screening for early detection of cervical neoplasia in Angola. Int J Gynaecol Obstet 2016; 111:68-72. [DOI: 10.1016/j.ijgo.2010.04.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 04/22/2010] [Accepted: 05/10/2010] [Indexed: 11/22/2022]
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Basu P, Banerjee D, Mittal S, Mandal R, Ghosh I, Das P, Muwonge R, Biswas J. Evaluation of a compact, rechargeable, magnifying device to triage VIA and HPV positive women in a cervical cancer screening program in rural India. Cancer Causes Control 2016; 27:1253-9. [PMID: 27581249 DOI: 10.1007/s10552-016-0805-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 08/26/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Many limited-resourced countries have either introduced cervical cancer screening programs or are contemplating to do so using visual inspection after acetic acid application (VIA) or human papillomavirus (HPV) detection tests. Both tests have high false-positivity and a suitable triaging strategy is required. Colposcopy triaging is not practicable in most resource-limited settings due to several reasons. We evaluated a portable, battery-operated, magnifying device (GynocularTM) to triage screen positive women in community setting in India. METHODS Women positive on VIA or oncogenic HPV test were examined with Gynocular by clinicians in primary health clinics. Findings were documented using the International Federation for Cervical Pathology and Colposcopy (IFCPC) terminology. Swede score was also calculated. Biopsy was performed irrespective of Gynocular findings. The accuracy of Gynocular to detect high-grade lesions or cancer (HSIL+) was estimated. The suitability of Gynocular to correctly triage screen positive cases for immediate ablative treatment was also evaluated by creating simulated scenarios. RESULTS Sensitivity and specificity of Gynocular were 96.4 and 47.1 %, respectively, to detect HSIL + at the threshold of IFCPC grade 1 findings. Increasing threshold to grade 2 changed sensitivity and specificity to 92.9 and 94.1 %, respectively. Optimum combination of sensitivity and specificity as determined by the receiver operating curve analysis was at the cut-off Swede score of 5. Triaging of VIA/HPV positive women to treatment using grade 2 criteria would have resulted in modest overtreatment and missing of very few high-grade lesions. CONCLUSION Gynocular can be used as an effective triaging device for VIA/HPV positive women.
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Affiliation(s)
- Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer (WHO), 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
| | | | - Srabani Mittal
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Ranajit Mandal
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Ishita Ghosh
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Pradip Das
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Richard Muwonge
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer (WHO), 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Jaydip Biswas
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
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Bobdey S, Sathwara J, Jain A, Balasubramaniam G. Burden of cervical cancer and role of screening in India. Indian J Med Paediatr Oncol 2016; 37:278-285. [PMID: 28144096 PMCID: PMC5234166 DOI: 10.4103/0971-5851.195751] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cervical cancer is a major cause of cancer mortality in women and more than a quarter of its global burden is contributed by developing countries. In India, in spite of alarmingly high figures, there is no nationwide government-sponsored screening program. This study was conducted to assess the burden of cervical cancer in India and review the performance characteristics of available cervical cancer screening tools, so as to provide evidence-based recommendations for application of most practically suited screening test to be used in resource-poor field settings. MATERIALS AND METHODS MEDLINE and Web of Science electronic database were searched from January 1990 to December 2015, using the keywords such as "cervical cancer", "screening", "early detection", "cervical cytology" and "visual inspection", and their corresponding MeSH terms in combination with Boolean operators "OR, AND." Two authors independently selected studies that are published in English and conducted in India. A total of 11 studies were found to be relevant and eligible to be included in the present study. RESULTS In India, cervical cancer contributes to approximately 6-29% of all cancers in women. The age-adjusted incidence rate of cervical cancer varies widely among registries; highest is 23.07/100,000 in Mizoram state and the lowest is 4.91/100,000 in Dibrugarh district. The pooled estimates of sensitivity and specificity of visual inspection with acetic acid (VIA), magnified VIA, visual inspection with Lugol's iodine (VILI), cytology (Pap smear), and human papillomavirus DNA were found to be 67.65% and 84.32%, 65.36% and 85.76%, 78.27% and 87.10%, 62.11% and 93.51%, and 77.81% and 91.54%, respectively. CONCLUSIONS In developing countries because of lack of necessary infrastructure and quality control, high-quality cytology screening may not be feasible for wide-scale implementation. Hence, cervical cancer screening program based on visual screening test such as VIA/VILI should be adopted as an integral part of primary health-care setup in resource-poor countries like India.
