Cervical cancer in Iran: integrative insights of epidemiological analysis

The Impact of Self-Care Recommendations with and without Tilt-Training on Quality of Life in Children and Adolescents with Vasovagal Syncope: A Randomized Clinical Trial

Background

Syncope is among the most common paroxysmal disorders in children and adolescents. Vasovagal syncope is the most common syncope in children and adolescents. The aim of this study was to evaluate the impact of self-care recommendations with and without tilt training on the Quality of Life (QoL) of children and adolescents with syncope.

Materials and Methods

This randomized controlled clinical trial was conducted in Isfahan, Iran, from April 2017 to June 2021 and included 120 patients with syncope. Eligible children and adolescents (aged 6-18 years) who met inclusion criteria were recruited by the simple sampling method and then assigned randomly into two groups. The intervention group (n = 60) received routine self-care recommendations such as dietary advice, behaviors to prevent syncope, and counter-pressure maneuvers along with tilt training, while the control group (n = 60) received self-care recommendations without tilt training. The education training included two face-to-face sessions, each of which lasted for 45-60 min. Then, both groups were followed up by telephone (once a month) for six months. A researcher-made self-care questionnaire and Pediatric Quality of Life Inventory (PedsQL™ 4.0) were completed for both groups before and after the intervention. Data were analyzed using descriptive and inferential statistical methods.

Results

The Wilcoxon test results showed a significant difference in the mean scores of physical functioning, emotional functioning, social functioning, school functioning, psychosocial functioning, understanding of health, and total QoL in the intervention and control groups before and after the intervention (p < 0.05). Also, the paired t-test results showed a significant difference in the mean scores of self-care domains and total self-care in the intervention and control groups before and after the intervention (p < 0.05).

Conclusions

Self-care recommendations with and without tilt training can improve QoL in children and adolescents with syncope.

Uptake of Human Papilloma Virus vaccine among young women living in fishing communities in Wakiso and Mukono districts, Uganda

Human Papilloma Virus (HPV) is a preventable cause of cervical cancer, the commonest cancer among women in Uganda. The Uganda Ministry of Health included the HPV vaccine in the free routine immunization schedule since 2015. Five years after this policy, we assessed the uptake of the HPV vaccine and associated socio-demographic factors among young women living in fishing communities in Central Uganda in 2020. We analyzed secondary data from 94 young women aged 9-25 years who were recruited from the two fishing communities (Kasenyi landing site and Koome Island) in a primary study that aimed to promote awareness of maternal and childhood vaccines. We assessed uptake of the HPV vaccine as the proportion of participants who self-reported to have ever received at least one dose of the HPV vaccine. We assessed the socio-demographic factors associated with HPV vaccine uptake using a modified Poisson regression model adjusted for clustering by study site in STATA version 17. The mean (standard deviation) age of study participants was 21.1 (3.1) years and most (81.9%) of them were from Kasenyi landing site. The uptake of the HPV vaccine was 10.6% [95% Confidence Interval (CI) 5.6, 18.9]. After adjusting for covariates, being 13-19 years old (adjusted prevalence ratio [aPR] 5.52, 95%CI 1.69, 18.00) and of Catholic religion (aPR 5.55, 95%CI 1.53, 20.16) were significantly associated with HPV vaccine uptake. The HPV vaccine uptake was very low, despite the reported 99% national coverage of HPV vaccination program for the first dose at the end of 2019. Age and religion showed to be important determinants of the HPV vaccine uptake. Reasons for such very low uptake of HPV vaccinations need to be carefully assessed to find effective strategies to improve it.

Epidemiology of cervical cancer in Iran in 2016: A nationwide study of incidence and regional variation

BACKGROUND

Cervical cancer is a common, and fatal cancer in women worldwide. This cancer is the fourth most common cancer in women after breast, colorectal, and lung cancer.

AIMS

This study aims to investigate the age-standardized incidence rate (ASR) and the geographical distribution of Cervical Cancer in Iran.

METHODS

This study was designed as a descriptive cross-sectional investigation. The study sample comprised all individuals registered as cervical cancer patients in the National Cancer Registry system in 2016. The crude rate and ASR for each province were computed independently. Furthermore, we employed ArcMap10.5 software and geographic information system to conduct an analysis of the gathered data. In order to ascertain the spatial distribution and clustering of cervical cancer incidence, we utilized Moran's I, which measures spatial autocorrelation.

RESULTS

We studied a total of 808 cases of cervical cancer with a median age to be 52.19 years (IQR≈1.35). Among these cases, 685 (84.7%) were diagnosed based on the pathological reports with morphological verification, while 81 patients (10.1%) were clinically identified, and 42 cases (5.2%) were diagnosed using the death certificate-only method. Squamous cell carcinoma accounted for 61% of all cases (n = 497). The ASR of cervical cancer in Iran was 1.90 per 100 000 populations. The provincial ASR ranged from 0.29 to 5.03 per 100 000, with the highest rates observed in Golestan (5.03), East Azerbaijan (4.07), and Ilam (3.72). We found no clustering patterns in the distribution of provincial crude, age-specific, and age-standardized incidence rates (p > .05).

