1
|
Wassie M, Zegeye AF, Mekonen EG, Tekeba B, Ali MS, Gonete AT, Kassie AT, Workneh BS, Alemu TG, Tamir TT. Human papillomavirus vaccination coverage among young women in the three sub-Saharan African countries using Demographic and Health Surveys data. Hum Vaccin Immunother 2024; 20:2370111. [PMID: 38946555 PMCID: PMC11218800 DOI: 10.1080/21645515.2024.2370111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/17/2024] [Indexed: 07/02/2024] Open
Abstract
Cervical cancer is the fourth most common cancer, with 99% of cases linked to human papillomavirus (HPV) infection. It reflects global inequity as its burden is highest in low- and middle-income countries. The aim of this study was to determine the HPV vaccination coverage and its determinant factors among young women in the three sub-Saharan African countries. Data from the Demographic and Health Surveys among three sub-Saharan African countries were used for analysis. A total of 4,952 women were included in the study. Stata 14 was used to analyze the data. The determinants of the outcome variable were identified using a multilevel mixed-effects logistic regression model. Factors with p-values < 0.05 at 95% confidence interval were declared statistically significant. About 7.5% young women were vaccinated for HPV vaccine against cervical cancer in the current study. Younger age, use of internet, rich economic class, and individual-level media exposure were found to be favorable conditions, whereas being employed was negatively associated with HPV vaccination. Only few segments of young women in these three countries got HPV vaccination. The authors recommend that increasing internet use, media exposure, and economic level of young women will increase the HPV vaccination rates. Furthermore, creating awareness among employed women will also increase the possibility of HPV vaccination.
Collapse
Affiliation(s)
- Mulugeta Wassie
- Schools of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
2
|
Wei F, Georges D, Man I, Baussano I, Clifford GM. Causal attribution of human papillomavirus genotypes to invasive cervical cancer worldwide: a systematic analysis of the global literature. Lancet 2024; 404:435-444. [PMID: 39097395 DOI: 10.1016/s0140-6736(24)01097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/09/2024] [Accepted: 05/23/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Understanding the proportion of invasive cervical cancer (ICC) caused by different human papillomavirus (HPV) genotypes can inform primary (ie, vaccination) and secondary (ie, screening) prevention efforts that target specific HPV genotypes. However, using the global literature to estimate population attributable fractions (AFs) requires a methodological framework to address HPV genotype-specific causality from aggregated data. We aimed to estimate the proportion of ICC caused by different HPV genotypes at the global, regional, and national level. METHODS This systematic review identified studies reporting HPV genotype-specific prevalence in ICC or people with normal cervical cytology. We searched PubMed, Embase, Scopus, and Web of Science up to Feb 29, 2024, using the search terms "cervix" and "HPV", with no language restrictions. Odds ratios (ORs) were estimated by comparing HPV genotype-specific prevalence between HPV-positive ICC and normal cervical cytology with logistic regression models, adjusting for region, year of paper publication, and HPV primer or test. HPV genotypes with a lower bound to the 95% CI of the OR greater than 1·0 were judged as causal to ICC. Corresponding regional genotype-specific AFs were calculated as regional HPV prevalence in ICC multiplied by (1 - [1 / OR]) and were proportionally adjusted to total 100%. Global AFs were calculated from regional AFs weighted by number of regional ICC cases in 2022 (GLOBOCAN). FINDINGS The systematic review identified 1174 studies with 111 902 cases of HPV-positive ICC and 2 755 734 of normal cervical cytology. 17 HPV genotypes were considered causal to ICC, with ORs ranging widely from 48·3 (95% CI 45·7-50·9) for HPV16 to 1·4 (1·2-1·7) for HPV51. HPV16 had the highest global AF (61·7%), followed by HPV18 (15·3%), HPV45 (4·8%), HPV33 (3·8%), HPV58 (3·5%), HPV31 (2·8%), and HPV52 (2·8%). Remaining causal genotypes (HPV35, 59, 39, 56, 51, 68, 73, 26, 69, and 82) had a combined global AF of 5·3%. AFs for HPV16 and 18 and HPV16, 18, 31, 33, 45, 52, and 58 combined were lowest in Africa (71·9% and 92·1%, respectively) and highest in central, western, and southern Asia (83·2% and 95·9%, respectively). HPV35 had a higher AF in Africa (3·6%) than other regions (0·6-1·6%). INTERPRETATION This study provides a comprehensive global picture of HPV genotype-specific AFs in ICC, before the influence of HPV vaccination. These data can inform HPV genotype-specific vaccination and screening strategies to reduce the burden of ICC. FUNDING EU Horizon 2020 Research and Innovation Programme.
Collapse
Affiliation(s)
- Feixue Wei
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Damien Georges
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Irene Man
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Iacopo Baussano
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Gary M Clifford
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France.
| |
Collapse
|
3
|
Fuady A, Setiawan D, Man I, de Kok IMCM, Baussano I. Toward a Framework to Assess the Financial and Economic Burden of Cervical Cancer in Low- and Middle-Income Countries: A Systematic Review. JCO Glob Oncol 2024; 10:e2400066. [PMID: 39116362 DOI: 10.1200/go.24.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE To review the economic burden assessment of cervical cancer in low- and middle-income countries (LMICs) and use the findings to develop a pragmatic, standardized framework for such assessment. METHODS We first systematically reviewed articles indexed in scientific databases reporting the methodology for collecting and calculating costs related to the cervical cancer burden in LMICs. Data on study design, costing approach, cost perspective, costing period, and cost type (direct medical costs [DMC], direct nonmedical costs [DNMC], and indirect costs [IC]) were extracted. Finally, we summarized the reported limitations in the methodology and used the solutions to inform our framework. RESULTS Cervical cancer treatment costs across LMICs vary greatly and can be extremely expensive, up to 70,968 International US dollars. Economic and financial assessment methods also vary greatly across countries. Of the 28 reviewed articles, 25 studies reported DMC for cervical cancer treatment by extracting cost information from billing or insurance databases (eight studies), conducting surveys (five), and estimating the costs (12). Only 11 studies-mainly through surveys-reported DNMC and IC. The economic burden assessment framework includes health care/payer and societal perspectives (DMC, DNMC, IC, and human capital loss) across the cervical cancer screening and treatment continuum. To assess health care/payer costs, we recommend combining the predefined treatment standards with actual local treatment practices, multiplied by unit costs. To assess societal costs, we recommend conducting a cost survey in line with a standardized yet adaptable protocol. CONCLUSION Our standardized, pragmatic framework allows assessment of economic and financial burden of cervical cancer in LMICs despite the different levels of available resources across countries. This framework will facilitate global comparisons and monitoring and may also be applied to other cancers.
Collapse
Affiliation(s)
- Ahmad Fuady
- International Agency for Research on Cancer, (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Evidence-based Health Policy Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Didik Setiawan
- Faculty of Pharmacy, University of Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Irene Man
- International Agency for Research on Cancer, (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Iacopo Baussano
- International Agency for Research on Cancer, (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| |
Collapse
|
4
|
Gottschlich A, Hong Q, Gondara L, Alam MS, Cook DA, Martin RE, Lee M, Melnikow J, Peacock S, Proctor L, Stuart G, Franco EL, Krajden M, Smith LW, Ogilvie GS. Evidence of Decreased Long-term Risk of Cervical Precancer after Negative Primary HPV Screens Compared with Negative Cytology Screens in a Longitudinal Cohort Study. Cancer Epidemiol Biomarkers Prev 2024; 33:904-911. [PMID: 38773687 PMCID: PMC11216858 DOI: 10.1158/1055-9965.epi-23-1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/05/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND The growing use of primary human papillomavirus (HPV) cervical cancer screening requires determining appropriate screening intervals to avoid overtreatment of transient disease. This study examined the long-term risk of cervical precancer after HPV screening to inform screening interval recommendations. METHODS This longitudinal cohort study (British Columbia, Canada, 2008 to 2022) recruited women and individuals with a cervix who received 1 to 2 negative HPV screens (HPV1 cohort, N = 5,546; HPV2 cohort, N = 6,624) during a randomized trial and women and individuals with a cervix with 1 to 2 normal cytology results (BCS1 cohort, N = 782,297; BCS2 cohort, N = 673,778) extracted from the provincial screening registry. All participants were followed through the registry for 14 years. Long-term risk of cervical precancer or worse [cervical intraepithelial neoplasia grade 2 or worse (CIN2+)] was compared between HPV and cytology cohorts. RESULTS Cumulative risks of CIN2+ were 3.2/1,000 [95% confidence interval (CI), 1.6-4.7] in HPV1 and 2.7/1,000 (95% CI, 1.2-4.2) in HPV2 after 8 years. This was comparable with the risk in the cytology cohorts after 3 years [BCS1: 3.3/1,000 (95% CI, 3.1-3.4); BCS2: 2.5/1,000 (95% CI, 2.4-2.6)]. The cumulative risk of CIN2+ after 10 years was low in the HPV cohorts [HPV1: 4.7/1,000 (95% CI, 2.6-6.7); HPV2: 3.9 (95% CI, 1.1-6.6)]. CONCLUSIONS Risk of CIN2+ 8 years after a negative screen in the HPV cohorts was comparable with risk after 3 years in the cytology cohorts (the benchmark for acceptable risk). IMPACT These findings suggest that primary HPV screening intervals could be extended beyond the current 5-year recommendation, potentially reducing barriers to screening.
Collapse
Affiliation(s)
- Anna Gottschlich
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
- Population Sciences and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Quan Hong
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lovedeep Gondara
- British Columbia Cervix Screening Program, BC Cancer, Vancouver, BC, Canada
| | - Md Saiful Alam
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Darrel A. Cook
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Ruth Elwood Martin
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marette Lee
- British Columbia Cervix Screening Program, BC Cancer, Vancouver, BC, Canada
| | - Joy Melnikow
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - Stuart Peacock
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Lily Proctor
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Cervix Screening Program, BC Cancer, Vancouver, BC, Canada
| | - Gavin Stuart
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Eduardo L. Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Mel Krajden
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Laurie W. Smith
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Gina S. Ogilvie
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
5
|
Pergialiotis V, Rodolakis I, Rodolakis A, Thomakos N. Controversies and Advances in the Personalized Surgical Treatment of Cervical Cancer. J Pers Med 2024; 14:606. [PMID: 38929827 PMCID: PMC11204897 DOI: 10.3390/jpm14060606] [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: 05/19/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Cervical cancer represents a global health issue as it is mostly encountered in women of reproductive age, while at the same time, survival outcomes seem to have remained constant during the last two decades. The need to implement fertility-sparing strategies as well as to decrease the morbidity that accompanies radical treatment has been extensively studied. During the last decade, several randomized clinical trials have been released, resulting in significant advances in the surgical treatment of early-stage disease. At the same time, evidence about the surgical treatment of advanced-stage disease as well as recurrent disease has gradually appeared and seems to be promising, thus leading the point forward towards personalized medicine that will remove the surgical barriers that seem concrete in our era. Nevertheless, the discrepancies in perioperative morbidity and survival outcomes that were observed among published studies raise several questions. In the present article, we chose to review the gray fields in the surgical treatment of early-stage and advanced-stage cervical cancer. Studies that are based on strong evidence that support current clinical practice are compared to smaller cohorts that present novel data that may form the basis for future research, and issues that remain poorly explored are discussed in an effort to help establish a consensus for future research development.