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Affiliation(s)
- Saurabh Bobdey
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jignasa Sathwara
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Aanchal Jain
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ganesh Balasubramaniam
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Thunga S, Andrews A, Ramapuram J, Satyamoorthy K, Kini H, Unnikrishnan B, Adhikari P, Singh P, Kabekkodu SP, Bhat S, Kadam A, Shetty AK. Cervical cytological abnormalities and human papilloma virus infection in women infected with HIV in Southern India. J Obstet Gynaecol Res 2016; 42:1822-1828. [PMID: 27641071 DOI: 10.1111/jog.13111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 03/21/2016] [Accepted: 06/18/2016] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to examine the association between CD4 count, human papilloma virus (HPV) infection, and the risk of cervical intraepithelial neoplasia among HIV-infected women. METHODS A cross-sectional study was conducted among 104 HIV-infected women attending an antiretroviral therapy clinic. They underwent Pap smear and cervical HPV DNA testing. RESULTS The overall prevalence of HPV infection was 57.7%. HPV 16 was the commonest genotype found (38.5%); HPV 16 and 18 put together contributed to 73.3% of HPV infection; 27.5% of HIV-infected women had squamous cell abnormalities. Cervical intraepithelial neoplasia was less likely among women with CD4 count > 500/mm3 (12%) and in those without opportunistic infections (17.8%). The prevalence of high-risk HPV infection was higher in women with high-grade squamous intraepithelial lesions or greater lesions (85.7%) as compared to women with normal cytology (52.1%). CONCLUSION The high prevalence of HPV infection and cervical intraepithelial neoplasia in HIV-infected women warrants the need for regular Pap smear screening in these women and routine HPV vaccination for adolescents to reduce the burden of cervical cancer in India.
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Affiliation(s)
- Suchitra Thunga
- Department of OBG, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | | | - John Ramapuram
- Department of Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Kapaettu Satyamoorthy
- Centre for Molecular and Cellular Biology, School of Life Sciences, Manipal University, Karnataka, India
| | - Hema Kini
- Department of Pathology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - B Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Prabha Adhikari
- Department of Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Prakhar Singh
- Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Shama Prasada Kabekkodu
- Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, Karnataka, India
| | - Samatha Bhat
- Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, Karnataka, India
| | - Anagha Kadam
- Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, Karnataka, India
| | - Avinash K Shetty
- Department of Pediatrics, Wake Forest School of Medicine, Salem, North Carolina, USA
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Current Technologies and Recent Developments for Screening of HPV-Associated Cervical and Oropharyngeal Cancers. Cancers (Basel) 2016; 8:cancers8090085. [PMID: 27618102 PMCID: PMC5040987 DOI: 10.3390/cancers8090085] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/23/2016] [Accepted: 08/30/2016] [Indexed: 12/27/2022] Open
Abstract
Mucosal infection by the human papillomavirus (HPV) is responsible for a growing number of malignancies, predominantly represented by cervical cancer and oropharyngeal squamous cell carcinoma. Because of the prevalence of the virus, persistence of infection, and long latency period, novel and low-cost methods are needed for effective population level screening and monitoring. We review established methods for screening of cervical and oral cancer as well as commercially-available techniques for detection of HPV DNA. We then describe the ongoing development of microfluidic nucleic acid-based biosensors to evaluate circulating host microRNAs that are produced in response to an oncogenic HPV infection. The goal is to develop an ideal screening platform that is low-cost, portable, and easy to use, with appropriate signal stability, sensitivity and specificity. Advances in technologies for sample lysis, pre-treatment and concentration, and multiplexed nucleic acid detection are provided. Continued development of these devices provides opportunities for cancer screening in low resource settings, for point-of-care diagnostics and self-screening, and for monitoring response to vaccination or surgical treatment.
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[Feasibility of cervical smear in HIV-positive women living in Chad]. ACTA ACUST UNITED AC 2016; 109:180-4. [PMID: 27299910 DOI: 10.1007/s13149-016-0496-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
Abstract
Cervical cancer is the leading cause of cancerrelated death in Sub-Saharan African women. HIV-infected women are at increased risk for cervical intraepithelial lesions and invasive cervical cancer. WHO guidelines for screening and treatment of precancerous cervical lesions are regularly actualized. There are no data on cervical squamous intraepithelial lesions in Chad. Between August 2013 and May 2015, screening for cervical squamous intraepithelial lesions was proposed to HIV-infected women living in Moundou (Chad). Cytology examination was performed after with Papanicolaou coloration. Three hundred and eleven HIV-seropositive women accepted the screening without refusal. Mean age of the patients was 38 years (95% Confidence Interval: 37.7-39.9). The women declared a mean of 4.1 pregnancies (range: 0-12). The patients had been followed-up for their seropositivity for 8 years (range: 0-25). All were on highly active antiretroviral therapy (HAART). Of the patients whose results were known (N = 231), 98% had a CD4 lymphocyte nadir count less than 350/mm(3). Cytological results were as follows: normal smear (N = 59; 19%), inflammatory or hemorrhagic smear (N = 139; 44%), low grade squamous intraepithelial lesion (N = 58; 19%), high grade squamous intraepithelial lesion (N = 28; 9%), epidermoid carcinoma (N = 13; 4%), and uninterpretable smear (N = 14; 5%). The inflammatory lesions were due to cervicitis (N = 54), vaginosis (N = 22), and trichomonas infection (N = 3). The patients' age, CD4 lymphocyte nadir count, and CD4 count at the time of the cervical smear were not different according to the cytological results. Only five patients had a cone biopsy. Three patients deceased during the study of whom two from a gynaecological cancer diagnosed too late. The screening of dysplasia and cervical cancer in HIV-seropositive women is possible in Chad. In our study, 13% of the women had highgrade dysplasia or carcinoma needing curative care. We also showed that simple cytology did not permit the interpretation of half of the smears. The performance of cervical smear would have increased if it had been preceded by the visualization of the cervix with coloration.
