Comparison of breast cancer and cervical cancer stage distributions in ten newly independent states of the former Soviet Union: a population-based study

Women's perspectives on the acceptability of risk-based cervical cancer screening

BACKGROUND

The increased knowledge of cervical cancer (CC) risk factors and suboptimal performance of present screening programs has generated interest in shifting from a universal screening approach to one based on individual risk assessment. To inform the future development of risk-based CC screening programs, it is crucial to gain insight into the factors influencing the acceptability of such approach among screening target group women. The aim of this study was to prospectively investigate the acceptability of risk-based CC screening and to identify potential barriers.

METHODS

In this qualitative study, one-to-one semi-structured interviews were conducted with a purposeful sample including women aged 30-65 years to explore women's perspectives on the acceptability of risk-based CC screening. The study was conducted in Estonia, and interviews were conducted from March to September 2023. Potential participants were approached in person by a member of the study team or by their healthcare providers at primary care or gynaecology clinics. The interview guides were developed based on the concept of acceptability of healthcare interventions.

RESULTS

Twenty participants (mean age 44.5, SD = 8.6) with diverse backgrounds were interviewed. The seven components of acceptability (affective attitude, burden, ethicality, opportunity costs, perceived effectiveness, self-efficacy, and intervention coherence) were explored as key themes. Generally, women supported risk-based screening. However, we identified several factors that may compromise the acceptability of risk-based screening. The participants were reluctant to accept less intense screening for low-risk women and anticipated that if risk-based approach was implemented, more frequent testing would remain an option. Providing in-person clinician support was expected, requiring additional healthcare resources. Knowledge gaps in CC prevention highlighted the need for accessible information and education. Most women were unworried about sensitive data inclusion in risk score calculations. However, some participants were concerned about potential confidentiality breaches by healthcare workers.

CONCLUSION

This study indicates that risk-based CC screening is acceptable, except for testing low-risk women less frequently. Our findings underscore the necessity for comprehensive understanding of the needs and concerns of the target group women for program development. Healthcare organizations are required to proactively address these needs by implementing comprehensive information dissemination and efficient communication approaches.

Sex differences in lung cancer incidence and mortality in Russia in the light of computed tomography usage expansion: breakpoint and age-period-cohort analyses

BACKGROUND

Russia has one of the highest lung cancer burdens globally, particularly in men. Mortality started to decline in the 1990s after the reduction in smoking prevalence. However, Russia's recent experience is largely unknown. This study aims to describe recent trends in the incidence and mortality of lung cancer in Russia along with the use of computed tomography (CT).

METHODS

We obtained incidence data from national cancer reports covering 1993-2021 and mortality and population data from the Russian Fertility and Mortality Database covering 1965-2021. The number of CT scanners was obtained from the OECD. Changes in age-standardized rates (Segi-Doll, per 100,000) were assessed using segmented regression and temporal effects using age-period-cohort analysis.

RESULTS

Lung cancer rates in men have been substantially higher than in women and have declined sharply since their peak in the 1990s. The latest breakpoints in incidence in women were in 2012 (95 % CI: 2000; 2014) from stagnation with an annual change of 0.7 % (-0.2; 1.5) to 3.4 % (1.6; 5.2) increase. In men, the decrease in incidence stopped in 2013 (2011; 2014) from -1.8 % (-2.1; -1.4) to 0.3 % (-0.7; 1.3). The growing number of CT scans accompanied the recent changes in incidence rates. Incidence declined sharply in 2020 in men and women. There were no substantial changes in declining mortality trends. Period effects were visible after 2012 when incidence rates increased and deviated from mortality. After accounting for the period effect, generations born after the 1950s had lower risks.

CONCLUSION

Increasing lung cancer incidence rates in Russia in the late 2010s, especially in women, and the stable mortality trends could be a possible sign of diagnostic or treatment period effect. The increased use of CT should be monitored for possible benefits and harms.

Breast Cancer Awareness and Screening Perceptions of Women in Yerevan, Armenia

Objectives

Breast cancer is the leading cause of female cancer mortality in Armenia. The government is considering covering breast cancer screening, but prevailing attitudes towards it are unknown. This cross-sectional study assessed Armenian women's awareness and perceptions of breast cancer screening.

Methods

We administered a validated telephone survey to women ages 35-65 registered in Yerevan's polyclinic system between 2019-2021, assessing sociodemographic characteristics, breast cancer exposure and screening attitudes, using an adapted Champion's Health Belief Model Scale (CHBMS). We analyzed the association, unadjusted and adjusted, between sociodemographic characteristics, screening exposure, and CHBMS scores.

Results

170 women completed surveys. Most (82.9%) were aware of screening, 48.5% knew someone with breast cancer, but only 42.5% had undergone screening, predominantly without their physician's recommendation (63.2%). Despite elevated awareness, 76.2% had never discussed screening with their provider. Barriers included cost and mistreatment concerns. Education consistently predicted prior screening and most CHBMS scores.

Conclusion

Armenian women are highly exposed to breast cancer, but knowledge and prior screening primarily emanate from non-physician sources. Results highlighted the influence of education, patient-provider relationships, and healthcare costs, underscoring the importance of multi-level interventions.