CONCLUSION

The incidence of cervical cancer in Iran was lower than the global average, and we did not identify any significant disparities in the incidence rates among the provinces. Although there were differences in incidence rates among the areas, these were not clustered. It is crucial to remember that cervical cancer is still a major public health issue in Iran, and in order to lessen the disease's burden, national initiatives to enhance screening, early identification, and access to efficient treatment should continue to be top priorities.

Comparison of Visual Inspection Methods with Pap Smear as Screening Test for Premalignant Lesions of the Cervix

Aim and Objectives

The present study was done to compare the visual inspection methods with Pap smear as a screening test for premalignant lesions of the cervix.

Materials and Methods

The present observational prospective study was done at the Department of Obstetrics and Gynecology at Teerthanker Mahaveer Medical College and Research Center for 18 months. All study subjects were subjected to Papanicolaou smear, VIA, and VILI examination. If any of these tests were found positive, then a colposcopy and cervical biopsy were done.

Results

The sensitivity of Pap, VIA, VILI, and colposcopy was 52.63%, 84.21%, 73.68%, and 84.21%, respectively. The specificity of Pap, VIA, VILI, and colposcopy was 60.0%, 80.0%, 60.0%, and 80.0%, respectively. The accuracy of Pap, VIA, VILI, and colposcopy was 54.17%, 83.33%, 70.83%, and 83.33%, respectively.

Conclusion

It is well known that VIA and VILI are very easy to carry out and apply. Even technically they do not cost much, consume less tax and can be applied to all the patients. Even the results are calculated in a faster manner which helps in chalking out the plan in an easy way.

Association of dietary intake and cervical cancer: a prevention strategy

INTRODUCTION

Cervical cancer is one of lethal cancers in women. As a global concern, identifying important factors of cancer is a useful strategy for prevention. Due to the role of diet/nutrition factors for cancer, the purpose of our study was to determine the impact of 150 nutrition/vitamin factors and 50 non-nutritional factor in cervical cancer and phase.

METHODS

Population samples of 2088 healthy subjects and patients with cervical cancer were investigated. 200 factors such as vitamin E, B1, B6, fruits, HPV, and age were gathered. Deep learning, Decision tree, and correlation matrix were used for modeling and identifying important factors. SPSS 26, R4.0.3, and Rapid miner were utilized for implementation.

RESULTS

Our findings indicated that zinc, Iron, Niacin, Potassium, Phosphorous, and Cooper have a beneficial impact in reducing the risk of cervical cancer and progression of phase in Iranian women, as well as Salt, snacks and milk Were identified as high-risk food factors (P value < 0.05 and coefficient correlation > 0.6). Also, alcohol, and sex patient with two groups, HPV positive have an impact on cervical cancer incidence. Phosphorus and selenium in the Micronutrients category (R² = 0.85, AUC = 0.993) and polyunsaturated fatty acid and salt in the Macronutrients category and other categories of nutrients were identified as the most effective factors in cervical cancer using deep learning (R² = 0.93, AUC = 0.999).

CONCLUSIONS

A diet and rich nutrition can be helpful for the prevention of cervix cancer and may reduce the risk of disease. Additional research is necessary for different countries.

A Preliminary Sequence Analysis of the Epstein-Barr Virus Nuclear Antigen 1 (EBNA1) Carboxy-Terminal Region in Cervical and Ovarian Cancers

Background & Objective

Epstein-Barr virus nuclear antigen-1 (EBNA1) is one of the most important proteins of Epstein-Barr virus (EBV) that might be mutated in various related cancers. The purpose of this study was to compare EBNA1 mutations in the C-terminal region between patients with cervical and ovarian cancer and healthy individuals.

Methods

As test and control groups, 18 EBV-positive paraffin-embedded samples of cervical and ovarian cancer and 10 age- and gender-matched healthy volunteers who did not have cancer but were EBV-positive were both used. Utilizing a commercial DNA extraction kit, total DNA was extracted following deparaffinization. The entire C-terminal region of the EBNA1 sequence was amplified using an in-house nested PCR. Phylogenetic analysis and Sanger sequencing were used to analyze the sequences using MEGA 7 software and through NJ method.

Results

Sequence analysis revealed that the P-Ala subtype of EBNA1 was present in all samples. In two and one samples, respectively, of cervical cancer patients, the mutations A1887G and G1891A were found. The G1595T mutation was also detected in four sequences taken from ovarian cancer patients. No statistically significant difference could be found between the frequency of mutations in patients and controls (P>0.05). No known amino acid substitutions were found in the USP7-binding region and the DBD/DD domain.

Conclusion

The findings showed that P-Ala is the predominant EBV subtype across all samples. Additionally, as the sequence of EBNA1's C-terminal region is so stable, it's possible that it had little impact on the pathogenesis of ovarian and cervical malignancies. It is advised to conduct additional research to verify these findings.

Utilization of cervical cancer screening services and its associated factors in Iran: a case-control study

BACKGROUND

Considering the high incidence rate of cervical cancer (CC) in Iran, screening is an effective way of reducing the impact of the disease due to early detection. Thus, the recognition of the factors affecting the use of cervical cancer screening (CCS) services is essential.The present study aimed to determine the associated factors of CCS in women living in the suburbs of Bandar Abbas in the south of Iran.

