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Oringtho S, Mwaka AD, Garimoi Orach C, Wabinga H. Awareness of cervical cancer risk factors and preventive approaches, and perceived causes of cervical cancer among secondary school girls: a cross-sectional study in Northern Uganda. Ann Med 2024; 56:2374860. [PMID: 38975806 DOI: 10.1080/07853890.2024.2374860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/18/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The majority of women in low- and middle-income countries have low awareness of cervical cancer. This study sought to establish awareness of cervical cancer risk factors and preventive approaches, as well as sources of information and perceived causes of cervical cancer among secondary school girls in northern Uganda. METHODS This was a cross-sectional study conducted in rural northern Uganda. We collected data using an investigator administered pre-tested questionnaire. Analysis was done with STATA version 14.0. Multivariate analyses with logistic regressions models were used to determine magnitudes of association between independent and outcome variables. Odds ratios and accompanying 95% confidence intervals are reported. Statistical significance was considered if the two sided p-value <.05. RESULTS Most participants (97%; n = 624) had heard of cervical cancer before this study. The most common source of information about cervical cancer was friends (31.1%; n = 194). More than half of the participants (59%; n = 380) had heard about a vaccine that prevents cervical cancer, but only a third (33%; n = 124) had ever received a dose of the vaccine. The majority of participants (89%; n = 550) reported that cervical cancer could be prevented; however only half (52%; n = 290) knew that vaccination of girls aged 9-13 years could prevent cervical cancer. The majority of participants did not recognize the risk factors for cervical cancer; for example, only 15% (n = 98), 7% (n = 45), and 1.4% (n = 9) recognized early onset of sexual intercourse, infection by the human papillomavirus (HPV), and smoking respectively. On adjusting for age, students' class, and religion, students in schools with school health programs were twice (aOR = 2.24: 95%CI; 1.24-4.06) more likely to know that cervical cancer is preventable. CONCLUSION Secondary school girls need information on cervical cancer risk factors and approaches to prevention so that they may avoid exposures to the risk factors and promptly seek and undertake preventive approaches including HPV vaccinations.
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Affiliation(s)
- Stephen Oringtho
- Department of Community Health, Anaka General Hospital, Nwoya district, Gulu, Uganda
- Department of Public Health, School of Medicine, Uganda Christian University, Mukono, Uganda
| | | | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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Malagón T, Franco EL, Tejada R, Vaccarella S. Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination. Nat Rev Clin Oncol 2024; 21:522-538. [PMID: 38760499 DOI: 10.1038/s41571-024-00904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/19/2024]
Abstract
Cervical cancer is the first cancer deemed amenable to elimination through prevention, and thus lessons from the epidemiology and prevention of this cancer type can provide information on strategies to manage other cancers. Infection with the human papillomavirus (HPV) causes virtually all cervical cancers, and an important proportion of oropharyngeal, anal and genital cancers. Whereas 20th century prevention efforts were dominated by cytology-based screening, the present and future of HPV-associated cancer prevention relies mostly on HPV vaccination and molecular screening tests. In this Review, we provide an overview of the epidemiology of HPV-associated cancers, their disease burden, how past and contemporary preventive interventions have shaped their incidence and mortality, and the potential for elimination. We particularly focus on the cofactors that could have the greatest effect on prevention efforts, such as parity and human immunodeficiency virus infection, as well as on social determinants of health. Given that the incidence of and mortality from HPV-associated cancers remain strongly associated with the socioeconomic status of individuals and the human development index of countries, elimination efforts are unlikely to succeed unless prevention efforts focus on health equity, with a commitment to both primary and secondary prevention.
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Affiliation(s)
- Talía Malagón
- Department of Oncology, McGill University, Montréal, Quebec, Canada.
- St Mary's Research Centre, Montréal West Island CIUSSS, Montréal, Quebec, Canada.
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada.
| | - Eduardo L Franco
- Department of Oncology, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Romina Tejada
- Department of Oncology, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada
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Sachdeva M, Datchoua AM, Yakam VF, Kenfack B, Jonnalagedda-Cattin M, Thiran JP, Petignat P, Schmidt NC. Acceptability of artificial intelligence for cervical cancer screening in Dschang, Cameroon: a qualitative study on patient perspectives. Reprod Health 2024; 21:92. [PMID: 38937771 PMCID: PMC11212410 DOI: 10.1186/s12978-024-01828-8] [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: 08/27/2023] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Cervical cancer is the fourth most frequent cancer among women, with 90% of cervical cancer-related deaths occurring in low- and middle-income countries like Cameroon. Visual inspection with acetic acid is often used in low-resource settings to screen for cervical cancer; however, its accuracy can be limited. To address this issue, the Swiss Federal Institute of Technology Lausanne and the University Hospitals of Geneva are collaborating to develop an automated smartphone-based image classifier that serves as a computer aided diagnosis tool for cancerous lesions. The primary objective of this study is to explore the acceptability and perspectives of women in Dschang regarding the usage of a screening tool for cervical cancer relying on artificial intelligence. A secondary objective is to understand the preferred form and type of information women would like to receive regarding this artificial intelligence-based screening tool. METHODS A qualitative methodology was employed to gain better insight into the women's perspectives. Participants, aged between 30 and 49 were invited from both rural and urban regions and semi-structured interviews using a pre-tested interview guide were conducted. The focus groups were divided on the basis of level of education, as well as HPV status. The interviews were audio-recorded, transcribed, and coded using the ATLAS.ti software. RESULTS A total of 32 participants took part in the six focus groups, and 38% of participants had a primary level of education. The perspectives identified were classified using an adapted version of the Technology Acceptance Model. Key factors influencing the acceptability of artificial intelligence include privacy concerns, perceived usefulness, and trust in the competence of providers, accuracy of the tool as well as the potential negative impact of smartphones. CONCLUSION The results suggest that an artificial intelligence-based screening tool for cervical cancer is mostly acceptable to the women in Dschang. By ensuring patient confidentiality and by providing clear explanations, acceptance can be fostered in the community and uptake of cervical cancer screening can be improved. TRIAL REGISTRATION Ethical Cantonal Board of Geneva, Switzerland (CCER, N°2017-0110 and CER-amendment n°4) and Cameroonian National Ethics Committee for Human Health Research (N°2022/12/1518/CE/CNERSH/SP). NCT: 03757299.
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Affiliation(s)
- Malika Sachdeva
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Alida Moukam Datchoua
- Department of Gynaecology and Obstetrics, Dschang Regional Annex Hospital, Dschang, Cameroon
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Virginie Flore Yakam
- Department of Gynaecology and Obstetrics, Dschang Regional Annex Hospital, Dschang, Cameroon
| | - Bruno Kenfack
- Department of Gynaecology and Obstetrics, Dschang Regional Annex Hospital, Dschang, Cameroon
| | - Magali Jonnalagedda-Cattin
- Signal Processing Laboratory LTS5, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- EssentialTech Centre, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jean-Philippe Thiran
- Signal Processing Laboratory LTS5, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Patrick Petignat
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicole Christine Schmidt
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Social Science, Catholic University of Applied Science, Munich, Germany
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Zegeye FR, Legasu TD, Bayou FD, Ali MA. Uptake of cervical cancer screening and associated factors among HIV positive women attending adult art clinic at public hospitals in Addis Ababa, Ethiopia, 2022. BMC Womens Health 2024; 24:377. [PMID: 38943118 PMCID: PMC11212152 DOI: 10.1186/s12905-024-03169-x] [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: 06/19/2023] [Accepted: 05/28/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Cervical cancer is the second most common malignancy in Ethiopia and first in some African countries. It is six times more likely to occur in positive cases of the human immunodeficiency virus than in the general population. If diagnosed and treated early enough, cervical cancer is both treatable and preventable. However, among Ethiopian women who test positive for HIV, the uptake of cervical cancer screening is low. Its determinant factors were not well studied in the study area. Hence, this study was aimed at filling this information gap. OBJECTIVE To assess uptake of cervical cancer screening services and associated factors among HIV-positive women attending an adult antiretroviral treatment clinic at public hospitals in Addis Ababa, Ethiopia, June 1-30, 2022. METHODS A cross-sectional investigation was carried out in a hospital. 407 participants in all were chosen using the systematic sampling technique. A pretested interviewer-administered questionnaire was used to collect the data from respondents. The data were entered into Epi data version 4.6 and exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression analysis was employed. Adjusted odds ratio with its 95% confidence interval and p value < 0.05 were used to estimate the strength and significance of the association. RESULT Among a total of 407 respondents, 238 (58.5%), 95% CI (53.5-63.3), HIV-positive women were screened at least once in the last five years. In multivariable analysis, age > 45 years old (AOR = 0.18, 95% CI: 0.053-0.644), number of children (3 children) (AOR = 0.19, 95% CI:0.036-0.979), perception of being susceptible to cervical cancer (AOR = 6.39, 95% CI: 1.79-22.74), knowledge of cervical cancer and its screening (AOR = 19.34, 95% CI: 7.87-47.75), and positive attitude towards cervical cancer screening (AOR = 8.06, 95% CI:3.62-17.91) were significantly associated factors with the uptake of cervical cancer screening. CONCLUSION AND RECOMMENDATION in this study, Age > 45 years, having less than three children, feeling susceptible, knowing about cervical cancer and screening, and having a positive attitude toward cervical cancer screening were significant factor of uptake of cervical cancer screening service. There is a need to strengthen the policy and health education on safe sexual practices and healthy lifestyles through information dissemination and communication to scale up screening service utilization.
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Affiliation(s)
- Fenta Reta Zegeye
- Department of General public Health, Addis Ababa Medical and Business College, Addis Ababa, Ethiopia.
| | | | - Fekade Demeke Bayou
- Department of Epidemiology, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Mohammed Ahmed Ali
- Department of Midwifery, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
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Lovane L, Tulsidás S, Carrilho C, Karlsson C. PD-L1 expression in squamous cervical carcinomas of Mozambican women living with or without HIV. Sci Rep 2024; 14:12974. [PMID: 38839923 PMCID: PMC11153591 DOI: 10.1038/s41598-024-63595-7] [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: 02/09/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
Programmed death-ligand 1 (PD-L1) is overexpressed in squamous cervical cancer (SCC) and can be used for targeted immunotherapy. The highest mortality rates of SCC are reported in sub-Saharan Africa, where Human immunodeficiency virus (HIV) prevalence is high. In Mozambique most SCC patients present at advanced stages. Thus, there is a need to introduce new treatment options. However, immunocompromised patients were frequently excluded in previous clinical trials. Our aim was to determine if PD-L1 expression in SCC is as prevalent among women living with HIV (WLWH) as among other patients. 575 SCC from Maputo Central Hospital were included. HIV status was available in 266 (46%) cases PD-L1 expression was scored through tumour proportion score (TPS) and combined positive score (CPS). PD-L1 was positive in 20.1% of the cases (n = 110), TPS (score ≥ 25%) and in 26.3% (n = 144), CPS (score ≥ 1). Stratifying according to the HIV status, WLWH were TPS positive in 16.7%, compared to 20.9%, p = 0.43, and concerning CPS 21.1% versus 28.7%, p = 0.19, respectively. PD-L1 status was not influenced by stage, Ki-67 or p16, CD8 expression influenced only CPS status. Our data indicates that the documented effect of PD-L1 therapy on SCC should be confirmed in randomized clinical trials in an HIV endemic milieu.
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Affiliation(s)
- Lucília Lovane
- Pathology Department, Maputo Central Hospital, Maputo, Mozambique.
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
| | - Satish Tulsidás
- Medical Oncology Service, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Pathology Department, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Christina Karlsson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Chandeying N, Thongseiratch T. Clinician Communication Training to Increase Human Papillomavirus Vaccination Uptake: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2024; 12:611. [PMID: 38932340 PMCID: PMC11209355 DOI: 10.3390/vaccines12060611] [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: 04/21/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
The battle against Human Papillomavirus (HPV)-related cancers is hindered by suboptimal vaccination rates, despite the proven efficacy and availability of vaccines. This systematic review and meta-analysis addressed this issue by evaluating the impact of clinician communication training on increasing HPV vaccination uptake among adolescents. From an initial pool of 3213 records, six randomized controlled trials involving 245,195 participants across the United States were rigorously selected and analyzed. Our findings indicated that clinician communication training could enhance vaccination uptake rates by an average of 5.2%. Specifically, presumptive communication strategies, which proactively assume a patient's acceptance of vaccination, achieved a significant 9.1% increase in uptake, markedly outperforming the 2.3% increase observed with more passive conversational techniques. Moreover, interventions that incorporated audit and feedback processes were particularly impactful, boosting vaccination rates by 9.4%. The most striking results emerged from combining presumptive communication with audit and feedback, which propelled the effectiveness to an 11.4% increase in vaccination rates. These outcomes highlight the pivotal role of deliberate, targeted clinician-patient communication in improving health interventions. This study offers actionable insights for healthcare providers and policymakers to refine communication strategies, thus potentially maximizing HPV vaccination rates and mitigating the spread of HPV-related conditions.
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Affiliation(s)
- Nutthaporn Chandeying
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
| | - Therdpong Thongseiratch
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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Pizzato M, Santucci C, Parazzini F, Negri E, La Vecchia C. Cancer mortality patterns in selected Northern and Southern African countries. Eur J Cancer Prev 2024; 33:192-199. [PMID: 37997906 DOI: 10.1097/cej.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Non-communicable diseases have been rapidly increasing in African countries. We provided updated cancer death patterns in selected African countries over the last two decades. METHODS We extracted official death certifications and population data from the WHO and the United Nations Population Division databases. We computed country- and sex-specific age-standardized mortality rates per 100 000 person-years for all cancers combined and ten major cancer sites for the periods 2005-2007 and 2015-2017. RESULTS Lung cancer ranked first for male cancer mortality in all selected countries in the last available period (with the highest rates in Réunion 24/100 000), except for South Africa where prostate cancer was the leading cause of death (23/100 000). Prostate cancer ranked second in Morocco and Tunisia and third in Mauritius and Réunion. Among Egyptian men, leukemia ranked second (with a stable rate of 4.2/100 000) and bladder cancer third (3.5/100 000). Among women, the leading cancer-related cause of death was breast cancer in all selected countries (with the highest rates in Mauritius 19.6/100 000 in 2015-2017), except for South Africa where uterus cancer ranked first (17/100 000). In the second rank there were colorectal cancer in Tunisia (2/100 000), Réunion (9/100 000) and Mauritius (8/100 000), and leukemia in Egypt (3.2/100 000). Colorectal and pancreas cancer mortality rates increased, while stomach cancer mortality rates declined. CONCLUSION Certified cancer mortality rates are low on a global scale. However, mortality rates from selected screening detectable cancers, as well as from infection-related cancers, are comparatively high, calling for improvements in prevention strategies.