Prevalence and trends of cervical cancer screening among women in Fiji from 2014 to 2018

Introduction

Cervical cancer is the third most common cancer in women both in developed and developing countries. This study aimed to determine the prevalence of cervical cancer and the trends of cervical cancer screening among women who had cervical cancer screening in Suva, Fiji between 2014 and 2018.

Materials and method

This study applied a 5-year retrospective electronic chart review of data from all women attending the Women's Wellness Clinic (WWC) in Suva, Fiji. The women who were selected for this study and screened for cervical cancer were Fijian citizens above 18 years of age and were registered in 2014-2018. A data collection form was used to collect data. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 24; p <0.05 % was considered as the level of significance.

Results

Among the 39,579 women who attended WWC for other family planning services, 12,074 women screened for cervical cancer with a prevalence of 30.5 %. The overall mean age for women screened for cervical cancer was 37.6 (SD ± 11.2). Two-thirds (76.4 %) of the women screened for cervical cancer were less than 46 years of age and 53.9 % were I-taukei. The number of women who came for Pap smear increased in 2015, however, a slight decline was observed in 2016 which was later improved to 35.1 % in 2018. Malignancy was more common in the age range of 42-49 respectively. In this study, women of 46 years and above had an OR of 0.51 (95 % CI: 0.36, 0.72), other ethnicity OR was 1.73 (95 % CI: 1.27, 2.35), and the Muslim religion OR recorded was 1.44 (95 % CI: 1.03, 2.01) which was comparatively considered a high-risk group. Women who are widowed 1.57 (95 % CI: 0.798, 3.11), single 1.29 (95 % CI: 0.87, 1.92) or divorced 1.08 (95 % CI: 0.59, 1.99), employed 1.01 (95 % CI: 0.83, 1.24) and are living in rural areas 1.19 (95 % CI: 0.82, 1.73) are also associated with higher odds of having abnormal results.

Conclusion

Cervical cancer is listed as the first and most common type of cancer in women which is noticeably increasing in Fiji. Even though cervical cancer screening has improved over the years, adequate surveillance systems and ongoing programs should be designed and implemented to increase awareness and monitor the trend of cervical cancer screening in order to reduce cervical cancer prevalence and mortality rates.

Trends in the Prevalence and Mortality of Cervical Cancer in the Kyrgyz Republic

BACKGROUND

Cervical cancer represents a significant health concern globally and is the fourth most common cancer among women, leading to substantial morbidity and mortality. The primary cause is persistent infection with high-risk human papillomavirus (HPV) types. Despite advancements in prevention, screening, diagnosis, and treatment, disparities in cervical cancer outcomes persist due to variations in screening accessibility and socioeconomic factors. This study focuses on women in the Kyrgyz Republic, highlighting regional disparities and the critical role of early detection.

METHODS

A retrospective data analysis was conducted on 1,338 women diagnosed with cervical cancer from 2012 to 2017 in the Kyrgyz Republic. Data were sourced from national health centers, focusing on sociodemographic metrics, clinical staging, and regional distributions. The study utilized statistical analysis to evaluate prevalence and mortality rates, employing the analysis of variance for comparison, significance, and analyzing trends over time.

RESULTS

The prevalence of cervical cancer in the Kyrgyz Republic increased from 97.5 per 100,000 females in 2012 to 105.3 per 100,000 in 2017, with mortality rates of 8.3-9.7%. Notably, regional disparities were evident, with Chui, Osh, Jalal-Abad, and Bishkek experiencing increased prevalence rates, while Talas, Issyk-Kul, Naryn, and Batken reported decreased prevalence. Screening programs, particularly the introduction of Pap smears, have been effective in reducing both prevalence and mortality rates in areas with broad population coverage. However, the study highlighted significant variations in outcomes across different regions, underscoring the importance of targeted prevention and screening efforts.

CONCLUSIONS

The study confirms the ongoing challenge of cervical cancer in the Kyrgyz Republic, emphasizing the need for improved screening and prevention strategies to address disparities in outcomes. The introduction of pilot screening programs represents a crucial step forward. However, the findings also point to the necessity for enhanced oncological literacy among primary care physicians and the implementation of comprehensive strategies to overcome socioeconomic and regional barriers to effective cervical cancer prevention and treatment. The reduction in prevalence observed in 2016 suggests progress, highlighting the potential impact of focused prevention and screening initiatives.

Trends in Mortality Due to Malignant Neoplasms of Female Genital Organs in Poland in the Period 2000-2021-A Population-Based Study

The aim of this study is to assess mortality trends due to malignant neoplasms of female genital organs (MNFGOs) in Poland between 2000 and 2021. For the purpose of the study, the authors used data on all deaths of Polish female inhabitants due to MNFGO between 2000 and 2021, obtained from the Statistics Poland database. The standardised death rates (SDR), potential years of life lost (PYLL), annual percentage change (APC) and average annual percentage change (AAPC) were calculated. Between the years 2000 and 2021, 138,000 women died due to MNFGOs in Poland. Of this number, 54,975 (39.8%) deaths were caused by ovarian cancer, 37,487 (27.2%) by cervix uteri cancer, and 26,231 (19.0%) by corpus uteri cancer. A decrease in mortality due to cervix uteri cancer (APC = -2.4%, p < 0.05) was the most favourable change that occurred in the period 2000-2021, while the least favourable change was an increase in mortality due to corpus uteri cancer for the period 2005-2019 (APC = 5.0%, p < 0.05). SDRs due to ovarian cancer showed a decreasing trend between 2007 and 2021 (APC = -0.5%, p < 0.05). The standardised PYLL index due to cervical cancer was 167.7 per 100,000 women in 2000 and decreased to 75.0 in 2021 (AAPC = -3.7, p < 0.05). The number of lost years of life due to ovarian cancer decreased from 143.8 in 2000 to 109.5 in 2021 (AAPC = -1.3, p < 0.05). High values of death rates due to MNFGO in Poland, compared to other European countries, show that there is a need to promote preventive programmes and continue to monitor changes in mortality.