METHODS

The present case-control study was conducted between January and March 2022 in the suburban areas of Bandar abbas. Two hundred participants were assigned to the case group and 400 participants were assigned to the control group. A self-constructed questionnaire was used to collect the data. This questionnaire contained demographic information, reproductive information, knowledge of CC, knowledge of CCS and access to the screening. Univariate and multivariate regression analyses were run to analyze the data. The data were analyzed in STATA 14.2 at a significance level of p < 0.05.

RESULTS

The mean and standard deviation of participants' age in the case group was 30.33 ± 4.892, and in the control group was 31.35 ± 6.149. The mean and standard deviation of knowledge in the case group was 10.21 ± 1.815 and in the control group was 7.24 ± 2.447. The mean and standard deviation of access was 43.72 ± 6.339 in the case and 37.17 ± 4.828 in the control group. The results of multivariate regression analysis showed the following factors increased the odds of CCS: knowledge (OR medium = 18.697, OR high = 13.413), access (OR medium = 4.028, OR high = 8.126), being married (OR = 3.193), being educated (OR diploma = 2.587, OR university degree = 1.432), middle and high SES (OR Middle = 6.078, OR Upper = 6.608), and not smoking (OR = 1.144). Also, women's reproductive status, including history of sexually transmitted diseases (OR = 2.612), use of oral contraceptives (OR = 1.579), sexual hygiene (OR = 8.718).

CONCLUSIONS

In the light of the present findings, it can be concluded that besides increasing suburban women's knowledge, their access to screening facilities should be improved. The present findings showed the need to remove the barriers to CCS in women of low SES to increase the rate of CCS. The present findings contribute to a better understanding of factors involved in CCS.

Global, regional and national burden, incidence, and mortality of cervical cancer

AIM

Among gynecological cancers, cervical cancer is the most common cause of cancer-related death in developing countries. This study analyzes the incidence, mortality, and burden of cervical cancer using the Global Burden of Disease (GBD) 2019 study.

MATERIALS AND METHODS

The GBD (2019) data on cervical cancer was extracted from the Global Health Data Exchange (GHDx) query tool. Age-standardized rate (ASR) incidence, deaths, lost years of life (YLLs), years of life with disabilities (YLDs), and adjusted years of life with disabilities (DALYs) of cervical cancer in women were extracted. Data were extracted globally for 204 countries and groups based on a socio-demographic index (SDI), World Health Organization (WHO) regions, continents, World Bank regions, and 22 GBD regions.

RESULTS

The higher standardized age incidence of cervical cancer is in lower SDI countries, Africa, the African region (According to the WHO), and Sub-Saharan Africa (According to GBD regions). The highest deaths of ASR is in countries with low SDI, low-income group, Africa, the African region (According to the World Health Organization), and Sub-Saharan Africa (According to GBD regions). According to SDI classification, the highest DALYs ASR is in low SDI countries, World Bank Low-income countries, African and then American continents, African region, Sub-Saharan Africa, and then Latin America & Caribbean-WB (Based on GBD regions).

CONCLUSION

In 2019, incidence, mortality, and DALYs of cervical cancer mostly affected countries with lower socioeconomic status. Given that cervical cancer is highly preventable, access to screening services and the presence of trained and knowledgeable health care staff can reduce illness, suffering, and death caused by this malignancy. It is recommended to use the national and international potentials to reduce the incidence of this malignancy.

The Prevalence of Human Papillomavirus Genotypes in Women with Genital Warts Using Polymerase Chain Reaction (PCR)

Background: The genotypic distribution of human papillomavirus (HPV) needs to be determined with detail as it is an important issue when it comes to public health and preparing vaccines since the HPV type may be different in various areas. Objectives: This study aimed at reporting the frequency of HPV types among women in Sari in the north of Iran. Methods: From 2018 October to 2019 April, 50 sterile swabs of vaginal and cervical discharge of women with genital warts, which were performed by a gynecologist, were examined to determine the prevalence of HPV genotyping by using polymerase chain reaction (PCR). Results: From 50 vaginal swab samples of patients with genital warts, the frequency distribution of types of HPV in women with genital warts included 5 patients (10.0%) with 2 high-risk serotypes as simultaneous serotypes 4% (16, 18), 4% (18, 35), 2% (66, 67), 1 patient (2%) HPV 33, 1 patient (2%) HPV 34, 1 patient (2%) 1 patient (2%) HPV 35, 2 patients (4%) HPV 66, 1 patient (2%) HPV 67, and 1 patient (2%) HPV 68. Conclusions: Since HPV genotype varies in diverse areas, these results can be used for screening, management, and vaccination of the target population against the common types of virus in Sari.

Epidemiology and survival of cervical cancer in Iran based on national cancer registry data (2008-2014)

Background

Cervical cancer (CC) is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in females worldwide, associated with the incidence of human papillomavirus (HPV) infection. The CC incidence is low in Iran, ranking 11th among cancers. This study aimed to estimate the survival rate of CC and the reasons for its low survival rate based on the data retrieved from the Iranian National Cancer Registry System.