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Affiliation(s)
- Margherita Pizzato
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Claudia Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan
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Schmit N, Kaur J, Aglago EK. Mosquito Bed Net Use and Burkitt Lymphoma Incidence in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e247351. [PMID: 38635267 DOI: 10.1001/jamanetworkopen.2024.7351] [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] [Indexed: 04/19/2024] Open
Abstract
Importance Burkitt lymphoma (BL) is one of the most common childhood cancers in sub-Saharan Africa and is etiologically linked to malaria. However, evidence for an effect of malaria interventions on BL is limited. Objective To investigate the potential population-level association between large-scale rollout of insecticide-treated bed nets (ITNs) in sub-Saharan Africa in the 2000s and BL incidence. Data Sources In this systematic review and meta-analysis, a search was conducted in the Embase, Global Health, and Medline databases and in cancer registry publications between January 1, 1990, and February 27, 2023. Study Selection All epidemiologic studies on BL incidence rates in children and adolescents aged 0 to 15 years in sub-Saharan African countries where malaria is endemic were identified by 2 reviewers blinded to each other's decision. Data Extraction and Synthesis The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data were extracted independently by 2 reviewers, and quality was scored based on 3 predefined criteria: data collection, case ascertainment, and calculation of person-time at risk. Main Outcomes and Measures Incidence rates of BL during childhood and mean ITN use in the population. Data were analyzed using a random-effects negative binomial regression model. Results Of 2333 studies meeting selection criteria, 23 comprising 66 data points on BL incidence were included based on 5226 BL cases from locations with large-scale ITN use in 17 countries. Rates of BL were 44% (95% CI, 12%-64%) lower in the period after ITN introduction compared with before. The adjusted pooled incidence rates of BL were 1.36 (95% CI, 0.88-2.10) and 0.76 (95% CI, 0.50-1.16) per 100 000 person-years before and after introduction of ITNs, respectively. After adjusting for potential confounders, a 1-percentage point increase in mean ITN use in the population in the 10 years before BL data collection was associated with a 2% (95% CI, 1%-4%) reduction in BL incidence. Conclusions and Relevance In this systematic review and meta-analysis, large-scale rollout of ITNs in the 2000s was associated with a reduction in BL burden among children in sub-Saharan Africa. Although published data may not be representative of all incidence rates across sub-Saharan Africa, this study highlights a potential additional benefit of malaria control programs.
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Affiliation(s)
- Nora Schmit
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Jeevan Kaur
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Elom K Aglago
- Department of Epidemiology and Biostatistics, Imperial College London, School of Public Health, London, United Kingdom
- Faculty of Science and Technology, University of Kara, Kara, Togo
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Ssedyabane F, Randall TC, Kajabwangu R, Namuli A, Tusubira D, Kakongi N, Galiwango M, Maling S, Turyakira E, Atukunda EC. Development of a customized m-Health-based intervention to reduce loss to follow-up among patients undergoing treatment for cervical lesions at a rural referral Hospital, South Western Uganda. Gynecol Oncol Rep 2024; 52:101338. [PMID: 38435345 PMCID: PMC10907155 DOI: 10.1016/j.gore.2024.101338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
Background Loss to follow-up (LTFU) in individuals undergoing cervical cancer treatment is a major challenge in many low resource settings. We describe development of a customized and tailored mHealth intervention for reducing LTFU among patients undergoing cervical cancer treatment at Mbarara Regional Referral Hospital (MRRH). Methods We interviewed all health care providers (HCPs) at the cervical cancer clinic of MRRH, between April and May 2023. Transcripts were subsequently derived, reviewed and coded to generate themes and categories using inductive content analytic approach. Four medical experts used this data to develop relevant SMS content, which was incorporated into an app. Results HCPs had owned a phone for 13.8 ≤ years, had worked at the clinic for 5 ≤ years, and used text messages regularly. Qualitative data revealed that the main challenge to re-engagement was absence of a reminder mechanism between HCPs and patients. HCPs preferred text and or audio mode of messaging to improve health care responsiveness to LTFUs, awareness, continuity of care, and health service uptake among the majority illiterate population; though with potential constraints of costs and workload. Identified key messaging content included; the importance of attending scheduled follow-ups, follow up visit date and clinic customization and tailoring the message to the intended recipient. SMS content was uploaded onto the cc-follow-up app platform and customized according to preferred language, day, frequency and time of delivery. Conclusion Tailoring an mHealth messaging intervention could help re-engage and reduce LTFU through improved information sharing, awareness, responsiveness, care engagement and medical compliance. A pilot study is required for our intervention in South Western Uganda.
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Affiliation(s)
- Frank Ssedyabane
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Thomas C. Randall
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Rogers Kajabwangu
- Department of Obstetrics & Gynecology, Faculty of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Alexcer Namuli
- Department of Obstetrics & Gynecology, Faculty of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Deusdedit Tusubira
- Department of Biochemistry, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Nathan Kakongi
- Department of Biochemistry, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Martin Galiwango
- Department of Electrical and Electronics Engineering, Faculty of Applied Sciences and Technology, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Samuel Maling
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Eleanor Turyakira
- Department of Community Health, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Esther Cathyln Atukunda
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
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Khanna D, Sharma P, Budukh A, Vishwakarma R, Sharma AN, Bagal S, Tripathi V, Maurya VK, Chaturvedi P, Pradhan S. Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry. BMC Cancer 2024; 24:308. [PMID: 38448839 PMCID: PMC10916062 DOI: 10.1186/s12885-024-12041-y] [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: 12/14/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Cancer incidence and mortality vary across the globe, with nearly two-thirds of cancer-related deaths occurring in low- and middle-income countries. The rural-urban disparity in socio-demographic, behavioural, and lifestyle-related factors, as well as in access to cancer care, is one of the contributing factors. Population-based cancer registries serve as a measure for understanding the burden of cancer. We aimed to evaluate the rural-urban disparity in cancer burden and care of patients registered by an Indian population-based cancer registry. METHODS This study collected data from Varanasi, Uttar Pradesh, India, between 2017 and 2019. Sex and site-specific age-standardised rates for incidence and mortality per 100,000 population were calculated. Rural-urban disparities in cancer incidence and mortality were estimated through rate differences and standardised rate ratios (with 95% confidence intervals). Univariable and multivariable regressions were applied to determine any significant differences in socio-demographic and cancer-related variables according to place of residence (rural/urban). Crude and adjusted odds ratios with 95% confidence intervals were calculated. RESULTS 6721 cancer patients were registered during the study duration. Urban patients were older and had better literacy and socioeconomic levels, while rural patients had higher odds of having unskilled or semi-skilled professions. Diagnostic and clinical confirmation for cancer was significantly higher in urban patients, while verbal autopsy-based confirmation was higher in rural patients. Rural patients were more likely to receive palliative or alternative systems of medicine, and urban patients had higher chances of treatment completion. Significantly higher incidence and mortality were observed for oral cancer among urban men and for cervical cancer among rural women. Despite the higher incidence of breast cancer in urban women, significantly higher mortality was observed in rural women. CONCLUSIONS Low- and middle-income countries are facing dual challenges for cancer control and prevention. Their urban populations experience unhealthy lifestyles, while their rural populations lack healthcare accessibility. The distinctness in cancer burden and pattern calls for a re-evaluation of cancer control strategies that are tailor-made with an understanding of urban-rural disparities. Context-specific interventional programmes targeting risk-factor modifications, cancer awareness, early detection, and accessibility to diagnosis and care are essential.
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Affiliation(s)
- Divya Khanna
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India.
| | - Priyanka Sharma
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
| | - Atul Budukh
- Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, 400012, Mumbai, India
| | - Rajesh Vishwakarma
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
| | - Anand N Sharma
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
| | - Sonali Bagal
- Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, 400012, Mumbai, India
| | - Varsha Tripathi
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
| | - Vijay Kumar Maurya
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, 400094, Mumbai, India
| | - Satyajit Pradhan
- Department of Radiation Oncology and Director, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
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Anakwenze CP, Allanson E, Ewongwo A, Lumley C, Bazzett-Matabele L, Msadabwe SC, Kamfwa P, Shouman T, Lombe D, Rubagumya F, Polo A, Ntekim A, Vanderpuye V, Ghebre R, Kochbati L, Awol M, Gnangnon FHR, Snyman L, Fokom Domgue J, Incrocci L, Ndlovu N, Razakanaivo M, Abdel-Wahab M, Trimble E, Schmeler K, Simonds H, Grover S. Mapping of Radiation Oncology and Gynecologic Oncology Services Available to Treat the Growing Burden of Cervical Cancer in Africa. Int J Radiat Oncol Biol Phys 2024; 118:595-604. [PMID: 37979709 DOI: 10.1016/j.ijrobp.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/09/2023] [Accepted: 10/22/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To meet the demand for cervical cancer care in Africa, access to surgical and radiation therapy services needs to be understood. We thus mapped the availability of gynecologic and radiation therapy equipment and staffing for treating cervical cancer. METHODS AND MATERIALS We collected data on gynecologic and radiation oncology staffing, equipment, and infrastructure capacities across Africa. Data was obtained from February to July 2021 through collaboration with international partners using Research Electronic Data Capture. Cancer incidence was taken from the International Agency for Research on Cancer's GLOBOCAN 2020 database. Treatment capacity, including the numbers of radiation oncologists, radiation therapists, physicists, gynecologic oncologists, and hospitals performing gynecologic surgeries, was calculated per 1000 cervical cancer cases. Adequate capacity was defined as 2 radiation oncologists and 2 gynecologic oncologists per 1000 cervical cancer cases. RESULTS Forty-three of 54 African countries (79.6%) responded, and data were not reported for 11 countries (20.4%). Respondents from 31 countries (57.4%) reported access to specialist gynecologic oncology services, but staffing was adequate in only 11 countries (20.4%). Six countries (11%) reported that generalist obstetrician-gynecologists perform radical hysterectomies. Radiation oncologist access was available in 39 countries (72.2%), but staffing was adequate in only 16 countries (29.6%). Six countries (11%) had adequate staffing for both gynecologic and radiation oncology; 7 countries (13%) had no radiation or gynecologic oncologists. Access to external beam radiation therapy was available in 31 countries (57.4%), and access to brachytherapy was available in 25 countries (46.3%). The number of countries with training programs in gynecologic oncology, radiation oncology, medical physics, and radiation therapy were 14 (26%), 16 (30%), 11 (20%), and 17 (31%), respectively. CONCLUSIONS We identified areas needing comprehensive cervical cancer care infrastructure, human resources, and training programs. There are major gaps in access to radiation oncologists and trained gynecologic oncologists in Africa.
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Affiliation(s)
- Chidinma P Anakwenze
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emma Allanson
- Division of Obstetrics & Gynecology, King Edward Memorial Hospital for Women, Subiaco, Australia, and Institute for Health Research, University of Notre Dame, Fremantle, Australia
| | | | - Christian Lumley
- Office of Global Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lisa Bazzett-Matabele
- Department of Obstetrics & Gynecology, University of Botswana, Gaborone, Botswana, and Department of Obstetrics & Gynecology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Paul Kamfwa
- Gynecologic Oncology Unit, Cancer Diseases Hospital, Lusaka, Zambia
| | | | - Dorothy Lombe
- Cancer Screening, Treatment and Support Cluster, Health New Zealand, Palmerston North, New Zealand
| | - Fidel Rubagumya
- Rwanda Military Hospital, Kigali, Rwanda, and Division of Cancer Care and Epidemiology and Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Alfredo Polo
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, Department of Nuclear Sciences & Applications, International Atomic Energy Agency, Vienna, Austria
| | - Atara Ntekim
- Department of Radiation Oncology, University of Ibadan, Ibadan, Nigeria
| | - Verna Vanderpuye
- National Center for Radiotherapy, Oncology, and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology, and Women's Health and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Lofti Kochbati
- Department of Radiotherapy, Abderrahmen Mami Hospital, Tunis, Tunisia
| | - Munir Awol
- Department of Oncology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Freddy Houéhanou Rodrigue Gnangnon
- Department of Visceral Surgery, National Teaching Hospital of Cotonou, Cotonou, Benin, Department of Epidemiology of Chronic Diseases in the Tropical Zone, Institute of Epidemiology and Tropical Neurology, Limoges, France, and Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
| | - Leon Snyman
- Department Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Joël Fokom Domgue
- Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, and Faculty of Medicine and Biomedical Sciences, Department of Obstetrics and Gynecology, University of Yaoundé, Yaoundé, Cameroon
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ntokozo Ndlovu
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe, and Department of Radiotherapy and Oncology, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Malala Razakanaivo
- Department of Radiotherapy, Joseph Ravoahangy Andrianavalona University Hospital, Antananarivo, Madagascar
| | - May Abdel-Wahab
- Division of Human Health, Department of Nuclear Sciences & Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - Kathleen Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hannah Simonds
- Department of Radiation Oncology, Stellenbosch University, Cape Town, South Africa, and Department of Oncology, University Hospitals Plymouth Trust, Plymouth, United Kingdom
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Enyan NIE, Ken-Amoah S, Tuoyire DA, Akakpo KP, Agyare E, Obiri-Yeboah D. HIV status and knowledge of cervical cancer among women in Ghana. BMC Womens Health 2024; 24:112. [PMID: 38347531 PMCID: PMC10863268 DOI: 10.1186/s12905-024-02953-z] [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: 04/20/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Cervical cancer remains a disease of significant concern to women's health. The aim of this study was to identify predictors of knowledge of cervical cancer among women living with HIV and those with negative or unknown HIV status at the Cape Coast Teaching Hospital (CCTH). METHODS This study was based on a larger hospital-based analytical cross-sectional study conducted at the antiretroviral therapy (ART) and gynaecology clinics of the Cape Coast Teaching Hospital in Ghana. Participants were women living with HIV (WLHIV) and women without HIV or whose status was unknown, aged 25 to 65 years, seeking healthcare. Data were collected with a questionnaire and analysed using frequencies, percentages, Chi-square test, binary logistic regression and multivariate analysis. RESULTS The mean age was 39.5 years (± 9.8) and 47.2 years (± 10.7) for women without or unknown HIV and WLHIV, respectively. HIV-negative/unknown women were mostly nulligravida (76%) and nullipara (69%), while WLHIV mostly had pregnancies (76%) and children (84%) in excess of seven. Knowledge of cervical cancer was statistically significantly associated with HIV status (X2 = 75.65; P-value = 0.001). The odds of having knowledge of cervical cancer for women considered to be negative/unknown for HIV were about three times (AOR = 3.07; 95% CI = 1.47, 6.41) higher than their compatriots with HIV. Women with post-secondary/tertiary (AOR = 4.45; 95% CI = 2.11, 9.35) education had significantly higher odds of having knowledge of cervical cancer than those with no education or those with just primary education. CONCLUSIONS To improve knowledge of cervical cancer among women, an intentionally structured health education programme is needed, particularly for WLHIV, those with lower levels of education and the unemployed.