Factors associated with advanced-stage diagnosis of cervical cancer in Estonia: a population-based study

OBJECTIVES

Cervical cancer (CC) remains a crucial public health issue in Estonia, with high incidence and late diagnosis. The aim of this study was to examine time trends of stage-specific CC incidence in Estonia and factors associated with advanced-stage diagnosis of CC.

STUDY DESIGN

This was a nationwide population-based retrospective study.

METHODS

Data on CC cases diagnosed in Estonia in 2007-2018 were obtained from the Estonian Cancer Registry, including tumour, nodes, metastases stage at diagnosis. Sociodemographic data were obtained from the Population Registry. To estimate the risk of advanced-stage diagnosis (stages II-IV vs stage I) associated with sociodemographic factors, Poisson regression with robust variance was used to calculate univariate and multivariate prevalence ratios (PR) with 95% confidence intervals (CIs). Time trends of stage-specific CC incidence for 2005-2019 were examined with joinpoint analysis.

RESULTS

Incidence of stage I CC showed a significant decline of 4.9% per year since 2007, whereas no change was seen for other stages. Of the 2046 women diagnosed in 2007-2018, 1137 (55.6%) were diagnosed at an advanced stage; this proportion increased from 51% in 2007-2009 to 58% in 2015-2018 (P = 0.004). Multivariate regression analysis showed that advanced-stage diagnosis was associated with age (PR 2.16, 95% CI 1.87-2.49 for women aged ≥75 years compared with those aged 30-44 years), educational level (PR 1.32, 95% CI 1.15-1.51 for women with basic/primary education compared to university education) and marital status (PR 1.14, 95% CI 1.01-1.29 for single women compared to married/cohabiting women). No associations were observed by region of residence or nationality.

CONCLUSIONS

To reduce CC mortality, it is crucial to improve prevention and early diagnosis of CC in Estonia through human papillomavirus vaccination and effective and quality-assured screening particularly targeting high-risk groups as well as encouraging symptom awareness and regular check-ups among older women.

Breast and cervical cancer screening practices in nine countries of Eastern Europe and Central Asia: A population-based survey

BACKGROUND

Eastern Europe and Central Asia (EECA) countries have higher cervical and breast cancer mortality rates and later stage at diagnosis compared with the rest of WHO European Region. The aim was to explore current early detection practices including "dispensarization" for breast and cervix cancer in the region.

METHODS

A questionnaire survey on early detection practices for breast and cervix cancer was sent to collaborators in 11 countries, differentiating services in the primary health setting, and population-based programs. Responses were received from Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Russian Federation (Arkhangelsk, Samara and Tomsk regions), Tajikistan, Ukraine, and Uzbekistan.

RESULTS

All countries but Georgia, Kyrgyzstan, and the Russian Federation had opportunistic screening by clinical breast exam within "dispensarization" program. Mammography screening programs, commonly starting from age 40, were introduced or piloted in eight of nine countries, organized at national oncology or screening centres in Armenia, Belarus and Georgia, and within primary care in others. Six countries had "dispensarization" program for cervix cancer, mostly starting from the age 18, with smears stained either by Romanowsky-Giemsa alone (Belarus, Tajikistan and Ukraine), or alternating with Papanicolaou (Kazakhstan and the Russian Federation). In parallel, screening programs using Papanicolaou or HPV test were introduced in seven countries and organized within primary care.

CONCLUSION

Our study documents that parallel screening systems for both breast and cervix cancers, as well as departures from evidence-based practices are widespread across the EECA. Within the framework of the WHO Initiatives, existing opportunistic screening should be replaced by population-based programs that include quality assurance and control.

Predicting diagnosis and survival of bone metastasis in breast cancer using machine learning

This study aimed at establishing more accurate predictive models based on novel machine learning algorithms, with the overarching goal of providing clinicians with effective decision-making assistance. We retrospectively analyzed the breast cancer patients recorded in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2016. Multivariable logistic regression analyses were used to identify risk factors for bone metastases in breast cancer, whereas Cox proportional hazards regression analyses were used to identify prognostic factors for breast cancer with bone metastasis (BCBM). Based on the identified risk and prognostic factors, we developed diagnostic and prognostic models that incorporate six machine learning classifiers. We then used the area under the receiver operating characteristic (ROC) curve (AUC), learning curve, precision curve, calibration plot, and decision curve analysis to evaluate performance of the machine learning models. Univariable and multivariable logistic regression analyses showed that bone metastases were significantly associated with age, race, sex, grade, T stage, N stage, surgery, radiotherapy, chemotherapy, tumor size, brain metastasis, liver metastasis, lung metastasis, breast subtype, and PR. Univariate and multivariate Cox regression analyses revealed that age, race, marital status, grade, surgery, radiotherapy, chemotherapy, brain metastasis, liver metastasis, lung metastasis, breast subtype, ER, and PR were closely associated with the prognosis of BCBM. Among the six machine learning models, the XGBoost algorithm predicted the most accurate results (Diagnostic model AUC = 0.98; Prognostic model AUC = 0.88). According to the Shapley additive explanations (SHAP), the most critical feature of the diagnostic model was surgery, followed by N stage. Interestingly, surgery was also the most critical feature of prognostic model, followed by liver metastasis. Based on the XGBoost algorithm, we could effectively predict the diagnosis and survival of bone metastasis in breast cancer and provide targeted references for the treatment of BCBM patients.