Collapse
Affiliation(s)
- Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, “Alexandra” General Hospital, National and Kapodistrian University of Athens, 15703 Athens, Greece; (I.R.); (A.R.); (N.T.)
| | | | | | | |
Collapse
|
6
|
Chen YC, Chen YY, Su SY, Jhuang JR, Chiang CJ, Yang YW, Lin LJ, Wu CC, Lee WC. Projected Time for the Elimination of Cervical Cancer Under Various Intervention Scenarios: Age-Period-Cohort Macrosimulation Study. JMIR Public Health Surveill 2024; 10:e46360. [PMID: 38635315 PMCID: PMC11066752 DOI: 10.2196/46360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/11/2023] [Accepted: 02/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The World Health Organization aims for the global elimination of cervical cancer, necessitating modeling studies to forecast long-term outcomes. OBJECTIVE This paper introduces a macrosimulation framework using age-period-cohort modeling and population attributable fractions to predict the timeline for eliminating cervical cancer in Taiwan. METHODS Data for cervical cancer cases from 1997 to 2016 were obtained from the Taiwan Cancer Registry. Future incidence rates under the current approach and various intervention strategies, such as scaled-up screening (cytology based or human papillomavirus [HPV] based) and HPV vaccination, were projected. RESULTS Our projections indicate that Taiwan could eliminate cervical cancer by 2050 with either 70% compliance in cytology-based or HPV-based screening or 90% HPV vaccination coverage. The years projected for elimination are 2047 and 2035 for cytology-based and HPV-based screening, respectively; 2050 for vaccination alone; and 2038 and 2033 for combined screening and vaccination approaches. CONCLUSIONS The age-period-cohort macrosimulation framework offers a valuable policy analysis tool for cervical cancer control. Our findings can inform strategies in other high-incidence countries, serving as a benchmark for global efforts to eliminate the disease.
Collapse
Affiliation(s)
- Yi-Chu Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yun-Yuan Chen
- Head Office, Taiwan Blood Services Foundation, Taipei, Taiwan
| | - Shih-Yung Su
- Master Program in Statistics, National Taiwan University, Taipei, Taiwan
| | - Jing-Rong Jhuang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Taiwan Cancer Registry, Taipei city, Taiwan
| | | | - Li-Ju Lin
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chao-Chun Wu
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Taiwan Cancer Registry, Taipei city, Taiwan
- Institute of Health Data Analytics, College of Public Health, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
7
|
Yen KY, Cheng JY, Li JQ, Toh ZA, He HG. The effectiveness of digital psychosocial interventions on psychological distress, depression, anxiety, and health-related quality of life in patients with gynaecological cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:240. [PMID: 38512538 DOI: 10.1007/s00520-024-08415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Patients with gynaecological cancer often experience psychological issues due to multiple stressors. Psychological disturbances have debilitating effects on patients with gynaecological cancer. In recent decades, digital psychosocial interventions have rapidly advanced and been incorporated into mental health interventions. Digital psychosocial interventions could provide patients with several benefits over traditional in-person interventions, including convenience, anonymity, flexible scheduling, and geographic mobility. The aim of this systematic review was to synthesize the effectiveness of digital psychosocial intervention in reducing psychological distress, depression, and anxiety and improving health-related quality of life in patients with gynaecological cancer. METHODS Three-step extensive search was performed on 22 December 2022 from nine bibliographic databases, trial registries and grey literature. Experimental studies involving patients with gynaecological cancer utilizing digital psychosocial interventions for the improvement of mental health outcomes were included. Meta-analysis was conducted using RevMan 5.4 software. Heterogeneity was analysed by Cochran's Q test and I2. Subgroup analyses were attempted to evaluate relative effect sizes of subgroup features. RESULTS Meta-analysis of nine studies revealed small effect size in reduction of depression post-intervention (d = 0.24, 95% CI - 0.46 to - 0.02) and medium effect size in reduction of psychological distress post-intervention (d = 0.51, 95% CI - 0.81 to - 0.21) and follow-up (d = 0.65, 95% CI - 1.25 to - 0.05) compared to the control group. The effects of digital psychosocial interventions on anxiety and health-related quality of life were not statistically significant. CONCLUSIONS Digital psychosocial interventions probably reduced psychological distress and slightly reduced depression amongst patients with gynaecological cancer compared to the control group, which can be integrated into clinical practice. Additional trials with rigorous methodology and bigger sample sizes are needed to validate findings. TRIAL REGISTRATION PROSPERO (CRD42023389502).
Collapse
Affiliation(s)
- Kai Yoong Yen
- Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Jing Ying Cheng
- Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Jin-Qiu Li
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
- Department of Nursing, Zhuhai Campus, Zunyi Medical University, Zhuhai, Guangdong, China
| | - Zheng An Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
- Division of Nursing, National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore.
- National University Health System, Singapore, Singapore.
| |
Collapse
|
8
|
Murakawa Y, Dobashi H, Kondo M, Nishiyama S, Okazaki R, Hasegawa Y, Moriyama M, Sugiura T, Onishi I, Honda M, Nagamura N, Yoshioka Y, Minamoto T. Questionnaire survey on the prevention and development of cervical cancer in patients with systemic lupus erythematosus in Japan. Mod Rheumatol 2024; 34:352-358. [PMID: 36929382 DOI: 10.1093/mr/road028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES The aim is to evaluate the prevention and development of cervical cancer in systemic lupus erythematosus (SLE) patients in Japan and its background based on a questionnaire survey. METHODS The questionnaire was handed to 460 adult female SLE patients at 12 medical institutions. The participants were grouped by age, and data related to their human papillomavirus vaccination status, age at first coitus, cervical cancer screening, and diagnosis of cervical cancer were analysed. RESULTS A total of 320 responses were received. Patients aged 35-54 years included a higher proportion of patients whose age at first coitus was <20 years. This group also showed a higher rate of cervical cancer/dysplasia. Only nine patients had a human papillomavirus vaccination history. Adequate frequency of cervical cancer screening was slightly higher (52.1%) among SLE patients than in the Japanese general population. However, 23% of the patients had never undergone examination, primarily because of a feeling of troublesome. The incidence of cervical cancer was significantly higher among SLE patients. One reason for this may be associated with the use of immunosuppressants, although the difference was not significant. CONCLUSIONS SLE patients are at a higher risk of cervical cancer and dysplasia. Rheumatologists should proactively recommend vaccination and screening examinations for SLE female patients.
Collapse
Affiliation(s)
- Yohko Murakawa
- Department of Internal Medicine III, Shimane University, Izumo, Japan
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
- Department of Rheumatology, Tamatsukuri Hospital, Matsue, Japan
| | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Masahiro Kondo
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
- National Hospital Organization Hamada Medical Center, Hamada, Japan
- Division of Rheumatology, Masuda Medical Association Hospital, Masuda, Japan
| | - Susumu Nishiyama
- Rheumatic Disease Center, Kurashiki Medical center, Kurashiki, Japan
| | - Ryota Okazaki
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yasuyuki Hasegawa
- Department of Rheumatology, Tottori Prefecture Central Hospital, Tottori, Japan
| | - Mayuko Moriyama
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
- Division of Rheumatology, Oda Municipal Hospital, Oda, Japan
| | - Tomoko Sugiura
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
- Sugiura Clnic, Izumo, Japan
| | | | - Manabu Honda
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
- Division of Rheumatology, Oda Municipal Hospital, Oda, Japan
| | - Norihiro Nagamura
- Department of Allergy & Rheumatology, Shimane Central Hospital, Izumo, Japan
| | - Yuki Yoshioka
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Toshiko Minamoto
- Department of Gynecology, Faculty of Medicine Shimane University, Izumo, Japan
| |
Collapse
|
9
|
Albayat SS, Mundodan JM, Elmardi K, Hasnain S, Khogali H, Baaboura R, Al-Romaihi HE, AlKubaisi NJ, Bougmiza MI. Knowledge, attitude, and practices regarding human papilloma virus vaccination among physicians in Qatar. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241227360. [PMID: 38282514 PMCID: PMC10826392 DOI: 10.1177/17455057241227360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND The human papilloma virus is a global problem that affects sexually active women and men, with cervical cancer being the most serious associated disease. Most cervical cancer cases can be prevented by vaccination against the human papilloma virus early in life. The objective of this study was to assess the knowledge, attitudes, and practices among physicians working in Qatar, regarding the human papilloma virus, infection, and prevention using vaccines. STUDY-DESIGN This was a cross-sectional study using quantitative data collection. METHODOLOGY An online survey targeting physicians working in Qatar was conducted, using a web-based pretested questionnaire. The questionnaire comprised four sections capturing a few demographic details, 33 questions in the Knowledge Section, 12 questions eliciting the attitude, and 14 practice-related questions. Mean knowledge score was calculated and those with a score more than the mean score were considered to have sufficient knowledge. Association between knowledge and attitude/practices/independent variables were looked for using bivariate and multivariate analysis. Logistic regression was used to identify the predictors for recommending human papilloma virus vaccines. RESULTS Of the 557 physicians who participated, 83.7% had sufficient knowledge, but only 69.1% knew that human papilloma virus vaccines were available in Qatar. The majority (89.4%) knew that human papilloma virus infection could be asymptomatic and 96.1% knew at least one symptom; 77% believed the human papilloma virus vaccine would substantially decrease the chances of human papilloma virus infection and related cancers and 46.5% felt physicians were less motivated to promote the human papilloma virus vaccine. The perceived barriers to community acceptance of the human papilloma virus vaccine were lack of awareness regarding the relationship between human papilloma virus and cervical cancer (61.6%), doubts regarding efficacy (32.5%), fear regarding safety (26.9%), concern that the human papilloma virus vaccination may encourage risky sexual behavior (26.8%), and perceived low-risk (23.3%) and cost (24.6%). Only 21.5% commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. Bivariate analysis showed nationality, specialization, discussing with patients, and recommending vaccine to be significantly associated with knowledge. Bivariate and regression analysis identified that female gender and physician's religion were significant predictors to recommend the human papilloma virus vaccine. CONCLUSION Most physicians have good knowledge. Less than one-fourth commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. This issue might affect the human papilloma virus vaccination program implementation if not well addressed.
Collapse
Affiliation(s)
| | | | - Khalid Elmardi
- HP-CDC, Department of Public Health, Ministry of Public Health, Doha, Qatar
| | - Samina Hasnain
- HP-CDC, Department of Public Health, Ministry of Public Health, Doha, Qatar
| | - Hayat Khogali
- HP-CDC, Department of Public Health, Ministry of Public Health, Doha, Qatar
| | | | | | | | - Mohamed Iheb Bougmiza
- Community Medicine Residency Program Director, Primary Health Care Corporation, Doha, Qatar
| |
Collapse
|
10
|
Yuan H, Li R, Lv J, Yi G, Sun X, Zhao N, Zhao F, Xu A, Kou Z, Wen H. Epidemiology of human papillomavirus on condyloma acuminatum in Shandong Province,China. Hum Vaccin Immunother 2023; 19:2170662. [PMID: 36919446 PMCID: PMC10064924 DOI: 10.1080/21645515.2023.2170662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/15/2023] [Indexed: 03/16/2023] Open
Abstract
Condyloma acuminatum (CA) is a sexually transmitted disease (STD) caused by human papillomavirus (HPV) infection. It is important to study the prevalence and distribution of HPV genotypes before implementing the HPV vaccination program. Therefore, the aim of this study was to evaluate the epidemiological characteristics of CA cases and the distribution of HPV genotypes in Shandong Province, China. One-to-one questionnaire surveys were conducted on all patients diagnosed with CA in sentinel hospitals from Shandong Province, China. HPV genotypes were determined using the polymerase chain reaction (PCR)-reverse dot blot hybridization method. The study enrolled 1185 patients (870 males and 315 females) and found that CA patients are mainly males and sexually active people between the ages of 20 and 40. Recurrence occurred in 34.7% patients. Among the 880 CA patients who underwent HPV typing, the HPV test positivity rate was 91.4%. In these cases, low-risk (LR) HPV infection was predominant, with an infection rate of 91.3%, while high-risk (HR) HPV genotypes were found in 53.5% patients. The most frequent HPV genotypes encountered were HPV6 (57.8%), HPV11 (37.2%), HPV16 (13.7%), and HPV42 (10.3%). HPV6 and/or HPV11 are the main infections in all patients, and more than half of the patients are coinfected with HR-HPV. However, unlike other regions, HPV42 has a higher prevalence rate among CA patients in Shandong Province and is a nonvaccine HPV genotype. Therefore, regular HPV typing helps to understand the characteristics of specific genotypes and the choice of the best type for vaccine coverage.