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Affiliation(s)
- Nancy Innocentia Ebu Enyan
- Department of Adult Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana.
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Derek Anamaale Tuoyire
- Department of Community Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Kafui Patrick Akakpo
- Department of Pathology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Dorcas Obiri-Yeboah
- Department of Microbiology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
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Ngwibete A, Ogunbode O, Swende LT, Agbada MM, Omigbodun A. Prevalence of precancerous lesions and other cervical abnormalities among internally displaced women in Benue State Nigeria. Pan Afr Med J 2024; 47:50. [PMID: 38681110 PMCID: PMC11055184 DOI: 10.11604/pamj.2024.47.50.39721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 01/17/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction visual inspection is a low-cost screening strategy that can be used to prevent cervical cancer in women. These techniques can improve screening health outcomes for internally displaced women (IDW) who have poor sexual and reproductive health and rights' behaviors and outcomes. This study aimed to determine the prevalence of precancerous lesions and other clinical features using a visual inspection with acetic acid (VIA) technique during a cervical cancer screening campaign in two internally displaced people (IDP) camps in Benue State, Nigeria. Methods this was a cross-sectional study of 166 IDW who voluntarily participated in the study during a VIA cervical cancer screening campaign in two IDP camps in Benue State, Nigeria the screening was done by a group of qualified and trained healthcare workers and data was collected using a structured, pretested questionnaire. Results a total of 99(60%) of the women had a first sexual experience at 16 years, while 78(47%) had more than 5 full-term pregnancies. Although only 72(43.4%) of the women acknowledged having more than one sexual partner, over 70% of the women stated that their sexual partner had another sexual partner. The prevalence of precancerous lesions among women was 10.8%. Smoking(p=0.003), age at menarche (p≤ 0.001) and sexual behaviors (p=0.009, p=0.004) were factors that had a statistically significant relationship with the presence of a precancerous lesion among the IDW. The study also highlights the high rate (95%) of cervicitis among the women and the relatively high rate (5.4%) of leukoplakia. Conclusion the majority of IDW had sociodemographic and lifestyle characteristics that predisposed them to developing cervical cancer More targeted interventions aimed at improving the sociodemographic and lifestyle characteristics of IDW are recommended. In addition, there is a need to create awareness about cervical cancer among IDW and make screening available in camp facilities for early detection and management.
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Affiliation(s)
- Atenchong Ngwibete
- Pan African University Life and Earth Sciences Institute (including Health and Agriculture)-PAULESI, University of Ibadan, Ibadan, Nigeria
| | - Olayinka Ogunbode
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Mangalu Mobhe Agbada
- Département des Sciences de la Population et du Développement, Faculté des Sciences Economiques et de Gestion, Université de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Akinyinka Omigbodun
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Daniels J, Asante K, Tackie JNO, Kyei KA. Survival rate of cervical cancer: a five year review at a Major Teaching Hospital in Ghana, West Africa. Ecancermedicalscience 2024; 18:1663. [PMID: 38439806 PMCID: PMC10911670 DOI: 10.3332/ecancer.2024.1663] [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: 08/18/2023] [Indexed: 03/06/2024] Open
Abstract
Cervical cancer (CC) is one of the leading causes of cancer-related deaths among females in Ghana. Despite the magnitude of the public health challenge posed by CC in Ghana, survival data as well as reported incidence and mortality rates are primarily based on studies conducted in the capital city of the country. Even though age at diagnosis is known to affect the overall survival of CC patients, the role of this factor in the prognosis of CC patients in Ghana has not been sufficiently explored. The aim of this study was to determine the 5-year survival rate of Ghanaian woman treated for CC at a large tertiary healthcare facility in Ghana. This research was a single-institution-based quantitative retrospective cohort study conducted among patients with histopathologically confirmed CC. Clinical and socio-demographic data were retrieved from patients' medical records. Data analysis was done using the Statistical Package for the Social Sciences software version 23. Kaplan Meier curves were used to present the survival rates and median survival time. The peak age at diagnosis was between 45 and 80 years with the modal age group of patients between 75 and 80 years. The mean age at diagnosis was 63.3 ± 15.7 years ranging from 27 to 104 years. The overall survival rates at 1, 3 and 5 years were 76.5%, 51.5% and 32.4%, respectively. The median survival time was 65.8 months. Age < 50 years was associated with higher survival estimates than age >50 years. The 5-year overall survival rate of CC patients reported in this study (32.4%) is relatively low compared with countries in the developed world but like previous reports at other healthcare facilities in Ghana as well as in other underdeveloped countries.
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Affiliation(s)
- Joseph Daniels
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
- https://orcid.org/0000-0002-1466-150X
| | - Kwesi Asante
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Judith Naa Odey Tackie
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Kofi Adesi Kyei
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Radiography, University of Ghana, Accra, Ghana
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Kajabwangu R, Bajunirwe F, Izudi J, Bazira J, Farjardo Y, Ssedyabane F, Lugobe HM, Muhumuza J, Kayondo M, Turanzomwe S, Randall TC, Ngonzi J. Magnitude and trends in cervical cancer at Mbarara Regional Referral Hospital in South Western Uganda: Retrospective analysis of data from 2017-2022. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002848. [PMID: 38241290 PMCID: PMC10798516 DOI: 10.1371/journal.pgph.0002848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/29/2023] [Indexed: 01/21/2024]
Abstract
High-income countries have documented a significant decline in the incidence and mortality of cervical cancer over the past decade but such data from low and middle-income countries such as Uganda is limited to ascertain trends. There is also paucity of data on the burden of cervical cancer in comparison to other gynaecologic malignancies and there is a likelihood that the incidence might be on the rise. To describe the current trends and magnitude of cervical cancer in comparison to other gynaecological malignancies histological types, we conducted a retrospective records review of charts of patients admitted with gynaecological malignancies on the gynaecological ward of Mbarara Regional Referral Hospital (MRRH) between January 2017 and December 2022. Of 875 patients with gynaecological malignancies admitted to the MRRH in the 6-year review period, 721 (82.4%) had cervical cancer. Patients with cervical cancer were significantly older than those with other gynaecological malignancies: (50.2±11.5 versus 43.8± 15.0 respectively, p<0.001). Between 2017 and 2022, cervical cancer rates increased by 17% annually compared to other gynaecological cancers (OR:1.17; 95% CI 1.06-1.28, p = 0.0046), with the majority of patients of cervical cancer patients (92.7%, n = 668) having squamous cell carcinoma. Most patients (87.9%, n = 634) had late-stage disease (stage 2 and above) and were referred to the Uganda Cancer Institute for chemoradiation. These results imply that there is a need to scale up screening services and other preventive measures such as vaccination against human papilloma virus.
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Affiliation(s)
- Rogers Kajabwangu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joel Bazira
- Department of Medical Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yarine Farjardo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Frank Ssedyabane
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joy Muhumuza
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Musa Kayondo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stuart Turanzomwe
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Thomas C. Randall
- Department of Obstetrics and Gynecology, Gynecological Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Asare M, Obiri-Yeboah D, Enyan NIE, Nuer-Allornuvor G, Fosu ES, Ken-Amoah S, Akakpo PK. An intervention to increase cervical cancer screening among women living with HIV: A mixed methods study. PATIENT EDUCATION AND COUNSELING 2024; 118:107993. [PMID: 37844427 DOI: 10.1016/j.pec.2023.107993] [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: 05/20/2023] [Revised: 09/01/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE We examined the effectiveness of a behavioral intervention in promoting cervical cancer screening among women living with HIV (WLWH) in Ghana. METHODS A Mixed-methods study was conducted involving 83 WLWH, who were randomly assigned to an intervention group (n = 42) to receive voice-recorded messages based on the 3 R model (Reframing, Reprioritizing, and Reforming) or a control group (n = 41) to receive standard care. The primary outcomes were screening uptake and HPV prevalence. Other outcomes were the acceptability, appropriateness, and feasibility of the intervention. RESULTS The intervention group had a 100% screening rate, and the control group had a 14.63% screening rate. The prevalent rate of high-risk (hr)-HPV genotypes among the women was 67.5% (95%C.I: 0.56-0.77). Over 48% of the participants had multiple hr-HPV genotypes, 64.29% had HPV16/18/45%, and 73.21% had HPV 31/33/45/52/58. Of the women (89.30%) who screened positive, 60% of them were diagnosed and treated for pre-cancer lesions. The intervention messages were acceptable (encourage proactive behavior), feasible (simple, easy to understand), and appropriate (helpful, informative). Facilitators and barriers to self-sampling were identified. CONCLUSION Combining the 3 R model with self-sampling increases cervical cancer screening among WLWH. PRACTICE IMPLICATION Healthcare professionals and policymakers can use this model to increase cervical cancer screening.
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Affiliation(s)
- Matthew Asare
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, PO Box 1 Bear Place, Waco, TX, USA
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, PO Box University Post Office, Cape Coast, Ghana
| | - Nancy Innocentia Ebu Enyan
- Department of Adult Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, PO Box University Post Office, Cape Coast, Ghana
| | - Gloria Nuer-Allornuvor
- Department of Obstetrics and Gynecology, Cape Coast Teaching Hospital, PO Box ct 1363, Cape Coast, Ghana
| | - Emmanuel Sarfo Fosu
- Department of Statistical Science, College of Arts & Sciences, Baylor University, PO Box 1 Bear Place, Waco, TX 76798, USA
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynecology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, PO Box University Post Office, Cape Coast, Ghana.
| | - Patrick Kafui Akakpo
- Department of Pathology, School of Medical Sciences, University of Cape Coast, PO Box University Post Office, Cape Coast, Ghana
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Habila MA, Sagay E, Obeng-Kusi M, Ali MJ, Magaji FA, Shambe IH, Daru PH, Jacobs ET, Madhivanan P, Sagay AS, Musa J. Utilization of opportunistic cervical cancer screening in Nigeria. Cancer Causes Control 2024; 35:9-20. [PMID: 37530986 DOI: 10.1007/s10552-023-01764-1] [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: 05/01/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND While various interventions have been conducted to decrease cervical cancer's burden in Nigeria, no study has examined the trends in cervical cancer screening uptake over time. The present study sought to fill this gap in knowledge using data collected at Jos University Teaching Hospital (JUTH) in Nigeria. METHODS Data collected continuously between 2006 and 2016 were analyzed to identify trends in screening uptake, changes in risk factors for cervical cancer, and to identify factors for women screened at Jos University Teaching Hospital (JUTH) in Jos, Nigeria. Categorical analyses and logistic regression models were used to describe patient characteristics by year, and to identify factors associated with repeated screening uptake. RESULTS A total of 14,088 women who were screened between 2006 and 2016 were included in the database; 2,800 women had more than one screening visit. Overall, screening uptake differed significantly by year. On average women were first screened at age 38. About 2% of women screened were women living with HIV. Most women (86%) had normal pap smear at first screening, with the greatest decreased risk of abnormalities observed between 2011 and 2014. Odds of a follow-up screening after a normal result decreased significantly between 2008 and 2016 compared to women screened in 2006 and 2007. Finally, women living with HIV had increased odds of follow-up screening after having a normal pap smear. CONCLUSIONS These findings contribute to our understanding of the potential social and health system barriers to cervical cancer control in Nigeria. The findings may assist policy makers to design interventions to increase access and compliance to recommended screening schedules in this vulnerable population.
