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Sanchez-Rodriguez IE, Medina-Gomez YG, Balderrama-Ibarra RI, Ramos-Vega JC, Ramos-Vega KW. Cervical Cancer in Mexico: From a Renowned Vaccination Program to Unfulfilled Needs in Treatment Access. Cureus 2024; 16:e61553. [PMID: 38962650 PMCID: PMC11220365 DOI: 10.7759/cureus.61553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 07/05/2024] Open
Abstract
Mexico's national human papillomavirus (HPV) vaccination program was established in 2008, providing free access to HPV vaccines and quickly becoming an immense success story, achieving significant coverage among young Mexican females. However, despite these efforts and notable achievements, cervical cancer caused mainly by HPV remains a challenging issue among Mexican women aged 15 years or older. A critical obstacle faced by women in the country is a lack of early detection and screening resources, coupled with delays in diagnosis and treatment, exacerbated by the poor distribution of already insufficient healthcare resources. This situation creates adverse conditions for the female demographic in the country. Our editorial aims to draw attention to the urgent need to improve access to adequate prevention, screening, and treatment for cervical cancer patients in Mexico, advocating for a collective effort between the Mexican government, public health professionals, and civil society.
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Affiliation(s)
| | | | | | - Jan C Ramos-Vega
- School of Medicine, Universidad Autónoma de Guadalajara, Zapopan, MEX
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Hurtado-Salgado E, Ortiz-Panozo E, Salmerón J, Luna-Gordillo R, Allen-Leigh B, Saavedra-Lara N, Franco EL, Lazcano-Ponce E. Prevalence of cervical human papillomavirus in Mexico, 2010-2017: analysis of 2.7 million women. Cancer Causes Control 2023; 34:123-132. [PMID: 36273050 DOI: 10.1007/s10552-022-01642-2] [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: 02/05/2021] [Accepted: 09/29/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Prevalence of cervical high-risk human papillomavirus (hrHPV) infection varies greatly. Data on distribution of hrHPV infection constitute important evidence for decision-making when implementing HPV testing into cervical cancer screening programs. We estimate the prevalence of cervical hrHPV infection in a large sample of women in a middle-income country and explore variation by age, community marginalization and region in women using public cervical cancer screening services. METHODS Records covering 2010-2017 from a registry of hrHPV test results (Hybrid Capture 2 and polymerase chain reaction) in 2,737,022 women 35-64 years were analyzed. In this observational study, 32 states were categorized into five geographical regions and classified by degree of marginalization. We stratified by test type and estimated crude and adjusted prevalence and rate ratios and used Poisson models and joinpoint regression analysis. RESULTS Prevalence was higher in women 35-39 years, at 10.4% (95% CI 10.3-10.5) and women 60-64 years, at 10.1% (95% CI 10.0-10.3). Prevalence was higher in the southeast, at 10.5% (95% CI 10.4-10.6). Women living in less marginalized areas had a significantly higher prevalence, at 10.3% (95% CI 10.2-10.4) compared to those in highly marginalized areas, at 8.7% (95% CI 8.5-8.7). HPV16 infection was detected in 0.92% (2,293/23,854) of women and HPV18 infection was detected in 0.39% (978/23,854) of women. CONCLUSION Understanding the distribution of HPV prevalence has value as evidence for developing policy in order to improve cervical cancer screening strategies. These results will constitute evidence to allow decision makers to better choose where to focus those resources that they do have.
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Affiliation(s)
- Erika Hurtado-Salgado
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Jorge Salmerón
- Political, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Betania Allen-Leigh
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | | | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Eduardo Lazcano-Ponce
- National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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Straw C, Sanchez-Antelo V, Kohler R, Paolino M, Viswanath K, Arrossi S. Implementation and scaling-up of an effective mHealth intervention to increase adherence to triage of HPV-positive women (ATICA study): perceptions of health decision-makers and health-care providers. BMC Health Serv Res 2023; 23:47. [PMID: 36653775 PMCID: PMC9847147 DOI: 10.1186/s12913-023-09022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The ATICA study was a Hybrid I type randomized effectiveness-implementation trial that demonstrated effectiveness of a multicomponent mHealth intervention (Up to four SMS messages sent to HPV-positive women, and one SMS message to CHWs to prompt a visit of women with no triage Pap 60 days after a positive-test), to increase adherence to triage of HPV positive women (ATICA Study). We report data on perceptions of health decision-makers and health-care providers regarding the intervention implementation and scaling-up. METHODS A qualitative study was carried out based on individual, semi-structured interviews with health decision-makers (n = 10) and health-care providers (n = 10). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and the maintenance dimension of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. RESULTS Both health-care providers and decision-makers had a positive assessment of the intervention through most included constructs: knowledge of the intervention, intervention source, design quality, adaptability, compatibility, access to knowledge and information, relative advantage, women's needs, and relative priority. However, some potential barriers were also identified including: complexity, leadership engagement, external policies, economic cost, women needs and maintenance. Stakeholders conditioned the strategy's sustainability to the political commitment of national and provincial health authorities to prioritize cervical cancer prevention, and to the establishment of the ATICA strategy as a programmatic line of work by health authorities. They also highlighted the need to ensure, above all, that there was staff to take Pap tests and carry out the HPV-lab work, and to guarantee a constant provision of HPV-tests. CONCLUSION Health decision-makers and health-care providers had a positive perception regarding implementation of the multicomponent mHealth intervention designed to increase adherence to triage among women with HPV self-collected tests. This increases the potential for a successful scaling-up of the intervention, with great implications not only for Argentina but also for middle and low-income countries considering using mHealth interventions to enhance the cervical screening/follow-up/treatment process.
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Affiliation(s)
- Cecilia Straw
- grid.7345.50000 0001 0056 1981Faculty of Social Sciences, University of Buenos Aires, Buenos Aires, Argentina ,Centre for the Study of State and Society, Buenos Aires, Argentina
| | - Victoria Sanchez-Antelo
- grid.423606.50000 0001 1945 2152Centre for the Study of State and Society, National Council for Scientific and Technical Research, Buenos Aires, Argentina
| | - Racquel Kohler
- grid.516084.e0000 0004 0405 0718Cancer Health Equity, Cancer Institute of New Jersey, Rutgers - the State University of New Jersey, New Brunswick, USA
| | - Melisa Paolino
- grid.423606.50000 0001 1945 2152Centre for the Study of State and Society, National Council for Scientific and Technical Research, Buenos Aires, Argentina
| | - Kasisomayajula Viswanath
- grid.38142.3c000000041936754XDepartment of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Silvina Arrossi
- grid.423606.50000 0001 1945 2152Centre for the Study of State and Society, National Council for Scientific and Technical Research, Buenos Aires, Argentina
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Piña-Sánchez P. Human Papillomavirus: Challenges and Opportunities for the Control of Cervical Cancer. Arch Med Res 2022; 53:753-769. [PMID: 36462952 DOI: 10.1016/j.arcmed.2022.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Viruses are the most abundant and genetically diverse entities on the planet, infect all life forms and have evolved with their hosts. To date, 263 viral species have been identified that infect humans, of which only seven are considered type I oncogenic. Human papillomavirus (HPV) is the main virus associated with cancer and is responsible for practically all cases of cervical carcinoma. Screening tests for early detection have been available since the 1960s. Undoubtedly, the entailment between knowledge of HPV biology and the natural history of cervical cancer has contributed to the significant advances that have been made for its prevention since the 21st century, with the development of prophylactic vaccines and improved screening strategies. Therefore, it is possible to eradicate invasive cervical cancer as a worldwide public health problem, as proposed by the WHO with the 90-70-90 initiative based on vaccination coverage, screening, and treatment, respectively. In addition, the emerging knowledge of viral biology generates opportunities that will contribute to strengthening prevention and treatment strategies in HPV-associated neoplasms.
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Affiliation(s)
- Patricia Piña-Sánchez
- Laboratorio Molecular de Oncología, Unidad de Investigación Oncológica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Rol ML, Picconi MA, Ferrera A, Sánchez GI, Hernández MDLL, Lineros J, Peraza A, Brizuela M, Mendoza L, Mongelós P, Cabrera Y, Rodríguez de la Peña M, Correa RM, Terán C, Colque Reynaga D, García L, Ramírez AT, Hernández-Nevarez P, Doimi F, Ramón M, Arias-Stella J, Zúñiga M, Villagra V, Bobadilla ML, Cardinal L, Valls J, Lucas E, Baena A, Fleider L, Venegas G, Cruz-Valdez A, Rodríguez G, Calderón A, Wiesner C, Luciani S, Broutet N, Herrero R, Almonte M. Implementing HPV testing in 9 Latin American countries: The laboratory perspective as observed in the ESTAMPA study. Front Med (Lausanne) 2022; 9:1006038. [PMID: 36465901 PMCID: PMC9714610 DOI: 10.3389/fmed.2022.1006038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Replacement of cytology screening with HPV testing is recommended and essential for cervical cancer elimination. HPV testing for primary screening was implemented in 12 laboratories within 9 Latin American countries, as part of the ESTAMPA cervical cancer screening study. Our observations provide information on critical operational aspects for HPV testing implementation in diverse resource settings. Methods We describe the implementation process of HPV testing in ESTAMPA, focusing on laboratory aspects. We assess the readiness of 12 laboratories to start HPV testing and their continuity capacity to maintain good quality HPV testing until end of recruitment or up to December 2021. Readiness was based on a checklist. Information from the study database; regular meetings and monitoring visits; and a questionnaire on laboratory operational aspects sent in May 2020 were used to assess continuity capacity. Compliance with seven basic requirements (readiness) and eight continuity requirements (continuity capacity) was scored (1 = compliant, 0 = not compliant) and totaled to classify readiness and continuity capacity as very limited, limited, moderate or high. Experiences, challenges, and enablers of the implementation process are also described. Results Seven of 12 laboratories had high readiness, three moderate readiness, and of two laboratories new to HPV testing, one had limited readiness and the other very limited readiness. Two of seven laboratories with high readiness also showed high continuity capacity, one moderate continuity capacity, and the other four showed limited continuity capacity since they could not maintain good quality HPV testing over time. Among three laboratories with moderate readiness, one kept moderate continuity capacity and two reached high continuity capacity. The two laboratories new to HPV testing achieved high continuity capacity. Based on gained expertise, five laboratories have become part of national screening programs. Conclusion High readiness of laboratories is an essential part of effective implementation of HPV testing. However, high readiness is insufficient to guarantee HPV testing high continuity capacity, for which a "culture of quality" should be established with regular training, robust monitoring and quality assurance systems tailored to local context. All efforts to strengthen HPV laboratories are valuable and crucial to guarantee effective implementation of HPV-based cervical screening.
