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Policy Considerations to Promote Equitable Cervical Cancer Screening and Treatment in Peru. Ann Glob Health 2021; 87:116. [PMID: 34900616 PMCID: PMC8622178 DOI: 10.5334/aogh.3442] [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] [Indexed: 11/20/2022] Open
Abstract
Background: Cervical cancer is one of the leading causes of death among Peruvian women. Women seeking screening or treatment services experience delays in receiving screening results provided at community clinics or district hospitals, and lack sufficient resources to pay out-of-pocket to travel to the capital city of Lima for specialized treatment. Continued disparities in health outcomes and systemic barriers to accessing services suggest there are gaps between policy measures and implementation. Objectives: We aim to understand why national policies and clinical pathways that are aligned to global standards have been insufficient in improving cervical cancer screening and treatment in Peru, particularly among women who experience systemic exclusion from health services. Methods: We conducted a policy analysis based on a literature review (2005–2020), in Spanish and English, on PubMed, Global Health, Scopus, EconLit, Lilacs, and Scielo using a value-based care framework. Findings: The main barriers included unequal distribution of health infrastructure and health care workforce, and differences in access to health insurance. Additional barriers, including limited political will and support, limit efforts to prioritize the implementation of cervical cancer policies. We propose policy considersations in redesigning payment models, expanding healthcare workforce, generating costing and policy evidence, and reviewing policies for point-of-care technologies. Conclusions and Recommendations: The barriers identified in this literature review are applicable not only to cervical cancer care, but to primary health care in Peru. Systematic policy changes that address root causes of health inequities and are implemented at scale are needed to advance health reform efforts.
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Wakwoya EB, Gemechu KS. Prevalence of Abnormal Cervical Lesions and Associated Factors Among Women in Harar, Eastern Ethiopia. Cancer Manag Res 2020; 12:12429-12437. [PMID: 33299351 PMCID: PMC7721125 DOI: 10.2147/cmar.s279712] [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: 08/31/2020] [Accepted: 11/15/2020] [Indexed: 01/22/2023] Open
Abstract
Purpose The primary objective of this study was to determine the prevalence of abnormal cervical lesions and associated factors and the secondary objective was to assess adherence to post-cryotherapy treatment recommendations, among women in Harari region, eastern Ethiopia. Materials and Methods This study was conducted in two public hospitals in Harar city from January 1 to May 30, 2019. A facility-based descriptive cross-sectional study was conducted and a total of 1181 women were included in the study. Structured face-to-face interviews with women aged 25–49 years were used to collect information on precancerous cervical lesion screening and adherence to post-cryotherapy treatment. Visual inspection with acetic acid (VIA) method was used to screen women for precancerous cervical lesions. The collected data were entered into Epi Info software and then exported to SPSS software for analysis. Logistic regression analysis was used to check the association between independent variables and abnormal cervical lesions. Results The prevalence of abnormal cervical lesions among the participants screened was 24.5% (95% CI = 20.8–27.9%). Having no formal education (AOR = 2.68, 95% CI = 1.32–5.46), lack of awareness of cervical cancer, (AOR = 2.65, 95% CI = 1.68–4.23) and having a husband with history of multiple sexual partners (AOR = 1.75, 95% CI = 1.13–2.7) were independently associated with abnormal cervical lesions. From the respondents who received cryotherapy treatment prior to the study, the majority, 92.9% (95% CI = 76.5–99.1), adhered to the post-cryotherapy treatment recommendations. Conclusion We found that the prevalence of abnormal cervical lesions in this area was high. Having no formal education, lack of awareness of cervical cancer and having a husband with history of multiple sexual partners were independently associated with having abnormal cervical lesions. The federal ministry of health and other stakeholders should focus on the primary prevention method (HPV vaccination) at an earlier stage to reduce the prevalence of abnormal cervical lesions in the study area. Harari regional health bureau should provide awareness creation activities and special attention should be given to uneducated women.