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Affiliation(s)
- Magdiel A Habila
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | - Emmanuel Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Mavis Obeng-Kusi
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Maryam J Ali
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Iornum H Shambe
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- Public Health Research Institute of India, Mysore, India
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
- Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Mali ME, Sanyang O, Harris KL, Sorensen J, Bittaye M, Nellermoe J, Price RR, Sutherland EK. Capacity assessment and spatial analysis of cervical cancer services in The Gambia. BMC Womens Health 2023; 23:660. [PMID: 38066506 PMCID: PMC10709932 DOI: 10.1186/s12905-023-02802-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Cervical cancer is the most common cancer and the leading cause of cancer-related death in Gambian women. The Gambian Ministry of Health is striving to improve access to screening, diagnostic, and treatment services for cervical cancer, but comprehensive data on currently available services is limited making it challenging to appropriately prioritize the ideal next steps for expanding care. This study aims to describe the current services available for the prevention, screening, and treatment of cervical cancer in The Gambia and provide suggestions for expanding geographic access to care. METHODS A survey aimed at assessing the availability of key cervical cancer-related services was developed and then administered in person by research assistants to all secondary and tertiary health facilities (HFs) in The Gambia. ArcGIS Pro Software and 2020 LandScan population density raster were used to visualize and quantify geographic access to care. Survey results were compared with published targets outlined by the Gambian Ministry of Health in the "Strategic Plan for the Prevention and Control of Cervical Cancer in The Gambia: 2016-2020." RESULTS One hundred and two HFs were surveyed including 12 hospitals, 3 major health centers, 56 minor health centers, and 31 medical centers/clinics. Seventy-eight of these HFs provided some form of cervical cancer-related service. HPV vaccination was available in all health regions. Two-thirds of the population lived within 10 km of a HF that offered screening for cervical cancer and half lived within 10 km of a HF that offered treatment for precancerous lesions. Ten HFs offered hysterectomy, but nine were located in the same region. Two HFs offered limited chemotherapy. Radiotherapy was not available. If all major health centers and hospitals started offering visual inspection with acetic acid and cryotherapy, 86.1% of the population would live within 25 km of a HF with both services. CONCLUSIONS Geographic access to cervical cancer screening, and precancer treatment is relatively widespread across The Gambia, but targeted expansion in line with the country's "Strategic Plan" would improve access for central and eastern Gambia. The availability of treatment services for invasive cancer is limited, and establishing radiotherapy in the country should continue to be prioritized.
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Affiliation(s)
- Meghan E Mali
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ousman Sanyang
- Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Katherine L Harris
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Justin Sorensen
- J. Willard Marriott Library, University of Utah, Salt Lake City, UT, USA
| | | | - Jonathan Nellermoe
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Raymond R Price
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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Lacika JL, Wabinga H, Kagaayi J, Opito R, Orach CG, Mwaka AD. Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study. BMC Womens Health 2023; 23:633. [PMID: 38012615 PMCID: PMC10683271 DOI: 10.1186/s12905-023-02785-3] [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: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Majority of patients with cervical cancer in the low- and middle-income countries experience long diagnostic and pre-treatment intervals. This study sought to determine the factors associated with the diagnostic and pre-treatment intervals among patients with cervical cancer. METHODS This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to January 2020. Patients aged ≥ 18 years with histological diagnosis of cervical cancer were consecutively sampled. Data were collected using a pre-tested semi-structured questionnaire and a data abstraction form. Diagnostic intervals, defined as the time between first visit of a patient to a primary healthcare provider to time of getting confirmed diagnosis, of ≤ 3 months was defined as early & >3 months as late. Pre-treatment intervals, which is the time from histological diagnosis to starting cancer chemo-radiotherapy of ≤ 1 month was defined as early and > 1 month as late. Data were analysed using STATA version 14.0. We used modified Poisson regression models with robust variance to determine socio-demographic and clinical factors associated with the intervals. RESULTS The mean age of the participants was 50.0 ± 11.7 years. The median diagnostic and pre-treatment intervals were 3.1 (IQR: 1.4-8.2) months and 2.4 (IQR: 1.2-4.1) months respectively. Half of the participants, 49.6% (200/403) were diagnosed early; one in 5 patients, 20.1% (81/403) promptly (within one month) initiated cancer chemo-radiotherapy. Participants more likely to be diagnosed early included those referred from district hospitals (level 5) (aPR = 2.29; 95%CI: 1.60-3.26) and with squamous cell carcinomas (aPR = 1.55; 95%CI: 1.07-2.23). Participants more likely to be diagnosed late included those who first discussed their symptoms with relatives, (aPR = 0.77; 95%CI: (0.60-0.98), had > 2 pre-referral visits (aPR = 0.75; 95%CI (0.61-0.92), and had advanced stage (stages 3 or 4) (aPR = 0.68; 95%CI: 0.55-0.85). Participants more likely to initiate cancer chemo-radiotherapy early included older patients (≥ 60 years) (aPR = 2.44; 95%CI: 1.18-5.03). Patients likely to start treatment late were those who had ≥2 pre-referral visits (aPR = 0.63; 95%CI: 0.41-0.98) and those that took 3 - 6 months with symptoms before seeking healthcare (aPR = 0.52;95%CI: 0.29 - 0.95). CONCLUSION Interventions to promote prompt health-seeking and early diagnosis of cervical cancer need to target primary healthcare facilities and aim to enhance capacity of primary healthcare professionals to promptly initiate diagnostic investigations. Patients aged < 60 years require targeted interventions to promote prompt initiation of chemo-radiation therapy.
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Affiliation(s)
- Jackie Lalam Lacika
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Joseph Kagaayi
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Ronald Opito
- Department of Public Health, School of Health Sciences, Soroti University, P.O Box 211, Soroti, Uganda
| | - Christopher Garimoi Orach
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
- Department of Medicine, Faculty of Medicine, Gulu University, P.O Box 166, Gulu, Uganda.
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Tsegaye K, Hagos A, Kindie H, Minyihun A, Teshale G. Evaluation of cervical cancer screening program in Gondar city administration public health facilities, Northwest Ethiopia, 2021: mixed method approach. BMC Cancer 2023; 23:1034. [PMID: 37880629 PMCID: PMC10598969 DOI: 10.1186/s12885-023-11533-7] [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: 10/03/2022] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Cervical cancer is one of the most malignancies in women all over the world. Over 90% of cases occurred in low and middle-income countries with limited resources. Even though cervical cancer is preventable, the Sub-Saharan countries are the most burdened. In Ethiopia 27.19 million women are at risk of acquiring cervical cancer. Although the prevalence of cervical cancer screening among women aged 18 to 69 was around 14%, due to COVID 19 and internal conflict the screening prevalence was lowered to 0.2% by 2022. OBJECTIVE This study aimed to evaluate cervical cancer screening program implementation at Gondar city administration public health facilities, Northwest Ethiopia. METHODS Single case study design with mixed method evaluation was employed in eight public health facilities of Gondar city administration from March 29 to May 30, 2021. The quantitative data were collected through exit interviews and resources inventory observations. While qualitative data were collected through Key informant interviews, non-participatory observation and document review. A total of 310 clients, 14 key informants, 30 non-participatory observations and six months retrospective document reviews were included in this evaluation. Quantitative data were entered into EPI-data version 4.6 and exported into SPSS version 20 for analysis. For qualitative data; records were transcribed, translated and analyzed in themes. Variables with P-value < 0.05 at 95% confidence interval and adjusted odds ratio were used to declare associated variables with client satisfaction. RESULTS The overall implementation of cervical cancer screening program with visual inspection with acetic acid was 64.5%. The availability of program resources, compliance of healthcare providers and satisfaction of mothers were 52.3%, 64.3% and 77.1% respectively. Being educated, having information on cervical cancer screening and the number of lifetime sexual partners were positively associated variables with client satisfaction. CONCLUSION The cervical cancer screening program was judged as partially-implemented and needs urgent improvement based on pre-determined judgment parameters. To implement the program properly and serve more women; human and material resources should be available, providers shall be trained and the health facilities should equip with full infrastructures like electric power supply and separate procedure rooms.
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Affiliation(s)
- Ketemaw Tsegaye
- University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Asebe Hagos
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hailemichael Kindie
- University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Amare Minyihun
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Teshale
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Omotoso O, Teibo JO, Atiba FA, Oladimeji T, Paimo OK, Ataya FS, Batiha GES, Alexiou A. Addressing cancer care inequities in sub-Saharan Africa: current challenges and proposed solutions. Int J Equity Health 2023; 22:189. [PMID: 37697315 PMCID: PMC10496173 DOI: 10.1186/s12939-023-01962-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/13/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION Cancer is a significant public health challenge globally, with nearly 2000 lives lost daily in Africa alone. Without adequate measures, mortality rates are likely to increase. The major challenge for cancer care in Africa is equity and prioritization, as cancer is not receiving adequate attention from policy-makers and strategic stakeholders in the healthcare space. This neglect is affecting the three primary tiers of cancer care: prevention, diagnosis, and treatment/management. To promote cancer care equity, addressing issues of equity and prioritization is crucial to ensure that everyone has an equal chance at cancer prevention, early detection, and appropriate care and follow-up treatment. METHODOLOGY Using available literature, we provide an overview of the current state of cancer care in Africa and recommendations to close the gap. RESULTS We highlight several factors that contribute to cancer care inequity in Africa, including inadequate funding for cancer research, poor cancer education or awareness, inadequate screening or diagnostic facilities, lack of a well-organized and effective cancer registry system and access to care, shortage of specialized medical staff, high costs for screening, vaccination, and treatment, lack of technical capacity, poor vaccination response, and/or late presentation of patients for cancer screening. We also provide recommendations to address some of these obstacles to achieving cancer care equity. Our recommendations are divided into national-level initiatives and capacity-based initiatives, including cancer health promotion and awareness by healthcare professionals during every hospital visit, encouraging screening and vaccine uptake, ensuring operational regional and national cancer registries, improving healthcare budgeting for staff, equipment, and facilities, building expertise through specialty training, funding for cancer research, providing insurance coverage for cancer care, and implementing mobile health technology for telemedicine diagnosis. CONCLUSION Addressing challenges to cancer equity holistically would improve the likelihood of longer survival for cancer patients, lower the risk factors for groups that are already at risk, and ensure equitable access to cancer care on the continent. This study identifies the existing stance that African nations have on equity in cancer care, outlines the current constraints, and provides suggestions that could make the biggest difference in attaining equity in cancer care.
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Affiliation(s)
- Olabode Omotoso
- Department of Biochemistry, University of Ibadan, Ibadan, Nigeria
| | - John Oluwafemi Teibo
- Department of Biochemistry, University of Ibadan, Ibadan, Nigeria.
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Festus Adebayo Atiba
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Oluwatomiwa Kehinde Paimo
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - Farid S Ataya
- Department of Biochemistry, College of Science, King Saud University, P.O. Box 2455, 11451, Riyadh, Saudi Arabia
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, AlBeheira, 22511, Damanhour, Egypt
| | - Athanasios Alexiou
- Department of Science and Engineering, Novel Global Community Educational Foundation, NSW, 2770, Hebersham, Australia
- AFNP Med, 1030, Wien, Austria
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Dessie TM, Kassaw AT, Alen GD. Determinants of precancerous cervical lesion among HIV infected women on ART in Woldia comprehensive specialized hospital NorthEast Ethiopia. BMC Womens Health 2023; 23:458. [PMID: 37644484 PMCID: PMC10464226 DOI: 10.1186/s12905-023-02580-0] [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: 04/03/2023] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Precancerous cervical lesion is a priority public health problem that jeopardizes the life of enormous women. previous studies in Ethiopia were more focused on knowledge, attitude, and practices of Cervical cancer screening. studies on the risk factors of pre-cancerous cervical lesions among the risk population (HIV infected) relative to the general population were limited. This study aimed to identify the determinants of precancerous cervical lesions among HIV Infected Women in Woldia Comprehensive Specialized Hospital in Northeast Ethiopia, 2022. METHODS Hospital-based unmatched case-control study was conducted in Woldia Comprehensive Specialized Hospital among HIV-infected women from June to August 2022. Data were collected from 104 cases and 208 controls using an interviewer-administered questionnaire and clinical data from the patient chart using Electronic Medical Record _ Anti-Retroviral Therapy Smart care database checklist. The binary logistic regression model was used to identify the determinants of the precancerous cervical lesion. An odds ratio with a 95% Confidence interval was used to measure the association and p-value < 0.05 were considered significant. RESULTS Women who have two or more lifetime sexual partners (AOR = 3.21,95% CI: 1.71-6.04), history of sexually transmitted infection (AOR = 4.97, 95% CI: 2.78-8.78), early age at first sexual intercourse (< 18 years) (AOR = 4.35,95% CI: 2.48-7.67) and baseline CD4 count < 200 cells/mm3 (AOR = 1.89, 95% CI: 1-3.57) had a higher odd of developing a precancerous cervical lesion. CONCLUSION This study confirms that having a history of sexually transmitted infection, two or more lifetime sexual Partners, the initiation of sexual intercourse before the age of 18 years, and Baseline CD4 count < 200 cells/mm3 were determinants for precancerous cervical lesions. So it should be focused on prevention through early detection and treatment of sexually transmitted infections.
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Affiliation(s)
- Tazeb Melkie Dessie
- Department of Public Health, Woldia Comprehensive Specialized Hospital, Woldia, Ethiopia
| | - Abebe Tarekegn Kassaw
- Department of Pharmacy, College of Health Science, Woldia University, Po. Box: 400, Woldia, Ethiopia.
| | - Gedefaw Diress Alen
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, DebreMarkos, Ethiopia
- Center for Alcohol Policy Reseach, La Trobe University, Melbourne, Australia
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Adeniji KA, Folaranmi OO, Odetunde OA, Adegboye O, Ibiyeye KM, Ighodalo JE, Olayiwola JO, Suleiman KA, Abubakar-Akanbi SK. Changing pattern of cancer distribution: experience from a tertiary health institution in Nigeria and review of literature. Niger J Clin Pract 2023; 26:902-907. [PMID: 37635573 DOI: 10.4103/njcp.njcp_520_22] [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] [Indexed: 08/29/2023]
Abstract
Background Over the years, epidemiological surveys have established that the five leading cancers in Africa (in descending order of prevalence) are cancers of the breast, cervix, prostate, liver, and colorectum.[1] However, a 10-year retrospective review of cases performed at the University of Ilorin Teaching Hospital (UITH) revealed some changes in the cancer incidence pattern in this region. Aims The aim of the study was to determine the distribution of cancers managed at the UITH, a tertiary health care center in North Central Nigeria, in the past 10 years and create awareness of changing cancer prevalence patterns in this region. Materials and Method This was a retrospective review of cancer epidemiology at UITH over a period of 10 years. Confirmed cancer cases within this period were extracted from the data in the Department of Anatomic Pathology and the Cancer registry. Descriptive and inferential statistics were applied to obtain rates and proportions for both sexes. Results There were 2430 confirmed cases of cancer during the study period from January 2011 to December 2020. Out of these cases, 1310 (54%) were seen in females and 1120 (46%) were seen in males. The most common cancer recorded (in total) was prostate cancer, which accounted for 18% of all cases, constituting approximately one in six of all cancer cases. This was followed closely by breast cancer (16.6%). The most commonly diagnosed cancer in males was prostate cancer (four in ten cancer cases in males), whereas in females, it was breast cancer (approximately three in ten cancer cases in females). Cancers of the lungs and liver were rare in both sexes in this study. In children, the most common malignancies were retinoblastoma (38.3%), non-Hodgkin lymphomas (16.8%), and nephroblastoma (12.8%). Conclusion There is a changing trend in cancer cases with some cancer cases now predominating compared to previous years. This may be because of increased awareness and/or better medical screening and diagnostic techniques.