Methods

In this retrospective cohort study, data for patients diagnosed with CC from 2008 to 2014 were collected and analyzed. The Kaplan-Meier method was used for survival analysis based on epidemiological and clinical factors.

Results

A total of 5,304 women were diagnosed from March 10, 2008 to March 9, 2014 and 2,423 patients were followed. The mean age of the cases was 51.91 years, and 65.91% were alive. The 5- and 10-year survival rates were 58% and 50%, respectively, with no difference between younger cases with SCC or AC but better survival rates for older patients with SCC.

Conclusions

As a preventable disease, CC is related to biological factors and geographical and sociodemographic indices. Geographical, cultural, and religious behaviors affect the CC incidence and survival. In Iran, the 5-year survival rate ranges from 34% to 70% among different geographic regions. Hence, effective screening based on cultural and sociodemographic issues is recommended.

Increasing cervical cancer screening in Iran: effectiveness of a theory-based educational intervention

Purpose of study

The high mortality rate of cervical cancer in developing countries is mainly related to inefficient screening programs. The aim of the present study was, thus, to determine the effect of an educational intervention based on BASNEF (Belief, Attitudes, Subjective Norms, and Enabling Factors) model on increasing the rate of cervical cancer screening (CCS) in Bandar Deir in the south of Iran.

Methods

A quasi-experimental educational intervention was made with 202 women participants (101 in the intervention group (IG) and 101 in the control group (CG)) in 2019–20. The sampling was convenience in type. The data were collected using a reliable and valid tripartite questionnaire (demographic information, knowledge, BASNEF constructs). A total number of 14 training sessions were held each taking 60 min, at two levels, personal and interpersonal (for family members, health workers and healthcare givers). Finally, there was a three-month follow-up held in December 2021.

Results

After the training, a statistically significant difference was found between the IG and CG in all model constructs (p < 0.001). Before the intervention, in the IG, the personal health score was 4.35 ± 2.52, which was increased to 5.25 ± 0.753 after the training (p < 0.001). However, in the CG, the difference was not statistically significant (p < 0.030). 63.4% of women in the IG and 32.7% in the CG performed the CCS and the between-group difference was statistically significant (p < 0.001). Attitude, enabling factors and behavioral intention were the main predictors of CCS.

Conclusion

The present findings showed though the training intervention based on the BASNEF model had limited resources and was run in a short time, it managed to motivate women to perform the CCS. It could maximally remove barriers at both personal and interpersonal levels and suggest strategies in the light of these barriers to achieve a successful screening program.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-022-01489-5.

Cervical cancer is the fourth most prevalent fatal cancer among women on a global scale, and is one of the few cancers that can be prevented through screening. The high mortality rate of cervical cancer in developing countries, including Iran, has been largely attributed to inefficient screening programs. In developing countries cervical cancer screening programs are far from qualified. Yet, theory-based educational interventions can play an important role in promoting CCS behavior. Therefore, the present study was designed to determine the effect of an educational intervention based on the Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF model on increasing CCS in women in the south of Iran. BASNEF model includes beliefs about behavioral outcomes, attitudes toward behavior, subjective norms and enabling factors. The most significant construct in BASNEF model is the behavior change. Beliefs and attitudes are influenced by culture, values, traditions, education, media, and personal experiences. Subjective norms include family, society, social media, and peer pressure. Enabling factors include income, women’s status, time, and skills. This model can be proposed as a new educational method. A quasi-experimental two-group (pretest–posttest) study was conducted in 2019–2020 on 202 women (101 in the intervention group, and 101 in the control group). In the intervention group, 14 training sessions (10 at the personal level and 4 at the interpersonal level) were held between 40 and 60 min’ long. In the control group, 1 training session was held in 6 groups of 15–20. It was 60 min’ long. The follow-up was held three months after the intervention. The results showed that the educational intervention, by affecting the BASNEF constructs, significantly affected women’s CCS behavior. Maximizing barriers at both personal and interpersonal levels and suggesting strategies based on these barriers can help achieve a successful screening program. In particular, we call for the implementation of goal-oriented training programs according to health education and health promotion models to increase the rate of CCS behavior.

Designing a novel fusion protein from Streptococcus agalactiae with apoptosis induction effects on cervical cancer cells

Cervical cancer remains life-threatening cancer in women around the world. Due to the limitations of conventional treatment approaches, there is an urgent need to develop novel and more efficient strategies against cervical cancer. Therefore, the researchers attend to the alternative anti-cancer compounds like bacterial products. Rib and α are known as surface proteins of Streptococcus agalactiae with immunologic effects. In the present study, we designed a new anti-cancer fusion protein (Rib-α) originating from S. agalactiae with in silico methods, and then, the recombinant gene was cloned in the pET-22 (+) expression vector. The recombinant protein was expressed in E. coli BL21. To purify the expressed protein, we applied the Ni-NTA column. The molecular mechanism by which Rib-α is cytotoxic to cancer cells has been discussed based on MTT, flow cytometry, and real-time PCR methods. The engineered fusion protein suppressed the proliferation of the cancer cells at 180 μg/ml. Cytotoxic assessment and morphological changes, augmentation of apoptotic-related genes, upregulation of caspase-3 mRNA, and flow cytometric analysis confirmed that apoptosis might be the principal mechanism of cell death. According to our findings, Rib-α fusion protein motivated the intrinsic apoptosis pathway. Therefore, it can be an exciting candidate to discover a new class of antineoplastic agents.