Collapse
Affiliation(s)
- Haowen Yuan
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Key laboratory for the prevention and control of infectious diseases (key labor-atory of China’s “13th Five-Year”, Shandong University), Jinan, China
| | - Renpeng Li
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Disease Prevention and Control, Jinan, China
| | - Jian Lv
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai’an, China
| | - Guipeng Yi
- School of Public Health, Weifang Medical University, Weifang, China
| | - Xihong Sun
- Department of Infectious Disease Prevention and Control, Jining City Center for Disease Control and Prevention, Jining, China
| | - Na Zhao
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Veneorology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Fengjun Zhao
- Department of Andrology, Shandong Oriental Andrology Hospital, Jinan, China
| | - Aiqiang Xu
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Disease Prevention and Control, Jinan, China
| | - Zengqiang Kou
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Disease Prevention and Control, Jinan, China
| | - Hongling Wen
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Key laboratory for the prevention and control of infectious diseases (key labor-atory of China’s “13th Five-Year”, Shandong University), Jinan, China
| |
Collapse
|
11
|
Wassie M, Zegeye AF, Worku W, Sisay T, Eyob T, Gebeyehu DA. Willingness to accept human papilloma virus vaccination and its associated factors among parents with eligible daughters in Addis Zemen town, Northwest Ethiopia. Infect Agent Cancer 2023; 18:84. [PMID: 38129887 PMCID: PMC10740298 DOI: 10.1186/s13027-023-00551-6] [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: 06/13/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Cervical cancer is one of the most common cancers in women. Evidences show that, routine immunization of girls at age 14 year and immunization of girls at age 9 year through a 5 years extended interval between doses are the most efficient to control the disease. Despite this, there is very little information on parents' willingness to accept the human papilloma virus vaccine. Therefore, assessing willingness to accept human papilloma virus vaccination and its associated factors among parents with eligible daughter will help to designing, implementing and monitoring effectiveness of HPV vaccine immunization program. METHODS A community-based cross-sectional study was conducted among 386 parents with eligible daughters from 8July-6August, 2022. The multistage sampling technique was used. Data was collected using an interviewer-administered questionnaire. Responses were coded and entered into the computer using EPI data version 4.606 statistical packages, and SPSS version 23 was used for data analysis. Frequencies, percentages and means were as to describe the study variables in relation to the participants. Bivariable and multivariable logistic regression were employed. The statistical significance was set at a p-value of < 0.05 with its respected odds ratio. RESULTS A total of 386 study participants were included in the study. Among participants, 80.3% (95% CI: 76.3, 84) were willing to vaccinate their daughters for HPV vaccination. The parents' willingness was affected by the male parents ([AOR = 3.5; 95% CI (1.673-7.371)], fear of side effects [AOR = 0.385; 95% CI (0.206-0.718)], and with poor awareness on the HPV vaccine [AOR = 0.483; 95% CI (0.259- 0.900)]. CONCLUSION The study has shown that willingness to accept the HPV vaccine is about 80% and significantly affected with parental sex, information on the HPV vaccine, and fear of side effects. As such, it may be helpful for the health care providers and the health care policy makers to emphasize on providing easily understandable information using mass media and social campaign. In addition giving trainings more targeted to female parents might be important.
Collapse
Affiliation(s)
- Mulugeta Wassie
- School of nursing, College of Medicine and health sciences, University of Gondar, Gondar, Ethiopia.
| | | | - Wondesen Worku
- School of nursing, College of Medicine and health sciences, University of Gondar, Gondar, Ethiopia
| | - Tiruye Sisay
- School of nursing, College of Medicine and health sciences, University of Gondar, Gondar, Ethiopia
| | - Tsadik Eyob
- School of nursing, College of Medicine and health sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Ayelegne Gebeyehu
- Department of Psychiatry, school of Medicine, College of Medicine and health sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
12
|
Barnabas RV, Brown ER, Onono MA, Bukusi EA, Njoroge B, Winer RL, Galloway DA, Pinder LF, Donnell D, N Wakhungu I, Biwott C, Kimanthi S, Heller KB, Kanjilal DG, Pacella D, Morrison S, A Rechkina E, L Cherne S, Schaafsma TT, McClelland RS, Celum C, Baeten JM, Mugo NR. Durability of single-dose HPV vaccination in young Kenyan women: randomized controlled trial 3-year results. Nat Med 2023; 29:3224-3232. [PMID: 38049621 PMCID: PMC10719107 DOI: 10.1038/s41591-023-02658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/20/2023] [Indexed: 12/06/2023]
Abstract
Cervical cancer burden is high where prophylactic vaccination and screening coverage are low. We demonstrated in a multicenter randomized, double-blind, controlled trial that single-dose human papillomavirus (HPV) vaccination had high vaccine efficacy (VE) against persistent infection at 18 months in Kenyan women. Here, we report findings of this trial through 3 years of follow-up. Overall, 2,275 healthy women aged 15-20 years were recruited and randomly assigned to receive bivalent (n = 760), nonavalent (n = 758) or control (n = 757) vaccine. The primary outcome was incident-persistent vaccine type-specific cervical HPV infection. The primary evaluation was superiority analysis in the modified intention-to-treat (mITT) HPV 16/18 and HPV 16/18/31/33/45/52/58 cohorts. The trial met its prespecified end points of vaccine type-specific persistent HPV infection. A total of 75 incident-persistent infections were detected in the HPV 16/18 mITT cohort: 2 in the bivalent group, 1 in the nonavalent group and 72 in the control group. Nonavalent VE was 98.8% (95% CI 91.3-99.8%, P < 0.0001) and bivalent VE was 97.5% (95% CI 90.0-99.4%, P < 0.0001). Overall, 89 persistent infections were detected in the HPV 16/18/31/33/45/52/58 mITT cohort: 5 in the nonavalent group and 84 in the control group; nonavalent VE was 95.5% (95% CI 89.0-98.2%, P < 0.0001). There were no vaccine-related severe adverse events. Three years after vaccination, single-dose HPV vaccination was highly efficacious, safe and conferred durable protection. ClinicalTrials.gov no. NCT03675256 .
Collapse
Affiliation(s)
- Ruanne V Barnabas
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- School of Medicine, Harvard Medical School, Boston, MA, USA.
- Department of Epidemiology, T. H. Chan Harvard School of Public Health, Boston, MA, USA.
| | - Elizabeth R Brown
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Maricianah A Onono
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Elizabeth A Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Betty Njoroge
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Denise A Galloway
- Human Biology Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Leeya F Pinder
- Department of Global Health, University of Washington, Seattle, WA, USA
- University of Cincinnati, Department of Obstetrics and Gynecology, Cincinnati, OH, USA
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Imelda N Wakhungu
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Charlene Biwott
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Syovata Kimanthi
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kate B Heller
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Diane G Kanjilal
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Pacella
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Morrison
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Elena A Rechkina
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Stephen L Cherne
- Department of Laboratory Medicine and Department of Pathology, University of Washington, Seattle, WA, USA
| | - Torin T Schaafsma
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - R Scott McClelland
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- East Africa STI Laboratory, University of Washington, Mombasa, Kenya
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Nelly R Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| |
Collapse
|
13
|
M de Carvalho T, Man I, Georges D, Saraswati LR, Bhandari P, Kataria I, Siddiqui M, Muwonge R, Lucas E, Sankaranarayanan R, Basu P, Berkhof J, Bogaards JA, Baussano I. Health and economic effects of introducing single-dose or two-dose human papillomavirus vaccination in India. BMJ Glob Health 2023; 8:e012580. [PMID: 37931940 PMCID: PMC10632817 DOI: 10.1136/bmjgh-2023-012580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/21/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Cervical cancer is a major public health problem in India, where access to prevention programmes is low. The WHO-Strategic Advisory Group of Experts recently updated their recommendation for human papillomavirus (HPV) vaccination to include a single-dose option in addition to the two-dose option, which could make HPV vaccination programmes easier to implement and more affordable. METHODS We combined projections from a type-specific HPV transmission model and a cancer progression model to assess the health and economic effects of HPV vaccination at national and state level in India. The models used national and state-specific Indian demographic, epidemiological and cost data, and single-dose vaccine efficacy and immunogenicity data from the International Agency for Research on Cancer India vaccine trial with 10-year follow-up. We compared single-dose and two-dose HPV vaccination for a range of plausible scenarios regarding single-dose vaccine protection, coverage and catch-up. We used a healthcare sector payer perspective with a time horizon of 100 years. RESULTS Under the base-case scenario of lifelong protection of single-dose vaccination in 10-year-old girls with 90% coverage, the discounted incremental cost-effectiveness ratio (ICER) of nationwide vaccination relative to no vaccination was US$406 (₹INR30 000) per DALY (disability-adjusted life-years) averted. This lay below an opportunity-cost-based threshold of 30% Indian gross domestic product per capita in each Indian state (state-specific ICER range: US$67-US$593 per DALY averted). The ICER of two-dose vaccination versus no vaccination vaccination was US$1404 (₹INR104 000). The ICER of two-dose vaccination versus single-dose vaccination, assuming lower initial efficacy and waning of single-dose vaccination, was at least US$2282 (₹INR169 000) per DALY averted. CONCLUSIONS Nationwide introduction of single-dose HPV vaccination at age 10 in India is highly likely to be cost-effective whereas extending the number of doses from one to two would have a less favourable profile.
Collapse
Affiliation(s)
- Tiago M de Carvalho
- Department of Epidemiology and Data Science, Amsterdam UMC VUMC Site, Amsterdam, The Netherlands
| | - Irene Man
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Damien Georges
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Prince Bhandari
- Research Triangle Institute (RTI) International India, New Delhi, India
| | - Ishu Kataria
- Research Triangle Institute (RTI) International India, New Delhi, India
| | - Mariam Siddiqui
- Research Triangle Institute (RTI) International India, New Delhi, India
| | - Richard Muwonge
- 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
| | | | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Johannes Berkhof
- Department of Epidemiology and Data Science, Amsterdam UMC VUMC Site, Amsterdam, The Netherlands
| | - Johannes A Bogaards
- Department of Epidemiology and Data Science, Amsterdam UMC VUMC Site, Amsterdam, The Netherlands
| | - Iacopo Baussano
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
14
|
Ong SK, Abe SK, Thilagaratnam S, Haruyama R, Pathak R, Jayasekara H, Togawa K, Bhandari AK, Shankar A, Nessa A, Jugder U, Agustina J, Biglari M, Yusuf A, Tshomo U, Fernando E, Cairo C, Kaung KK, Rath B, Vongdala C, Pradhananga KK, Kim J, Chung YK, Thanh Huong TT, Sangrajran S, Zhang Y, Basu P, Woo YL, Sukumaran B, Hwang WY. Towards elimination of cervical cancer - human papillomavirus (HPV) vaccination and cervical cancer screening in Asian National Cancer Centers Alliance (ANCCA) member countries. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 39:100860. [PMID: 37576906 PMCID: PMC10415801 DOI: 10.1016/j.lanwpc.2023.100860] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023]
Abstract
About 95% of cervical cancers worldwide are caused by human papillomavirus (HPV). Cervical cancer is preventable and curable if it is detected and treated early. We reviewed the latest national cervical cancer indicators, and barriers to HPV vaccination and cervical cancer screening in 21 Asian National Cancer Centers Alliance (ANCCA) member countries. Half (n = 11, 52%) of the countries have introduced HPV vaccination for girls as part of their national vaccination programme, three countries reported coverage of over 90%. Most ANCCA member countries have cervical cancer screening programmes, only five countries reported screening uptake of over 50%. The barriers to HPV vaccination coverage and cervical cancer screening participation have been identified. Ensuring health service accessibility and affordability for women, addressing sociocultural barriers, and strengthening the healthcare system and continuum of care are essential to increase HPV vaccination and cervical cancer screening coverage.