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Affiliation(s)
- Mary Luz Rol
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | | | - María de la Luz Hernández
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- SMS-Oncology, Amsterdam, Netherlands
| | - Joana Lineros
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Ana Peraza
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Marisol Brizuela
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Pamela Mongelós
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Yessy Cabrera
- Grupo de Infección y Cáncer, Universidad de Antioquia, Medellín, Colombia
| | | | - Rita Mariel Correa
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Deisy Colque Reynaga
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Laura García
- Laboratorio de Biología Molecular, Departamento de Patología Clínica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Arianis Tatiana Ramírez
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Franco Doimi
- Laboratorio de Patología Oncológica SAC, Lima, Peru
| | - María Ramón
- Laboratorio de Patología Oncológica SAC, Lima, Peru
| | | | - Michael Zúñiga
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, San José, Guanacaste, Costa Rica
| | | | | | - Lucía Cardinal
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Joan Valls
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Eric Lucas
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Laura Fleider
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Gino Venegas
- Clínica Angloamericana, Lima, Peru
- Liga contra el Cáncer, Lima, Peru
| | | | | | - Alejandro Calderón
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | | | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, DC, United States
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rolando Herrero
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, San José, Guanacaste, Costa Rica
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Hurtado-Salgado E, Cárdenas-Cárdenas L, Salmerón J, Luna-Gordillo R, Ortiz-Panozo E, Allen-Leigh B, Saavedra-Lara N, Franco EL, Lazcano-Ponce E. Comparative performance of the human papillomavirus test and cytology for primary screening for high-grade cervical intraepithelial neoplasia at the population level. Int J Cancer 2021; 150:1422-1430. [PMID: 34921727 DOI: 10.1002/ijc.33905] [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: 03/18/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
The World Health Organization recommends high-risk human papillomavirus (hrHPV)-based screening for women 39 to 49 years, based on the greater accuracy of hrHPV-based screening for cervical cancer detection. Many cervical cancer screening programs have incorporated hrHPV testing and multiple early cervical cancer detection strategies have been evaluated, mostly under controlled conditions. However, there are few evaluations of combined hrHPV and cytology strategies post-implementation at the population level. Our study sought to estimate the relative yield of hrHPV testing compared to cervical cytology, as a primary screening test for cervical intraepithelial neoplasia grade 2+ (CIN2+), used at the population level. We analyzed screening data from Mexico's public cervical cancer prevention program from 2010 to 2015 in women 35 to 64 years. The study population consisted of two cohorts: one from a total of 2 881 962 cytology-based screening tests and another from a total of 2 004 497 hrHPV-based screening tests, which are concurrent in time. We performed a relative yield analysis using Poisson regression models to compare the effectiveness of hrHPV testing for CIN2+ with cervical cytology. A total of 4 886 459 records were analyzed, including 23 999 biopsies; 0.12% (n = 6166) had a CIN2+ histologic diagnosis. hrHPV testing with cytological triage detects twice as many CIN2+ cases as screening using cytology alone.
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Affiliation(s)
- Erika Hurtado-Salgado
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Luz Cárdenas-Cárdenas
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Jorge Salmerón
- Political, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Betania Allen-Leigh
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - Nenetzen Saavedra-Lara
- School of Public Health of Mexico, National Institute of Public Health, Cuernavaca, Mexico
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
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de Degani GL, Duarte L, Ismael J, Martinez L, López F. The impact of the COVID-19 pandemic on cancer care in the public health subsector, province of Santa Fe, Argentina. Ecancermedicalscience 2021; 15:1270. [PMID: 34567255 PMCID: PMC8426009 DOI: 10.3332/ecancer.2021.1270] [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: 04/30/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The severe acute respiratory syndrome coronavirus 2 pandemic coronavirus disease (COVID-19) and the measures taken to lessen its impact have had side effects affecting timely care of other diseases. The aim of this paper is to quantify the impact of the pandemic on the cancer care line in the province of Santa Fe, Argentina. METHOD It is an observational cross-sectional study comparing the impact on selected variables of the pre-pandemic and intra-pandemic periods. The formula of percentage variation was used to show the differences. The positivity index was calculated and expressed as a percentage. The proportions of both periods were compared through the chi-squared test and its p-value. RESULTS Reductions were observed in all the variables under study. However, the deeper impact was evident in screening, with 56%-87% decreases in the number of procedures carried out. A 26% reduction was seen in diagnosis. Treatment was the variable with the least impact, with a 3% decrease. DISCUSSION COVID-19 as well as the measures taken to reduce its impact caused alterations in the cancer care line in the province, with clear differences according to the variable under study. Measures related to cancer screening were displaced, prioritising the care of patients already diagnosed and treated. CONCLUSION Considering the new increase in the number of COVID-19 cases, it is essential to adapt the healthcare system, and design new innovative strategies to reduce long-term consequences.
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Affiliation(s)
- Graciela Lopez de Degani
- Cancer Control Agency, Ministry of Health, Bv. Pellegrini 3551, Zip Code 3000, Santa Fe, Argentina
| | - Leandro Duarte
- Cancer Control Agency, Ministry of Health, Bv. Pellegrini 3551, Zip Code 3000, Santa Fe, Argentina
| | - Julia Ismael
- Cancer Control Agency, Ministry of Health, Bv. Pellegrini 3551, Zip Code 3000, Santa Fe, Argentina
| | - Laura Martinez
- Cancer Control Agency, Ministry of Health, Bv. Pellegrini 3551, Zip Code 3000, Santa Fe, Argentina
| | - Florencia López
- Cancer Control Agency, Ministry of Health, Bv. Pellegrini 3551, Zip Code 3000, Santa Fe, Argentina
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Arrossi S, Paolino M, Laudi R, Thouyaret L. Changing the paradigm of cervical cancer prevention through introduction of HPV-testing: evaluation of the implementation process of the Jujuy Demonstration Project in Argentina. Ecancermedicalscience 2021; 15:1199. [PMID: 33889208 PMCID: PMC8043686 DOI: 10.3332/ecancer.2021.1199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction The Jujuy Demonstration Project (JDP) was a project carried out over the course of 4 years (2011–2014) to develop, implement and evaluate the programmatic components of a Human Papilloma Virus (HPV)-based screening programme in Argentina. The aim of this paper is to present a qualitative evaluation of the context and implementation process of the JDP. Methods We used an adaptation of the Health System Framework (HSF), which includes interconnected contextual factors that are considered key drivers for successful health interventions. We reviewed secondary documents, which included scientific reports, norms and regulations, information sheets, power point presentations and manuals and recommendations published by the National Programme for Cervical Cancer Prevention. We also carried out semi-structured interviews with key informants to explore their views about technology acceptability. Results Key components of the JDP implementation process were: a high level of political support and consensus among stakeholders, the demonstrated effectiveness of the technology and its acceptability by health authorities and providers, the funding of tests and diagnosis/treatment services, the implementation of an information system for monitoring and evaluation and the reorganisation of the network of screening, diagnosis and treatment services. Conclusion This analysis examines the policy context in which the JDP was implemented and the system components that were key for the demonstrated effectiveness of the strategy. Such analyses provide useful insights into core components of HPV testing implementation that are needed to guarantee its potential effectiveness to reduce cervical cancer incidence and mortality.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Rosa Laudi
- Hospital Ramos Mejía, Urquiza 609, Buenos Aires 1221, Argentina
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer (Argentina), Julio A, Roca 781, Buenos Aires 1067, Argentina
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Ramírez-Palacios P, Chen A, Flores YN, Crespi CM, Lazcano-Ponce E, Alvarez-Escobedo D, Torres-Ibarra L, Rivera-Paredez B, León-Maldonado L, Hernández-López R, Mendiola-Pastrana IR, Méndez-Hernández P, Cuzick J, Carmona E, Figueroa H, Montiel-Cordero F, Meneses-León J, Rao J, Salmerón J. Benefit of double-reading cytology smears as a triage strategy among high-risk human papillomavirus-positive women in Mexico. Cancer Cytopathol 2020; 128:715-724. [PMID: 32520446 DOI: 10.1002/cncy.22303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The goal of this study was to determine whether the detection of histologically confirmed cases of cervical high-grade squamous intraepithelial lesions or worse (HSIL+) can be increased by having each liquid-based cytology (LBC) slide read by 2 cytotechnologists as part of routine screening. METHODS Over 36,212 women aged 30 to 64 years participated in the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening and Triage (FRIDA) Study in Mexico between 2013 and 2016. For each participant, 2 cervical samples were collected at the same clinic visit, one to test for high-risk human papillomavirus (hrHPV) and the other for LBC, which was used to triage those with a hrHPV positive result. LBC slides were evaluated by 7 cytotechnologists, with each slide read independently by 2 blinded cytotechnologists. All women with atypical cells of undetermined significance or a worse result were referred to colposcopy for further evaluation and diagnosis. Three pathologists evaluated the biopsy specimens to confirm the final HSIL+ diagnosis. The HSIL+ detection rates for the single versus double reading were estimated and compared. RESULTS A total of 3,914 women with a positive hrHPV result were triaged with LBC. The first and second cytology readings resulted in 43 HSIL+ cases detected; the double-reading strategy detected 9 additional HSIL+ cases, resulting in a total of 52 HSIL+ cases. The HSIL+ detection rate increased from 10.99/1000 with a single reading to 13.29/1000 with the double-reading strategy (P = .004). CONCLUSION A 20.9% increase in HSIL+ cases detected was achieved with a double reading of the LBC slides in this sample of hrHPV-positive women.