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Affiliation(s)
- K A Adeniji
- Department of Anatomic Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - O O Folaranmi
- Department of Anatomic Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - O A Odetunde
- Department of Anatomic Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - O Adegboye
- Department of Anatomic Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - K M Ibiyeye
- Department of Anatomic Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - J E Ighodalo
- Department of Anatomic Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - J O Olayiwola
- Department of Anatomic Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - K A Suleiman
- Department of Anatomic Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - S K Abubakar-Akanbi
- Department of Anatomic Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Akakpo PK, Ken-Amoah S, Enyan NIE, Agyare E, Salia E, Baidoo I, Derkyi-Kwarteng L, Asare M, Adjei G, Addo SA, Obiri-Yeboah D. High-risk human papillomavirus genotype distribution among women living with HIV; implication for cervical cancer prevention in a resource limited setting. Infect Agent Cancer 2023; 18:33. [PMID: 37237313 DOI: 10.1186/s13027-023-00513-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 05/22/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND For women living with HIV (WLHIV), the burden of persistent HPV infection, cervical pre-cancerous lesions and cancer have been demonstrated to be higher than among HIV-negative women. As Ghana and other lower-middle-income countries (LMIC) work toward developing national cervical cancer programmes, it is essential that local scientific evidence be provided to guide policy decisions, especially for such special populations. The objective of this study was to determine the distribution of high-risk HPV genotype and related factors among WLHIV and its implication for the prevention of cervical cancer prevention efforts. METHODS A cross-sectional study was conducted at the Cape Coast Teaching Hospital in Ghana. WLHIV, aged 25-65 years, who met the eligibility criteria were recruited through a simple random sampling method. An interviewer-administered questionnaire was used to gather socio-demographic, behavioural, clinical and other pertinent information. The AmpFire HPV detection system (Atila BioSystem, Mointain View, CA was used to detect 15 high-risk HPV genotypes from self-collected cervico-vaginal samples. The data collected were exported to STATA 16.0 for statistical analysis. RESULTS In all, 330 study participants, with mean age of 47.2 years (SD ± 10.7), were involved. Most (69.1%, n = 188/272) had HIV viral loads < 1000 copies/ml and 41.2% (n = 136) had ever heard of cervical screening. The overall hr-HPV prevalence was 42.7% (n = 141, 95% CI 37.4-48.1) and the five commonest hr-HPV types among screen positives were HPV59 (50.4%), HPV18 (30.5%), HPV35 (26.2%), HPV58 (17%) and HPV45 (14.9%). Most infected women (60.3%, n = 85) had multiple hr-HPV infections, with about 57.4% (n = 81) having 2-5 h-HPV types, while 2.8% (n = 4) had more than five hr-HPV types. A total of 37.6% (n = 53) had HPV16 and/or18, while 66.0% (n = 93) had the hr-HPV genotypes covered by the nonavalent vaccine. Women with HIV viral load ≥ 1000copies/ml (AOR = 5.58, 95% CI 2.89-10.78, p < 0.001) had a higher likelihood of being co-infected. CONCLUSION This study found out that the prevalence of hr-HPV still remains high in women with HIV, with a notable occurrence of multiple infections and infection with genotypes 16 and/or18. Additionally, an association was established between hr-HPV and infection HIV viral load.. Therefore, comprehensive HIV care for these women should include awareness of cervical cancer, consideration of vaccination and implementation of screening and follow-up protocols. National programmes in LMIC, such as Ghana, should consider using HPV-based screen-triage-treat approach with partial genotyping.
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Affiliation(s)
- Patrick Kafui Akakpo
- Department of Anatomic Pathology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Nancy Innocentia Ebu Enyan
- Department of Adult Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Agyare
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel Salia
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Ibrahim Baidoo
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Leonard Derkyi-Kwarteng
- Department of Anatomic Pathology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Matthew Asare
- Department of Public Health, Robbins College of Health and Human Services, Baylor University, Waco, TX, USA
| | - George Adjei
- Department of Community Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Dorcas Obiri-Yeboah
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana.
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.
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Akoto EJ, Allsop MJ. Factors Influencing the Experience of Breast and Cervical Cancer Screening Among Women in Low- and Middle-Income Countries: A Systematic Review. JCO Glob Oncol 2023; 9:e2200359. [PMID: 37141559 DOI: 10.1200/go.22.00359] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PURPOSE The persistent high morbidity and mortality from breast and cervical cancer in low- and middle-income countries (LMICs) may be influenced by global disparities in the uptake of screening services. This review sought to synthesize existing evidence to determine factors that influence the experience of women relating to breast and cervical screening in LMICs. METHODS A qualitative systematic review of the literature identified through Global Health, Embase, PsycInfo, and MEDLINE. Eligible studies included those outlining primary qualitative research or mixed-method studies with reporting of qualitative findings, detailing women's experiences of involvement with programs for breast or cervical cancer screening. Framework synthesis was used to explore and organize findings from primary qualitative studies and the Critical Appraisal Skills Programme checklist used for quality assessment. RESULTS Database searches yielded 7,264 studies for title and abstract screening and 90 full-text articles for screening, with qualitative data from 17 studies and a total of 722 participants included in this review. Four stages influencing experiences of women were generated across both breast and cervical cancer screening approaches, with individual (eg, knowledge of cancer), social (eg, religion, cultural beliefs), and health system (eg, accessibility) factors identified that influence women's initial and subsequent engagement. CONCLUSION This study synthesizes existing evidence of factors that influence engagement with breast and cervical cancer screening in LMICs. Evidence-informed recommendations are proposed that may improve the experience of cancer screening in LMICs, with further research necessary to explore their operationalization and impact on cancer care delivery.
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Affiliation(s)
- Edem J Akoto
- Lekma Hospital, Accra, Ghana
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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Oketch SY, Ochomo EO, Orwa JA, Mayieka LM, Abdullahi LH. Communication strategies to improve human papillomavirus (HPV) immunisation uptake among adolescents in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Open 2023; 13:e067164. [PMID: 37012006 PMCID: PMC10083777 DOI: 10.1136/bmjopen-2022-067164] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVES Developing countries face the greatest cervical cancer disease burden and mortality with suboptimal immunisation uptake. This review explores the communication strategies adopted, successes, challenges and lessons learnt in sub-Saharan countries to enhance human papillomavirus (HPV) immunisation. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Hinari, Cochrane Library, Trip database, CINAHL, Web of Science, Scopus and seven grey resources were searched through May 2022. ELIGIBILITY CRITERIA We included observational studies addressing communication strategies for HPV immunisation uptake. DATA EXTRACTION AND SYNTHESIS Two independent reviewers used standardised methods to search, screen and code included studies. Data extraction and assessment of risk of bias were done in duplicate to enhance validity of the results. Meta-analysis was conducted using the random-effects model. Findings were summarised and synthesised qualitatively. RESULTS Communication intervention to facilitate decision-making achieved uptake rate of 100% (95% CI 0.99% to 1.00%), followed by intervention to enable communication, which achieved 92% (95% CI 0.92% to 0.92%). Communication intervention to inform and educate achieved 90% (95% CI 0.90% to 0.90%).Targeting both healthcare workers and community leaders with the communication intervention achieved 95% (95% CI 0.91% to 0.98%), while teachers and school boards achieved 92% (95% CI 0.84% to 1.01%). Targeting policymakers achieved 86% (95% CI 0.78% to 0.93%).Based on the method of communication intervention delivery, use of training achieved an uptake rate of 85% (95% CI 0.84% to 0.87%); similarly, drama and dance achieved 85% (95% CI 0.84% to 0.86%). However, use of information, education and communication materials achieved 82% (95% CI 0.78% to 0.87%). CONCLUSION HPV vaccine communication is critical in ensuring that the community understands the importance of vaccination. The most effective communication strategies included those which educate the population about the HPV vaccine, facilitate decision-making on vaccine uptake and community ownership of the vaccination process immunisation. PROSPERO REGISTRATION NUMBER CRD42021243683.
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Affiliation(s)
- Sandra Y Oketch
- Research Department, African Institute for Development Policy, Nairobi, Kenya
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edwin O Ochomo
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jeniffer A Orwa
- Department of Resource Development and Knowledge Management, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lilian M Mayieka
- Department of Resource Development and Knowledge Management, Kenya Medical Research Institute, Nairobi, Kenya
| | - Leila H Abdullahi
- Research Department, African Institute for Development Policy, Nairobi, Kenya
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Gottschlich A, Payne BA, Trawin J, Albert A, Jeronimo J, Mitchell-Foster S, Mithani N, Namugosa R, Naguti P, Pedersen H, Rawat A, Simelela PN, Singer J, Smith LW, van Niekerk D, Orem J, Nakisige C, Ogilvie G. Community-integrated self-collected HPV-based cervix screening in a low-resource rural setting: a pragmatic, cluster-randomized trial. Nat Med 2023; 29:927-935. [PMID: 37037880 DOI: 10.1038/s41591-023-02288-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/02/2023] [Indexed: 04/12/2023]
Abstract
Effective approaches to improve coverage of self-collected human papillomavirus (HPV)-based cervix screening (SCS) as well as attendance at treatment for HPV-positive participants are needed to inform policy on optimal integration of cervical cancer screening programs within existing infrastructure in low-resource settings. ASPIRE Mayuge was a pragmatic cluster-randomized trial in rural Mayuge district, Uganda, comparing the superiority of two recruitment implementation strategies for SCS: Door-to-Door versus Community Health Day. Villages were randomized (unblinded) to a strategy, and participants aged 25-49 years with no previous history of hysterectomy or treatment for cervical cancer or pre-cancer were eligible. Participants completed a survey and participated in SCS. The primary outcome was rate of attendance at treatment after a positive SCS. The trial randomized 31 villages and 2,019 participants included in these analyses (Door-to-Door: 16 clusters, 1,055 participants; Community Health Day: 15 clusters, 964 participants). Among HPV-positive participants, attendance at treatment rates were 75% (Door-to-Door) and 67% (Community Health Day) (P = 0.049). Participants in the Community Health Day intervention were less likely to attend treatment compared to Door-to-Door (risk ratio = 0.78, 95% confidence interval: 0.64-0.96). No adverse events were reported. Policymakers in low-resource settings can use these results to guide implementation of SCS programs. ISRCTN registration: 12767014 . ClinicalTrials.gov registration: NCT04000503 .
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Affiliation(s)
- Anna Gottschlich
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada.
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.
| | - Beth A Payne
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Jessica Trawin
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Arianne Albert
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | | | - Sheona Mitchell-Foster
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- Northern Medical Program, University of British Columbia, Prince George, British Columbia, Canada
| | - Nadia Mithani
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | | | | | - Heather Pedersen
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Angeli Rawat
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - Joel Singer
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Laurie W Smith
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Gina Ogilvie
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
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Punchoo R, Dreyer G, Pillay TS. 25-Hydroxycholecalciferol Inhibits Cell Growth and Induces Apoptosis in SiHa Cervical Cells via Autocrine Vitamin D Metabolism. Biomedicines 2023; 11:biomedicines11030871. [PMID: 36979850 PMCID: PMC10045786 DOI: 10.3390/biomedicines11030871] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
Preclinical studies show that the anticancer actions of vitamin D metabolites are mediated by apoptosis, inhibition of cell proliferation and induction of cell cycle arrest. Cervical cancer cells express an autocrine vitamin D metabolising system (VDMS) comprised of a vitamin D receptor, vitamin D catabolic enzyme (CYP24A1), and the activating enzyme of 25-hydroxycholecalciferol (25(OH)D3), CYP27B1. We assessed the anticancer effects of 25(OH)D3 at clinically relevant concentrations on a cervical squamous cell cancer cell line, SiHa. We evaluated cell health parameters (cell count, viability, and cell cycle), cell death modes (apoptosis, autophagic-dependent death, and necrosis by flow cytometry and transmission electron microscopy), and autocrine VDMS gene and protein expression by qPCR and Western blot, respectively. Our study demonstrates that physiological and supraphysiological doses of 25(OH)D3 inhibit cell growth and viability and induce biochemical and morphological apoptosis in SiHa cells. These growth effects are mediated by alteration in the VDMS gene and protein expression, with prominent negative feedback at supraphysiological treatment dose. These data identify promising therapeutic potential of 25(OH)D3 in cervical cancer, which warrants further clinical translational investigations.