Collapse
Affiliation(s)
- Sok King Ong
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
| | - Sarah K. Abe
- National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | | | - Rei Haruyama
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Japan
| | - Ruchi Pathak
- Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, India
| | - Harindra Jayasekara
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Kayo Togawa
- National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | | | - Abhishek Shankar
- Department of Radiation Oncology, Dr B R Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Ashrafun Nessa
- Department of Gynaecological Oncology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - Uranbolor Jugder
- Cancer Registry-surveillance and Early Detection Division, National Cancer Center of Mongolia, Ulaanbaatar, Mongolia
| | - Julyanti Agustina
- National Cancer Center Indonesia, Dharmais Cancer Hospital, Jakarta, Indonesia
| | - Mohammed Biglari
- Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Aasim Yusuf
- Shaukat Khanum Memorial Cancer Hospital and Research Centres, Lahore and Peshawar, Pakistan
| | - Ugyen Tshomo
- Jigme Dorji Wangchuck National Referral Hospital, Bhutan
| | - Eshani Fernando
- National Cancer Control Programme, Ministry of Health, Sri Lanka
| | - Clarito Cairo
- Department of Health, Disease Prevention and Control Bureau, Manila, Philippines
| | - Kyaw Kan Kaung
- Department of Public Health, Ministry of Health, Naypyidaw, Myanmar
| | | | | | | | - Jeongseon Kim
- National Cancer Center Korea, Goyang, Republic of Korea
| | | | | | | | - Yawei Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Partha Basu
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Yin Ling Woo
- University of Malaya & ROSE Foundation, Kuala Lumpur, Malaysia
| | | | | |
Collapse
|
15
|
Man I, Georges D, Sankaranarayanan R, Basu P, Baussano I. Building resilient cervical cancer prevention through gender-neutral HPV vaccination. eLife 2023; 12:e85735. [PMID: 37486822 PMCID: PMC10365835 DOI: 10.7554/elife.85735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/08/2023] [Indexed: 07/26/2023] Open
Abstract
The COVID-19 pandemic has disrupted HPV vaccination programmes worldwide. Using an agent-based model, EpiMetHeos, recently calibrated to Indian data, we illustrate how shifting from a girls-only (GO) to a gender-neutral (GN) vaccination strategy could improve the resilience of cervical cancer prevention against disruption of HPV vaccination. In the base case of 5-year disruption with no coverage, shifting from GO to GN strategy under 60% coverage (before disruption) would increase the resilience, in terms of cervical cancer cases still prevented in the disrupted birth cohorts per 100,000 girls born, by 2.8-fold from 107 to 302 cases, and by 2.2-fold from 209 to 464 cases under 90% coverage. Furthermore, shifting to GN vaccination helped in reaching the World Health Organization (WHO) elimination threshold. Under GO vaccination with 60% coverage, the age-standardised incidence rate of cervical cancer in India in the long term with vaccination decreased from 11.0 to 4.7 cases per 100,000 woman-years (above threshold), as compared to 2.8 cases (below threshold) under GN with 60% coverage and 2.4 cases (below threshold) under GN with 90% coverage. In conclusion, GN HPV vaccination is an effective strategy to improve the resilience to disruption of cancer prevention programmes and to enhance the progress towards cervical cancer elimination.
Collapse
Affiliation(s)
- Irene Man
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections BranchLyonFrance
| | - Damien Georges
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections BranchLyonFrance
| | | | - Partha Basu
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections BranchLyonFrance
| | - Iacopo Baussano
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections BranchLyonFrance
| |
Collapse
|
16
|
Gao M, Hu S, Zhao X, You T, Jit M, Liu Y, Qiao Y, Zhao F, Wang C. Health and economic impact of delaying large-scale HPV vaccination and screening implementation on cervical cancer in China: a modelling study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 36:100768. [PMID: 37547038 PMCID: PMC10398607 DOI: 10.1016/j.lanwpc.2023.100768] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/14/2023] [Accepted: 03/28/2023] [Indexed: 08/08/2023]
Abstract
Background Current uptake of HPV vaccination and screening in China is far below World Health Organization 2030 targets for cervical cancer elimination. We quantified health and economic losses of delaying large-scale HPV vaccination and screening implementation in China. Methods We used a previously validated transmission model to project lifetime health benefits, costs, effectiveness, and timeline for cervical cancer elimination of alternative scenarios, including combining HPV vaccination initiated from 2022 to 2030 with screening in different modalities and coverage increase rates, as well as screening alone. All women living or projected to be born in China during 2022-2100 were considered. We employed a societal perspective. Findings Regardless of vaccine type, immediate large-scale vaccination initiated in 2022 and achieving 70% coverage of HPV-based screening in 2030 (no-delay scenario) would be the least costly and most effective. Compared with the no-delay scenario, delaying vaccination by eight years would result in 434,000-543,000 additional cervical cancer cases, 138,000-178,000 deaths, and $2863-4437 million costs, and delay elimination by 9-10 years. Even with immediate vaccination, the gradual scale-up of LBC-based screening to 70% coverage in 2070 would result in 2,530,000-3,060,000 additional cases, 909,000-1,040,000 deaths, and $5098-5714 million costs compared with no-delay scenario, and could not achieve elimination if domestic 2vHPV or 4vHPV vaccines are used (4.09-4.21 cases per 100,000 woman in 2100). Interpretation Delaying large-scale HPV vaccination and/or high-performance screening implementation has detrimental consequences for cervical cancer morbidity, mortality, and expenditure. These findings should spur health authorities to expedite large-scale vaccine rollout and improve screening. Funding Bill & Melinda Gates Foundation (INV-031449 and INV-003174) and CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-004).
Collapse
Affiliation(s)
- Meng Gao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shangying Hu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuelian Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tingting You
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yang Liu
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fanghui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
17
|
Amaral E, Cain JM, Hearing F, Lumsden MA. FIGO guidance for sustainable implementation of vaccination programs for women: Pregnancy and HPV. Int J Gynaecol Obstet 2023; 162 Suppl 1:3-23. [PMID: 37424377 DOI: 10.1002/ijgo.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Eliana Amaral
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
- Obstetrics & Gynecology Department, University of Campinas, São Paulo, Brazil
| | - Joanna M Cain
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
- Obstetrics & Gynecology Department (retired), University of Massachusetts, Worcester, Massachusetts, USA
| | - Francesca Hearing
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
| | - Mary Ann Lumsden
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
| |
Collapse
|
18
|
Sayinzoga F, Tenet V, Heideman DAM, Sibomana H, Umulisa MC, Franceschi S, Hakizimana JDD, Clifford GM, Baussano I. Human papillomavirus vaccine effect against human papillomavirus infection in Rwanda: evidence from repeated cross-sectional cervical-cell-based surveys. Lancet Glob Health 2023; 11:e1096-e1104. [PMID: 37207683 PMCID: PMC10282073 DOI: 10.1016/s2214-109x(23)00193-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/16/2023] [Accepted: 04/03/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Rwanda was the first African country to implement national human papillomavirus (HPV) vaccination (against types HPV6, 11, 16, and 18). In 2011, a school-based catch-up programme was initiated to vaccinate girls aged younger than 15 years but it also reached older girls in schools. We aimed to estimate the population-level effect of HPV vaccination on HPV prevalence. METHODS Cross-sectional surveys were done between July, 2013, and April, 2014 (baseline), and between March, 2019, and December, 2020 (repeat), in sexually active women aged 17-29 years at health centres in the Nyarugenge District of Kigali, Rwanda. HPV prevalence was assessed in cervical cell samples collected by a health-care worker in PreservCyt solution (Cytyc, Boxbourough, MA, USA) and tested using a general primer (GP5+ or GP6+)-mediated PCR. Adjusted overall, total, and indirect (herd immunity) vaccine effectiveness was computed as the percentage of HPV detection among all women and among unvaccinated women. FINDINGS 1501 participants completed the baseline survey and 1639 completed the repeat survey. HPV vaccine-type prevalence in participants aged 17-29 years decreased from 12% (173 of 1501) in the baseline survey to 5% (89 of 1639) in the repeat survey, with an adjusted overall vaccine effectiveness of 47% (95% CI 31 to 60) and an adjusted indirect vaccine effectiveness of 32% (9 to 49). Among participants aged 17-23 years, who were eligible for catch-up vaccination, the adjusted overall vaccine effectiveness was 52% (35 to 65) and the adjusted indirect vaccine effectiveness was 36% (8 to 55), with important heterogeneity according to education (overall vaccine effectiveness was 68% [51 to 79] in participants with ≥6 years of school completed and 16% [-34 to 47] in those with <6 years) and HIV status (overall vaccine effectiveness was 55% [36 to 69] for HIV-negative participants and 24% [-62 to 64] for HIV-positive participants). INTERPRETATION In Rwanda, the prevalence of vaccine-targeted HPV types has been significantly decreased by the HPV vaccine programme, most notably in women who were attending school during the catch-up programme in 2011. HPV vaccine coverage and population-level impact is expected to increase in future cohorts who are eligible for routine HPV vaccination at age 12 years. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Felix Sayinzoga
- Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda; Susan Thompson Buffett Foundation, Kigali, Rwanda
| | - Vanessa Tenet
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Daniëlle A M Heideman
- Pathology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands
| | - Hassan Sibomana
- Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | - Marie-Chantal Umulisa
- Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda; Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | | | | | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Iacopo Baussano
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
| |
Collapse
|
19
|
Man I, Georges D, Bonjour M, Baussano I. Approximating missing epidemiological data for cervical cancer through Footprinting: A case study in India. eLife 2023; 12:e81752. [PMID: 37227260 PMCID: PMC10212556 DOI: 10.7554/elife.81752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 04/17/2023] [Indexed: 05/26/2023] Open
Abstract
Local cervical cancer epidemiological data essential to project the context-specific impact of cervical cancer preventive measures are often missing. We developed a framework, hereafter named Footprinting, to approximate missing data on sexual behaviour, human papillomavirus (HPV) prevalence, or cervical cancer incidence, and applied it to an Indian case study. With our framework, we (1) identified clusters of Indian states with similar cervical cancer incidence patterns, (2) classified states without incidence data to the identified clusters based on similarity in sexual behaviour, (3) approximated missing cervical cancer incidence and HPV prevalence data based on available data within each cluster. Two main patterns of cervical cancer incidence, characterized by high and low incidence, were identified. Based on the patterns in the sexual behaviour data, all Indian states with missing data on cervical cancer incidence were classified to the low-incidence cluster. Finally, missing data on cervical cancer incidence and HPV prevalence were approximated based on the mean of the available data within each cluster. With the Footprinting framework, we approximated missing cervical cancer epidemiological data and made context-specific impact projections for cervical cancer preventive measures, to assist public health decisions on cervical cancer prevention in India and other countries.