Lead (Pb) exposure from outdoor air pollution: a potential risk factor for cervical intraepithelial neoplasia related to HPV genotypes

Human papillomavirus genotypes (HPVs) have been confirmed to be the major cause of cervical intraepithelial neoplasia (CIN) that remains to be one of the most common women cancers around the world. It seems other risk factors have synergistic effects on cervical cancer occurrence including smoking, dietary pattern, sexual behavior, ethnicity, epigenetics, and environmental hazardous materials. Our study characterized the potential cancerous role of lead (Pb) as a common toxic environmental pollutant agent on CIN outcomes. Lead concentration was quantified using an atomic absorption spectrometer in liquid-based cytology specimens of 40 CIN-HPV positive subjects, 50 HPV infected non-cancerous cases, and 43 non-HPV infected/non-cancerous women. Pb concentration was 5.5 (4.7-6.4) μg/dL, 4.7 (4.2-8.7) μg/dL, and 4.7 (4.5-5.4) μg/dL in the CIN-HPV positive group, HPV infected non-cancerous cases, and non-HPV infected/non-cancerous group, respectively. The results showed higher Pb concentration is associated with higher risk for cervical malignancy in comparison with non-HPV infected/non-cancerous subjects, after controlling for age effect (aOR = 4.55, 95% CI: 1.55-15.07, P < 0.01). Our finding suggested a direct significant association between Pb accumulation and CIN existence. The consequences need to be further validated by including more relevant risk factors and controlling the confounders for better understating of Pb impact from outdoor air pollution on cervical cancer progression.

Comparison of cytopathologic findings in patients with negative Pap test and positive high-risk HPV infection among three groups

PURPOSE

Comparison of colposcopy-guided biopsy and endocervical cytologic (ECC) results in patients with negative Papanicolaou (Pap) and positive high-risk (HR) HPV tests in the three groups of HPV 16/18, non-16/18 HR-HPV (other HR-HPV), and concurrent infection of either HPV 16/18 and at least one subtype of other HR-HPVs.

METHODS

This cross-sectional study was conducted among women aged 30-65 who had negative Pap and positive HR-HPV DNA tests. Pap test was performed using liquid cytology. For HPV DNA testing, the polymerase chain reaction (PCR) method was used.

RESULTS

Among 394 participants, 111 (28.2%) were in the HPV 16/18, 226 (57.4%) in the Other HR-HPV, and 57 (14.4%) in the concurrent group. The mean age of participants was 35.71 ± 7.1 years. Cervical intraepithelial neoplasia (CIN) grade 2/3 were seen in 29 (26.1%) patients of HPV 16/18, 60 (26.5%) of other HR-HPV, and 18 (31.6%) of concurrent infection group (P = 0.593). HPV 52 was the most common subtype in the other HR-HPV group (15%).

CONCLUSIONS

The risk of high-grade CIN lesions in patients with negative Pap test and positive other HR-HPV was not significantly less than patients with positive HPV 16/18. Besides, the risk of losing the patients to 1-year follow-up seems high.

High RPS27A Expression Predicts Poor Prognosis in Patients With HPV Type 16 Cervical Cancer

In recent years, the incidence and the mortality rate of cervical cancer have been gradually increasing, becoming one of the major causes of cancer-related death in women. In particular, patients with advanced and recurrent cervical cancers present a very poor prognosis. In addition, the vast majority of cervical cancer cases are caused by human papillomavirus (HPV) infection, of which HPV16 infection is the main cause and squamous cell carcinoma is the main presenting type. In this study, we performed screening of differentially expressed genes (DEGs) based on The Cancer Genome Atlas (TCGA) database and GSE6791, constructed a protein–protein interaction (PPI) network to screen 34 hub genes, filtered to the remaining 10 genes using the CytoHubba plug-in, and used survival analysis to determine that RPS27A was most associated with the prognosis of cervical cancer patients and has prognostic and predictive value for cervical cancer. The most significant biological functions and pathways of RPS27A enrichment were subsequently investigated with gene set enrichment analysis (GSEA), and integration of TCGA and GTEx database analyses revealed that RPS27A was significantly expressed in most cancer types. In this study, our analysis revealed that RPS27A can be used as a prognostic biomarker for HPV16 cervical cancer and has biological significance for the growth of cervical cancer cells.

The Outcome of Locally Advanced Cervical Cancer in Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Hysterectomy and Primary Surgery

Background:

In recent years, before radical hysterectomy, neoadjuvant chemotherapy (NACT) has been administered to patients with locally advanced cervical cancer to shrink large tumors. It has been reported that this treatment significantly reduces the need for radiotherapy after surgery. The current study aimed to assess the outcome (survival, recurrence, and the need for adjuvant radiotherapy) of locally advanced cervical cancer in patients treated with NACT followed by radical hysterectomy and primary surgery.