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Affiliation(s)
- Elias Bekele Wakwoya
- Department of Midwifery, College of Health Sciences, Arsi University, Assela, Ethiopia
| | - Kasiye Shiferaw Gemechu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Revilla-López J, Anampa-Guzmán A, Marquez LC, Weeks K, Pollard S, Olórtegui-Yzú A, Ruiz-Velazco M, Davila-Edquen A, Castro-Dorer D, Wong-Barrenechea J, Abad-Seminario J, Gonzáles-Ramos P, Rivera-Sandoval F, Carracedo-Gonzáles C. Cancer cases detected in the prevention and control service of a private cancer clinic in Peru. Infect Agent Cancer 2019; 14:44. [PMID: 31798681 PMCID: PMC6884821 DOI: 10.1186/s13027-019-0259-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/18/2019] [Indexed: 02/02/2023] Open
Abstract
Purpose Describe the characteristics of patients seen at the Cancer Prevention and Control Service at a Peruvian private cancer clinic in 2014. Patients and methods This retrospective clinical study analyzed the prevalence of 10 cancers and characteristics of patients seen at a private cancer center located in Lima, Peru. The study sample included 7680 adults, and data were collected from de-identified medical records. Results The average age of the patients was 44.71 years and 98,82% of them had private insurance. The majority of patients were women (67.69%). Our gross incidence rate of cancer was 35.16 per 100,000 in the Cancer Prevention and Control Service in 2014. Only 0.35% had cancer, and most of those diagnosed with cancer (77.78%) were diagnosed in the early stages, stages I and II. The two most common cancers observed were breast and thyroid cancer. Conclusions The high rates of early, rather than late-stage diagnoses at this clinic are dramatically different than national rates. This difference may be because we are analyzing data from a prevention service seeing mainly patients with private insurance as opposed to national data, which consists primarily of patients seen in oncologic services with national insurance.
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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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Piñeros M, Ramos W, Antoni S, Abriata G, Medina LE, Miranda JJ, Payet E, Bray F. Cancer patterns, trends, and transitions in Peru: a regional perspective. Lancet Oncol 2017; 18:e573-e586. [PMID: 28971824 DOI: 10.1016/s1470-2045(17)30377-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/10/2017] [Accepted: 03/22/2017] [Indexed: 01/24/2023]
Abstract
Peru, like several other South American countries, is experiencing remarkable population growth, ageing, and urbanisation, which has given rise to profound changes in its epidemiological profile. Prostate and breast cancer are the most frequent cancers in men and women, respectively, in Lima and Arequipa, the two areas with population-based cancer registries. However, infection-associated cancers (cervix and stomach) are also common, and rank highest in the national cancer mortality profile. Although a foundation of surveillance informs cancer-control initiatives in Peru, improvements in the vital statistics system, and the quality and use of incidence data for the planning and assessment of cancer prevention and control actions, are needed. Existing population-based cancer registries in Lima and Arequipa, and linkages to the established national mandatory cancer reporting system, are crucial for the collection of high-quality data on national cancer incidence. The delivery of effective cancer prevention and control measures requires sustained investment in the collection of high-quality data capable of informing policies and driving research programmes.
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Affiliation(s)
- Marion Piñeros
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - Willy Ramos
- National Centre of Disease Epidemiology, Prevention and Control, Ministry of Health, Peru
| | - Sébastien Antoni
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | | | - Luis E Medina
- Population-based Cancer Registry of Arequipa, Instituto Regional de Enfermedades Neoplásicas del Sur, Arequipa, Peru
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, University Cayetano Heredia, Lima, Peru
| | - Eduardo Payet
- Metropolitan Lima Cancer Registry, National Institute of Neoplastic Diseases, Lima, Peru
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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DeGregorio GA, Bradford LS, Manga S, Tih PM, Wamai R, Ogembo R, Sando Z, Liu Y, Schwaiger C, Rao SR, Kalmakis K, Kennedy Sheldon L, Nulah K, Welty E, Welty T, Ogembo JG. Prevalence, Predictors, and Same Day Treatment of Positive VIA Enhanced by Digital Cervicography and Histopathology Results in a Cervical Cancer Prevention Program in Cameroon. PLoS One 2016; 11:e0157319. [PMID: 27280882 PMCID: PMC4900564 DOI: 10.1371/journal.pone.0157319] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background In 2007, the Cameroon Baptist Convention Health Services (CBCHS) implemented a screen-and-treat cervical cancer prevention program using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC). Methods We retrospectively analyzed 46,048 medical records of women who received care through the CBCHS Women’s Health Program from 2007 through 2014 to determine the prevalence and predictors of positive VIA-DC, rates of same day treatment, and cohort prevalence of invasive cervical cancer (ICC). Results Of the 44,979 women who were screened for cervical cancer, 9.0% were VIA-DC-positive, 66.8% were VIA-DC-negative, 22.0% were VIA-DC-inadequate (normal ectocervix, but portions of the transformation zone were obscured), and 2.2% were VIA-DC-uncertain (cervical abnormalities confounding VIA-DC interpretation). Risk factors significantly associated with VIA-DC-positive screen were HIV-positivity, young age at sexual debut, higher lifetime number of sexual partners, low education status and higher gravidity. In 2014, 31.1% of women eligible for cryotherapy underwent same day treatment. Among the 32,788 women screened from 2007 through 2013, 201 cases of ICC were identified corresponding to a cohort prevalence of 613 per 100,000. Conclusions High rate of VIA-DC-positive screens suggests a significant burden of potential cervical cancer cases and highlights the need for expansion of cervical cancer screening and prevention throughout the 10 regions of Cameroon. VIA-DC-inadequate rates were also high, especially in older women, and additional screening methods are needed to confirm whether these results are truly negative. In comparison to similar screening programs in sub-Saharan Africa there was low utilization of same day cryotherapy treatment. Further studies are required to characterize possible program specific barriers to treatment, for example cultural demands, health system challenges and cost of procedure. The prevalence of ICC among women who presented for screening was high and requires further investigation.