Collapse
Affiliation(s)
- Irene Man
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Damien Georges
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Maxime Bonjour
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Iacopo Baussano
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| |
Collapse
|
20
|
Chen L, Sun X, Luo J, Zhang Y, Ha Y, Xu X, Tao L, Mu X, Gao S, Han Y, Wang C, Wang F, Wang J, Yang B, Guo X, Yu Y, Ma X, Liu L, Ma W, Xie P, Wang C, Li G, Lu Q, Cui F. A Case-Control Study on Factors of HPV Vaccination for Mother and Daughter in China. Vaccines (Basel) 2023; 11:vaccines11050976. [PMID: 37243080 DOI: 10.3390/vaccines11050976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/20/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: To explore the influencing factors of human papillomavirus (HPV) vaccination among mothers and daughters so as to provide evidence and strategies for improving the HPV vaccination rate of 9-18-years-old girls. (2) A questionnaire survey was conducted among the mothers of 9-18-year-old girls from June to August 2022. The participants were divided into the mother and daughter vaccinated group (M1D1), the mother-only vaccinated group (M1D0), and the unvaccinated group (M0D0). Univariate tests, the logistic regression model, and the Health Belief Model (HBM) were employed to explore the influencing factors. (3) Results: A total of 3004 valid questionnaires were collected. According to the regions, Totally 102, 204, and 408 mothers and daughters were selected from the M1D1, M1D0, and M0D0 groups, respectively. The mother having given her daughter sex education (OR = 3.64; 95%CI 1.70, 7.80), the mother's high perception of disease severity (OR = 1.79; 95%CI 1.02, 3.17), and the mother's high level of trust in formal information (OR = 2.18; 95%CI 1.26, 3.78) were all protective factors for both the mother and her daughter's vaccination. The mother's rural residence (OR = 0.51; 95%CI 0.28, 0.92) was a risk factor for vaccination of both mother and daughter. The mother's education of high school or above (OR = 2.12; 95%CI 1.06, 4.22), the mother's high level of HPV and HPV vaccine knowledge (OR = 1.72; 95%CI 1.14, 2.58), and the mother's high level of trust in formal information (OR = 1.72; 95%CI 1.15, 2.57) were protective factors of mother-only vaccination. The older the mother (OR = 0.95; 95%CI 0.91, 0.99) was classed as a risk factor for mother-only vaccination. "Waiting until the daughters are older to receive the 9-valent vaccine" is the main reason why the daughters of M1D0 and M0D0 are not vaccinated". (4) Chinese mothers had a high willingness to vaccinate their daughters with the HPV vaccine. The higher education level of the mother, giving sex education to the daughter, the older ages of mothers and daughters, the mother's high level of HPV and HPV vaccine knowledge, a high level of perception of the disease severity, and a high level of trust in formal information were promoting factors of HPV vaccination for mother and daughter, and rural residence was a risk factor to vaccination. To promote HPV vaccination in girls from 9-18 years old, communities could provide health education to rural mothers with low education levels; the government could advocate for HPV vaccination through issuing policy documents; and doctors and the CDC could popularize the optimal age for HPV vaccination to encourage mothers to vaccinate their daughters at the age of 9-14 years old.
Collapse
Affiliation(s)
- Linyi Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Xihong Sun
- Jining Center for Disease Control and Prevention, Jining 272209, China
| | - Jing Luo
- Suzhou City Center for Disease Control and Prevention, Suzhou 234000, China
| | - Yuanshan Zhang
- Lingcheng Center for Disease Control and Prevention, Dezhou 253500, China
| | - Yu Ha
- Disease Control and Prevention Center of Jiuzhaigou County, Aba 623400, China
| | - Xiaoxia Xu
- Longxi Center for Disease Control and Prevention, Dingxi 748000, China
| | - Liandi Tao
- Chengguan Center for Disease Control and Prevention, Lanzhou 730020, China
| | - Xuefeng Mu
- Yilan Center for Disease Control and Prevention, Harbin 154800, China
| | - Shengnan Gao
- Nangang Center for Disease Control and Prevention, Harbin 150006, China
| | - Yongchao Han
- Qingfeng County Center for Disease Control and Prevention, Puyang 457000, China
| | - Chi Wang
- Nangang Center for Disease Control and Prevention, Harbin 150006, China
| | - Fuliang Wang
- Xiaoshan Center for Disease Control and Prevention, Hangzhou 311201, China
| | - Juan Wang
- Disease Control and Prevention Center of Jiuzhaigou County, Aba 623400, China
| | - Bingying Yang
- Si County Center for Disease Control and Prevention, Suzhou 234300, China
| | - Xiaoyan Guo
- Qingfeng County Center for Disease Control and Prevention, Puyang 457000, China
| | - Yajie Yu
- Yilan Center for Disease Control and Prevention, Harbin 154800, China
| | - Xian Ma
- Chengguan Center for Disease Control and Prevention, Lanzhou 730020, China
| | - Lijian Liu
- Jinxiang Center for Disease Control and Prevention, Jining 272200, China
| | - Wenmin Ma
- Jinxiang Center for Disease Control and Prevention, Jining 272200, China
| | - Pengmin Xie
- Longxi Center for Disease Control and Prevention, Dingxi 748000, China
| | - Chao Wang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
| | - Guoxing Li
- Puyang Center for Disease Control and Prevention, Puyang 457000, China
| | - Qingbin Lu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
| |
Collapse
|
21
|
Liu Y, Li Z, Yuan L, Liu F, Wu K, Xiao X, Zhu C. Human papillomavirus genotypic characteristics of 60,685 subjects under age-expansion vaccination of the nine-valent human papillomavirus vaccine: A cross-sectional study. J Infect Public Health 2023; 16:989-995. [PMID: 37167646 DOI: 10.1016/j.jiph.2023.04.018] [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: 01/23/2023] [Revised: 04/06/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination is a key initiative to promote the WHO global strategy to accelerate the elimination of cervical cancer, and this study aimed to investigate the current status of HPV infection and genotypic characteristics of the population under the impact of age-expansion of nine-valent HPV vaccination policy in China. METHODS The clinical data of 60,685 subjects who were admitted in the Renmin Hospital of Wuhan University and underwent HPV genotyping from January 2017 to October 2022 were retrospectively analyzed. RESULTS The total number of positive HPV genotyping in the included population was 10,303, with a positivity rate of 17.0 %. The HPV positivity rate in the male and female populations increased slowly year by year, with a higher rate of positivity in men (32.7 %) than in women (16.7 %) (P < 0.001). HPV was predominantly single infection in all populations, with higher prevalence of high-risk HPV than low-risk HPV in females, while low-risk HPV infection was predominant in the male population. The age distribution of female subjects infected with HPV, with HPV52 as the most common type, showed a bimodal pattern. As for HPV infected male subjects, HPV6 was the main type, and there was no bimodal age distribution. The expanded age vaccination of the nine-valent HPV vaccine will result in 42.4 % efficiency of vaccine protection for 49.9 % of age-eligible women. If the nine-valent HPV vaccine were open to males in China, it would reduce HPV infections in men by 56.4 %. CONCLUSIONS The HPV positivity rate in the population remains high and tends to increase, and the age-expansion of the nine-valent HPV vaccine would contribute to reducing the threat of disease caused by HPV infection for age-eligible women. Moreover, attention should be paid to enhancing HPV screening in males and opening up vaccination when appropriate.
Collapse
Affiliation(s)
- Yu Liu
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, PR China; Department of Medical Laboratory Technology, School of Medicine, Yunnan College of Business Management, Kunming, Yunnan 650106, PR China
| | - Zhiqiang Li
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, PR China
| | - Li Yuan
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430060, PR China
| | - Fang Liu
- State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan, Hubei 430072, PR China
| | - Kailang Wu
- State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan, Hubei 430072, PR China
| | - Xuan Xiao
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, PR China
| | - Chengliang Zhu
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, PR China.
| |
Collapse
|
22
|
Oliveira SP, Montezuma D, Moreira A, Oliveira D, Neto PC, Monteiro A, Monteiro J, Ribeiro L, Gonçalves S, Pinto IM, Cardoso JS. A CAD system for automatic dysplasia grading on H&E cervical whole-slide images. Sci Rep 2023; 13:3970. [PMID: 36894572 PMCID: PMC9998461 DOI: 10.1038/s41598-023-30497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Cervical cancer is the fourth most common female cancer worldwide and the fourth leading cause of cancer-related death in women. Nonetheless, it is also among the most successfully preventable and treatable types of cancer, provided it is early identified and properly managed. As such, the detection of pre-cancerous lesions is crucial. These lesions are detected in the squamous epithelium of the uterine cervix and are graded as low- or high-grade intraepithelial squamous lesions, known as LSIL and HSIL, respectively. Due to their complex nature, this classification can become very subjective. Therefore, the development of machine learning models, particularly directly on whole-slide images (WSI), can assist pathologists in this task. In this work, we propose a weakly-supervised methodology for grading cervical dysplasia, using different levels of training supervision, in an effort to gather a bigger dataset without the need of having all samples fully annotated. The framework comprises an epithelium segmentation step followed by a dysplasia classifier (non-neoplastic, LSIL, HSIL), making the slide assessment completely automatic, without the need for manual identification of epithelial areas. The proposed classification approach achieved a balanced accuracy of 71.07% and sensitivity of 72.18%, at the slide-level testing on 600 independent samples, which are publicly available upon reasonable request.
Collapse
Affiliation(s)
- Sara P Oliveira
- INESCTEC, 4200-465, Porto, Portugal.,FEUP, University of Porto, 4200-465, Porto, Portugal
| | - Diana Montezuma
- IMP Diagnostics, 4150-146, Porto, Portugal. .,ICBAS, University of Porto, 4050-313, Porto, Portugal.
| | - Ana Moreira
- FEUP, University of Porto, 4200-465, Porto, Portugal
| | | | - Pedro C Neto
- INESCTEC, 4200-465, Porto, Portugal.,FEUP, University of Porto, 4200-465, Porto, Portugal
| | | | | | | | | | | | - Jaime S Cardoso
- INESCTEC, 4200-465, Porto, Portugal.,FEUP, University of Porto, 4200-465, Porto, Portugal
| |
Collapse
|
23
|
Kakotkin VV, Semina EV, Zadorkina TG, Agapov MA. Prevention Strategies and Early Diagnosis of Cervical Cancer: Current State and Prospects. Diagnostics (Basel) 2023; 13:diagnostics13040610. [PMID: 36832098 PMCID: PMC9955852 DOI: 10.3390/diagnostics13040610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
Cervical cancer ranks third among all new cancer cases and causes of cancer deaths in females. The paper provides an overview of cervical cancer prevention strategies employed in different regions, with incidence and mortality rates ranging from high to low. It assesses the effectiveness of approaches proposed by national healthcare systems by analysing data published in the National Library of Medicine (Pubmed) since 2018 featuring the following keywords: "cervical cancer prevention", "cervical cancer screening", "barriers to cervical cancer prevention", "premalignant cervical lesions" and "current strategies". WHO's 90-70-90 global strategy for cervical cancer prevention and early screening has proven effective in different countries in both mathematical models and clinical practice. The data analysis carried out within this study identified promising approaches to cervical cancer screening and prevention, which can further enhance the effectiveness of the existing WHO strategy and national healthcare systems. One such approach is the application of AI technologies for detecting precancerous cervical lesions and choosing treatment strategies. As such studies show, the use of AI can not only increase detection accuracy but also ease the burden on primary care.