Validation of an Eastern Armenian breast cancer health belief survey

With the fourth highest breast cancer mortality rate in the world, breast cancer prevention and early detection is a priority for Armenia. The Ministry of Health recently initiated efforts to expand access to breast cancer screening. However, little is known about the population's understanding and perception of breast cancer screening programs. This cross-sectional telephone-based study sought to develop and validate an Eastern Armenian language version of the Champion's Health Belief Model Scale (CHBMS) for future use. The English-language CHBMS survey was first rigorously translated by two Armenian nationals and evaluated for face validity. Telephone surveys were then administered to randomly-selected women of approximately screening age (35-65 years) with no prior history of breast cancer living in Armenia's capital between 2019-2020 (n = 103). The translated survey's psychometric properties were evaluated, examining (1) content equivalence, (2) test-retest reliability and (3) internal consistency. Content equivalence and test-retest reliability of the Armenian CHBMS were characterized using correlational analysis with Pearson's coefficient ranging from 0.76-0.97 (p<0.001) and 0.72-0.97 (p<0.001), respectively, for all five CHBMS domains. The translated survey's internal consistency was comparable to the original English-language CHBMS with a Cronbach's alpha greater than 0.7 for all five domains (0.75-0.94 (p<0.001). The translated Eastern Armenian version of CHBMS is a valid, internally-consistent, and reliable research tool that is ready for imminent use among screening-age women to investigate breast cancer perceptions and beliefs as the Armenian government seeks to expand screening access.

Anoikis-related long non-coding RNA signatures to predict prognosis and small molecular drug response in cervical cancer

Background: Cervical cancer (CC) is a major health threat to females, and distal metastasis is common in patients with advanced CC. Anoikis is necessary for the development of distal metastases. Understanding the mechanisms associated with anoikis in CC is essential to improve its survival rate. Methods: The expression matrix of long non-coding RNAs (lncRNAs) from cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC) patients was extracted from The Cancer Genome Atlas (TCGA), and highly relevant anoikis-related lncRNAs (ARLs) were identified by the single sample gene set enrichment analysis (ssGSEA) method. ARLs-related molecular subtypes were discerned based on prognosis-related ARLs. ARLs-related prognostic risk score (APR_Score) was calculated and risk model was constructed using LASSO COX and COX models. In addition, we also assessed immune cell activity in the immune microenvironment (TME) for both subtypes and APR_Score groups. A nomogram was utilized for predicting improved clinical outcome. Finally, this study also discussed the potential of ARLs-related signatures in predicting response to immunotherapy and small molecular drugs. Results: Three ARLs-related subtypes were identified from TCGA-CESC (AC1, AC2, and AC3), with AC3 patients having the highest ARG scores, higher angiogenesis scores, and the worst prognosis. AC3 had lower immune cell scores in TME but higher immune checkpoint gene expression and higher potential for immune escape. Next, we constructed a prognostic risk model consisting of 7-ARLs. The APR_Score exhibited a greater robustness as an independent prognostic indicator in predicting prognosis, and the nomogram was a valuable tool for survival prediction. ARLs-related signatures emerged as a potential novel indicator for immunotherapy and small molecular drug selection. Conclusion: We firstly constructed novel ARLs-related signatures capable of predicting prognosis and offered novel ideas for therapy response in CC patients.

Disparities in stage at diagnosis for liver cancer in China

Background

The stage at diagnosis is a major factor in making treatment strategies and cancer control policies. However, the stage distribution for liver cancer in China was not well studied. In this multi-center hospital-based study, we aimed to identify the distribution and factors associated with stage at diagnosis for liver cancer in China.

Methods

We included patients diagnosed with primary liver cancer in 13 hospitals of 10 provinces covering various geographic and socioeconomic populations during 2016-2017 in China. The stage distribution overall, and by sex and age at diagnosis were analyzed. We used logistic regression to identify the factors associated with stage III-IV disease. We further compared these estimates with data from the USA.

Results

We included 2,991 patients with known stage at diagnosis in China. The proportion of patients diagnosed with stage I, II, III, and IV was 17.5%, 25.6%, 29.3%, and 27.6%, respectively. The proportion of stage III-IV cases was higher in women [65.1% vs 54.9%, adjusted odds ratio (OR) = 1.5, 95% CI: 1.2, 1.8] and those ≥ 60 years (61.6% vs 52.8%, OR = 1.4, 95% CI: 1.2, 1.6). We found an increased risk of stage III-IV among drinkers and those without a family history of cancer. Compared to the USA, our study population had a substantially higher proportion of stage III-IV cases (56.9% vs 45.6%).