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Affiliation(s)
- Rivak Punchoo
- Tshwane Academic Division, National Health Laboratory Service (NHLS), Pretoria 0001, South Africa
- Department of Chemical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
- Correspondence: ; Tel.: +27-12-3192671
| | - Greta Dreyer
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Tahir S. Pillay
- Tshwane Academic Division, National Health Laboratory Service (NHLS), Pretoria 0001, South Africa
- Department of Chemical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
- Division of Chemical Pathology, Department of Pathology, University of Cape Town, Rondebosch 7701, South Africa
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Ola IO, Okunowo AA, Habeebu MY, Miao Jonasson J. Clinical and non-clinical determinants of cervical cancer mortality: A retrospective cohort study in Lagos, Nigeria. Front Oncol 2023; 13:1105649. [PMID: 36874121 PMCID: PMC9978796 DOI: 10.3389/fonc.2023.1105649] [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: 12/01/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Cervical cancer (CCa) is the fourth most frequent and a common cause of cancer mortality in women, the majority of whom live in low- and middle-income countries. Data on CCa mortality and its determinants have been poorly studied in Nigeria, resulting in a paucity of information that can assist patient management and cancer control policy. Aim The purpose of this study was to assess the mortality rate among CCa patients in Nigeria as well as the major factors influencing CCa mortality. Study design Data from the medical records of 343 CCa patients seen at the Lagos University Teaching Hospital and NSIA-LUTH Cancer Center from 2015 to 2021 were used in a retrospective cohort analysis. The hazard ratios (HR) and confidence intervals (CI) associated with the exposure variables and CCa mortality were calculated using Cox proportional hazard regression. Results The CCa mortality rate was 30.5 per 100 women-years after 2.2 years of median follow-up. Clinical factors such as HIV/AIDS (adjusted HR [aHR]: 11.9; 95% CI: 4.6, 30.4), advanced clinical stage (aHR: 2.7; 95% CI: 1.5, 4.7), and anemia at presentation (aHR: 1.8; 95% CI: 1.1, 3.0) were associated with a higher mortality risk, as were non-clinical factors such as age at diagnosis >50 years (aHR: 1.4; 95% CI: 1.0, 1.9) and family history of CCa (aHR: 3.5; 95%CI: 1.1, 11.1). Conclusion CCa has a high mortality rate in Nigeria. Incorporating these clinical and non-clinical factors into CCa management and control policies may improve women's outcomes.
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Affiliation(s)
- Idris Olasunmbo Ola
- Global Health Program, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Departments of Clinical and Community Service, The Blue-Pink Center for Women's Health, Lagos, Nigeria
| | - Adeyemi Adebola Okunowo
- Department of Obstetrics & Gynaecology, College of Medicine University of Lagos, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Muhammad Yaqub Habeebu
- Department of Radiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Radiotherapy, Lagos University Teaching Hospital, Lagos, Nigeria
- Lead Oncologist, NSIA-LUTH Cancer Centre (NLCC), Lagos, Nigeria
| | - Junmei Miao Jonasson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Research and Development, Region Halland, Halmstad, Sweden
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Beltrán Ponce SE, Abunike SA, Bikomeye JC, Sieracki R, Niyonzima N, Mulamira P, Kibudde S, Ortiz de Choudens S, Siker M, Small C, Beyer KMM. Access to Radiation Therapy and Related Clinical Outcomes in Patients With Cervical and Breast Cancer Across Sub-Saharan Africa: A Systematic Review. JCO Glob Oncol 2023; 9:e2200218. [PMID: 36795990 PMCID: PMC10166435 DOI: 10.1200/go.22.00218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
PURPOSE To better understand the barriers to accessing standard-of-care radiation therapy (RT) for breast and cervical cancer in sub-Saharan Africa and their impact on outcomes. METHODS A comprehensive literature search was completed with a medical librarian. Articles were screened by title, abstract, and full text. Included publications were analyzed for data describing barriers to RT access, available technology, and disease-related outcomes, and further grouped into subcategories and graded according to predefined criteria. RESULTS A total of 96 articles were included: 37 discussed breast cancer, 51 discussed cervical cancer, and eight discussed both. Financial access was affected by health care system payment models and combined burdens of treatment-related costs and lost wages. Staffing and technology shortages limit the ability to expand service locations and/or increase capacity within existing centers. Patient factors including use of traditional healers, fear of stigma, and low health literacy decrease the likelihood of early presentation and completion of therapies. Survival outcomes are worse than most high- and middle-income countries and are affected by many factors. Side effects are similar to other regions, but these findings are limited by poor documentation capabilities. Access to palliative RT is more expeditious than definitive management. RT was noted to lead to feelings of burden, lower self-esteem, and worsened quality of life. CONCLUSION Sub-Saharan Africa represents a diverse region with barriers to RT that differ on the basis of funding, available technology and staff, and community populations. Although long-term solutions must focus on building capacity by increasing the number of treatment machines and providers, short-term improvements should be implemented, such as interim housing for traveling patients, increased community education to reduce late-stage diagnoses, and use of virtual visits to avoid travel.
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Affiliation(s)
| | - Sarah Adamma Abunike
- Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Jean C Bikomeye
- Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Rita Sieracki
- Medical College of Wisconsin Libraries, Milwaukee, WI
| | | | | | | | | | - Malika Siker
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Christina Small
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Kirsten M M Beyer
- Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
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Maitanmi JO, Fabiyi TE, Eniola O, Sansi TO, Josiah BO, Maitanmi B, Ojewale MO, Dairo AA, Adebiyi DA, Akingbade O. Knowledge and acceptability of cervical cancer screening among female undergraduates in Babcock University Ilishan-Remo, Ogun State, Nigeria. Ecancermedicalscience 2023; 17:1502. [PMID: 36816789 PMCID: PMC9937068 DOI: 10.3332/ecancer.2023.1502] [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: 08/22/2022] [Indexed: 02/04/2023] Open
Abstract
Background Cervical cancer (CC) is currently the fourth most common cancer among women. There are several factors which have, in recent times, posed a threat to the recognition and acceptance of CC screening in Nigeria. This study was undertaken to assess the predictors of knowledge of female undergraduates at Babcock University, Ogun State, Nigeria, on CC screening and the level of acceptance readiness. Method This study was a descriptive cross-sectional survey of 345 female undergraduates at Babcock University, Ogun State, Nigeria, using a self-administered structured questionnaire. Data collected were analysed using the Statistical Package for the Social Sciences (SPSS) version 23 software. Hypotheses were tested using Pearson product-moment correlation at p < 0.05 level of significance. Results This study revealed that majority of the respondents have a substantial awareness and knowledge of CC screening (68.4%). The study suggested that health talk and level of exposure might be responsible for the good knowledge. While 47.5% were ready to undergo CC screening, 76.2% were ready to undergo the screening if a health professional performed the procedure, and 66.1% will tell their family members to go for screening. However, 49.9% reported not having the correct information on CC screening. A significant correlation was found between knowledge and acceptability of CC screening among the students (r = -0.366, p ˂ 0.05). Also, this study suggested that the age of female undergraduates is correlated with acceptance of CC screening (r = -0.221, p ˂ 0.05). Conclusion As the acceptability of CC screening was high, CC screening facilities could be made available for the students. Similarly, educational interventions to improve awareness of CC screening among this population are warranted, as over one-third reported they did not have the correct information on CC screening.
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Affiliation(s)
- Julius O Maitanmi
- School of Nursing, Babcock University, Ilishan Remo, Ogun State 121103, Nigeria
| | - Temidara E Fabiyi
- School of Nursing, Babcock University, Ilishan Remo, Ogun State 121103, Nigeria
| | - Oluwadara Eniola
- Institute of Nursing Research, Osogbo, Osun State 230262, Nigeria
| | - Toluwalope O Sansi
- School of Nursing, Babcock University, Ilishan Remo, Ogun State 121103, Nigeria
| | - Blessing O Josiah
- Institute of Nursing Research, Osogbo, Osun State 230262, Nigeria,Turks and Caicos Islands Community College, P.O. Box 236, Grand Turk, Turks and Caicos Islands
| | - Bukola Maitanmi
- School of Nursing, Babcock University, Ilishan Remo, Ogun State 121103, Nigeria
| | | | - Abiodun A Dairo
- Institute of Nursing Research, Osogbo, Osun State 230262, Nigeria
| | | | - Oluwadamilare Akingbade
- Institute of Nursing Research, Osogbo, Osun State 230262, Nigeria,The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong 999077, China
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Dickson KS, Boateng ENK, Acquah E, Ayebeng C, Addo IY. Screening for cervical cancer among women in five countries in sub-saharan Africa: analysis of the role played by distance to health facility and socio-demographic factors. BMC Health Serv Res 2023; 23:61. [PMID: 36670402 PMCID: PMC9862532 DOI: 10.1186/s12913-023-09055-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cervical cancer significantly affects women in Sub-Saharan Africa (SSA). However, limited studies have concentrated on cervical screening behaviour among women in SSA. This study aimed to assess the interplay of distance to health facilities and socio-demographic factors with cervical screening behaviour among women in five SSA countries. METHODS The study was based on pooled data of 40,555 women included in Demographic and Health Surveys (DHS) conducted between 2013 to 2021. Proportions and logistic regression models were used in assessing the interplay of distance to health facilities and socio-demographic factors with cervical screening behaviour. RESULTS Approximately, 7.9% of women that saw the distance to a health facility as a big problem, tested for cervical cancer compared to 13.5% who indicated that distance to a health facility is not a big problem. More women in urban areas, with a higher level of education, of richest wealth index, aged 40-44 years and using contraceptives who also indicated that distance to a health facility was a big problem tested for cervical cancer compared to those in rural areas with no education, of poorest wealth index, aged 15-19 years and not using contraceptives. Education, age, contraceptive use, frequent exposure to mass media and Sexual Transmitted Infections (STI) had a significant relationship with testing for cervical cancer. CONCLUSION The prevalence of cervical cancer screening was low in the five SSA countries largely due to distance barriers and was also significantly influenced by education, age, contraceptive use, frequent exposure to mass media, and STI status. To improve the screening for cervical cancer and its associated benefits in the five SSA countries, there is a need for policymakers, clinicians and public health workers to channel more commitment and efforts to addressing the barriers identified in this study.
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Affiliation(s)
- Kwamena S. Dickson
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer N. K. Boateng
- grid.413081.f0000 0001 2322 8567Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana
| | - Evelyn Acquah
- grid.449729.50000 0004 7707 5975Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Castro Ayebeng
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Isaac Y. Addo
- grid.1005.40000 0004 4902 0432Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
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Ng'ambi W, Zyambo C. Cervical cancer care cascade among women living with human immunodeficiency virus in 13 sub-Saharan Africa countries between 2019 and 2021: An ecological analysis of PEPFAR Panorama cervical cancer program data. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2023. [DOI: 10.4103/jncd.jncd_14_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Derbie A, Mekonnen D, Nibret E, Misgan E, Maier M, Woldeamanuel Y, Abebe T. Cervical cancer in Ethiopia: a review of the literature. Cancer Causes Control 2023; 34:1-11. [PMID: 36242682 DOI: 10.1007/s10552-022-01638-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 09/26/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cervical cancer is one of the most common malignancies affecting women worldwide with large geographic variations in prevalence and mortality rates. It is one of the leading causes of cancer-related deaths in Ethiopia, where vaccination and screening are less implemented. However, there is a scarcity of literature in the field. Therefore, the objective of this review was to describe current developments in cervical cancer in the Ethiopian context. The main topics presented were the burden of cervical cancer, knowledge of women about the disease, the genotype distribution of Human papillomavirus (HPV), vaccination, and screening practices in Ethiopia. METHODS Published literature in the English language on the above topics until May 2021 were retrieved from PubMed/Medline, SCOPUS, Google Scholar, and the Google database using relevant searching terms. Combinations of the following terms were considered to retrieve literature; < Cervical cancer, uterine cervical neoplasms, papillomavirus infections, papillomavirus vaccines, knowledge about cervical cancer, genotype distribution of HPV and Ethiopia > . The main findings were described thematically. RESULTS Cervical cancer is the second most common and the second most deadly cancer in Ethiopia, The incidence and prevalence of the disease is increasing from time to time because of the growth and aging of the population, as well as an increasing prevalence of well-established risk factors. Knowledge and awareness about cervical cancer is quite poor among Ethiopian women. According to a recent report (2021), the prevalence of previous screening practices among Ethiopian women was at 14%. Although HPV 16 is constantly reported as the common genotype identified from different grade cervical lesions in Ethiopia, studies reported different HPV genotype distributions across the country. According to a recent finding, the most common HPV types identified from cervical lesions in the country were HPV-16, HPV-52, HPV-35, HPV-18, and HPV-56. Ethiopia started vaccinating school girls using Gardasil-4™ in 2018 although the coverage is insignificant. Recently emerging reports are in favor of gender-neutral vaccination strategies with moderate coverage that was found superior and would rapidly eradicate high-risk HPVs than vaccinating only girls. CONCLUSIONS Cervical cancer continues to be a major public health problem affecting thousands of women in Ethiopia. As the disease is purely preventable, classic cervical cancer prevention strategies that include HPV vaccination using a broad genotype coverage, screening using a high precision test, and treating cervical precancerous lesions in the earliest possible time could prevent most cervical cancer cases in Ethiopia. The provision of a focused health education supported by educational materials would increase the knowledge of women about cervical cancer in general and the uptake of cervical cancer prevention and screening services in particular.
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Affiliation(s)
- Awoke Derbie
- Department of Medical Microbiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia.
- Department of Health Biotechnology, Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia.