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Affiliation(s)
- Paula Ramírez-Palacios
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Mexico
| | - Aiyu Chen
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California
| | - Yvonne N Flores
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Mexico
- Department of Health Policy and Management and Kaiser Permanente Center for Health Equity, Fielding School of Public Health, University of California, Los Angeles, California
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
| | - Catherine M Crespi
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Daniel Alvarez-Escobedo
- Unidad de Medicina Familiar, Hospital General Regional No. 1, Instituto Mexicano del Seguro Social, Cuernavaca, Mexico
| | - Leticia Torres-Ibarra
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Berenice Rivera-Paredez
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Rubí Hernández-López
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Indira R Mendiola-Pastrana
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Pablo Méndez-Hernández
- Departamento de Calidad y Educación en Salud, Secretaria de Salud Tlaxcala, Santa Ana Chiautempan, Mexico
- Facultad de Ciencias de la Salud, Universidad Autónoma de Tlaxcala, Zacatelco, Mexico
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
| | | | - Héctor Figueroa
- Laboratorio de Citología, Laboratorio Estatal de Salud Pública, Tlaxcala, México
| | | | - Joacim Meneses-León
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jianyu Rao
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, California
| | - Jorge Salmerón
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Sompawong N, Mopan J, Pooprasert P, Himakhun W, Suwannarurk K, Ngamvirojcharoen J, Vachiramon T, Tantibundhit C. Automated Pap Smear Cervical Cancer Screening Using Deep Learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:7044-7048. [PMID: 31947460 DOI: 10.1109/embc.2019.8856369] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
This study aims to apply Mask Regional Convolutional Neural Network (Mask R-CNN) to cervical cancer screening using pap smear histological slides. Based on our current literature review, this is the first attempt of using Mask R-CNN to detect and analyze the nucleus of the cervical cell, screening for normal and abnormal nuclear features. The data set were liquid-based histological slides obtained from Thammasat University (TU) Hospital. The slides contained both cervical cells and various artifacts such as white blood cells, mimicking the slides obtained in actual clinical settings. The proposed algorithm achieved mean average precision (mAP) of 57.8%, accuracy of 91.7%, sensitivity of 91.7%, and specificity of 91.7% per image. As we needed to evaluate the efficiency of our algorithm in comparison to single cell classification algorithm (Zhang et al., IEEE JBHI, vol. 21, no. 6, pp. 1633, 2017), we modified our method to also classify single cells on TU dataset test using Mask R-CNN segmentation. The results obtained had an accuracy of 89.8%, sensitivity of 72.5%, and specificity of 94.3%.
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Flores YN, Salmerón J, Glenn BA, Lang CM, Chang LC, Bastani R. Clinician offering is a key factor associated with HPV vaccine uptake among Mexican mothers in the USA and Mexico: a cross-sectional study. Int J Public Health 2018; 64:323-332. [PMID: 30506364 DOI: 10.1007/s00038-018-1176-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/01/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the knowledge, beliefs, and practices regarding HPV vaccination among mothers of vaccine-eligible girls in Mexico and the USA. METHODS Similar samples of Mexican mothers with vaccine-eligible daughters were surveyed at two clinics in Cuernavaca, Morelos, from July to October 2012 (n = 200) and at two clinics in Oxnard, California, from August to November 2013 (n = 200). RESULTS Although mothers in the USA had less knowledge and more negative attitudes toward the vaccine than their counterparts in Mexico, vaccine uptake rates were higher in the USA (49% vs. 40%). US mothers were more likely to have discussed and been offered the HPV vaccine by a clinician than mothers in Mexico. In multivariate analyses, having been offered the HPV vaccine was the most important predictor of vaccine uptake. CONCLUSIONS Our results suggest that healthcare access or other system, clinic, or provider factors are the main drivers of vaccine receipt in this binational sample of Mexican mothers. Interventions and programs that encourage clinicians to offer the HPV vaccine should be developed to increase vaccine uptake in both countries.
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Affiliation(s)
- Yvonne N Flores
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, Mexico.
- UCLA Department of Health Policy and Management and Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Los Angeles, CA, USA.
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, Mexico
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Beth A Glenn
- UCLA Department of Health Policy and Management and Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Los Angeles, CA, USA
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Cathy M Lang
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - L Cindy Chang
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Roshan Bastani
- UCLA Department of Health Policy and Management and Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Los Angeles, CA, USA
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
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Di J, Rutherford S, Chu C. Review of the Cervical Cancer Burden and Population-Based Cervical Cancer Screening in China. Asian Pac J Cancer Prev 2016; 16:7401-7. [PMID: 26625735 DOI: 10.7314/apjcp.2015.16.17.7401] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Cervical cancer continues to be a serious public health problem in the developing world, including China. Because of its large population with geographical and socioeconomic inequities, China has a high burden of cervical cancer and important disparities among different regions. In this review, we first present an overview of the cervical cancer incidence and mortality over time, and focus on diversity and disparity in access to care for various subpopulations across geographical regions and socioeconomic strata in China. Then, we describe population-based cervical cancer screening in China, and in particular implementation of the National Cervical Cancer Screening Program in Rural Areas (NACCSPRA) and the challenges that this program faces. These include low screening coverage, shortage of qualified health care personnel and limited funds. To improve prevention of cervical cancer and obtain better cancer outcomes, the Chinese government needs to urgently consider the following key factors: reducing disparities in health care access, collecting accurate and broadly representative data in cancer registries, expanding target population size and increasing allocation of government funding for training of personnel, improving health education for women, enhancing quality control of screening services and improving a system to increase follow up for women with positive results.
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Affiliation(s)
- Jiangli Di
- Centre for Environment and Population Health, Environment School, Griffith University , Brisbane, Australia E-mail :
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Sankaranarayanan R, Bhatla N, Basu P. Current global status & impact of human papillomavirus vaccination: Implications for India. Indian J Med Res 2016; 144:169-180. [PMID: 27934795 PMCID: PMC5206867 DOI: 10.4103/0971-5916.195023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Indexed: 11/23/2022] Open
Abstract
This review addresses the effectiveness and safety of human papillomavirus (HPV) vaccines, the current status of its introduction in the National Immunization Programmes (NIPs) and its relevance to India, which contributes a fifth of the global burden of cervical cancer. The vast literature on efficacy, acceptability and safety of HPV vaccination and its impact after population level introduction was reviewed and discussed. The efficacy of HPV vaccines in preventing high-grade precancerous lesions caused by vaccine-targeted HPV infections was 90 per cent or higher in HPV naοve women in randomized clinical trials. Two doses at 6 or 12 months apart are recommended for 9-14 yr old girls and three doses over six months to one year period for those aged above 15 yr. More than 80 countries or territories have introduced HPV vaccination in their NIPs, of which 33 are low- and middle-income countries (LMICs); in addition, 25 LMICs have introduced pilot programmes before a phased national expansion. Significant reductions in the frequency of HPV 16 and 18 infections, genital warts and cervical premalignant lesions in vaccinated cohorts and herd immunity in general populations have been reported from countries that introduced vaccination in NIPs as early as 2007. More than 280 million doses of HPV vaccines have been administered worldwide with the excellent safety profile with no serious adverse events linked to it. The high burden of cervical cancer and the high efficacy and safety of HPV vaccination justify its introduction in the Indian NIP at the earliest possibility to substantially reduce the cervical cancer burden in future.
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Affiliation(s)
- Rengaswamy Sankaranarayanan
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC-WHO), Lyon, France
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Arrossi S, Thouyaret L, Laudi R, Marín O, Ramírez J, Paolino M, Herrero R, Campanera A. Implementation of HPV-testing for cervical cancer screening in programmatic contexts: The Jujuy demonstration project in Argentina. Int J Cancer 2015; 137:1709-18. [PMID: 25807897 DOI: 10.1002/ijc.29530] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/12/2015] [Indexed: 11/11/2022]
Abstract
The aim of this article is to present results of programmatic introduction of HPV testing with cytologic triage among women 30 years and older in the province of Jujuy, Argentina, including description of the planning phase and results of program performance during the first year. We describe the project implementation process, and calculate key performance indicators using SITAM, the national screening information system. We also compare disease detection rates of HPV testing in 2012 with cytology as performed during the previous year. HPV testing with cytology triage was introduced through a consensus-building process. Key activities included establishment of algorithms and guidelines, creating the HPV laboratory, training of health professionals, information campaigns for women and designing the referral network. By the end of 2012, 100% (n = 270) of public health care centers were offering HPV testing and 22,834 women had been HPV tested, 98.5% (n = 22,515) were 30+. HPV positivity among women over 30 was 12.7%, 807 women were HPV+ and had abnormal cytology, and 281 CIN2+ were identified. CIN2+ detection rates was 1.25 in 2012 and 0.62 in 2011 when the program was cytology based (p = 0.0002). This project showed that effective introduction of HPV testing in programmatic contexts of low-middle income settings is feasible and detects more disease than cytology.