Collapse
Affiliation(s)
- Viktor V. Kakotkin
- Scientific and Educational Cluster MEDBIO, Immanuel Kant Baltic Federal University, A. Nevskogo St., 14, 236041 Kaliningrad, Russia
| | - Ekaterina V. Semina
- Scientific and Educational Cluster MEDBIO, Immanuel Kant Baltic Federal University, A. Nevskogo St., 14, 236041 Kaliningrad, Russia
| | - Tatiana G. Zadorkina
- Kaliningrad Regional Centre for Specialised Medical Care, Barnaulskaia Street, 6, 236006 Kaliningrad, Russia
| | - Mikhail A. Agapov
- Scientific and Educational Cluster MEDBIO, Immanuel Kant Baltic Federal University, A. Nevskogo St., 14, 236041 Kaliningrad, Russia
- Correspondence: ; Tel.: +7-(4012)-59-55-95
| |
Collapse
|
24
|
Zaridze DG, Stilidi IS, Mukeria AF. Scientific evidence for the effectiveness of primary and secondary (screening) prevention of cervical cancer. Public Health 2022. [DOI: 10.21045/2782-1676-2022-2-4-15-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The evidence of HPV vaccination effectiveness is overwhelming. The randomized clinical trials showed that all three vaccines currently in use, bivalent (CERVARIX), quadrivalent (GARDASIL) and nanvalent (GARDASIL9) effectively prevent HPV infection, cervical intraepithelial neoplasia (CIN) 1–3 and invasive cervical cancer. The results of clinical trials have been confirmed by real life evidence – population data from countries were vaccination of 12–13 girls started in 2006–08. HPV vaccination is safe. This is proven by long term follow up of the cohorts of vaccinated women. In 2020 the WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. The document includes the interim targets for 2030: vaccination of 90% of girls by 15 years; HPV testing based screening at age 35 and 45 of 70% of women; treatment of 90% of women with screening detected cervical pathology; treatment of 90% of women with precancerous lesions and cancer of the cervix. Under elimination of cervical cancer WHO means the decrease in its incidence down to 4 cases per 100 000 population. This goal will be achieved by 2030 in countries that started HPV vaccination 15 years ago in 2006–2007.In Russia incidence of cervical cancer is on increase since 1993 from 10, 2 to 16, 1 in 2018. It is predicted that the increase will continue and in 2030 the age standardized incidence rate will reach 20 per 100 000 women. HPV vaccination and HPV test based screening will change the direction of the trend from increase to decrease and save several hundreds of lives
Collapse
Affiliation(s)
- D. G. Zaridze
- N.N. Blokhin National Medical Research Center of Oncology
| | - I. S. Stilidi
- N.N. Blokhin National Medical Research Center of Oncology
| | - A. F. Mukeria
- N.N. Blokhin National Medical Research Center of Oncology
| |
Collapse
|
25
|
Dzinamarira T, Moyo E, Dzobo M, Mbunge E, Murewanhema G. Cervical cancer in sub-Saharan Africa: an urgent call for improving accessibility and use of preventive services. Int J Gynecol Cancer 2022; 33:592-597. [PMID: 36368710 DOI: 10.1136/ijgc-2022-003957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sub-Saharan Africa has the highest rates of cervical cancer in the world, largely attributed to low cervical cancer screening coverage. Cervical cancer is the most common cause of death among women in 21 of the 48 countries in sub-Saharan Africa. Close to 100% of all cases of cervical cancer are attributable to Human papillomavirus (HPV). HPV types 16 and 18 cause at least 70% of all cervical cancers globally, while types 31, 33, 45, 52, and 58 cause a further 20% of the cases. Women living with HIV are six times more likely to develop cervical cancer than those without HIV. Considering that sub-Saharan Africa carries the greatest burden of cervical cancer, ways to increase accessibility and use of preventive services are urgently required. With this review, we discuss the preventive measures required to reduce the burden of cervical cancer in sub-Saharan Africa, the challenges to improving accessibility and use of the preventive services, and the recommendations to address these challenges.
Collapse
Affiliation(s)
- Tafadzwa Dzinamarira
- Department of Public Health, University of Pretoria, Pretoria, South Africa
- ICAP at Columbia University, Harare, Zimbabwe
| | - Enos Moyo
- Department of Public Health, Oshakati Medical Centre, Oshakati, Namibia
| | - Mathias Dzobo
- Department of Public Health, University of Pretoria, Pretoria, South Africa
| | - Elliot Mbunge
- Department of Information Technology, University of Eswatini, Kwaluseni, Swaziland
| | - Grant Murewanhema
- Unit of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
| |
Collapse
|
26
|
Man I, Georges D, de Carvalho TM, Ray Saraswati L, Bhandari P, Kataria I, Siddiqui M, Muwonge R, Lucas E, Berkhof J, Sankaranarayanan R, Bogaards JA, Basu P, Baussano I. Evidence-based impact projections of single-dose human papillomavirus vaccination in India: a modelling study. Lancet Oncol 2022; 23:1419-1429. [PMID: 36174583 PMCID: PMC9622421 DOI: 10.1016/s1470-2045(22)00543-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the high burden of cervical cancer, access to preventive measures remains low in India. A single-dose immunisation schedule could facilitate the scale-up of human papillomavirus (HPV) vaccination, contributing to global elimination of cervical cancer. We projected the effect of single-dose quadrivalent HPV vaccination in India in comparison with no vaccination or to a two-dose schedule. METHODS In this modelling study, we adapted an HPV transmission model (EpiMetHeos) to Indian data on sexual behaviour (from the Demographic and Health Survey and the Indian National AIDS Control Organisation), HPV prevalence data (from two local surveys, from the states of Tamil Nadu and West Bengal), and cervical cancer incidence data (from Cancer Incidence in Five Continents for the period 2008-12 [volume XI], and the Indian National Centre for Disease Informatics and Research for the period 2012-16). Using the model, we projected the nationwide and state-specific effect of HPV vaccination on HPV prevalence and cervical cancer incidence, and lifetime risk of cervical cancer, for 100 years after the introduction of vaccination or in the first 50 vaccinated birth cohorts. Projections were derived under a two-dose vaccination scenario assuming life-long protection and under a single-dose vaccination scenario with protection duration assumptions derived from International Agency for Research on Cancer (IARC) India vaccine trial data, in combination with different vaccination coverages and catch-up vaccination age ranges. We used two thresholds to define cervical cancer elimination: an age-standardised incidence rate of less than 4 cases per 100 000 woman-years, and standardised lifetime risk of less than 250 cases per 100 000 women born. FINDINGS Assuming vaccination in girls aged 10 years, with 90% coverage, and life-long protection by two-dose or single-dose schedule, HPV vaccination could reduce the prevalence of HPV16 and HPV18 infection by 97% (80% UI 96-99) in 50 years, and the lifetime risk of cervical cancer by 71-78% from 1067 cases per 100 000 women born under a no vaccination scenario to 311 (80% UI 284-339) cases per 100 000 women born in the short term and 233 (219-252) cases per 100 000 women born in the long term in vaccinated cohorts. Under this scenario, we projected that the age-standardised incidence rate threshold for elimination could be met across India (range across Indian states: 1·6 cases [80% UI 1·5-1·7] to 4·0 cases [3·8-4·4] per 100 000 woman-years), while the complementary threshold based on standardised lifetime risk was attainable in 17 (68%) of 25 states, but not nationwide (range across Indian states: 207 cases [80% UI 194-223] to 477 cases [447-514] per 100 000 women born). Under the considered assumptions of waning vaccine protection, single-dose vaccination was projected to have a 21-100% higher per-dose efficiency than two-dose vaccination. Single-dose vaccination with catch-up for girls and women aged 11-20 years was more impactful than two-dose vaccination without catch-up, with reduction of 39-65% versus 38% in lifetime risk of cervical cancer across the ten catch-up birth cohorts and the first ten routine vaccination birth cohorts. INTERPRETATION Our evidence-based projections suggest that scaling up cervical cancer prevention through single-dose HPV vaccination could substantially reduce cervical cancer burden in India. FUNDING The Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Irene Man
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France.
| | - Damien Georges
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France
| | - Tiago M de Carvalho
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands
| | | | | | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | | | - Richard Muwonge
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France
| | - Eric Lucas
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France
| | - Johannes Berkhof
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands
| | | | - Johannes A Bogaards
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France
| | - Iacopo Baussano
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France
| |
Collapse
|
27
|
Li H, Xiao Z, Xing B, Wu S, Wang Y, Liu Z, Zeng Y, Mushi JC, Sun H, Li P. Association between common vaginal and HPV infections and results of cytology test in the Zhoupu District, Shanghai City, China, from 2014 to 2019. Virol J 2022; 19:127. [PMID: 35906702 PMCID: PMC9338504 DOI: 10.1186/s12985-022-01850-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/08/2022] [Indexed: 12/12/2022] Open
Abstract
Background HPV (human papillomavirus) is an important cause of cervical cancer. Cervical-vaginal infection with pathogens, such as herpes simplex virus (HSV), bacterial vaginosis Trichomonas vaginalis and vaginal candidiasis could be a cofactor. This study aimed to assess the relationship between vaginal infection with HPV genotype and cytology test results and analyze the relationship between vaginal and HPV infections and cervical cancer. Methods We performed a district-based study to elucidate the relationship among the vaginal and HPV infections and cervical cancer. We collected the cervical exfoliation data of 23,724 women admitted to the Shanghai Zhoupu Hospital and received ThinPrep cytology test (TCT) and HPV detection between 2014 and 2019. Results Total vaginal infection rate was 5.3%, and the HPV-positive group had a slightly higher vaginal infection rate than the HPV-negative group (P < 0.01). The incidence rate of cervical intraepithelial neoplasia or cervical cancer with vaginal infection was higher than without vaginal infection (P < 0.001). Conclusion HPV/vaginal infection-positive women tended to have abnormal results of TCT. Women with vaginal infection were more likely to develop HPV infection. HSV combined with HPV infection was noted as a causal factor for HSIL. Supplementary Information The online version contains supplementary material available at 10.1186/s12985-022-01850-x.
Collapse
Affiliation(s)
- Huaping Li
- Department of Obstetrics and Gynecology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, No.1500 zhouyuan Road, Pudong New District, Shanghai, 201318, China
| | - Zhengguang Xiao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, China
| | - Baoling Xing
- Department of Obstetrics and Gynecology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, No.1500 zhouyuan Road, Pudong New District, Shanghai, 201318, China
| | - Suqin Wu
- Department of Obstetrics and Gynecology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, No.1500 zhouyuan Road, Pudong New District, Shanghai, 201318, China
| | - Ying Wang
- Department of Obstetrics and Gynecology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, No.1500 zhouyuan Road, Pudong New District, Shanghai, 201318, China
| | - Zhou Liu
- Department of Obstetrics and Gynecology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, No.1500 zhouyuan Road, Pudong New District, Shanghai, 201318, China
| | - Yanan Zeng
- College of Information and Communication Technologies (CoICT), University of Dar Es Salaam, 14113, Dar es Salaam, Tanzania
| | - Joseph Cosmas Mushi
- College of Medical Instrumentation, Shanghai University of Medicine & Health Sciences, No.279 Zhouzhu, Pudong New District, Shanghai, 201318, China
| | - Hudie Sun
- Sino-European School of Technology, Shanghai University, No.99 Shangda Road, Baoshan District, Shanghai, 200444, China
| | - Ping Li
- College of Information and Communication Technologies (CoICT), University of Dar Es Salaam, 14113, Dar es Salaam, Tanzania.