Conclusion

The disparities in liver cancer stage at diagnosis among different populations within China, and between China and the USA, imply the necessity for improving cancer awareness and early detection for liver cancer in China.

The Effects of the Ukrainian Conflict on Oncological Care: The Latest State of the Art

BACKGROUND

The COVID-19 pandemic has dramatically affected all aspects of the patient's pathway to cancer diagnosis and subsequent treatment. Our main objective was to evaluate the status of cancer trials in Ukraine as of September 2022.

METHODS

Initially, we examined with a narrative review the state of breast, colorectal, and cervical cancer population-based screening. Subsequently, we assessed each trial status for the years 2021 and 2022.

RESULTS

Estimates of participation in breast and cervical cancer screening are different from region to region. Moreover, regarding cervical cancer screening, extremely different participation estimates were reported: 73% in 2003 vs. <10% 2020. Our data show that from 2014 to 2020, despite the pandemic, cancer trials in Ukraine significantly increased from 27 to 44. In 2021 no trials were completed; in fact, we observed that out of 41 trials, 8 were active not recruiting, 33 were recruiting, and 0 were completed or terminated. In 2022 in Ukraine, for oncological pathologies, only 3 trials were registered, while in 2021, 41 trials were registered. The suspension of trials regarded above all concern hematological tissue (66.7%) and the genitourinary tract (60%).

CONCLUSIONS

Our work has highlighted how the areas most affected by the conflict present criticalities in oncological care.

Prevalence, incidence, and mortality rates of breast cancer in Kazakhstan: data from the Unified National Electronic Health System, 2014-2019

Background

Although there are numerous sources of epidemiologic information on breast cancer in Kazakhstan, none of them have specifically examined the burden of this disease. Therefore, this article aims to provide an overview of the breast cancer prevalence, incidence, mortality, and distribution and changes over time in Kazakhstan based on nationwide large-scale healthcare data from the National Registry in order to encourage more research on the impact of various diseases at the regional and national levels.

Methods

The study cohort included all adult women older than 25 years who were diagnosed with breast cancer in any clinical setting of the Republic of Kazakhstan during the period of 2014-2019. The data were extracted from the Unified Nationwide Electronic Health System (UNEHS) to get an overview of descriptive statistics, incidence, prevalence, and mortality rate calculations and the Cox proportional hazards regression model. All survival functions and factors associated with mortality were tested for significance.

Results

The cohort population (n = 55,465) comprised subjects with the age at the diagnosis of breast cancer from 25 to 97 years, with a mean of 55.7 ± 12.0 years. The majority of the study population belonged to the age group 45-59 years, which is 44.8% of the cohort. The all-cause mortality rate of the cohort is 16%. The prevalence rate increased from 30.4 per 10,000 population in 2014 to 50.6 in 2019. The incidence rate varied from 4.5 per 10,000 population in 2015 to 7.3 in 2016. Mortality rates were stable and high in the senile age patients (75-89 years old). Breast cancer mortality was positively associated with women who had been diagnosed with diabetes, HR 1.2 (95% CI, 1.1-2.3), whereas it was negatively associated with arterial hypertension, HR 0.4 (95% CI, 0.4-0.5).

Conclusion

Overall, Kazakhstan is experiencing an increase in the incidence of breast cancer cases, but the mortality rate has started to decline. The switch to population mammography screening could reduce the breast cancer mortality rate. These findings should be utilized to help Kazakhstan determine what cancer control priorities should be utilized, including the need to implement efficient and affordable screening and prevention programs.

Staging practices and breast cancer stage among population-based registries in the MENA region

BACKGROUND

Availability of stage information by population-based cancer registries (PBCR) remains scarce for diverse reasons. Nevertheless, stage is critical cancer control information particularly for cancers amenable to early detection. In the framework of the Global Initiative for Cancer Registry Development (GICR), we present the status of stage data collection and dissemination among registries in the Middle East and Northern Africa (MENA) region as well as the stage distribution of breast cancer patients.

METHODS

A web-based survey exploring staging practices and breast cancer stage was developed and sent to 30 PBCR in 18 countries of the MENA region.

RESULTS

Among 23 respondent PBCR, 21 collected stage data, the majority (80%) for all cancers. Fourteen registries used a single classification (9 TNM and 5 SEER), 7 used both staging systems in parallel. Out of 12,888 breast cancer patients (seven registries) 27.7% had unknown TNM stage (11.1% in Oman, 46% in Annaba). When considering only cases with known stage, 65.3% were early cancers (TNM I+II), ranging from 57.9% in Oman to 83.3% in Batna (Algeria), and 9.9% were stage IV cancers. Among the nine registries providing SEER Summary stage for breast cancer cases, stage was unknown in 19% of the cases, (0 in Bahrain, 39% in Kuwait). Stage data were largely absent from the published registry reports.

CONCLUSION

Despite wide stage data collection by cancer registries, missing information and low dissemination clearly limit informing efforts on early detection. The use of two classification systems in parallel implies additional workload and might undermine completeness. The favourable results of early cancer (TNM I+II) in two thirds of breast cancer patients needs to be interpreted with caution and followed up in time. Although efforts to improve quality of stage data are needed, our findings are particularly relevant to the WHO Global Breast Cancer Initiative.