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Affiliation(s)
- Silvina Arrossi
- Consejo Nacional de Investigaciones Científicas y Técnicas/Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante 27, Buenos Aires, Argentina
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer (Argentina), Julio A. Roca 781, Piso 9, Buenos Aires, Argentina
| | - Rosa Laudi
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer, Rivadavia 875, Buenos Aires, Argentina
| | - Oscar Marín
- Hospital Pablo Soria, Güemes 1345, San Salvador de Jujuy, Argentina
| | - Josefina Ramírez
- Ministerio de Salud de la provincia de Jujuy, Av. Italia Esq, Independencia, San Salvador de Jujuy, Argentina
| | - Melisa Paolino
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer (Argentina), Julio A. Roca 781, Piso 9, Buenos Aires, Argentina
| | - Rolando Herrero
- International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France
| | - Alicia Campanera
- Ministerio de Salud de la Provincia de Jujuy, Av. Italia Esq, Independencia, San de Salvador de Jujuy, Argentina
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Murphy M. Unsettling care: Troubling transnational itineraries of care in feminist health practices. SOCIAL STUDIES OF SCIENCE 2015; 45:717-737. [PMID: 26630818 DOI: 10.1177/0306312715589136] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Responding to the call by Maria Puig de la Bellacasa for Science and Technology Studies to take up 'matters of care', this article cautions against equating care with positive feelings and, in contrast, argues for the importance of grappling with the non-innocent histories in which the politics of care already circulates, particularly in transnational couplings of feminism and health. The article highlights these histories by tracing multiple versions of the politics of care in a select set of feminist engagements with the pap smear and cervical cancer. Drawing on postcolonial and indigenous feminist commitments, as well as amplifying Donna Haraway's call to 'stay with the trouble', the article seeks to disturb hegemonic histories and arrangements of race, colonialism, and political economy, while simultaneously valuing divergent multi-local itineraries as relevant to technoscientific matters of care. This call for a politics of 'unsettling' care strives to stir up and put into motion what is sedimented, while embracing the generativity of discomfort, critique, and non-innocence.
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Serrano B, Alemany L, Ruiz PAD, Tous S, Lima MA, Bruni L, Jain A, Clifford GM, Qiao YL, Weiss T, Bosch FX, de Sanjosé S. Potential impact of a 9-valent HPV vaccine in HPV-related cervical disease in 4 emerging countries (Brazil, Mexico, India and China). Cancer Epidemiol 2014; 38:748-56. [PMID: 25305098 DOI: 10.1016/j.canep.2014.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/06/2014] [Accepted: 09/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND We estimated the potential impact of an investigational 9-valent human papillomavirus (HPV) vaccine (HPVs 6/11/16/18/31/33/45/52/58) in HPV-related cervical disease in Brazil, Mexico, India and China, to help to formulate recommendations on cervical cancer prevention and control. METHODS Estimations for invasive cervical cancer (ICC) were based on an international study including 1356 HPV-positive cases for the four countries altogether, and estimations for precancerous cervical lesions were extracted from a published meta-analysis including 6 025 HPV-positive women from the four mentioned countries. Globocan 2012 and 2012 World Population Prospects were used to estimate current and future projections of new ICC cases. RESULTS Combined proportions of the 9 HPV types in ICC were 88.6% (95%CI: 85.2-91.3) in Brazil, 85.7% (82.3-88.8) in Mexico, 92.2% (87.9-95.3) in India and 97.3% (93.9-99.1) in China. The additional HPV 31/33/45/52/58 proportions were 18.8% (15.3-22.7) in Brazil, 17.6% (14.2-21.2) in Mexico, 11.3% (7.5-16.1) in India and 11.9% (7.5-17.2) in China. HPV6 and 11 single types were not identified in any of the samples. Proportion of the individual 7 high risk HPV types included in the vaccine varied by cytological and histological grades of HPV-positive precancerous cervical lesions. HPV 16 was the dominant type in all lesions, with contributions in low grade lesions ranging from 16.6%(14.3-19.2) in Mexico to 39.8% (30.0-50.2) in India, and contributions in high grade lesions ranging from 43.8% (36.3-51.4) in Mexico to 64.1% (60.6-67.5) in Brazil. After HPV 16, variations in other majors HPV types were observed by country, with an under representation of HPV 18 and 45 compared to ICC. CONCLUSION The addition of HPVs 31/33/45/52/58 to HPV types included in current vaccines could increase the ICC preventable fraction in a range of 12 to 19% across the four countries, accounting the 9-types altogether 90% of ICC cases. Assuming the same degree of efficacy of current vaccines, the implementation of the 9-valent HPV vaccine in Brazil, Mexico, India and China would substantially impact on the reduction of the world cervical cancer burden.
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Affiliation(s)
- Beatriz Serrano
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain.
| | - Laia Alemany
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain; CIBER Epidemiología y Salud Pública, CIBERESP, Barcelona, Spain.
| | | | - Sara Tous
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain.
| | | | - Laia Bruni
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain.
| | - Asha Jain
- Cancer Prevention and Relief Society, Raipur, India.
| | | | - You Lin Qiao
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Thomas Weiss
- Global Health Outcomes, Merck & Co., Inc., West Point, PA USA.
| | - F Xavier Bosch
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain.
| | - Silvia de Sanjosé
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain; CIBER Epidemiología y Salud Pública, CIBERESP, Barcelona, Spain.
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Abstract
Less-developed-region countries (LDCs) are seeing a rapid rise in cancer incidence owing to changing lifestyles, infections, environmental carcinogens and increasing longevity. LDCs have poor resources to deal with cancers, leading to high mortality rates. Investment in nationally implementable and sustainable cancer prevention and screening strategies would be more appropriate for LDCs. This Science and Society article outlines the burden of preventable cancers in selected LDCs and discusses evidence on cost-effective and widely implementable prevention and screening strategies.
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Affiliation(s)
- Aditi Shastri
- Albert Einstein College of Medicine, Hematology-Oncology, 1300 Morris Park Avenue, Bronx, New York, New York 10461, USA
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Yoshida T, Nishijima Y, Hando K, Vilayvong S, Arounlangsy P, Fukuda T. Primary study on providing a basic system for uterine cervical screening in a developing country: analysis of acceptability of self-sampling in Lao PDR. Asian Pac J Cancer Prev 2014; 14:3029-35. [PMID: 23803074 DOI: 10.7314/apjcp.2013.14.5.3029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most developing countries have been unable to implement well-organized health care systems, especially comprehensive Pap smear screening-based programs. One of the reasons for this is regional differences in medical services, and a low-cost portable cervical screening system is necessary. To improve regional discrepancies in cervical screening systems, we investigated the usefulness and acceptability of cervical self- sampling by liquid-based cytology (LBC) for 290 volunteers in the Lao PDR. MATERIALS AND METHODS Following health education with comprehensive documents, cervical self-sampling kits by LBC were distributed in three provincial, district, and village areas to a total of 290 volunteers, who were asked to take cytology samples by themselves. Subsequently, the acceptability of self-sampling was evaluated using a questionnaire. RESULTS The documents were well understood in all three regions. Regarding the acceptability of self-sampling, the selections for subsequent screening were 62% self-sampling, 36% gynecologist-sampling, 1% either method, and 1% other methods. The acceptability rates were higher in the district and the village than in the province. For the relationship between acceptability and pregnancy, the self-sampling selection rate was higher in the pregnancy-experienced group (75%) than in the pregnancy-inexperienced group (60%). For the relationship between selection of self-sampling and experience of screening, the self-sampling selection rate was higher in the screening-inexperienced group (62%) than in the screening-experienced group (52%). CONCLUSIONS Our data show that this new way forward, involving a combination of self-sampling and LBC, is highly acceptable regardless of age, educational background, and residence in rural areas in a developing country.
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Affiliation(s)
- Tomomi Yoshida
- Department of Laboratory Sciences, Graduate School of Health Sciences, Gunma University, Gunma, Japan.
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Soneji S, Fukui N. Socioeconomic determinants of cervical cancer screening in Latin America. Rev Panam Salud Publica 2014; 33:174-82. [PMID: 23698136 DOI: 10.1590/s1020-49892013000300003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 12/18/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the impact of health care access and socioeconomic determinants on Pap smear screening in Latin America. METHODS Individual-level data was collected from the Demographic and Health Surveys in Bolivia, Brazil, Dominican Republic, Ecuador, Guatemala, Nicaragua, Peru, and Trinidad and Tobago between 1987 and 2008. Multivariate logistic regression analyses were used to identify socioeconomic and health care determinants of two outcomes: knowledge of Pap smears and recent Pap smear screening. RESULTS In all countries, the proportion of women with a recent Pap smear screening remained below 55%. Key determinants of knowledge of Pap smears were age, education, and recent doctor's visit. For recent Pap smear screening, key determinants were wealth and recent doctor's visit. Women were between 1.47 and 3.44 times more likely to have received a recent Pap smear if they had a recent doctor's visit. Even the poorest women with a recent doctor's visit were more likely to screen than the richest women without a recent visit. CONCLUSIONS These data suggest that visiting a doctor is an important determinant of cervical cancer screening in Latin America. Because screening may coincide with other medical visits, physicians could effectively encourage screening.
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Affiliation(s)
- Samir Soneji
- Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Geisel School of Medicine, Lebanon, New Hampshire, United States of America.
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Ali-Risasi C, Mulumba P, Verdonck K, Vanden Broeck D, Praet M. Knowledge, attitude and practice about cancer of the uterine cervix among women living in Kinshasa, the Democratic Republic of Congo. BMC WOMENS HEALTH 2014; 14:30. [PMID: 24548698 PMCID: PMC3937079 DOI: 10.1186/1472-6874-14-30] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 02/13/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cervical cancer is the most frequent cancer of women in the Democratic Republic of Congo (DRC). Nevertheless, the level of women's awareness about cervical cancer is unknown. Knowledge, attitude and practice (KAP) are important elements for designing and monitoring screening programs. The study purpose was to estimate KAP on cervical cancer and to identify associated factors. METHODS A cross-sectional study was conducted in Kinshasa, DRC, including 524 women aged 16-78 years (median age 28; interquartile range 22-35). The women were interviewed at home by trained field workers using a standardized questionnaire. The women's score on knowledge, attitude and practice were dichotomized as sufficient or insufficient. We used binary and multiple logistic regression to assess associations between obtaining sufficient scores and a series of socio-demographic factors: age, residence, marital status, education, occupation, religion, and parity. RESULTS The women's score on knowledge was not significantly correlated with their score on practice (Spearman's rho = 0.08; P > 0.05). Obtaining a sufficient score on knowledge was positively associated with higher education (adjusted odds ratio (OR) 7.65; 95% confidence interval (95% CI) 3.31-17.66) and formal employment (adjusted OR 3.35; 95% CI 1.85-6.09); it was negatively associated with being single (adjusted OR 0.44; 95% CI 0.24-0.81) and living in the eastern, western and northern zone of Kinshasa compared to the city centre. The attitude score was associated with place of residence (adjusted OR for east Kinshasa: 0.49; 95% CI 0.27-0.86 and for south Kinshasa: 0.48; 95% CI 0.27-0.85) and with religion (adjusted OR 0.55; 95% CI 0.35-0.86 for women with a religion other than Catholicism or Protestantism compared to Catholics). Regarding practice, there were negative associations between a sufficient score on practice and being single (adjusted OR 0.24; 95% CI 0.13-0.41) and living in the eastern zone of the city (adjusted OR 0.39; 95% CI 0.22-0.70). Although 84% of women had heard about cervical cancer, only 9% had ever had a Papanicolaou (Pap) smear test. CONCLUSIONS This study shows a low level of knowledge, attitude and practice on cervical cancer among women in Kinshasa. Increasing women's awareness would be a first step in the long chain of conditions to attain a lower incidence and mortality.