| |
Collapse
|
28
|
Zaridze DG, Stilidi IS, Maksimovich DM, Dzitiev DM. Prognosis of incidence and mortality from cervical cancer in Russia depending on vaccination against HPV. Public Health 2022. [DOI: 10.21045/2782-1676-2022-2-2-4-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human papilloma virus (HPV) is carcinogenic to humans and causes cervical cancer, as well as cancers of the vagina, vulva, penis, anus and oropharynx both in men and women. Based on this evidence the vaccines against HPV have been developed, registered and a recommended for use. These include bivalent vaccine (CERVARIX), quadrivalent vaccine (GARDASIL) and nonavalent vaccine (GARDASIL9). The effectiveness and safety of these vaccines were shown in the randomized clinical trials as well as in the real life in the countries where vaccination of girls aged 12–13 years was started in 2007–8. Vaccination prevents: a) HPV infection among vaccinated, b) cervical intraepithelial neoplasia (CIN) and c) invasive cervical cancer.World health organization (WHO) strategy to eliminate cervical cancer proposes the following targets that must be met by 2030: 90% of girls fully vaccinated by age 15; 70% women screened by 35 and again in 45 years of age. The goal of WHO is the decrease cervical cancer incidence to 4 cases per 100 000 population.In Russia the incidence of cervical cancer is on increase since early 1990 s and further rise is predicted. Mortality from cervical cancer has slightly increased in early 1990 s and since has stabilized. In 2019 the incidence (age standardized rates) of cervical cancer was 15,4 and mortality 5,6 per 100 000 population. The number of newly diagnosed cases was 17 500 and amount of dearth from cervical cancer – 6300.In this paper we assess the number of the preventable cervical cancer cases and death from this disease in women aged 15–79 years during the forthcoming years of 21 century as a result of the HPV vaccination of girls born in 2009–2018, 2019–28, 2029–2038. The prognosis is based on the incidence and mortality from cervical cancer in 2018 and predicted rates for 2032. Our assumption was that of 90% of girls under 15 years will be covered by vaccination and the effectiveness of vaccination will be 79,80% in decrease of the HPV prevalence.The estimates based on 2018 statistics suggest that among women born in 2009–2038 years – 348 850 will be diagnosed with cervical cancer and 117 862 will die from it. The timely vaccination of 90% of girls will prevent 250544 cases and 84648 deaths from cervical cancer. Based on the estimated incidence and mortality for 2032 among these cohorts of women 470 729 will be diagnosed with and 130 811will die from cervical cancer. vaccination will prevent 338 078 cases of disease and save 93 948 lives.We have shown that vaccination results in the decrease in incidence and mortality from cervical cancer and will save hundred thousands of lives. This is the strongest argument for urgent implementation of vaccination program in Russia. An additional important task is the assessment of economic impact of vaccination in comparison with the heavy burden imposed by disease and deaths from cervical cancer. The financial losses due to high incidence and mortality from cervical cancer or any other disease in addition to the costs of treatment include demographic and social factors. The latter will have largest impact on the economy and wellbeing of the country.Therefore the next step of our study will be the analyses of the cost-effectiveness of HPV vaccination in the cohort of 24 million women born in 2009–2038 based on the predicted in this paper incidence and mortality of cervical cancer and number of disease and deaths that will be prevented by vaccination.
Collapse
Affiliation(s)
- D. G. Zaridze
- N. N. Blokhin National Medical Research Center of Oncology
| | - I. S. Stilidi
- N. N. Blokhin National Medical Research Center of Oncology
| | | | - D. M. Dzitiev
- N. N. Blokhin National Medical Research Center of Oncology
| |
Collapse
|
29
|
Liu J, Li Y, Bo D, Wang J, Wang Y. High-risk human papillomavirus infection in pregnant women: a descriptive analysis of cohorts from two centers. J Investig Med 2022; 70:1494-1500. [PMID: 35728867 DOI: 10.1136/jim-2022-002442] [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: 06/01/2022] [Indexed: 11/03/2022]
Abstract
The aim was to descriptively analyze the clinical characteristics, cytopathology, and outcomes of pregnant patients with high-risk human papillomavirus (HPV) infection. Clinical data of 151,516 female patients with high-risk HPV infection were retrospectively collected. Baseline data, cervical cytology results, histopathology, HPV types, delivery mode, and follow-up outcomes were recorded for descriptive analysis. A total of 157 patients were identified as positive for high-risk HPV. There were 32 (24.2%), 6 (4.5%), and 107 (81.1%) cases of HPV-16, HPV-18, and other types, respectively. Additionally, 12 patients showed combined infection with HPV-18 or HPV-16 and other types. Cytopathological examinations showed that the most common type was low-grade squamous intraepithelial lesion (LSIL; 104 cases, 78.8%), followed by high-grade squamous intraepithelial lesion (HSIL; 17 cases, 12.8%), atypical squamous cells of undetermined significance (10 cases, 9.6%), and cervical cancer (1 case, 0.7%). Thirty-seven patients underwent colposcopic biopsy, of whom 9 (24.3%) showed normal results, while 12 (32.4%) and 13 (35.1%) patients had LSIL and HSIL, respectively. χ2 tests demonstrated that different delivery modes did not show significant difference in patients' cervical cytopathology (p>0.05). However, therapeutic methods were statistically different among patients with different cytopathological types (p<0.05). Cervical alterations in pregnancy mostly go along with high-risk HPV infection. High-risk HPV infection in pregnancy with abnormal cervical cytology should be followed closely during the pregnancy and postpartum period.
Collapse
Affiliation(s)
- Jing Liu
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yuhong Li
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Di Bo
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jiandong Wang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yudong Wang
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
30
|
Cai C, Peng X, Zhang Y. Serum IL-6 Level Predicts the Prognosis and Diagnosis in Cervical Cancer Patients. Int J Womens Health 2022; 14:655-663. [PMID: 35547839 PMCID: PMC9081182 DOI: 10.2147/ijwh.s347740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background Interleukin-6 (IL-6) has been reported to be associated with the prognosis of cancers. As for cervical cancer (CC), previous studies investigated the association between IL-6 expression in CC tumor tissue and CC prognosis; however, no studies assessed the effects of serum IL-6 levels on the survival of CC. This study aimed to explore the effects of serum IL-6 levels on prognosis in patients with CC. Methods In total, 327 patients with CC and 355 controls were recruited from this hospital from May 2015 to May 2016. Serum IL-6 levels were measured before treatment. The Kaplan–Meier method was utilized to estimate survival rates. The overall survival (OS) and disease-free survival (DFS) were evaluated. The univariate and multivariate Cox regression analyses were used to identify risk factors associated with the prognosis of CC. Results We found that the serum IL-6 level in the CC group was significantly higher than that in the control group. The diagnostic value of serum IL-6 level in detecting CC patients was moderate, and the specificity and sensitivity were 77.46% and 47.09%, respectively. Data suggested that the serum IL-6 level was significantly linked with the smoking status, FIGO stage, tumor size, treatment methods, and HPV infection. The univariate and multivariate analysis indicated that FIGO stage IIB-IIIC, lymph node metastasis, and high serum IL-6 levels were negatively associated with the OS and DFS in patients with CC. Conclusion Serum IL-6 has a moderate diagnostic ability for detecting CC and may be a potential CC biomarker. High serum IL-6 level is associated with adverse prognosis in patients with CC and could be a prognosis indicator for CC patients.
Collapse
Affiliation(s)
- Chunyan Cai
- Department of Gynaecology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, People's Republic of China
| | - Xing Peng
- Department of Gynaecology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, People's Republic of China
| | - Yumei Zhang
- Department of Gynaecology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, People's Republic of China
| |
Collapse
|
31
|
Fakhrolmobasheri M, Mousavi Seresht L. Cost-Effectiveness of HPV vaccination; Need for Economic and Social Policy Intervention. ARCHIVES OF IRANIAN MEDICINE 2022; 25:343-346. [PMID: 35943012 DOI: 10.34172/aim.2022.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/27/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Mohammad Fakhrolmobasheri
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Mousavi Seresht
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
32
|
Jiang L, Wang X. The miR-133b/brefeldin A-inhibited guanine nucleotide-exchange protein 1 (ARFGEF1) axis represses proliferation, invasion, and migration in cervical cancer cells. Bioengineered 2022; 13:3323-3332. [PMID: 35048795 PMCID: PMC8973932 DOI: 10.1080/21655979.2022.2027063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Cervical cancer is a common gynecological malignancy, and miR-133b is an abnormally expressed cervical cancer gene, which suggests that miR-133b may be involved in the occurrence and development of cervical cancer. However, the underlying mechanism is still unclear. miR-133b was overexpressed or silenced in the cervical cancer cell line C33A. Brefeldin A-inhibited guanine nucleotide-exchange protein 1 (ARFGEF1) was combined with overexpression of miR-133b in C33A cells. Cell Counting Kit-8, clone formation, and Transwell assays were performed to determine the influence of miR-133b and ARFGEF1 on clone formation, proliferation, migration, and invasion of C33A cells. The interaction between miR-133b and ARFGEF1 was verified using a luciferase reporter assay. Finally, the mRNA and protein expression of miR-133b and ARFGEF1 in the tumor and adjacent normal tissues of cervical cancer patients was detected by real-time quantitative PCR, Western blotting, and immunohistochemistry. The results indicated that miR-133b up-regulation suppressed the proliferation, invasion, migration, and clone formation abilities of C33A cells (P < 0.05). However, silence of miR-133b promoted the proliferation, invasion, and migration of C33A cells (P < 0.05). Clone formation ability of C33A cells was also elevated by miR-133b deficiency (P < 0.05). Moreover, miR-133b interacted with ARFGEF1 and repressed ARFGEF1 expression in C33A cells (P < 0.05). ARFGEF1 overexpression weakened miR-133b overexpression-mediated inhibition of proliferation, invasion, and migration of C33A cells (P < 0.05). miR-133b expression was decreased, and ARFGEF1 was up-regulated in tumor tissues of cervical cancer patients (P < 0.05). All results revealed that miR-133b suppresses cervical cancer progression by inhibiting proliferation, invasion, and migration of cervical cancer cells via targeting ARFGEF1. Thus, our study determined the mechanism of miR-133b in cervical cancer, and confirmed miR-133b/ARFGEF1 may become a potential therapeutic target for cervical cancer.
Collapse
Affiliation(s)
- Lingling Jiang
- Department of Gynaecology and Obstetrics, First People's Hospital of Wenling, Wenling, Zhejing, China
| | - Xuexin Wang
- Department of Gynaecology and Obstetrics, First People's Hospital of Wenling, Wenling, Zhejing, China
| |
Collapse
|
33
|
Liu CH, Kung YH, Chien-Fu Lin J, Chuang CM, Wu HH, Jiang LY, Shih YC, Wang PH, Chen YJ. Synergistic therapeutic effect of low-dose bevacizumab with cisplatin-based chemotherapy for advanced or recurrent cervical cancer. J Chin Med Assoc 2021; 84:1139-1144. [PMID: 34610623 DOI: 10.1097/jcma.0000000000000629] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cisplatin-based chemotherapy (CBC) is highly efficacious for advanced cervical cancer; its efficacy can be enhanced by combining with 15 mg/kg (standard dose) bevacizumab (BEV). However, this standard dose is associated with various adverse events (AEs). Therefore, in this retrospective study, we analyzed the survival outcomes and AEs in patients with advanced or recurrent cervical cancer treated with CBC in combination with BEV 7.5 mg/kg. METHODS Registered patient data were retrieved between October 2014 and September 2019, and 64 patients with advanced or recurrent cervical cancer treated with CBC + BEV (n = 21) or CBC alone (n = 43) were analyzed. The primary endpoints were progression-free survival (PFS) and overall survival (OS); the secondary endpoints were the frequency and severity of AEs. The Cox proportional-hazards model was applied to explore prognostic factors associated with PFS and OS. RESULTS The 1-, 2-, and 3-year PFS rates (95% CI) were 36.24% (22.0-50.5), 20.7% (9.8-34.2), and 17.7% (7.7-31.1) for the CBC group; and 71.4% (47.1-86.0), 51.0% (27.9-70.1), and 51.0% (27.9-70.1) for the CBC + BEV group, respectively. The 1-, 2-, and 3-year OS rates were 62.6% (46.4-75.18), 32.4% (18.8-46.9), and 23.2% (11.2-37.6) for the CBC group; and 85.7% (61.9-95.1), 66.6% (42.5-82.5), and 55.5% (27.1-76.7) for the CBC + BEV group, respectively. The CBC + BEV group presented higher PFS and OS rates, p = 0.003 and p = 0.005, respectively. Proteinuria (6 vs 9, p = 0.025) and hypertension (0 vs 10, p < 0.001) were less common, but anemia was more common in the CBC group (35 vs 11, p = 0.021). CONCLUSION Overall, CBC + BEV significantly improved the PFS and OS compared with CBC alone. CBC + BEV also prevents severe AEs and hence is an efficacious and safe therapeutic option.