- Department of Medical Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Daniel Mekonnen
- Department of Medical Microbiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Health Biotechnology, Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
| | - Endalkachew Nibret
- Department of Biology, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eyaya Misgan
- Department of Gynecology and Obstetrics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melanie Maier
- Department of Diagnostics, Institute of Virology, Leipzig University Hospital, Leipzig, Germany
| | - Yimtubezinash Woldeamanuel
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Medical Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Medical Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Amonoo HL, Abdul-Rahim SA, Atobrah D, Addo-Mensah D, Longley RM, Jacobo MC, Pirl WF. Psychosocial oncology in Sub-Saharan Africa: Lessons from Ghana. Psychooncology 2023; 32:139-147. [PMID: 35584290 DOI: 10.1002/pon.5965] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Salisu A Abdul-Rahim
- National Radiotherapy, Oncology, and Nuclear Medicine Center, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Deborah Atobrah
- Institute of African Studies, University of Ghana, Accra, Ghana
| | - Dorothy Addo-Mensah
- Department of Adult Health, School of Nursing and Midwifery, University of Cape-Coast, Cape-Coast, Ghana
| | - Regina M Longley
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michelle C Jacobo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - William F Pirl
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Liu X, Zhang J, Ju S, Liu L, Sun Y, Guo L, Zhen Q, Han S, Lu W, Zhang Y. ECT2 promotes malignant phenotypes through the activation of the AKT/mTOR pathway and cisplatin resistance in cervical cancer. Cancer Gene Ther 2023; 30:62-73. [PMID: 36056253 DOI: 10.1038/s41417-022-00525-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/09/2022] [Accepted: 08/19/2022] [Indexed: 01/19/2023]
Abstract
Epithelial cell transforming sequence 2 (ECT2) is expressed at high levels in various malignancies and contributes to malignant phenotypes in cancers. However, ECT2 is still not fully understood regarding its function and carcinogenic mechanism in cervical cancer. This research indicated that ECT2 expression was elevated in cervical cancer based on bioinformatics analysis and clinical specimens. Experiments in vitro and in vivo confirmed that ECT2 knockdown could suppress the proliferation and metastasis of cervical carcinoma cells. In addition, we found that silencing ECT2 could enhance the sensitivity to cisplatin and promote cell apoptosis. Mechanistically, we observed that ECT2 knockdown could inhibit the AKT/mTOR pathway and activate apoptosis, while ECT2 overexpression induced the opposite effect. The relationship between ECT2 and AKT was further confirmed by immunoprecipitation and rescue experiments. We found that the ECT2 and AKT could interact to form a complex, and knockdown AKT could offset all of the effects induced by ECT2. Our study emphasized the key point of ECT2 in the reversal of cisplatin resistance, and ECT2 could become a potential therapeutic target in cervical cancer.
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Affiliation(s)
- Xiaoli Liu
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Jinan, China.,Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Junhua Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Jinan, China.,Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Shuang Ju
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Jinan, China.,Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Lu Liu
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Jinan, China.,Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Yu Sun
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Jinan, China.,Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Lingyu Guo
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Jinan, China.,Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Qianwei Zhen
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Jinan, China.,Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Sai Han
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Jinan, China.,Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Wei Lu
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Jinan, China.,Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China. .,Key Laboratory of Gynecologic Oncology of Shandong Province, Jinan, China. .,Shandong Engineering Laboratory for Urogynecology, Qilu Hospital of Shandong University, Jinan, China.
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Smith SM, Eadara A, Parkash V. Addressing quality and safety in anatomic pathology in low- and middle-income countries. Front Med (Lausanne) 2022; 9:1060179. [PMID: 36619634 PMCID: PMC9817141 DOI: 10.3389/fmed.2022.1060179] [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: 10/02/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
The World Health Organization (WHO) has created a sustainable development goal of reducing preventable mortality from cancer in low- and middle-income countries (LMICs) by 30% by 2030. Central to achieving this goal is the creation and maintenance of quality anatomic pathology services (APS). Within the last decade, quality assurance programs and patient safety measures have become a major focus of research for upper middle- and high-income countries (UMHICs), which has led to marked documented improvement in the quality of services provided by laboratories, as well as a decrease in patient safety events. We propose that as APS are developed in LMICs, the lessons learned by UMHICs are necessary to incorporate to produce quality and safe services toward obtaining the aforementioned goal. Furthermore, data suggests that Quality Improvement work requires change at the macrosystems and microsystems levels to achieve these goals. Here, we propose five "microsystems" strategies for professional organizations, healthcare institutions in LMICs and UMHICs that would accelerate quality improvement programs/systems implementation in APS in LMICs.
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Affiliation(s)
- Stephen M. Smith
- Department of Laboratory Medicine & Pathobiology, University Health Network, Toronto, ON, Canada
| | | | - Vinita Parkash
- Department of Pathology, Yale School of Medicine, Yale University, New Haven, CT, United States,*Correspondence: Vinita Parkash,
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Zhang W, Gao K, Fowkes FJI, Adeloye D, Rudan I, Song P, Jin M, Chen K. Associated factors and global adherence of cervical cancer screening in 2019: a systematic analysis and modelling study. Global Health 2022; 18:101. [PMID: 36494856 PMCID: PMC9733311 DOI: 10.1186/s12992-022-00890-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cervical cancer screening is vital for its prevention. Adherence is a crucial indicator that implies the individual willingness to take cervical cancer screening. We aimed to estimate the global and regional adherence rates of cervical cancer screening in 2019 and identify its associated factors among general women. METHOD We searched studies in PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Database, ProQuest theses database and Google Web, without a lower time limit and until 23 June, 2021. Survey studies were considered eligible if they investigated cervical cancer screening adherence among general women, with data on sample size, the number of adherent subjects, and/or adherence rate. Random-effects were used to pool the odds ratios (ORs) of associated factors of adherence. Using modelling analysis, we estimated 2019 overall and age-specific adherence rates at the global and regional levels in women aged 20-69 years. RESULTS Eight thousand two hundred ninety records were identified, and 153 articles were included. Being married (vs not married: OR, 1.34; 95% confidence interval [CI]: 1.23-1.46), higher educational attainment (higher than high school vs less than high school: OR, 1.44; 95% CI: 1.35-1.53), having healthcare (OR, 1.64; 95% CI: 1.43-1.88), former smoking (OR, 1.20; 95% CI: 1.07-1.34), physical activity (OR, 1.19; 95% CI: 1.05-1.36), parity (OR, 1.07; 95% CI: 1.01-1.12), and chronic disease (OR, 1.17; 95% CI: 1.04-1.32) were associated with better adherence, whereas obesity (vs normal: OR, 0.85; 95% CI: 0.74-0.97) and current smoking (vs former/never: OR, 0.64; 95% CI: 0.54-0.76) were associated with worse adherence. In 2019, the adherence was at 33.66% (95% CI: 23.34-39.30%) worldwide, and was higher in high-income countries (HICs) (75.66, 95% CI: 66.74-82.81%) than in low and middle-income countries (LMICs) (24.91, 95% CI: 14.30-30.24%). It varied across regions, the highest in the European region (65.36, 95% CI: 55.40-74.19%), but the lowest in the African region (5.28, 95% CI: 3.43-8.03%). CONCLUSIONS Cervical cancer screening adherence remained low globally, exhibiting geographical discrepancy with HICs higher than LMICs. Further implementations of screening programs should comprehensively consider the local economy, social benefits, and demographic structure to adapt delivery for vulnerable or underserved women to boost screening adherence.
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Affiliation(s)
- Wanting Zhang
- grid.412465.0Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058 China
| | - Kai Gao
- grid.412465.0Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058 China
| | - Freya J. I. Fowkes
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, VIC Australia
| | - Davies Adeloye
- grid.4305.20000 0004 1936 7988Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Igor Rudan
- grid.4305.20000 0004 1936 7988Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Peige Song
- grid.412465.0Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058 China
| | - Mingjuan Jin
- grid.412465.0Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058 China
| | - Kun Chen
- grid.412465.0Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058 China
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Mwenda V, Bor JP, Nyangasi M, Temmerman M. Mobilizing stakeholders to drive the cervical cancer elimination agenda in Kenya: The national cervical cancer stakeholders' forum 2022. DIALOGUES IN HEALTH 2022; 1:100066. [PMID: 38515876 PMCID: PMC10953883 DOI: 10.1016/j.dialog.2022.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 03/23/2024]
Abstract
Background Kenya is among the nineteen countries in Sub-Saharan Africa with the highest burden of cervical cancer globally. The high burden of cervical cancer in developing countries reflects the absence of effective cervical cancer prevention programs with limited resources invested to provide comprehensive services. Objective We aimed to engage stakeholders in a structured consultative forum, to gain insights and forge effective partnerships to drive the cervical cancer elimination agenda in Kenya. Methods The National Cervical Cancer Stakeholders Consultative Forum was organized as a part of activities to commemorate the National Cervical Cancer Awareness Month on 19th January 2022 in Nairobi, Kenya. The overall goal of the meeting was to provide a forum to sensitize stakeholders on the National Cervical Cancer Prevention and Control Program (NCCP) with a view to strengthen partnerships, increase coordination for improved service delivery and to provide a forum for resource mobilisation and alignment of key stakeholders towards elimination of cervical cancer in Kenya. Nominal group technique was adopted for structured discussions, and the findings analysed to derive key themes. Findings Key challenges to primary and secondary prevention of cervical cancer were identified as low awareness, stigma and misinformation, high unmet need for treatment of early lesions, few health care providers with capacity to screen and treat, inadequate supplies, inefficient health information systems and poor referral pathways. Championing integration of cervical cancer screening and treatment services into routine health programs, strengthening policy implementation and robust monitoring and evaluation were identified as critical interventions. Conclusion The National Cervical Cancer Stakeholders Forum 2022 provided insights for enabling Kenya to progress on the 2030 elimination targets. Such forums can be useful in bringing all actors together to evaluate achievements and identify opportunities for more effective national cervical cancer prevention and control programs.
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Affiliation(s)
- Valerian Mwenda
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Joan-Paula Bor
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Mary Nyangasi
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
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Tong Y, Orang’o E, Nakalembe M, Tonui P, Itsura P, Muthoka K, Titus M, Kiptoo S, Mwangi A, Ong’echa J, Tonui R, Odongo B, Mpamani C, Rosen B, Moormann A, Cu-Uvin S, Bailey JA, Oduor CI, Ermel A, Yiannoutsos C, Musick B, Sang E, Ngeresa A, Banturaki G, Kiragga A, Zhang J, Song Y, Chintala S, Katzenellenbogen R, Loehrer P, Brown DR. The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS. Ann Med 2022; 54:1202-1211. [PMID: 35521812 PMCID: PMC9090376 DOI: 10.1080/07853890.2022.2067897] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 12/24/2022] Open
Abstract
The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety. KEY MESSAGESThe East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer.Collaborations have been established between researchers in North America and East African countries for these studies.Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.
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Affiliation(s)
- Y. Tong
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - M. Nakalembe
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | | | | | - M. Titus
- Maseno University, Kisumu, Kenya
| | | | | | - J. Ong’echa
- Kenya Medical Research Institute, Eldoret, Kenya
| | | | | | - C. Mpamani
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - B. Rosen
- Beaumont Gynecology Oncology, Royal Oak, MI, USA
| | - A. Moormann
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | | | | | - A. Ermel
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - C. Yiannoutsos
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - B. Musick
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - G. Banturaki
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - A. Kiragga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - J. Zhang
- Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Y. Song
- Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
| | - S. Chintala
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - P. Loehrer
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - D. R. Brown
- Indiana University School of Medicine, Indianapolis, IN, USA
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Boily MC, Barnabas RV, Rönn MM, Bayer CJ, van Schalkwyk C, Soni N, Rao DW, Staadegaard L, Liu G, Silhol R, Brisson M, Johnson LF, Bloem P, Gottlieb S, Broutet N, Dalal S. Estimating the effect of HIV on cervical cancer elimination in South Africa: Comparative modelling of the impact of vaccination and screening. EClinicalMedicine 2022; 54:101754. [PMID: 36583170 PMCID: PMC9793279 DOI: 10.1016/j.eclinm.2022.101754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background In 2020, the World Health Organization (WHO) launched its initiative to eliminate cervical cancer as a public health problem. To inform global efforts for countries with high HIV and cervical cancer burden, we assessed the impact of human papillomavirus (HPV) vaccination and cervical cancer screening and treatment in South Africa, on cervical cancer and the potential for achieving elimination before 2120, considering faster HPV disease progression and higher cervical cancer risk among women living with HIV(WLHIV) and HIV interventions. Methods Three independent transmission-dynamic models simulating HIV and HPV infections and disease progression were used to predict the impact on cervical cancer incidence of three scenarios for all women: 1) girls' vaccination (9-14 years old), 2) girls' vaccination plus 1 lifetime cervical screen (at 35 years), and 3) girls' vaccination plus 2 lifetime cervical screens (at 35 and 45 years) and three enhanced scenarios for WLHIV: 4) vaccination of young WLHIV aged 15-24 years, 5) three-yearly cervical screening of WLHIV aged 15-49 years, or 6) both. Vaccination assumed 90% coverage and 100% lifetime protection with the nonavalent vaccine (against HPV-16/18/31/33/45/52/58). Cervical cancer screening assumed HPV testing with uptake increasing from 45% (2023), 70% (2030) to 90% (2045+). We also assumed that UNAIDS 90-90-90 HIV treatment and 70% male circumcision targets are reached by 2030. We examined three elimination thresholds: age-standardised cervical cancer incidence rates below 4 or 10 per 100,000 women-years, and >85% reduction in cervical cancer incidence rate. We conducted sensitivity analyses and presented the median age-standardised predictions of outcomes of the three models (minimum-maximum across models). Findings Girls' vaccination could reduce age-standardised cervical cancer incidence from a median of 47.6 (40.9-79.2) in 2020 to 4.5 (3.2-6.3) per 100,000 women-years by 2120, averting on average ∼4% and ∼46% of age-standardised cumulative cervical cancer cases over 25 and 100 years, respectively, compared to the basecase. Adding 2 lifetime screens helped achieve elimination over the century among all women (2120 cervical cancer incidence: 3.6 (1.9-3.6) per 100,000 women-years), but not among WLHIV (10.8 (5.3-11.6)), and averted more cumulative cancer cases overall (∼45% over 25 years and ∼61% over 100 years compared to basecase) than girls' vaccination alone. Adding three-yearly cervical screening among WLHIV (to girls' vaccination and 2 lifetime cervical screens) further reduced age-standardised cervical cancer incidence to 3.3 (1.8-3.6) per 100,000 women-years overall and to 5.2 (3.9-8.5) among WLHIV by 2120 and averted on average 12-13% additional cumulative cancer cases among all women and 21-24% among WLHIV than girls' vaccination and 2 lifetime cervical screens over 25 years or longer. Long-term vaccine protection and using the nonavalent vaccine was required for elimination. Interpretation High HPV vaccination coverage of girls and 2 lifetime cervical screens could eliminate cervical cancer among women overall in South Africa by the end of the century and substantially decrease cases among all women and WLHIV over the short and medium term. Cervical cancer elimination in WLHIV would likely require enhanced prevention strategies for WLHIV. Screening of WLHIV remains an important strategy to reduce incidence and alleviate disparities in cervical cancer burden between women with and without HIV, despite HIV interventions scale-up. Funding World Health Organization. National Cancer Institute, National Institutes of Health. MRC Centre for Global Infectious Disease Analysis, UK Medical Research Council. National Institute of Child Health and Human Development research. Cancer Association of South Africa. Canadian Institutes of Health Research and the Fonds de recherche du Québec - Santé research.