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Affiliation(s)
- Catherine Ali-Risasi
- Laboratory of Anatomopathology, General Reference Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo.
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Evaluation of a low-cost liquid-based Pap test in rural El Salvador: a split-sample study. J Low Genit Tract Dis 2013; 18:151-5. [PMID: 24270191 DOI: 10.1097/lgt.0b013e31829aa052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to test the diagnostic efficacy of a low-cost, liquid-based cervical cytology that could be implemented in low-resource settings. MATERIALS AND METHODS A prospective, split-sample Pap study was performed in 595 women attending a cervical cancer screening clinic in rural El Salvador. Collected cervical samples were used to make a conventional Pap (cell sample directly to glass slide), whereas residual material was used to make the liquid-based sample using the ClearPrep method. Selected samples were tested from the residual sample of the liquid-based collection for the presence of high-risk Human papillomaviruses. RESULTS Of 595 patients, 570 were interpreted with the same diagnosis between the 2 methods (95.8% agreement). There were comparable numbers of unsatisfactory cases; however, ClearPrep significantly increased detection of low-grade squamous intraepithelial lesions and decreased the diagnoses of atypical squamous cells of undetermined significance. ClearPrep identified an equivalent number of high-grade squamous intraepithelial lesion cases as the conventional Pap. High-risk human papillomavirus was identified in all cases of high-grade squamous intraepithelial lesion, adenocarcinoma in situ, and cancer as well as in 78% of low-grade squamous intraepithelial lesions out of the residual fluid of the ClearPrep vials. CONCLUSIONS The low-cost ClearPrep Pap test demonstrated equivalent detection of squamous intraepithelial lesions when compared with the conventional Pap smear and demonstrated the potential for ancillary molecular testing. The test seems a viable option for implementation in low-resource settings.
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Conde-Ferraez L, Suarez Allen RE, Carrillo Martinez JR, Ayora-Talavera G, Gonzalez-Losa MDR. Factors associated with cervical cancer screening amongst women of reproductive age from Yucatan, Mexico. Asian Pac J Cancer Prev 2013; 13:4719-24. [PMID: 23167409 DOI: 10.7314/apjcp.2012.13.9.4719] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This study aimed to analyse the participation of women of reproductive age in a cancer screening program, and survey reasons for non-screening in a region from Mexico with high cervical cancer mortality. A total of 281 obstetric patients from a previous HPV study in a social security hospital during 2008-2009 were included. Reasons for not participating in the screening were directly asked. HPV positive patients were invited to participate in an informative workshop, and they filled in a knowledge questionnaire. The women ranged in age from 14-47 years; 123 (43.8%) had never participated in screening, of which 97 (78.9%) had their first sexual intercourse 2 to 10 years ago, resulting in 25% HPV positive. Screening history was strongly associated with 2 or more gestations (OR= 10.07, p=0.00) and older age (OR=6.69 p=0.00). When 197 women were contacted and interviewed, reasons referred for non-screening were ignorance, lack of interest or time, recent sexual onset, shame and fear. More than 50% of the workshop participants showed knowledge of HPV, while 38.9% and 25% knew about Pap smear and cervical cancer. A high percentage of women of reproductive age have never had a Pap smear. Promoting the screening program in medical facilities seems to be important in this population. New approaches to inform vulnerable individuals on the benefits of screening need to be implemented, especially for young women.
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Affiliation(s)
- Laura Conde-Ferraez
- Centro de Investigaciones Regionales, Universidad Autonoma de Yucatan (UADY), Yucatan, Mexico.
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Abstract
Context.—Cervical cancer remains the most common malignancy in women living in low- and middle-income countries, despite the decline of the disease in countries where cervical cytology screening programs have been implemented.
Objectives.—To review the current incidence of cervical cancer in low-resource countries, the availability and types of screening programs, and the treatment options.
Data Sources.—Literature review through PubMed, Internet search, and personal communication.
Conclusions.—Although data are incomplete, available figures confirm that the rate of cervical cancer deaths and the availability of cervical cancer screening programs are inversely proportional and vary, in general, by the wealth of the nation. Despite the success of cervical cytology screening, many major health care organizations have abandoned screening by cytology in favor of direct visualization methods with immediate treatment of lesions by cryotherapy provided by trained, nonmedical personnel.
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Affiliation(s)
- Rosemary Tambouret
- From the Department of Pathology, Massachusetts General Hospital, Boston
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Ajenifuja KO, Gage JC, Adepiti AC, Wentzensen N, Eklund C, Reilly M, Hutchinson M, Burk RD, Schiffman M. A population-based study of visual inspection with acetic acid (VIA) for cervical screening in rural Nigeria. Int J Gynecol Cancer 2013; 23:507-12. [PMID: 23354369 PMCID: PMC3580031 DOI: 10.1097/igc.0b013e318280f395] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Cervical cancer is the most common gynecological cancer in developing countries. Visual inspection with acetic acid (VIA) was introduced to screen for cervical premalignant lesions in developing countries owing to the inability of many countries to implement high-quality cytologic services. We sought to compare VIA performance among different health workers in Nigeria. METHODS In a population-based project, 7 health workers who had been screening women with VIA for approximately 2 years at local government health centers in rural Nigeria were retrained in a 2-week program using the International Agency for Research on Cancer training manual. Women from a rural village who had never had cervical cancer screening were recruited into the study. Each woman had cervical cancer screening by VIA, liquid-based cytologic test, and oncogenic human papillomavirus (HPV) DNA test. RESULTS Despite similar participant characteristics, across all age groups, providers had wide ranges of VIA results; 0% to 21% suspect cancer and 0% to 25% were VIA positive. Visual inspection with acetic acid was insensitive compared to a combination of cytologic and HPV tests. CONCLUSION In our study, VIA was not reproducible, nor was it sensitive compared to cytologic and HPV tests.
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Affiliation(s)
| | - Julia C. Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Akinfolarin C. Adepiti
- Department of Obstetrics, Gynaecology & Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Claire Eklund
- Women and Infants Hospital, Providence, Rhode Island, USA
| | - Mary Reilly
- Women and Infants Hospital, Providence, Rhode Island, USA
| | | | - Robert D. Burk
- Departments of Microbiology and Immunology, Pediatrics, Obstetrics, Gynecology, and Women’s Health, and Epidemiology and Population Health, Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
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Wall KM, Rocha GMN, Salinas-Martínez AM, Baraniuk S, Day RS. Modifiable barriers to cervical cancer screening adherence among working women in Mexico. J Womens Health (Larchmt) 2011; 19:1263-70. [PMID: 20509792 DOI: 10.1089/jwh.2009.1572] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To determine predictors of adherence to cervical cancer screening guidelines among women working in Monterrey, Mexico. Cases (n = 94) were sexually active female store clerks working in Monterrey, Mexico, aged 18-64, who were not adherent to Official Mexican Standard cervical cancer screening guidelines; controls (n = 135) were adherent to guidelines. The outcome of interest was adherence to cervical cancer screening services according to national screening guidelines. METHODS Multivariate logistic regression analyzed knowledge factors and perceptions associated with adherence. RESULTS Having no or inaccurate knowledge of screening guidelines (odds ratio [OR] 11.1, 95% confidence interval [95% CI] 4.3-28.5) and no knowledge of Pap examination utility (OR 6.8, 95% CI 1.0-46.4) were associated with screening guideline nonadherence. Perceptions of fear/embarrassment (OR 16.2, 95% CI 5.1-51.5) and lower levels of spousal/partner acceptance (OR 5.8, 95% CI 1.3-25.3) of the Pap examination were associated with screening guideline nonadherence. Results were adjusted for age at initiation of sexual activity, civil status, level of education, use of family planning/birth control, and income. CONCLUSIONS Identification of knowledge factors and perceptions that predict screening guideline adherence can inform population-specific recommendations to increase screening and reduce cervical cancer morbidity and mortality among employed Mexican women.