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Affiliation(s)
- Geneva A. DeGregorio
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Leslie S. Bradford
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Simon Manga
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Pius M. Tih
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Richard Wamai
- Department of African American Studies, Northeastern University, Boston, MA, United States of America
| | - Rebecca Ogembo
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Zacharie Sando
- Yaoundé Gyneco-Obstetrics and Pediatric Hospital, Yaoundé, Centre Region, Cameroon
| | - Yuxin Liu
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Constance Schwaiger
- School of Nursing, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Sowmya R. Rao
- Department of Surgery, Boston University School of Medicine, Boston, MA, United States of America
| | - Karen Kalmakis
- School of Nursing, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Lisa Kennedy Sheldon
- Department of Nursing, University of Massachusetts Boston, Boston, MA, United States of America
| | - Kathleen Nulah
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Edith Welty
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Thomas Welty
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Javier Gordon Ogembo
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
- * E-mail:
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Kruk ME, Nigenda G, Knaul FM. Redesigning primary care to tackle the global epidemic of noncommunicable disease. Am J Public Health 2015; 105:431-7. [PMID: 25602898 PMCID: PMC4330840 DOI: 10.2105/ajph.2014.302392] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 01/19/2023]
Abstract
Noncommunicable diseases (NCDs) have become the major contributors to death and disability worldwide. Nearly 80% of the deaths in 2010 occurred in low- and middle-income countries, which have experienced rapid population aging, urbanization, rise in smoking, and changes in diet and activity. Yet the health systems of low- and middle-income countries, historically oriented to infectious disease and often severely underfunded, are poorly prepared for the challenge of caring for people with cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We have discussed how primary care can be redesigned to tackle the challenge of NCDs in resource-constrained countries. We suggest that four changes will be required: integration of services, innovative service delivery, a focus on patients and communities, and adoption of new technologies for communication.
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Affiliation(s)
- Margaret E Kruk
- At the time of the study, Margaret E. Kruk was with the Department of Health Policy and Management and Better Health Systems Initiative, Mailman School of Public Health, Columbia University, New York, NY. At the time of the study, Gustavo Nigenda was with the Harvard Global Equity Initiative, Harvard University, Boston, MA. Felicia Marie Knaul is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston, and the Harvard Global Equity Initiative, Boston
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Fong J, Gyaneshwar R, Lin S, Morrell S, Taylor R, Brassil A, Stuart A, McGowan C. Cervical Screening Using Visual Inspection with Acetic Acid (VIA) and Treatment with Cryotherapy in Fiji. Asian Pac J Cancer Prev 2015; 15:10757-62. [DOI: 10.7314/apjcp.2014.15.24.10757] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Structural barriers to screening for and treatment of cervical cancer in Peru. REPRODUCTIVE HEALTH MATTERS 2013; 20:49-58. [PMID: 23245408 DOI: 10.1016/s0968-8080(12)40680-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Through in-depth interviews with 30 key informants from 19 institutions in the health care system in four regions of Peru, this study identifies multiple barriers to obtaining cervical cancer screening, follow-up, and treatment. Some facilities outside Lima do not have the capacity to take Pap smear samples; others cannot do so on a continuing basis. Variation in procedures used by facilities and between regions, differences in women's ability to pay, as well as varying levels of training of laboratory personnel, all affect the quality and timing of service delivery and outcomes. In some settings, perverse incentives to accrue overtime payments increase the lag time between sample collection and reporting back of results. Some patients with abnormal results are lost to follow-up; others find needed treatment to be out of their financial or geographic reach. To increase coverage for cervical cancer screening and follow-up, interventions are needed at all levels, including an institutional overhaul to ensure that referral mechanisms are appropriate and that treatment is accessible and affordable. Training for midwives and gynaecologists is needed in good sample collection and fixing, and quality control of samples. Training of additional cytotechnologists, especially in the provinces, and incentives for processing Pap smears in an appropriate, timely manner is also required.