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Affiliation(s)
- Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Ruanne V. Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Minttu M. Rönn
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Cara J. Bayer
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA, USA
| | - Cari van Schalkwyk
- The South African Department of Science and Innovation/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Nirali Soni
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Darcy W. Rao
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA, USA
| | - Lisa Staadegaard
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Gui Liu
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA, USA
| | - Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Marc Brisson
- Centre de Recherche du CHU de Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Paul Bloem
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Sami Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shona Dalal
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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Vilares AT, Ciabattoni R, Cunha TM, Félix A. Cervical cancer in Cape Verde: reappraisal upon referral to a tertiary cancer centre. Ecancermedicalscience 2022; 16:1471. [PMID: 36819824 PMCID: PMC9934889 DOI: 10.3332/ecancer.2022.1471] [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: 07/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Cervical cancer (CC) is the first cause of cancer-related deaths among Cape Verdean women. The absence of a national screening programme and a lack of dedicated cancer treatment facilities contribute to its high mortality rate. In an effort to improve the prognosis of these women, a health cooperation agreement was established between Portugal and Cape Verde (CV), allowing their evacuation to Portuguese hospitals. Our aim was to characterise CC among CV women, and to assess the response given to these patients in Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), so that their treatment and follow-up protocols can be optimised and overall prognosis improved. Methods Retrospective evaluation of women diagnosed with CC in CV that underwent therapy in IPOLFG between 2013 and 2020. Risk factors, demographic and tumour characteristics, treatment and outcomes were reviewed. Results Fifty-eight patients were included. Squamous cell carcinoma was the most frequent (91.5%) histological type. HPV DNA was present in 25 out of 26 samples.The agreement rate between the pathology analysis performed in CV and in Portugal was high (87.9%); however, the agreement regarding the FIGO stage was low (15.5%). This may be explained by both the time interval between diagnosis and treatment (around 6 months) and by the absence of resources to accurately stage the disease in CV. In IPOLFG, 77.6% of patients received combined chemo-radiotherapy. Post-treatment follow-up varied widely, due to disease-related and bureaucratic issues. Eighteen patients developed cancer-related complications and/or cancer-related death. The survival rate and median overall survival (OS) in our cohort were of 89.7% and 73.2 months, respectively. Conclusions Although most women had advanced-stage disease, the OS in our cohort was better than what has been reported for other African countries, probably because state-of-the-art treatment, frequently not accessible in those countries, was offered to all patients.
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Affiliation(s)
- Ana Teresa Vilares
- Department of Radiology, Centro Hospitalar Universitário de São João, Porto 4200-319, Portugal,Medical School, University of Porto, Porto 4200-319, Portugal,https://orcid.org/0000-0001-7375-491X
| | - Riccardo Ciabattoni
- Azienda Sanitaria Universitaria Giuliano-Isontina, Dipartimento Universitario di Scienze Mediche Chirurgiche e Sperimentali, Università degli Studi di Trieste, Trieste 34148, Italy,https://orcid.org/0000-0003-4555-6128
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon 1099-023, Portugal,https://orcid.org/0000-0003-2411-0207
| | - Ana Félix
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon 1099-023, Portugal,NOVA Medical School, NMS, Universidade NOVA de Lisboa, Lisbon, Portugal,https://orcid.org/0000-0002-2653-2262
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Gebresilasie SF, Zegeye A. Accuracy of VIA for the diagnosis of cervical cancer and associated factors among women attending cervical cancer screening at Hawassa university comprehensive specialized hospital, southern Ethiopia: Institutional based cross sectional study. Ann Med Surg (Lond) 2022; 84:104873. [DOI: 10.1016/j.amsu.2022.104873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/09/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
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The role of mixed lineage kinase 3 (MLK3) in cancers. Pharmacol Ther 2022; 238:108269. [DOI: 10.1016/j.pharmthera.2022.108269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
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Competing Endogenous RNA (ceRNA) Networks and Splicing Switches in Cervical Cancer: HPV Oncogenesis, Clinical Significance and Therapeutic Opportunities. Microorganisms 2022; 10:microorganisms10091852. [PMID: 36144454 PMCID: PMC9501168 DOI: 10.3390/microorganisms10091852] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/25/2022] [Accepted: 09/09/2022] [Indexed: 12/20/2022] Open
Abstract
Cervical cancer (CC) is the primary cause of female cancer fatalities in low-middle-income countries (LMICs). Persistent infections from the human papillomavirus (HPV) can result in cervical cancer. However, numerous different factors influence the development and progression of cervical cancer. Transcriptomic knowledge of the mechanisms with which HPV causes cervical cancer pathogenesis is growing. Nonetheless, there is an existing gap hindering the development of therapeutic approaches and the improvement of patient outcomes. Alternative splicing allows for the production of numerous RNA transcripts and protein isoforms from a single gene, increasing the transcriptome and protein diversity in eukaryotes. Cancer cells exhibit astounding transcriptome modifications by expressing cancer-specific splicing isoforms. High-risk HPV uses cellular alternative splicing events to produce viral and host splice variants and proteins that drive cancer progression or contribute to distinct cancer hallmarks. Understanding how viruses utilize alternative splicing to drive pathogenesis and tumorigenesis is essential. Although research into the role of miRNAs in tumorigenesis is advancing, the function of other non-coding RNAs, including lncRNA and circRNA, has been understudied. Through their interaction with mRNA, non-coding RNAs form a network of competing endogenous RNAs (ceRNAs), which regulate gene expression and promote cervical cancer development and advancement. The dysregulated expression of non-coding RNAs is an understudied and tangled process that promotes cervical cancer development. This review will present the role of aberrant alternative splicing and immunosuppression events in HPV-mediated cervical tumorigenesis, and ceRNA network regulation in cervical cancer pathogenesis will also be discussed. Furthermore, the therapeutic potential of splicing disruptor drugs in cervical cancer will be deliberated.
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Aruho C, Mugambe S, Baluku JB, Taremwa IM. Human Papillomavirus Vaccination Uptake and Its Predictors Among Female Adolescents in Gulu Municipality, Northern Uganda. Adolesc Health Med Ther 2022; 13:77-91. [PMID: 36186270 PMCID: PMC9524482 DOI: 10.2147/ahmt.s383872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/17/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Caroline Aruho
- Coalition for Health Promotion and Social Development, Kampala, Uganda
| | - Samuel Mugambe
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
| | | | - Ivan Mugisha Taremwa
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
- Correspondence: Ivan Mugisha Taremwa, Email
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Khumalo PG, Carey M, Mackenzie L, Ampofo AG, Sanson-Fisher R. Trends in cervical cancer screening research in sub-Saharan Africa: A bibliometric analysis of publications from 2001 to 2020. J Cancer Policy 2022; 34:100356. [PMID: 35995396 DOI: 10.1016/j.jcpo.2022.100356] [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: 11/22/2021] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 12/24/2022]
Abstract
Sub-Saharan Africa has the highest incidence of cervical cancer globally. However, compared to developed countries, the region has lower uptake of cervical cancer screening. Research contribution and progress in the field of cervical cancer in the region has not been well investigated. This bibliometric review aimed to address this information gap by examining changes in research volume and type over a 20 year time frame. Medline, Embase, PsycINFO, CINAHL, and Cochrane Library were searched to identify peer-reviewed publications about cervical cancer screening in sub-Saharan Africa. Changes (from 2001 to 2020) in the (i) total publications, (ii) number and proportion of data-based publications relative to non-data-based publications, and descriptive relative to intervention publications, and (iii) the number and proportion of publications meeting the EPOC design criteria relative to those not meeting the EPOC design criteria were assessed using a generalised linear Poisson model, a generalised binomial model and the Pearson Chi-squared test respectively. A two-year increase in time was associated with an estimated 32 % increase in the total number of publications. While no measurement studies were recorded, the bulk of data-based publications (89 %) were descriptive studies. Relative to descriptive publications, a 1 % increase in the proportion of intervention publications was observed over time. Only a small proportion (28 %) of intervention studies met the EPOC design criteria. Our findings suggest that researchers and funders in the region should invest more effort and money in measurement and rigorous intervention research to inform outcome measures and cervical cancer screening policy and practice, respectively.
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Affiliation(s)
- Phinda G Khumalo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Mariko Carey
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Lisa Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Ama G Ampofo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.
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Ammoun R, Wami WM, Otieno P, Schultsz C, Kyobutungi C, Asiki G. Readiness of health facilities to deliver non-communicable diseases services in Kenya: a national cross-sectional survey. BMC Health Serv Res 2022; 22:985. [PMID: 35918710 PMCID: PMC9344761 DOI: 10.1186/s12913-022-08364-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Non-communicable diseases (NCDs) account for an estimated 71% of all global deaths annually and nearly 80% of these deaths occur in low- and middle-income countries. This study aimed to assess the readiness of existing healthcare systems at different levels of health care in delivering NCDs management and prevention services in Kenya. Methods A cross-sectional survey of 258 facilities was conducted between June 2019 and December 2020 using multistage sampling, examining facility readiness based on the availability of indicators such as equipment, diagnostic capacity, medicines and commodities, trained staff and guidelines for NCDs management. Readiness scores were calculated as the mean availability of tracer items expressed as a percentage and a cut-off threshold of ≥ 70% was used to classify facilities as “ready” to manage NCDs. Descriptive and bivariate analyses were performed to assess the readiness of facilities by type, level, and location settings. Logistic regressions were used to identify factors associated with the readiness of facilities to provide disease-specific services. Results Of the surveyed facilities, 93.8% offered chronic respiratory disease (CRD) diagnosis and/or management services, 82.2% diabetes mellitus, 65.1% cardiovascular disease (CVD), and only 24.4% cervical cancer screening services. The mean readiness scores for diabetes mellitus (71%; 95% CI: 67–74) and CVD (69%; 95% CI: 66–72) were relatively high. Although CRD services were reportedly the most widely available, its mean readiness score was low (48%; 95% CI: 45–50). The majority of facilities offering cervical cancer services had all the necessary tracer items available to provide these services. Modeling results revealed that private facilities were more likely to be “ready” to offer NCDs services than public facilities. Similarly, hospitals were more likely “ready” to provide NCDs services than primary health facilities. These disparities in service readiness extended to the regional and urban/rural divide. Conclusions Important gaps in the current readiness of facilities to manage NCDs in Kenya at different levels of health care were revealed, showing variations by disease and healthcare facility type. A collective approach is therefore needed to bridge the gap between resource availability and population healthcare needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08364-w.
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Affiliation(s)
- Rita Ammoun
- Faculty of Médicine, Limoges Université, 2 Rue du Docteur Marcland, 87025, LIMOGES CEDEX, France
| | - Welcome Mkhululi Wami
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya. .,Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands.
| | - Peter Otieno
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya
| | - Constance Schultsz
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Catherine Kyobutungi
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya.,Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya.,Department of Women's and Children's Health (KBH), Karolinka Institutet, Tomtebodavägen 18A, 171 77, Solna, Sweden
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Auxiliary classification of cervical cells based on multi-domain hybrid deep learning framework. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lemma D, Aboma M, Girma T, Dechesa A. Determinants of utilization of cervical cancer screening among women in the age group of 30–49 years in Ambo Town, Central Ethiopia: A case-control study. PLoS One 2022; 17:e0270821. [PMID: 35830438 PMCID: PMC9278774 DOI: 10.1371/journal.pone.0270821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Globally, cervical cancer is the second most common and the leading cause of death in women in low-income countries. It is one of the potentially preventable cancers, and an effective screening program can result in a significant reduction in the morbidity and mortality associated with this cancer; however, evidence showed that only a small percentage of the women were screened. As a result, predictors of cervical cancer screening usage among women in Ambo town, central Ethiopia, were identified in this study. Method Unmatched, a community-based case-control study was conducted among 195 randomly sampled women in the age group of 30–49 years in Ambo town from February 1 to March 30, 2020. Data was collected using an interviewer-administered questionnaire. Descriptive, bivariate, and multivariable binary logistic regression analysis was done using SPSS. Results A total of 195 study participants, sixty-five cases and one hundred thirty controls, participated in this study, making a response rate of 100%. Being in the age group of 30–34 years old (AOR = 0.2; 95% CI: 0.06–0.7), being Para five and above (AOR = 4.5; 95% CI: 1.4–14.1), modern contraceptive utilization (AOR = 5.4; 95% CI: 1.8–16.3) and having high-level knowledge regarding cervical cancer screening and its predisposing factors (AOR = 5.9; 95% CI: 2–17) were significantly associated with the utilization of cervical cancer screening. Conclusion The age of women, parity, use of modern contraception, and level of knowledge regarding cervical cancer screening and its predisposing factors were the determinants of the utilization of cervical cancer screening among women. As a result, the media, the health bureau, and health professionals should advocate raising awareness about cervical cancer and its preventative methods, which are primarily focused on screening.
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Affiliation(s)
- Dereje Lemma
- Ambo University College of Medicine and Health Sciences, Ambo, Ethiopia
| | - Mecha Aboma
- Ambo University College of Medicine and Health Sciences, Ambo, Ethiopia
- * E-mail: ,
| | - Teka Girma
- Ambo University College of Medicine and Health Sciences, Ambo, Ethiopia
| | - Abebe Dechesa
- Ambo University College of Medicine and Health Sciences, Ambo, Ethiopia
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