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Affiliation(s)
- Kristin M Wall
- Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Lee WC. Evidence-based National Cancer Screening program of Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2011. [DOI: 10.5124/jkma.2011.54.10.1028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Won-Chul Lee
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Flores YN, Bishai DM, Lorincz A, Shah KV, Lazcano-Ponce E, Hernández M, Granados-García V, Pérez R, Salmerón J. HPV testing for cervical cancer screening appears more cost-effective than Papanicolau cytology in Mexico. Cancer Causes Control 2010; 22:261-72. [PMID: 21170578 PMCID: PMC3025113 DOI: 10.1007/s10552-010-9694-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 11/10/2010] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To determine the incremental costs and effects of different HPV testing strategies, when compared to Papanicolau cytology (Pap), for cervical cancer screening in Mexico. METHODS A cost-effectiveness analysis (CEA) examined the specific costs and health outcomes associated with (1) no screening; (2) only the Pap test; (3) only self-administered HPV; (4) only clinician administered HPV; and (5) clinician administered HPV plus the Pap test. The costs of self- and clinician-HPV testing, as well as with the Pap test, were identified and quantified. Costs were reported in 2008 US dollars. The health outcome associated with these screening strategies was defined as the number of high-grade cervical intraepithelial neoplasia or cervical cancer cases detected. This CEA was performed using the perspective of the Mexican Institute of Social Security (IMSS) in Morelos, Mexico. RESULTS Screening women between the ages of 30-80 for cervical cancer using clinical-HPV testing or the combination of clinical-HPV testing, and the Pap is always more cost-effective than using the Pap test alone. CONCLUSIONS This CEA indicates that HPV testing could be a cost-effective screening alternative for a large health delivery organization such as IMSS. These results may help policy-makers implement HPV testing as part of the IMSS cervical cancer screening program.
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Affiliation(s)
- Yvonne N Flores
- Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México.
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Perkins RB, Langrish SM, Cotton DJ, Simon CJ. Maternal support for human papillomavirus vaccination in Honduras. J Womens Health (Larchmt) 2010; 20:85-90. [PMID: 21091226 DOI: 10.1089/jwh.2009.1919] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cervical cancer is a leading cause of cancer death for women in Latin America, and vaccinating against human papillomavirus (HPV) has the potential to limit this disease. We sought to determine Honduran women's awareness of HPV vaccination and interest in vaccinating their daughters against HPV. METHODS We interviewed mothers aged ≥17 at primary care clinics in Honduras. First, we collected demographic information and assessed knowledge related to cervical cancer prevention and awareness of HPV and HPV vaccination. Because most participants were not familiar with HPV, education about the relationships among HPV, sexual activity, and cervical cancer was provided before we asked participants if they would accept HPV vaccination for a 9-year-old daughter. We used multivariable logistic regression to determine predictors of vaccine acceptance. RESULTS We interviewed 632 mothers. Only 13% had heard of HPV vaccination before the interview. After education, 91% would accept HPV vaccination for a 9-year-old daughter. Mothers who intended to vaccinate knew more at baseline about cervical cancer prevention than did those who did not endorse vaccination. Demographic characteristics did not predict vaccine acceptance. CONCLUSIONS Few Honduran mothers were aware of HPV or HPV vaccination. However, most Honduran mothers would accept HPV vaccination for their daughters after receiving education about the relationship between HPV infection and cervical cancer. Baseline cervical cancer knowledge was associated with vaccine acceptance.
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Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA 02118, USA.
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Immigration, health care access, and recent cancer tests among Mexican-Americans in California. J Immigr Minor Health 2010; 12:433-44. [PMID: 19052868 DOI: 10.1007/s10903-008-9198-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Immigrants' lower rates of cancer testing may be due to lack of fluency in English and other skills and knowledge about navigating US health care markets, lack of access to health services, or both. We analyzed 9,079 Mexican-American respondents to the 2001 California Health Interview Survey (CHIS) grouped as born in the US, living in the US 10 or more years, or living in the US less than 10 years. The CHIS provides the largest Mexican-American sample in a US survey. Access to care meant having health insurance coverage and a usual source of care. English proficiency meant the respondent took the interview in English. Multivariate logistic regression was used to predict outcomes. Respondents reporting more time in the US were more likely to report access to medical care and to report getting a cancer screening exam. Regardless of time in the US, respondents reporting access had similar test rates. Regression results indicate that time in the US and primary language were not significant relative to use of cancer screening tests, but access to care was. Cancer screening tests that are covered by Every Woman Counts, California's breast and cervical cancer early detection program, had smaller gaps among groups than colorectal cancer screening which is not covered by a program. California is the only state with a survey able to monitor changes in small population groups. Understanding barriers specific to subgroups is key to developing appropriate policy and interventions to increase use of cancer screening exams.
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Dunn RA, Tan AK. Cervical cancer screening in Malaysia: Are targeted interventions necessary? Soc Sci Med 2010; 71:1089-93. [DOI: 10.1016/j.socscimed.2010.06.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 06/04/2010] [Accepted: 06/11/2010] [Indexed: 10/19/2022]
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Lazcano-Ponce E, Allen-Leigh B. Innovation in cervical cancer prevention and control in Mexico. Arch Med Res 2010; 40:486-92. [PMID: 19853189 DOI: 10.1016/j.arcmed.2009.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
Abstract
Disparities related to cervical cancer continue to exist in Mexico, including insufficient screening coverage, problems with quality control and a resulting greater risk of mortality among women from marginalized areas. A lack of opportunities and requirements for continuing education and accreditation of healthcare personnel involved in the screening program is also an issue. HPV DNA testing and HPV vaccines are recent technological innovations that offer a potential solution to the continued negative impact of cervical cancer among Mexican women. This essay attempts to answer questions such as: Why should HPV testing be integrated into the early detection program in Mexico? How can HPV testing best be integrated into the program in Mexico? How-from a public health perspective that seeks to reduce disparities-can HPV vaccination best be implemented in Mexico? HPV testing allows increased positive predictive value while also reducing costly and unnecessary overtreatment of low-grade abnormalities, and HPV vaccines offer the possibility of primary prevention of cervical cancer. The strategy proposed for Mexico includes primary prevention with HPV vaccination for girls aged between 12 and 16 years (before sexual initiation), Pap testing with excellent quality control for women 24-34 years of age and high-risk HPV DNA testing for women 35 years and older. HPV samples would be either clinically collected or self-collected and women with positive HPV test results would receive follow-up high-quality Pap testing. This approach is creative and focuses on reducing disparities and providing high-quality care that is also cost effective.
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Affiliation(s)
- Eduardo Lazcano-Ponce
- Center for Population Health Research, National Institute of Public Health, Mexico, D.F., Mexico
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Lee WC, Lee SY. National Health Screening Program of Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2010. [DOI: 10.5124/jkma.2010.53.5.363] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Won-Chul Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Soon-Young Lee
- Department of Preventive Medicine, School of Medicine, Ajou University, Korea
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Impact of patient adherence and test performance on the cost-effectiveness of cervical cancer screening in developing countries: the case of Honduras. Womens Health Issues 2009; 20:35-42. [PMID: 19944623 DOI: 10.1016/j.whi.2009.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 09/04/2009] [Accepted: 09/09/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We examined the impact of patient adherence and screening test performance on the cost-effectiveness of visual inspection with acetic acid (VIA) and Pap smears when used with colposcopy for diagnosis. MATERIALS AND METHODS Cost-effectiveness analysis was performed using computer modeling. The primary outcome was cancer prevalence in the 10 years after screening. Three hypothetical populations of 35-year-old women were compared: never-screened women, women screened with VIA, and women screened with Pap smears. We used community-based data from our screening program in Honduras to estimate screening test sensitivity and specificity, adherence to follow-up, and costs of screening and colposcopy services. Published data were used to model disease outcomes. RESULTS VIA was more sensitive than Pap smears (70% vs. 4%), less expensive (U.S. 0.23 dollars vs. 3.17 dollars), and the 2-vist VIA system had a higher rate of adherence to follow-up than the 3-visit Pap smear system (84% vs. 38%). VIA had a higher false-positive rate than Pap smears resulting in higher colposcopy referral rates, but more dysplasia was detected and treated. Cost-effectiveness analysis revealed that screening with VIA would cost U.S. 3,198 dollars per cancer case avoided and reduce cancer cases by 42%, versus U.S. 36,802 dollars and 2% for Pap screening. Although Pap smear quality was low in Honduras, sensitivity analysis showed that VIA was more cost-effective than Pap smears, even when test accuracy was equivalent. CONCLUSION In developing countries, systems barriers can limit the cost-effectiveness of Pap smears. VIA may be a cost-effective alternative for some resource-poor settings, although systems barriers, quality control, and feasibility issues must be considered.
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Efectividad de la citología cérvico-uterina para la detección temprana de cáncer de cuello uterino en el marco del sistema de salud de Colombia. BIOMEDICA 2009. [DOI: 10.7705/biomedica.v29i3.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ding L, Zou XJ, Ao JE, Yao AX, Cai L. ELISA test to detect CDKN2A (p16(INK4a)) expression in exfoliative cells: a new screening tool for cervical cancer. Mol Diagn Ther 2009; 12:395-400. [PMID: 19035626 DOI: 10.1007/bf03256305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The purpose of this study was to use an enzyme-linked immunosorbent assay (ELISA) to detect cyclin-dependent kinase inhibitor 2A (CDKN2A; also known as p16(INK4a)) in exfoliative cervical cells. CDKN2A is upregulated and considered as a surrogate marker for cervical intraepithelial neoplasia and cancer. METHODS Liquid-based ThinPrep((R)) cytologic test (TCT) and ELISA were performed on 1356 specimens collected prior to biopsy. A cotton swab was used to gather exfoliative cells. A sandwich ELISA was performed to measure the amount of solublized CDKN2A protein. RESULTS The sensitivity and specificity of the TCT for screening of cervical dysplasia and cancer were 82.93% and 88.11%, respectively. The sensitivity and specificity for measuring CDKN2A with ELISA to detect significant cervical disease were 87.80% and 92.43%, respectively. CDKN2A expression was correlated with the severity of cervical damage (r = 0.774; p < 0.001). CONCLUSION The sensitivity and specificity of detecting CDKN2A expression with ELISA in exfoliative cervical cells was superior to TCT (p = 0.023 and p < 0.001, respectively). These results suggest that detecting CDKN2A with ELISA has the potential to become a new screening method for cervical cancer.