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Cost-Effectiveness of Screening and Treatment for Cervical Cancer in Tanzania: Implications for other Sub-Saharan African Countries. Value Health Reg Issues 2016; 10:1-6. [PMID: 27881270 DOI: 10.1016/j.vhri.2016.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 02/11/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To compare the institutional cost per person of screening and treatment between two groups of patients-those screened and those not screened before treatment for cervical cancer at Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania-and to perform a cost-effectiveness analysis of the ORCI cervical cancer screening program. METHODS The study included 721 screened and 333 unscreened patients treated at ORCI for cervical cancer from 2002 to 2011. We compared the cost of cervical cancer treatment per patient with life-years gained for patients screened at ORCI versus not screened. RESULTS Patients with cancer were diagnosed at an earlier stage after participating in screening compared with nonparticipants. For example, 14.0% of stage I cancer patients had received screening by ORCI compared with 7.8% of unscreened cases. For stage IV cancer, these percentages were 1.4% and 6.9%, respectively. Average screening and treatment cost for patients receiving cancer screening ($2526) was higher than that for unscreened patients ($2482). However, we calculated an incremental cost-effectiveness ratio of $219 per life-year gained from receiving cervical cancer screening compared with not being screened, and thus the ORCI screening program was highly cost-effective. Furthermore, the screening program was associated with averting 1.3 deaths from cervical cancer each year resulting from earlier diagnoses of cancer cases, with the incremental cost-effectiveness ratio of $4597 per life saved. CONCLUSIONS Although Sub-Saharan Africa faces substantial challenges in population health management, our study highlights the potential benefits from expanding access to regular cervical cancer screening for women in this region.
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Lee H, Kang Y, Ju W. Cervical Cancer Screening in Developing Countries: Using Visual Inspection Methods. Clin J Oncol Nurs 2016; 20:79-83. [DOI: 10.1188/16.cjon.79-83] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cao D, Shen K, Li Z, Xu Y, Wu D. Association between vitamin C Intake and the risk of cervical neoplasia: A meta-analysis. Nutr Cancer 2016; 68:48-57. [PMID: 26731169 DOI: 10.1080/01635581.2016.1115101] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
To assess the association between vitamin C intake and cervical neoplasia (CN) risk. Databases including PubMed, Embase, and Springer link were retrieved up to June 10, 2014 with predefined strategy. The combined odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for overall and subgroup analyses. The publication bias was assessed using Begg's test and Egger's test. Sensitivity analysis was also conducted. Twelve studies consisting of 1 prospective cohort study and 11 case-control studies were included. In overall analysis, vitamin C intake was significantly associated with the reduced risk of CN (OR = 0.58; 95% CI: 0.44 to 0.75; P < 0.001). Subgroup analysis stratified by vitamin C dose indicated all dose categories achieved a reduced CN risk. Furthermore, increased vitamin C intake by 50 mg/day was related to the reduced risk of CN (OR = 0.92; 95% CI: 0.89 to 0.94; P < 0.05). No publication bias was detected by Begg's test (P = 0.169) and no apparent fluctuation was observed in summary OR by sensitivity analysis. Vitamin C intake was inversely associated with the risk of CN and this association was dose-dependent. However, more randomized controlled trials are required for further validation.
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Affiliation(s)
- Dan Cao
- a Department of Gynecology & Obstetrics , International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Kaiying Shen
- b Department of Pediatric Orthopedics , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Zhunan Li
- a Department of Gynecology & Obstetrics , International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Ying Xu
- a Department of Gynecology & Obstetrics , International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Dan Wu
- a Department of Gynecology & Obstetrics , International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
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