Methods:

In a retrospective cohort study, the records of 258 patients with cervical cancer (stage IB2, IIA, or IIB), who referred to Imam Khomeini Hospital (Tehran, Iran) from 2007 to 2017 were evaluated. The patients were assigned into two groups; group A (n=58) included patients, who underwent radical hysterectomy and group B (n=44) included those, who underwent a radical hysterectomy after NACT. The outcome measures were the recurrence rate, five-year survival rate, and the need for adjuvant radiotherapy.

Results:

The median for overall survival time in group A and B was 113.65 and 112.88 months, respectively (P=0.970). There was no recurrence among patients with stage IB2 cervical cancer in group B, while the recurrence rate in group A was 19.5% with a median recurrence time of 59.13 months. Lymph node involvement was the only factor that affected patients’ survival. The need for postoperative adjuvant radiotherapy in group B was lower than in group A (P=0.002).

Conclusion:

NACT before the hysterectomy was found to reduce the need for postoperative radiotherapy in patients with locally advanced cervical cancer according to disease stages. As a direct result, adverse side effects and the recurrence rate were reduced, and the overall survival rate of patients with stage IIB cervical cancer was increased.

The Catastrophic HPV/HIV Dual Viral Oncogenomics in Concert with Dysregulated Alternative Splicing in Cervical Cancer

Cervical cancer is a public health problem and has devastating effects in low-to-middle-income countries (LTMICs) such as the sub-Saharan African (SSA) countries. Infection by the human papillomavirus (HPV) is the main cause of cervical cancer. HIV positive women have higher HPV prevalence and cervical cancer incidence than their HIV negative counterparts do. Concurrent HPV/HIV infection is catastrophic, particularly to African women due to the high prevalence of HIV infections. Although various studies show a relationship between HPV, HIV and cervical cancer, there is still a gap in the knowledge concerning the precise nature of this tripartite association. Firstly, most studies show the relationship between HPV and cervical cancer at genomic and epigenetic levels, while the transcriptomic landscape of this relationship remains to be elucidated. Even though many studies have shown HPV/HIV dual viral pathogenesis, the dual molecular oncoviral effects on the development of cervical cancer remains largely uncertain. Furthermore, the effect of highly active antiretroviral therapy (HAART) on the cellular splicing machinery is unclear. Emerging evidence indicates the vital role played by host splicing events in both HPV and HIV infection in the development and progression to cervical cancer. Therefore, decoding the transcriptome landscape of this tripartite relationship holds promising therapeutic potential. This review will focus on the link between cellular splicing machinery, HPV, HIV infection and the aberrant alternative splicing events that take place in HIV/HPV-associated cervical cancer. Finally, we will investigate how these aberrant splicing events can be targeted for the development of new therapeutic strategies against HPV/HIV-associated cervical cancer.

Role of Phytonutrients in Nutrigenetics and Nutrigenomics Perspective in Curing Breast Cancer

Breast cancer (BC) is one of the most common type of cancer and an important contributor to female mortality. Several genes and epigenetic modifications are involved in the development and progression of BC. Research in phytochemistry, nutrigenomics, and nutrigenetics has provided strong evidence that certain phytonutrients are able to modulate gene expression at transcriptional and post-transcriptional levels. Such phytonutrients may also be beneficial to prevent and treat BC. In this review, we will focus on the nutrigenomic effects of various phytochemicals including polyphenols, phytosterols, terpenoids, alkaloids, and other compounds from different sources. Overall, these phytonutrients are found to inhibit BC cell proliferation, differentiation, invasion, metastasis, angiogenesis, and induce apoptotic cell death by targeting various molecular pathways. They also alter epigenetic mechanisms and enhance the chemosensitivity and radiosensitivity of cancer cells. Such phytochemicals may be used for the effective management of BC patients in the clinical setting in the future. The present article aims to summarize the specific molecular pathways involved in the genetic effects of phytochemicals in BC.

The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women

Objective

Cervical cancer is considered treatable as long as it is detected early and managed effectively. Pap smear test is a screening tool that plays an important role in the early detection, prevention and can prevent any early cervical cell changes from becoming cancer. This study aims to survey the effect of educational programs based on beliefs, subjective norms, and perceived behavior control on doing the pap-smear test in a sample of Iranian women.

Materials and methods

This experimental interventional study was performed on 300 women admitted to Fasa City, Fars Province, Iran health centers in 2018–2019. A questionnaire consisting of demographic information, knowledge, Health Belief Model, and Theory of Planned Behavior constructs were used to measure on doing of Pap smear test in women before and after 6 months’ educational intervention.

Results

The results revealed that 6 months after the intervention, 108 women (72%) in the experimental group and only 9 women (6%) in the control group received the Pap smear test.

Conclusions

The current research results revealed that education based on the combination of the health Belief model and theory of planned behavior might be promoting participation and an increasing rate of receiving Pap smear tests in women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01419-w.

Burden of Cervical Cancer in the Eastern Mediterranean Region During the Years 2000 and 2017: Retrospective Data Analysis of the Global Burden of Disease Study

BACKGROUND

Cervical cancer is a growing health concern, especially in resource-limited settings.

OBJECTIVE

The objective of this study was to assess the burden of cervical cancer mortality and disability-adjusted life years (DALYs) in the Eastern Mediterranean Region (EMR) and globally between the years 2000 and 2017 by using a pooled data analysis approach.