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Affiliation(s)
- Li Ding
- Department of Pathology, Jingmen Hubei Province First Peoples' Hospital, Jingmen, China
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Harries J, Moodley J, Barone MA, Mall S, Sinanovic E. Preparing for HPV vaccination in South Africa: Key challenges and opinions. Vaccine 2009; 27:38-44. [PMID: 18977271 DOI: 10.1016/j.vaccine.2008.10.033] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 10/13/2008] [Indexed: 11/26/2022]
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Lazcano-Ponce E, Palacio-Mejia LS, Allen-Leigh B, Yunes-Diaz E, Alonso P, Schiavon R, Hernandez-Avila M. Decreasing Cervical Cancer Mortality in Mexico: Effect of Papanicolaou Coverage, Birthrate, and the Importance of Diagnostic Validity of Cytology. Cancer Epidemiol Biomarkers Prev 2008; 17:2808-17. [DOI: 10.1158/1055-9965.epi-07-2659] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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López-Revilla R, Martínez-Contreras LA, Sánchez-Garza M. Prevalence of high-risk human papillomavirus types in Mexican women with cervical intraepithelial neoplasia and invasive carcinoma. Infect Agent Cancer 2008; 3:3. [PMID: 18307798 PMCID: PMC2294112 DOI: 10.1186/1750-9378-3-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 02/28/2008] [Indexed: 11/28/2022] Open
Abstract
Background Prevalence of high risk (HR) human papillomavirus (HPV) types in the states of San Luis Potosí (SLP) and Guanajuato (Gto), Mexico, was determined by restriction fragment length-polymorphism (RFLP) analysis on the E6 ~250 bp (E6-250) HR-HPV products amplified from cervical scrapings of 442 women with cervical intraepithelial neoplasia and invasive carcinoma (280 from SLP and 192 from Gto). Fresh cervical scrapings for HPV detection and typing were obtained from all of them and cytological and/or histological diagnoses were performed on 383. Results Low grade intraepithelial squamous lesions (LSIL) were diagnosed in 280 cases (73.1%), high grade intraepithelial squamous lesions (HSIL) in 64 cases (16.7%) and invasive carcinoma in 39 cases (10.2%). In the 437 cervical scrapings containing amplifiable DNA, only four (0.9%) were not infected by HPV, whereas 402 (92.0%) were infected HR-HPV and 31 (7.1%) by low-risk HPV. RFLP analysis of the amplifiable samples identified infections by one HR-HPV type in 71.4%, by two types in 25.9% and by three types in 2.7%. The overall prevalence of HR-HPV types was, in descending order: 16 (53.4%) > 31 (15.6%) > 18 (8.9%) > 35 (5.6) > 52 (5.4%) > 33 (1.2%) > 58 (0.7%) = unidentified types (0.7%); in double infections (type 58 absent in Gto) it was 16 (88.5%) > 31 (57.7%) > 35 (19.2%) > 18 (16.3%) = 52 (16.3%) > 33 (2.8%) = 58 (2.8%) > unidentified types (1.0%); in triple infections (types 33 and 58 absent in both states) it was 16 (100.0%) > 35 (54.5%) > 31 (45.5%) = 52 (45.5%) > 18 (27.3%). Overall frequency of cervical lesions was LSIL (73.1%) > HSIL (16.7%) > invasive cancer (10.2%). The ratio of single to multiple infections was inversely proportional to the severity of the lesions: 2.46 for LSIL, 2.37 for HSIL and 2.15 for invasive cancer. The frequency of HR-HPV types in HSIL and invasive cancer lesions was 16 (55.0%) > 31 (18.6%) > 35 (7.9%) > 52 (7.1%) > 18 (4.3%) > unidentified types (3.6%) > 33 (2.9%) > 58 (0.7%). Conclusion Ninety percent of the women included in this study were infected by HR-HPV, with a prevalence 1.14 higher in Gto. All seven HR-HPV types identifiable with the PCR-RFLP method used circulate in SLP and Gto, and were diagnosed in 99.3% of the cases. Seventy-one percent of HR-HPV infections were due to a single type, 25.9% were double and 2.7% were triple. Overall frequency of lesions was LSIL (73.1%) > HSIL (16.7%) > invasive cancer (10.2%), and the ratio of single to multiple infections was inversely proportional to severity of the lesions: 2.46 for LSIL, 2.37 for HSIL and 2.15 for invasive cancer. The frequency of HR-HPV types found in HSIL and invasive cancer was 16 (55.0%) > 31 (18.6%) > 35 (7.9%) > 52 (7.1%) > 18 (4.3%) > unidentified types (3.6%) > 33 (2.9%) > 58 (0.7%). Since the three predominant types (16, 31 and 18) cause 77.9% of the HR-HPV infections and immunization against type 16 prevents type 31 infections, in this region the efficacy of the prophylactic vaccine against types 16 and 18 would be close to 80%.
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Affiliation(s)
- Rubén López-Revilla
- División de Biología Molecular, Instituto Potosino de Investigación Científica y Tecnológica, Camino a la Presa San José 2055, 78216 San Luis Potosí, S,L,P,, México.
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Wallace D, Hunter J, Papenfuss M, De Zapien JG, Denman C, Giuliano AR. Pap smear screening among women >/=40 years residing at the United States-Mexico border. Health Care Women Int 2008; 28:799-816. [PMID: 17907008 DOI: 10.1080/07399330701563111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Invasive cervical cancer is a preventable disease due to screening for precursor lesions using the Papanicolaou cytological testing (Pap smear). Participants were assessed regarding their access to and utilization of health care services, prevention orientation, history of chronic disease screening, and reproductive health history. Factors independently positively associated with Pap smear screening were age, clinical breast exam (CBE) in the last year, doctor recommendation of a Pap test, living in the United States, and checkup in the past year. Having a regular source of health care, as well as a doctor's recommendation for a Pap smear, appears to have a positive effect on women's Pap smear screening rates in U.S.-Mexico border communities.
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Affiliation(s)
- Danelle Wallace
- Harborview Medical Center, University of Washington, Seattle, Washington, USA
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Augmented serum level of major histocompatibility complex class I-related chain A (MICA) protein and reduced NKG2D expression on NK and T cells in patients with cervical cancer and precursor lesions. BMC Cancer 2008; 8:16. [PMID: 18208618 PMCID: PMC2270854 DOI: 10.1186/1471-2407-8-16] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 01/21/2008] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cervical cancer is the second most common cancer in women worldwide. NK and cytotoxic T cells play an important role in the elimination of virus-infected and tumor cells through NKG2D activating receptors, which can promote the lysis of target cells by binding to the major histocompatibility complex class I-related chain A (MICA) proteins. Increased serum levels of MICA have been found in patients with epithelial tumors. The aim of this study was to compare the levels of soluble MICA (sMICA) and NKG2D-expressing NK and T cells in blood samples from patients with cervical cancer or precursor lesions with those from healthy donors. METHODS Peripheral blood with or without heparin was collected to obtain mononuclear cells or sera, respectively. Serum sMICA levels were measured by ELISA and NKG2D-expressing immune cells were analyzed by flow cytometry. Also, a correlation analysis was performed to associate sMICA levels with either NKG2D expression or with the stage of the lesion. RESULTS Significant amounts of sMICA were detected in sera from nearly all patients. We found a decrease in the number of NKG2D-expressing NK and T cells in both cervical cancer and lesion groups when compared to healthy donors. Pearson analysis showed a negative correlation between sMICA and NKG2D-expressing T cells; however, we did not find a significant correlation when the analysis was applied to sMICA and NKG2D expression on NK cells. CONCLUSION Our results show for the first time that high sMICA levels are found in sera from patients with both cervical cancer and precursor lesions when compared with healthy donors. We also observed a diminution in the number of NKG2D-expressing NK and T cells in the patient samples; however, a significant negative correlation between sMICA and NKG2D expression was only seen in T cells.
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Insinga RP, Dasbach EJ, Elbasha EH, Puig A, Reynales-Shigematsu LM. Cost-effectiveness of quadrivalent human papillomavirus (HPV) vaccination in Mexico: a transmission dynamic model-based evaluation. Vaccine 2007; 26:128-39. [PMID: 18055075 DOI: 10.1016/j.vaccine.2007.10.056] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 10/17/2007] [Accepted: 10/18/2007] [Indexed: 11/16/2022]
Abstract
We examined the potential health outcomes and cost-effectiveness of quadrivalent human papillomavirus (HPV) 6/11/16/18 vaccination strategies in the Mexican population using a multi-HPV type dynamic transmission model. Assuming similar cervical screening practices, with or without vaccination, we examined the incremental cost-effectiveness of vaccination strategies for 12 year-old females, with or without male vaccination, and temporary age 12-24 catch-up vaccination for females or both sexes. The most effective strategy therein was vaccination of 12-year-olds, plus a temporary 12-24-year-old catch-up program covering both sexes; whereby HPV 6/11/16/18-related cervical cancer, high-grade cervical precancer, and genital wart incidence was reduced by 84-98% during year 50 following vaccine introduction. Incremental cost-effectiveness ratios in the primary analyses ranged from approximately 3000 dollars (U.S.) per quality-adjusted life year (QALY) gained for female vaccination strategies to approximately 16000 dollars /QALY for adding male vaccination with catch-up.
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Affiliation(s)
- Ralph P Insinga
- Department of Health Economic Statistics UG1C-60, Merck Research Laboratories, PO Box 1000, North Wales, PA 19454-1099, USA.
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Shinn E, Basen-Engquist K, Crain B, Follen M. A theory-aided dissemination strategy for emerging technologies in cervical cancer screening. Gynecol Oncol 2007; 107:S35-9. [PMID: 17870151 DOI: 10.1016/j.ygyno.2007.07.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 07/06/2007] [Indexed: 11/30/2022]
Affiliation(s)
- E Shinn
- The University of Texas M.D. Anderson Cancer Center, Department of Behavioral Science,1515 Holcombe Blvd., Unit 1330, Houston, TX 77030, USA.