Breast Cancer in Asia: Incidence, Mortality, Early Detection, Mammography Programs, and Risk-Based Screening Initiatives

Close to half (45.4%) of the 2.3 million breast cancers (BC) diagnosed in 2020 were from Asia. While the burden of breast cancer has been examined at the level of broad geographic regions, literature on more in-depth coverage of the individual countries and subregions of the Asian continent is lacking. This narrative review examines the breast cancer burden in 47 Asian countries. Breast cancer screening guidelines and risk-based screening initiatives are discussed.

Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: a review and synthetic analysis

BACKGROUND

Cervical cancer screening coverage is a key monitoring indicator of the WHO cervical cancer elimination plan. We present global, regional, and national cervical screening coverage estimates against the backdrop of the 70% coverage target set by WHO.

METHODS

In this review and synthetic analysis, we searched scientific literature, government websites, and official documentation to identify official national recommendations and coverage data for cervical cancer screening for the 194 WHO member states and eight associated countries and territories published from database inception until Oct 30, 2020, supplemented with a formal WHO country consultation from Nov 27, 2020, to Feb 12, 2021. We extracted data on the year of introduction of recommendations, the existence of individual invitation to participate, financing of screening tests, primary screening and triage tests used, recommended ages and screening intervals, use of self-sampling, and use of screen-and-treat approaches. We also collected coverage data, either administrative or survey-based, as disaggregated as possible by age and for any available screening interval. According to data completeness and representativeness, different statistical models were developed to produce national age-specific coverages by screening interval, which were transformed into single-age datapoints. Missing data were imputed. Estimates were applied to the 2019 population and aggregated by region and income level.

FINDINGS

We identified recommendations for cervical screening in 139 (69%) of 202 countries and territories. Cytology was the primary screening test in 109 (78%) of 139 countries. 48 (35%) of 139 countries recommended primary HPV-based screening. Visual inspection with acetic acid was the most recommended test in resource-limited settings. Estimated worldwide coverage in women aged 30-49 years in 2019 was 15% in the previous year, 28% in the previous 3 years, and 32% in the previous 5 years, and 36% ever in lifetime. An estimated 1·6 billion (67%) of 2·3 billion women aged 20-70 years, including 662 million (64%) of 1·0 billion women aged 30-49 years, had never been screened for cervical cancer. 133 million (84%) of 158 million women aged 30-49 years living in high-income countries had been screened ever in lifetime, compared with 194 million (48%) of 404 million women in upper-middle-income countries, 34 million (9%) of 397 million women in lower-middle-income countries, and 8 million (11%) of 74 million in low-income countries.

INTERPRETATION

Two in three women aged 30-49 years have never been screened for cervical cancer. Roll-out of screening is very low in low-income and middle-income countries, where the burden of disease is highest. The priority of the WHO elimination campaign should be to increase both screening coverage and treatment of detected lesions; however, expanding the efforts of surveillance systems in both coverage and quality control are major challenges to achieving the WHO elimination target.

FUNDING

Instituto de Salud Carlos III, European Regional Development Fund, Secretariat for Universities and Research of the Department of Business and Knowledge of the Government of Catalonia, and Horizon 2020.

TRANSLATIONS

For the French, Spanish translations of the abstract see Supplementary Materials section.

Comparison of female breast cancer between Russia and Germany: A population-based study on time trends and stage at diagnosis

OBJECTIVES

While a mammography-screening program (MSP) is being offered systematically in Germany since 2009, the dispanserizatsiya has been implemented in Russia since 2013. This study examined trends of stage at breast cancer diagnosis in two Russian regions and compared the results with the development in Germany. In addition, we aimed to gain further insights into the early detection of breast cancer in Russia.

METHODS

Incidence data from two cancer registries in Russia and 12 population-based cancer registries in Germany were used to analyse breast cancer incidence rates among women above age 30 over time. Further, we calculated rate ratios to compare the age group-specific incidence rates after the implementation of MSP in Germany (2010-2014) with the period before implementation (2003-2005) separately for each tumour stage and all stages combined.

RESULTS

During the study period from 2003 to 2014, age-standardised rates for breast cancer were 54.6 and 116.7 per 100,000 for Russia and Germany, respectively. The proportion of the T1 stage at diagnosis among Russian women aged 50 + is half than that in Germany. Nevertheless, we observed an increasing trend of early-stage alongside the reduction of advanced-stage incidence rates of breast cancer in Russia.

CONCLUSIONS

The observed trend in Russia may reflect overall positive changes in early detection of breast cancer, with actual proportion of T1 stage still far behind Germany. Advances in breast cancer screening efforts through the dispanserizatsiya may help to further reduce the breast cancer burden.

Early and late detection of cancer in Georgia: Evidence from a population-based cancer registry, 2018-2019

BACKGROUND

Georgia is an upper middle-income country, which has lower cancer survival rates than most of the countries in the World Health Organization European region, as well as compared to many other post-Soviet states and upper middle-income countries. The purpose of our study was to analyse the cancer stage distribution data of Georgia as a first step towards identifying the areas of early cancer detection in the country that might need improvement or require further research.

METHODS

Descriptive analysis of the population-based cancer registry of Georgia was performed using the data for the period of 01.01.2018-31.12.2019.