Collapse
Affiliation(s)
- Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yen-Hsuan Kung
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jeff Chien-Fu Lin
- Department of Statistics, National Taipei University, Taipei, Taiwan, ROC
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chi-Mu Chuang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hua-Hsi Wu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ling-Yu Jiang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ying-Chu Shih
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| |
Collapse
|
34
|
Bai Y, Rong L, Hu B, Ma X, Wang J, Chen H. The Combination of T Stage and the Number of Pathologic Lymph Nodes Provides Better Prognostic Discrimination in Early-Stage Cervical Cancer With Lymph Node Involvement. Front Oncol 2021; 11:764065. [PMID: 34804967 PMCID: PMC8602848 DOI: 10.3389/fonc.2021.764065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Stage I and II cervical cancer with pelvic and/or para-aortic lymph node (LN) metastases are upstaged to stage IIIC under the new FIGO 2018 staging system, and radical chemoradiotherapy was recommended. But heterogeneity in outcome existed in this group of patients. We conducted this retrospective analysis to evaluate the heterogeneity of these patients and tried to provide a more detailed classification to reflect the prognosis and guide the treatment. We also evaluated the efficacy and toxicity of surgery followed by sequential chemoradiotherapy in this cohort. Methods Early-stage cervical cancer with LN involvement that had radical hysterectomy followed by sequential chemoradiotherapy were retrospectively analyzed. Survival analyses were conducted to identify the prognostic factors. Results A total of 242 patients were included in the study; 64 (26.4%) patients had treatment failure, and 51 (21.1%) died. Pathology, T stage, the number of pathologic LN (pLN), and neoadjuvant chemotherapy or not were independent prognostic factors for disease-free survival and overall survival (OS). Patients with T1N < 3 pLN had significantly better survival than T2N < 3 pLN/T1-2 N≥ 3 pLN, with failure rates of 11.6% and 35.8% in each group; and 5 year OS was 92% and 62%, respectively (P = 0.000). About 1.5% of the patients discontinued radiotherapy, and 14.1% had G3-4 hematological toxic effects during radiotherapy; 1.7% developed G2-3 lower limb edema, and 2.9% developed severe urinary toxicity. Conclusion Nodal involvement alone is inadequate as the sole pathologic factor to predict survival in early-stage cervical cancer. The combination of tumor and node subcategory provides better prognostic discrimination.
Collapse
Affiliation(s)
- Yongrui Bai
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Ling Rong
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Bin Hu
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiumei Ma
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jiahui Wang
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Haiyan Chen
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| |
Collapse
|
35
|
Junejo MH, Sheikh UA. Human papillomavirus-Inequalities in disease prevention and the impact on racial, ethnic, sexual, and gender minorities. Pediatr Dermatol 2021; 38 Suppl 2:170-173. [PMID: 34351009 DOI: 10.1111/pde.14740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HPV, a sexually transmitted viral infection, is the etiological agent of significant dermatologic disease including benign anogenital warts and invasive cancers. Sexual and gender minority individuals are particularly vulnerable to HPV-associated disease due to reduced vaccination rates in these cohorts, low awareness of HPV, lack of provider recommendation, and inadequate consensus guidelines on screening and prevention in these individuals. A targeted approach is needed with regards to vaccination in all children -especially those from racial, ethnic, sexual, and gender minorities; provider recommendation, especially from pediatric dermatologists, is crucial. Effort must also be made to use transgender and non-binary affirming language as dividing vaccination programs by anatomic sex and sexuality reinforces problematic notions of gender identity and sexuality, isolating the most vulnerable.
Collapse
Affiliation(s)
- Muhammad Hyder Junejo
- Department of Dermatology, Homerton University Hospital, London, UK.,Homerton Anogenital Neoplasia Service, Homerton University Hospital, London, UK
| | - Umar Ahmad Sheikh
- Section of Dermatology, University of Chicago Medical Center, Chicago, IL, USA
| |
Collapse
|
36
|
Abstract
Since the publication of the 2018 FIGO Cancer Report, giant strides have been made in the global effort to reduce the burden of cervical cancer, with the World Health Organization (WHO) rolling out a global strategy for cervical cancer elimination, aiming for implementation by 2030. In over 130 countries, including low- and middle-income countries, HPV vaccination is now included in the national program. Screening has seen major advances with wider implementation of HPV testing. These interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. FIGO's revised staging of cervical cancer (2018) has been widely implemented and retrospective analyses of data based on the new staging have been published. Minimally invasive surgery has been shown to be disadvantageous in women with cervical cancer. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.
Collapse
Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and GynecologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Daisuke Aoki
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
| | - Daya Nand Sharma
- Department of Radiation OncologyAll India Institute of Medical SciencesNew DelhiIndia
| | | |
Collapse
|
37
|
Mahantshetty U, Lavanya G, Grover S, Akinfenwa CA, Carvalho H, Amornwichet N. Incidence, Treatment and Outcomes of Cervical Cancer in Low- and Middle-income Countries. Clin Oncol (R Coll Radiol) 2021; 33:e363-e371. [PMID: 34274204 DOI: 10.1016/j.clon.2021.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 12/23/2022]
Abstract
Cervical cancer is one of the most common cancers in developing nations. It has had a tremendous impact on the lifetime of millions of women over the last century and continues to do so. In this collaborative clinicians' review, we highlight the incidence, treatment and clinical outcomes of cervical cancer in low-income (LICs) and low- and middle-income countries (LMICs) across Asia, South America, South Africa and Eastern Europe. With the cervical cancer burden and locally advanced cancers being high, the majority of LICs/LMICs have been striving to adhere to optimal evaluation and treatment guidelines. However, the huge gap in resource availability, rural versus urban disparity and access to resources have led to poor compliance to evaluation, treatment and post-treatment rehabilitation. To mitigate the overwhelming numbers, various treatment strategies like neoadjuvant chemotherapy, hypofractionation radiation schedules (both external and brachytherapy) have been attempted with no major success. Also, the compliance to concurrent chemoradiation in various regions is a major challenge. With the burden of advanced cancers, the lack of palliative care services and their integration in cancer care is still a reality.
Collapse
Affiliation(s)
- U Mahantshetty
- Radiation Oncology Homi Bhabha Cancer Hospital and Research Centre (a Unit of Tata Memorial Centre, Mumbai), Visakhapatnam, India.
| | - G Lavanya
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - S Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Botswana-UPENN Partnership, Gaborone, Botswana
| | - C A Akinfenwa
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - H Carvalho
- Department of Radiology and Oncology, Radiotherapy Division, University of São Paulo, São Paulo, Brazil; Department of Radiotherapy - Hospital Sírio-Libanês, São Paulo, Brazil
| | - N Amornwichet
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn, University, Bangkok, Thailand
| |
Collapse
|
38
|
Santamaría-Ulloa C, Quirós-Rojas I, Montero-López M, Quesada-Leitón H. Women's Participation in Pap Smear Screening in a Developing Country: Evidence for Improving Health Systems. Front Oncol 2021; 11:642841. [PMID: 34211837 PMCID: PMC8239285 DOI: 10.3389/fonc.2021.642841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Every year about 83,000 women are diagnosed with cervical cancer in the Americas. Latin America and the Caribbean (LAC) has one of the highest incidence and mortality rates from cervical cancer in the world. Although incidence has decreased by half in the last 30 years, cervical cancer remains a public health concern. The detection of precursor lesions through Papanicolaou (Pap) smear remains a critical tool in the context of prevention in Costa Rica and many other LAC countries. Objective To determine predictors of participation in Pap smear screening among Costa Rican women, with a special focus on women who have never had a Pap smear or have had a smear 5 or more years ago. Methods The data source for this study is the Costa Rican Households National Survey conducted in 2014. This survey is representative at the national, urban/rural zone, and administrative region level. A subsample of women aged 20 to 69 years who responded to the survey's Papanicolaou Module were included in this study (n = 11,709). Statistical analyses were conducted in R-Studio. Statistical significance level was set at 5%. Two multinomial regression models were estimated. The first model aimed to explain the five different categories of cytology use, which were defined according to the last time women had a Pap smear. The second model aimed to explain the five different categories of reasons why women had never had a Pap smear. Both models controlled for age, educational attainment, and marital status. Results Young women with high educational attainment were more likely to have never had a cytology. Women with a lower educational attainment, married, or in domestic relationship and of older age had greater odds of having had a cytology 5 or more years ago. Each year increment in age was significantly associated with an increase in the odds of never having a Pap smear because of health care access issues or because of cultural reasons as compared to not having an active sexual life. Conclusions Findings can inform public policy targeted to higher risk female populations where access to health services can be improved.
Collapse
Affiliation(s)
| | - Ileana Quirós-Rojas
- Coordinacion Tecnica del Cancer, Caja Costarricense del Seguro Social, San Jose, Costa Rica
| | - Melina Montero-López
- Instituto de Investigaciones en Salud, Universidad de Costa Rica, San Jose, Costa Rica
| | | |
Collapse
|
39
|
Verrier F, Le Coeur S, Delory T. Cervical Human Papillomavirus Infection (HPV) and High Oncogenic Risk Genotypes among Women Living with HIV in Asia: A Meta-Analysis. J Clin Med 2021; 10:jcm10091911. [PMID: 33924989 PMCID: PMC8125216 DOI: 10.3390/jcm10091911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 12/14/2022] Open
Abstract
Women living with HIV (WLHIV) are prone to harbor several high-risk human papillomavirus (HR-HPV) genotypes and to develop cervical cancerous lesions. Data on HPV prevalence in these women are needed to inform immunization programs, especially in Asia where few data are available. We conducted a systematic review and meta-analysis to estimate the prevalence of HPV and HR-HPV cervical infection in WLHIV in Asia and identify possible sources of heterogeneity for HR-HPV carriage. Pooled prevalence and its 95% confidence interval (95CI) were estimated using the inverse-variance weighting method. Linear regression weighted on study size was used to identify sources of heterogeneity. Among 7834 WLHIV (40 studies), the prevalence of HPV infection was 42.6% (95CI, 38.2% to 47.1%), and 34.6% (95CI, 30.3% to 39.1%) harbored HR-HPV genotypes, with significant heterogeneity across countries. In India, Thailand, and China, HPV-16 was the most frequent genotype (10.3%), followed by HPV-52 (5.4%), HPV-58 (5.0%), HPV-18 (4.1%), and HPV-33 (3.3%). In these women, most of whom were receiving antiretroviral therapy, we did not identify determinants of heterogeneity for HR-HPV infection. Our results underline the need for immunization programs based on nonavalent or new generation vaccines to prevent cervical cancer in WLHIV in Asia.
Collapse
Affiliation(s)
- Florian Verrier
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (S.L.C.); (T.D.)
- Institut National d’Etudes Démographiques (INED), 9 Cours des Humanités, 93322 Aubervilliers, France
- Institut de Recherche Pour le Développement (IRD) UMI 174-PHPT, 13002 Marseille, France
- Correspondence:
| | - Sophie Le Coeur
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (S.L.C.); (T.D.)
- Institut National d’Etudes Démographiques (INED), 9 Cours des Humanités, 93322 Aubervilliers, France
- Institut de Recherche Pour le Développement (IRD) UMI 174-PHPT, 13002 Marseille, France
| | - Tristan Delory
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (S.L.C.); (T.D.)
- Institut National d’Etudes Démographiques (INED), 9 Cours des Humanités, 93322 Aubervilliers, France
- Institut de Recherche Pour le Développement (IRD) UMI 174-PHPT, 13002 Marseille, France
- Délégation à la Recherche Clinique et à l’Innovation (DRCI), Centre Hospitalier Annecy-Genevois, 74370 Epargny Metz-Tessy, France
| |
Collapse
|