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Perkins RB, Langrish SM, Stern LJ, Figueroa J, Simon CJ. Comparison of visual inspection and Papanicolau (PAP) smears for cervical cancer screening in Honduras: should PAP smears be abandoned? Trop Med Int Health 2007; 12:1018-25. [PMID: 17875013 DOI: 10.1111/j.1365-3156.2007.01888.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare visual inspection with acetic acid (VIA) to Papanicolau (PAP) smears in a community setting in a developing nation. METHODS Women undergoing cervical cancer screening in Honduras received either VIA and PAP smears (VIA/PAP group) or PAP smears alone (PAP-only group). Local healthcare providers performed PAP screening. A VIA-trained nurse performed VIA exams. All PAP smears were processed in Honduras. PAP smears from the VIA/PAP group were reviewed in the United States. Women with positive VIA or PAP tests were offered colposcopy. We compared the relative accuracy of PAP smears and VIA and the proportions of women completing follow-up colposcopy after positive screening tests. RESULTS In total, 1709 PAP smears were performed including women from both the VIA/PAP and PAP-only groups. Nine PAP smears were positive (0.5%). Three women completed colposcopy (33%). All three had biopsy-confirmed dysplasia. In the VIA/PAP group (n = 339), 49 VIA exams were abnormal (14%) and two PAP smears were abnormal when read in Honduras (0.6%). When reviewed in the United States, 14 of the 339 PAP smears were abnormal (4%). Forty women (83%) completed follow-up colposcopy after a positive VIA exam. Twenty-three had biopsy-proven dysplasia. All 23 dysplasia cases had negative PAP smear readings in Honduras; four PAP smears were reclassified as positive in the United States. CONCLUSIONS Although few developing countries can maintain high-quality PAP smear programmes, many governments and charitable organizations support cervical cancer screening programmes that rely on PAP smears. This study underscores the need to promote alternative technologies for cervical cancer screening in low-resource settings.
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Affiliation(s)
- R B Perkins
- Department of Obstetrics and Gynecology, Boston University Medical Center, Boston, MA 02118, USA.
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Nene B, Jayant K, Arrossi S, Shastri S, Budukh A, Hingmire S, Muwonge R, Malvi S, Dinshaw K, Sankaranarayanan R. Determinants of womens participation in cervical cancer screening trial, Maharashtra, India. Bull World Health Organ 2007; 85:264-72. [PMID: 17546307 PMCID: PMC2636321 DOI: 10.2471/blt.06.031195] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 07/25/2006] [Accepted: 07/28/2006] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To determine the factors associated with participation in cervical cancer screening and follow-up treatment in the context of a randomized controlled trial. The trial was initiated to evaluate the efficacy and cost effectiveness of visual inspection with acetic acid, cytological screening and testing for human papillomavirus in reducing the incidence of and mortality from cervical cancer in Maharashtra, India. METHODS Between October 1999 and November 2003 women aged 30-59 years were randomized to receive one of the three tests or to a control group. Participation was analysed for all three intervention arms. The differences between those who were screened versus those who were not was analysed according to the sociodemographic characteristics of the 100,800 eligible women invited for screening. Those who were treated versus those who were not were analysed according to the sociodemographic characteristics of the 932 women diagnosed with high-grade lesions. Participation in screening and compliance with treatment were also analysed according to the type of test used. FINDINGS Compared with women who were not tested, screened women were younger (aged 30-39), better educated and had ever used contraception. A higher proportion of screened women were married and a lower proportion had never been pregnant. Of the 932 women diagnosed with high-grade lesions or invasive cancer, 85.3% (795) received treatment. Women with higher levels of education, who had had fewer pregnancies and those who were married were more likely to comply with treatment. There were no differences in rates of screening or compliance with treatment when results were analysed by the test received. CONCLUSIONS Irrespective of the test being used, good participation levels for cervical cancer screening can be achieved in rural areas of developing countries by using appropriate strategies to deliver services. Communication methods and delivery strategies aimed at encouraging older, less-educated women, who have less contact with reproductive services, are needed to further increase screening uptake.
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Affiliation(s)
- Bhagwan Nene
- Tata Memorial Centre Rural Cancer Extension Project, Nargis Dutt Memorial Hospital, Barshi, India
| | - Kasturi Jayant
- Tata Memorial Centre Rural Cancer Extension Project, Nargis Dutt Memorial Hospital, Barshi, India
| | - Silvina Arrossi
- International Agency for Research on Cancer–WHO, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
| | | | - Atul Budukh
- Tata Memorial Centre Rural Cancer Extension Project, Nargis Dutt Memorial Hospital, Barshi, India
| | - Sanjay Hingmire
- Tata Memorial Centre Rural Cancer Extension Project, Nargis Dutt Memorial Hospital, Barshi, India
| | - Richard Muwonge
- International Agency for Research on Cancer–WHO, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
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Almonte M, Ferreccio C, Winkler JL, Cuzick J, Tsu V, Robles S, Takahashi R, Sasieni P. Cervical screening by visual inspection, HPV testing, liquid-based and conventional cytology in Amazonian Peru. Int J Cancer 2007; 121:796-802. [PMID: 17437272 DOI: 10.1002/ijc.22757] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cervical cancer is an important public health problem in many developing countries, where cytology screening has been ineffective. We compared four tests to identify the most appropriate for screening in countries with limited resources. Nineteen midwives screened 5,435 women with visual inspection (VIA) and collected cervical samples for HPV testing, liquid-based cytology (LBC) and conventional cytology (CC). If VIA was positive, a doctor performed magnified VIA. CC was read locally, LBC was read in Lima and HPV testing was done in London. Women with a positive screening test were offered colposcopy or cryotherapy (with biopsy). Inadequacy rates were 5% and 11% for LBC and CC respectively, and less than 0.1% for VIA and HPV. One thousand eight hundred eighty-one women (84% of 2,236) accepted colposcopy/cryotherapy: 79 had carcinoma in situ or cancer (CIS+), 27 had severe- and 42 moderate-dysplasia on histology. We estimated a further 6.5 cases of CIS+ in women without a biopsy. Sensitivity for CIS+ (specificity for less than moderate dysplasia) was 41.2% (76.7%) for VIA, 95.8% (89.3%) for HPV, 80.3% (83.7%) for LBC, and 42.5% (98.7%) for CC. Sensitivities for moderate dysplasia or worse were better for VIA (54.9%) and less favourable for HPV and cytology. In this setting, VIA and CC missed the majority of high-grade disease. Overall, HPV testing performed best. VIA gives immediate results, but will require investment in regular training and supervision. Further work is needed to determine whether screened-positive women should all be treated or triaged with a more specific test.
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Affiliation(s)
- Maribel Almonte
- Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Queen Mary's School of Medicine and Dentistry, London, United Kingdom
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Suba EJ, Murphy SK, Donnelly AD, Furia LM, Huynh MLD, Raab SS. Systems analysis of real-world obstacles to successful cervical cancer prevention in developing countries. Am J Public Health 2006; 96:480-7. [PMID: 16449592 PMCID: PMC1470502 DOI: 10.2105/ajph.2004.061606] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Papanicolaou screening is feasible anywhere that screening for cervical cancer, the leading cause of cancer-related death among women in developing countries, is appropriate. After documenting that the Vietnam War had contributed to the problem of cervical cancer in Vietnam, we participated in a grass roots effort to establish a nationwide cervical cancer prevention program in that country and performed root cause analyses of program deficiencies. We found that real-world obstacles to successful cervical cancer prevention in developing countries involve people far more than technology and that such obstacles can be appropriately managed through a systems approach focused on programmatic quality rather than through ideological commitments to technology. A focus on quality satisfies public health goals, whereas a focus on technology is compatible with market forces.
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Affiliation(s)
- Eric J Suba
- Department of Pathology, Kaiser Permanente Medical Center, 1200 El Camino Real, South San Francisco, CA 94080, USA.
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Agurto I, Sandoval J, De La Rosa M, Guardado ME. Improving cervical cancer prevention in a developing country. Int J Qual Health Care 2006; 18:81-6. [PMID: 16439421 DOI: 10.1093/intqhc/mzi100] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE to enhance the delivery of services, using continuous quality improvement, and an outreach strategy. DESIGN AND SETTING pre and post measurements in a Primary Health Care system in El Salvador. Outcome indicators: women screened for the first time in their lifetime, unsatisfactory samples, turnaround time, and follow-up. INTERVENTION involvement of policy, service provision and community levels in 4 plan-do-study-act cycles, facilitating linkages between work processes and a quality control group. RESULTS 3,408 women screened for the first time in their lifetime in 1 year in regular services; unsatisfactory samples reduced by 1/2; turnaround time reduced by almost 1/3; follow-up increased from 24% (22/90) to 100% (196/196) .146 of the 151 women cytologically defined as low and high-grade squamous intraepithelial lesions (L-HSIL) were confirmed on histology as cervical intraepithelial neoplasia (CIN), while 5 showed benign changes. Of the 43 women classified as having high-grade squamous intraepithelial lesion on cytology, 36 were diagnosed with CIN2 lesions, 7 with CIN3 and 2 were confirmed with invasive carcinoma. CONCLUSION improvements in delivery of screening can be made with few additional resources in the absence of an organized system. We promoted linkages between detection and diagnosis through enhancement of teamwork and functional coordination, which improved follow-up rates. We restored links between screening and reading processes through minor adjustments, which improved the turnaround time of samples. Trained outreach workers created new links between community and health services, identifying women who had never been screened before in their lives and facilitating their access to regular clinic services.
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Affiliation(s)
- Irene Agurto
- Pan American Health Organization, Washington, DC 20037, USA.
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Moodley J, Kawonga M, Bradley J, Hoffman M. Challenges in implementing a cervical screening program in South Africa. ACTA ACUST UNITED AC 2006; 30:361-8. [DOI: 10.1016/j.cdp.2006.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2006] [Indexed: 11/16/2022]
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Jacob M, Bradley J, Barone MA. Human papillomavirus vaccines: what does the future hold for preventing cervical cancer in resource-poor settings through immunization programs? Sex Transm Dis 2005; 32:635-40. [PMID: 16205306 DOI: 10.1097/01.olq.0000179892.78342.79] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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