RESULTS

Around 57 % of cancers in males and 56 % of cancers in females were amenable to early detection. At least 35.7 % of these cancers in males and 44.2 % in females were detected early. 15.2 % (n = 964) of male and 35.3 % (n = 3179) of female cancer patients met the age criteria for the respective cancer screening programmes. Breast, colorectal, cervical and stomach cancers contributed to 58.7 % of all late-stage cancers in females. Lung, prostate, colorectal, laryngeal and stomach cancers made up 72.4 % of all late-stage cancer cases among males. At least 83.8 % (n = 1438) of thyroid cancers in females and 84.2 % (n = 246) of thyroid cancers in males were diagnosed at stage I. Moreover, stage I thyroid cancer cases made up 50.7 % of all stage I cancer cases detected in women and 25.6 % of all stage I cancers in men. At least 42.4 % of stage I thyroid cancers in females and 37.4 % of stage I thyroid cancers in males were papillary microcarcinomas.

CONCLUSION

The potential of early cancer detection is underutilised in Georgia and there is a need to strengthen screening and especially early diagnosis in the country. The possibility of thyroid cancer overdiagnosis requires further investigation.

Integration of immunotherapy into treatment of cervical cancer: Recent data and ongoing trials

Cervical cancer constitutes a significant health burden for women globally. While most patients with early-stage disease can be cured with radical surgery or chemoradiotherapy, patients with high-risk locally advanced disease or with recurrent/metastatic disease have a poor prognosis with standard treatments. Immunotherapies are a rational treatment for this HPV-driven cancer that commonly expresses programmed cell death ligand-1. Before 2021, pembrolizumab was the only United States Food and Drug Administration-approved immunotherapy in cervical cancer, specifically for the second-line recurrent or metastatic (r/m) setting. In late 2021, the antibody-drug conjugate tisotumab vedotin was approved for second-line r/m cervical cancer and pembrolizumab combined with chemotherapy ± bevacizumab was approved for first-line r/m disease based on results from KEYNOTE-826. Moreover, with at least 2 dozen additional immunotherapy clinical trials in the second-line and first-line r/m setting, as well as in locally advanced disease, the treatment landscape for cervical cancer may eventually encounter a potential paradigm shift. Pivotal trials of immunotherapies for cervical cancer that were recently approved or with the potential for regulatory consideration through 2024 are reviewed. As immunotherapy has the opportunity to establish new standards of care in the treatment of cervical cancers, new biomarkers to identify the ideal patient populations for these therapies may also become important. However, issues with access, affordability, and compliance in low- and middle-income countries are anticipated.

Progress in reducing premature mortality from cancer and cardiovascular disease in the former Soviet Union, 2000-19

Background

A reduction in non-communicable diseases premature mortality by one-third by 2030 is one of the targets of the UN Sustainable Development Goals (SDG3.4). We examined the mortality profiles in the Newly Independent States of the former Soviet Union (NIS) and the European Union (EU) and assessed progress in reductions of premature mortality from cancer, as compared to cardiovascular disease (CVD).

Methods

We used WHO’s Global Health Estimates and GLOBOCAN 2020 to examine current mortality profiles and computed the unconditional probabilities of dying at ages 30–70 from CVD and cancer for the years 2000–19 in both sexes, using a linear extrapolation of this trend to predict whether the target of a one-third reduction, as set in 2015, would be met in 2030.

Results

CVD was the main cause of premature death in the NIS (43%), followed by cancer (23%), inversely from the EU with 42% cancer and 24% CVD deaths. The NIS achieved major reductions in premature CVD mortality, although the probabilities of death in 2019 remained about five times higher in the NIS compared to the EU. For cancer, mortality reductions in most NIS were quite modest, other than large declines seen in Kazakhstan (44%) and Kyrgyzstan (30%), with both on course to meet the 2030 target.

Conclusions

Limited progress in cancer control in the NIS calls for policy action both in terms of structural changes towards universal health coverage, and scaling up of national cancer control plans, including a shift from opportunistic to evidence-based early detection practices.

Circular RNA circLMO1 Suppresses Cervical Cancer Growth and Metastasis by Triggering miR-4291/ACSL4-Mediated Ferroptosis

Background

A number of studies have demonstrated that circular RNA (circRNA) plays a critical role in tumorigenesis and tumor progression. However, the biological effects of most circRNAs on cervical cancer remain unclear. Hsa_circ_0021087 (thereafter named circLMO1) is a circRNA generated from the circularization of exon 2 and exon 3 of LIM Domain Only 1 (LMO1) and first identified as a tumor suppressor in gastric cancer. We aimed to identify the role of circLMO1 in cervical cancer progression.

Methods

CircLMO1 was verified through qPCR and Sanger sequencing. The biological role of circLMO1 in regulating cervical cancer growth and metastasis was investigated both in vitro and in the nude mouse xenograft tumor model. The dual luciferase reporter assay and rescue experiment were conducted to evaluate the interactions among circLMO1, microRNA (miR)-4291, and acyl-CoA synthetase long chain family member 4 (ACSL4). The role of circLMO1 in regulating ferroptosis was assessed by analyzing lipid reactive oxygen species (ROS), and malonyl dialdehyde (MDA), and glutathione (GSH) content.