METHODS

We used an ecological approach at the country level. This included extracting data from publicly available databases and linking them together in the following 3 steps: (1) extraction of data from the Global Burden of Disease (GBD) study in the years 2000 and 2017, (2) categorization of EMR countries according to the World Bank gross domestic product per capita, and (3) linking age-specific population data from the Population Statistics Division of the United Nations (20-29 years, 30-49 years, and >50 years) and GBD's data with gross national income per capita and globally extracted data, including cervical cancer mortality and DALY numbers and rates per country. The cervical cancer mortality rate was provided by the GBD study using the following formula: number of cervical cancer deaths × 100,000/female population in the respective age group.

RESULTS

The absolute number of deaths due to cervical cancer increased from the year 2000 (n=6326) to the year 2017 (n=8537) in the EMR; however, the mortality rate due to this disease decreased from the year 2000 (2.7 per 100,000) to the year 2017 (2.5 per 100,000). According to age-specific data, the age group ≥50 years showed the highest mortality rate in both EMR countries and globally, and the age group of 20-29 years showed the lowest mortality rate both globally and in the EMR countries. Further, the rates of cervical cancer DALYs in the EMR were lower compared to the global rates (2.7 vs 6.8 in 2000 and 2.5 vs 6.8 in 2017 for mortality rate per 100,000; 95.8 vs 222.2 in 2000 and 86.3 vs 211.8 in 2017 for DALY rate per 100,000; respectively). However, the relative difference in the number of DALYs due to cervical cancer between the year 2000 and year 2017 in the EMR was higher than that reported globally (34.9 vs 24.0 for the number of deaths and 23.5 vs 18.1 for the number of DALYs, respectively).

CONCLUSIONS

We found an increase in the burden of cervical cancer in the EMR as per the data on the absolute number of deaths and DALYs. Further, we found that the health care system has an increased number of cases to deal with, despite the decrease in the absolute number of deaths and DALYs. Cervical cancer is preventable if human papilloma vaccination is taken and early screening is performed. Therefore, we recommend identifying effective vaccination programs and interventions to reduce the burden of this disease.

Evaluating the effect of an educational program on increasing cervical cancer screening behavior among women in Fasa, Iran

Background

Cervical cancer is the second most common cancer and the fifth deadliest cancer among women in Iran. Educational interventions based on the proper behavior promoting models can lead to early diagnosis of cervical cancer.This study aimed to investigate the effects of educational intervention on performing Pap smear tests based on the Theory of Planned Behavior among women living in Fasa, Iran.

Methods

A cross-sectional study was conducted on 700 participants. Thereafter, the educational intervention based on the results of cross-sectional study was conducted in a workshop form for 50 women as the intervention group and 50 women as the control group. Afterward, the data were entered into the SPSS statistical software and then analyzed via logistic regressions analysis, paired t test, independent t test, chi-square test, and McNemar test.

Result

According to the results, 45.7% of the patients had a history of performing a Pap smear test, and 20.7% of them regularly performed this test. The knowledge, attitude, subjective norms, and perceived behavioral control were the predictors of intention and behavior of Pap smear test among the women (P < 0.05). These components accounted for 57.4% and 31.6% of the intention and behavior variances, respectively. After the intervention, a significant increase was observed in the means of attitude, subjective norms, and perceived behavioral control in the intervention group compared to the control group. The results reveal no significant difference between these two groups regarding the behavioral intention (p = 0.41) and performance of the Pap smear test (p = 0.583). The number of the participants undergone the Pap smear test has increased from 10 to 26 in the intervention group by passing 3 months from the intervention. The results of McNemar test indicated that this difference was statistically significant.

Conclusion

The results indicated an increase in the women’s performance of the Pap smear screening test by appropriate planning, provision of educational packages based on the women’s needs, and using effective subjective norms.

Trial Registration: Current Controlled Trials IRCT20160830029608N3:12/31/2018. “Retrospectively registered”.

A questionnaire on factors affecting the precaution adoption process model for cervical cancer - Psychometric properties

BACKGROUND

Implementing a cervical cancer prevention program requires an exploration of certain behaviors concerning this disease. This study is aimed to evaluate the psychometrics of a questionnaire that enquired about the factors involved in Precaution Adoption Process Model (PAPM) for cervical cancer among suburban women in Bandar Abbas, south of Iran.

MATERIALS AND METHODS

The primary draft of the questionnaire was developed with a review of the related literature on cervical cancer and the constructs affecting PAPM, with 68 items. The face validity, content validity ratio (CVR), and content validity index (CVI) of the questionnaire were approved by a panel of 10 experts. The internal consistency and test-retest reliability of the questionnaire were estimated too. Field testing sample included 300 women recruited from a women's healthcare center in suburban areas of Bandar Abbas in the south of Iran. Exploratory factor analysis was used to evaluate validity, and Cronbach's alpha coefficient was estimated for reliability.