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Deodhar K, Sankaranarayanan R, Jayant K, Jeronimo J, Thorat R, Hingmire S, Muwonge R, Chiwate A, Deshpande R, Ajit D, Kelkar R, Rekhi B, Ruben I, Malvi SG, Chinoy R, Jambhekar N, Nene BM. Accuracy of concurrent visual and cytology screening in detecting cervical cancer precursors in rural India. Int J Cancer 2012; 131:E954-62. [PMID: 22581670 DOI: 10.1002/ijc.27633] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 04/17/2012] [Indexed: 11/09/2022]
Abstract
The high burden of cervical cancer and inadequate/suboptimal cytology screening in developing countries led to the evaluation of visual screening tests, like visual inspection with acetic acid (VIA) and Lugol's iodine (VILI). We describe the performance of VIA, VILI and cytology, carried out in a multinational project called "Screening Technologies to Advance Rapid Testing" in 5,519 women aged 30-49 years, in detecting cervical intraepithelial neoplasia (CIN). VIA, VILI and cytology were positive in 16.9%, 15.6% and 6.1% women, respectively. We found 57 cases of CIN2, 55 of CIN3 and 12 of cervical cancer; 90% of CIN3 and 43% CIN2 cases were positive for p16 overexpression and high-risk HPV infection, indicating a high validity of histological diagnosis. The sensitivity of VIA, VILI and cytology to detect high-grade CIN were 64.5%, 64.5% and 67.7%, respectively; specificities were 84.2%, 85.5% and 95.4%. A high proportion of p16 positive CIN 3 (93.8%) and 2 (76.9%) were positive on cytology compared with visual tests (68.8% and 53.8%, respectively) indicating a higher sensitivity of cytology to detect p16 positive high-grade CIN. However, the immediate availability of the results from the visual tests permits diagnosis and/or treatment to be performed in the same sitting, which can potentially reduce loss to follow-up when women must be recalled following positive cytology. Organizing visual screening services in low-resource countries may facilitate the gradual building of an infrastructure committed to screening allowing the eventual introduction of more sensitive, highly objective, reproducible and affordable human papillomavirus screening tests in future.
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Affiliation(s)
- Kedar Deodhar
- Tata Memorial Center, Tata Memorial Hospital and Cancer Research Institute, E. Borges Marg, Parel, Mumbai 400 012, India
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Alnajjar HM, Lam W, Bolgeri M, Rees RW, Perry MJA, Watkin NA. Treatment of carcinoma in situ of the glans penis with topical chemotherapy agents. Eur Urol 2012; 62:923-8. [PMID: 22421082 DOI: 10.1016/j.eururo.2012.02.052] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 02/29/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of topical agents in the treatment of carcinoma in situ (CIS) of the penis has been well described in the literature. Previous studies have been limited by small sample size and imprecise end points. OBJECTIVE Establish the response rate of 5-fluorouracil (5-FU) and imiquimod (IQ) in the treatment of penile CIS in a large contemporary series in a supranetwork centre. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of all primary and recurrent cases of penile CIS treated with 5-FU and IQ identified from a prospective database over a 10-yr period. Therapy was standardised in all cases with application to the lesion for 12h every 48 h for 28 d. INTERVENTION 5-FU was the first-line therapy, and IQ was the second-line topical agent. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was defined as complete response (CR; i.e., resolution of lesion), partial response (PR; i.e., lesion reduced in size and or visibility), or no response (NR; ie, no improvement in lesion size and or visibility). The secondary end points included local toxicity and adverse events. No statistical analysis or software was used. RESULTS AND LIMITATIONS A total of 86 patients were diagnosed with CIS of the penis over the 10-yr period. Forty-four (51%) received topical chemotherapy. The mean follow-up was 34 mo. CR to topical chemotherapy was seen in 25 (57%), PR was seen in 6 (13.6%), and NR was seen in the remaining 13 (29.5%) patients. Local toxicity was experienced by 10% of patients, and 12% had an adverse event following application of 5-FU. The retrospective design and short follow-up were the major limitations of this study. CONCLUSIONS Topical chemotherapy agents are moderately effective first-line therapy in the treatment of penile CIS. Toxicity and adverse events were few with our treatment protocol. The issues of long-term surveillance and assessment of partial responders remain a challenge. Topical chemotherapy should remain a first-line treatment option for penile CIS.
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