Results

The level of circLMO1 was down-regulated in cervical cancer tissues and was associated with the International Federation of Gynecology and Obstetrics (FIGO) staging. Functionally, circLMO1 overexpression inhibited cervical cancer growth and metastasis both in vitro and in vivo, whereas circLMO1 depletion promoted cervical cancer cell proliferation and invasion. Mechanistically, circLMO1 acted as a competing endogenous RNA (ceRNA) by sponging miR-4192 to repress target gene ACSL4. CircLMO1 promoted cervical cancer cell ferroptosis through up-regulating ACSL4 expression. Overexpression of miR-4291 or knockdown of ACSL4 reversed the effect of circLMO1 on facilitating ferroptosis and repressing cervical cancer cell proliferation and invasion.

Conclusion

CircLMO1 acted as a tumor suppressor of cervical cancer by regulating miR-4291/ACSL4-mediated ferroptosis, and could be a promising biomarker for the clinical management of cervical cancer.

FNDC3B and BPGM Are Involved in Human Papillomavirus-Mediated Carcinogenesis of Cervical Cancer

Human papillomavirus (HPV)-mediated cervical carcinogenesis is a multistep progressing from persistent infection, precancerous lesion to cervical cancer (CCa). Although molecular alterations driven by viral oncoproteins are necessary in cervical carcinogenesis, the key regulators behind the multistep process remain not well understood. It is pivotal to identify the key genes involved in the process for early diagnosis and treatment of this disease. Here we analyzed the mRNA expression profiles in cervical samples including normal, cervical intraepithelial neoplasia (CIN), and CCa. A co-expression network was constructed using weighted gene co-expression network analysis (WGCNA) to reveal the crucial modules in the dynamic process from HPV infection to CCa development. Furthermore, the differentially expressed genes (DEGs) that could distinguish all stages of progression of CCa were screened. The key genes involved in HPV-CCa were identified. It was found that the genes involved in DNA replication/repair and cell cycle were upregulated in CIN compared with normal control, and sustained in CCa, accompanied by substantial metabolic shifts. We found that upregulated fibronectin type III domain-containing 3B (FNDC3B) and downregulated bisphosphoglycerate mutase (BPGM) could differentiate all stages of CCa progression. In patients with CCa, a higher expression of FNDC3B or lower expression of BPGM was closely correlated with a shorter overall survival (OS) and disease-free survival (DFS). A receiver operating characteristic (ROC) analysis of CIN and CCa showed that FNDC3B had the highest sensitivity and specificity for predicting CCa development. Taken together, the current data showed that FNDC3B and BPGM were key genes involved in HPV-mediated transformation from normal epithelium to precancerous lesions and CCa.

Machine learning-based prediction of survival prognosis in cervical cancer

BACKGROUND

Accurately forecasting the prognosis could improve cervical cancer management, however, the currently used clinical features are difficult to provide enough information. The aim of this study is to improve forecasting capability by developing a miRNAs-based machine learning survival prediction model.

RESULTS

The expression characteristics of miRNAs were chosen as features for model development. The cervical cancer miRNA expression data was obtained from The Cancer Genome Atlas database. Preprocessing, including unquantified data removal, missing value imputation, samples normalization, log transformation, and feature scaling, was performed. In total, 42 survival-related miRNAs were identified by Cox Proportional-Hazards analysis. The patients were optimally clustered into four groups with three different 5-years survival outcome (≥ 90%, ≈ 65%, ≤ 40%) by K-means clustering algorithm base on top 10 survival-related miRNAs. According to the K-means clustering result, a prediction model with high performance was established. The pathways analysis indicated that the miRNAs used play roles involved in the regulation of cancer stem cells.

CONCLUSION

A miRNAs-based machine learning cervical cancer survival prediction model was developed that robustly stratifies cervical cancer patients into high survival rate (5-years survival rate ≥ 90%), moderate survival rate (5-years survival rate ≈ 65%), and low survival rate (5-years survival rate ≤ 40%).

Overexpression of LINC00673 Promotes the Proliferation of Cervical Cancer Cells

Objective

To study the expression of LINC00673 in cervical cancer and cervical intraepithelial neoplasia (CIN) and to explore the role of LINC00673 in the development of cervical cancer.

Methods

The expression of LINC00673 in serum from cervical cancer patients, CIN patients, and healthy participants was detected by RT-qPCR. The function of LINC00673 in cervical cancer cells was analyzed using in vitro and in vivo experiments.

Results

Our results revealed that serum LINC00673 levels were highest in cervical cancer patients, followed by patients with CIN and healthy controls. In vitro experiments demonstrated that overexpression of LINC00673 enhanced the proliferation and cell cycle progression of HeLa and SiHa cells. In vivo experiments showed that the tumor weight and volume of nude mice subcutaneously injected with LINC00673-overexpressing HeLa cells were larger than those of nude mice injected with control cells (P < 0.05). Western blotting showed that cell cycle-related proteins cyclin A2 and cyclin E and interstitial-associated proteins Snail and N-cadherin were upregulated and p53 signaling pathway-related proteins were downregulated in LINC00673-overexpressing HeLa and SiHa cells.

Conclusion

LINC00673 plays an important role in the development of cervical cancer and may serve as a new therapeutic target for cervical cancer.