RESULTS

After the face validation, 11 items were eliminated. Once CVR was estimated, two items were discarded. The remaining items had a CVR >0.79. All had a CVI >0.79. Six items were eliminated in the factor analysis. The final questionnaire included 49 items organized in 8 factors including awareness, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, social norms, fear, and self-efficacy. Principal component analysis with varimax rotation indicated eight main components that explained 56.25% of the variance. Reliability assessment showed a good internal consistency for all subscales and the Cronbach's alpha score ranged between 0.82 and 0.90. The test-retest reliability showed that the correlation coefficients (between 0.81 and 0.89) were significant at the 0.01 level for all sub-scales.

CONCLUSIONS

The final questionnaire was a new instrument comprised the effective constructs of PAPM and had a high reliability and validity. Thus, this questionnaire is recommended to be used to explore and enhance preventive behaviors of cervical cancer.

Distribution of the most common types of HPV in Iranian women with and without cervical cancer

Cervical cancer is an important cause of death in women worldwide. About 99.7% of all cervical cancers have been related to human papillomavirus, especially types 16 and 18. Types 6 and 11 cause genital warts. We aimed to determine the prevalence of common HPV genotypes among women in the general population and women with cervical cancer. A total of 571 healthy women cytology specimens and 113 tissue samples of cervical cancer were investigated using HPV type-specific primers. HPV DNA was detected in 24% of healthy women: 3.3% were positive for high-risk HPV and 11.6% for low-risk HPV. HPV6 (9.3%) had the highest prevalence followed by HPV11 (2.3%), HPV16 (1.8%), HPV18 (1.2%), and 9.1% of samples were positive for unknown types. Among cervical cancer samples, HPV DNA was found in 78.8% including 43.4% HPV16, 8% HPV18, and 27.4% an unknown HPV type. HPV6 and HPV11 were not detected in any cervical cancer cases and 21.2% were negative for HPV. We found no association between HPV-16/18 and age in cervical cancer. The prevalence of HPV infection is relatively high in Iran without vaccination backgrounds. HPV DNA screening and vaccination programs can prevent cervical cancer and health problems caused by genital warts.

Supervised Algorithms of Machine Learning for the Prediction of Cervical Cancer

Background

Compared to other genital cancers, cervical cancer is the most prevalent and the main cause of mortality in females in third-world countries, affected by different factors, including smoking, poor nutritional status, immune-deficiency, long-term use of contraceptives and so on.

Objective

The present study was conducted to predict cervical cancer and identify its important predictors using machine learning classification algorithms.

Material and Methods

In a cross-sectional study, the data of 145 patients with 23 attributes, which referred to Shohada Hospital Tehran, Iran during 2017-2018, were analyzed by machine learning classification algorithms which included SVM, QUEST, C&R tree, MLP and RBF. The criteria measurement used to evaluate these algorithms included accuracy, sensitivity, specificity and area under the curve (AUC).

Results

The accuracy, sensitivity, specificity and AUC of Quest and C&R tree were, respectively 95.55, 90.48, 100, and 95.20, 95.55, 90.48, 100, and 95.20, those of RBF 95.45, 90.00, 100 and 91.50, those of SVM 93.33, 90.48, 95.83 and 95.80 and those of MLP 90.90, 90.00, 91.67 and 91.50 percentage. The important predictors in all the algorithms were found to comprise personal health level, marital status, social status, the dose of contraceptives used, level of education and number of caesarean deliveries.

Conclusion

This investigation confirmed that ML can enhance the prediction of cervical cancer. The results of this study showed that Decision Tree algorithms can be applied to identify the most relevant predictors. Moreover, it seems that improving personal health and socio-cultural level of patients can be causing cervical cancer prevention.

Impacts of CD152 polymorphisms on cervical cancer susceptibility

AIM

The objective of this study was to discuss the effect of CD152 polymorphisms rs231775, rs3087243 and rs5742909 on the susceptibility to cervical cancer.

METHODS

The databases of PubMed, EMBASE, Cochrane Library, ISI Web of Science, Google Scholar Web, CNKI and Wanfang were searched for eligible studies. Chi-square-based Q test examined heterogeneity between included studies, and when P_{heterogeneity} was less than 0.05, random-effect model was used to calculate odds ratios (ORs) with their 95 % confidence intervals (95 % CIs); or else, fixed-effect model was selected. Sensitivity analysis was implemented to determine the stability of final results through removing enrolled studies one at a time and then re-obtaining overall estimates. Publication bias among included studies was checked employing Begg's funnel plot and Egger's test.

RESULTS

CD152 polymorphism rs231775 decreased cervical cancer risk in total analysis under the genetic models of GG vs. AA, GG vs. AA + AG and G vs. A (OR = 0.73, 95 % CI = 0.59-0.91; OR = 0.78, 95 % CI = 0.65-0.94; OR = 0.92, 95 % CI = 0.87-0.98), and so did the polymorphism rs3087243 in total analysis under the comparisons of AA vs. GG, AA + GA vs. GG, AA vs. GG + GA, A vs. G and GA vs. GG (OR = 0.51, 95 % CI = 0.42-0.60; OR = 0.71, 95 % CI = 0.62-0.82; OR = 0.57, 95 % CI = 0.50-0.66; OR = 0.70, 95 % CI = 0.64-0.77; OR = 0.83, 95 % CI = 0.72-0.97). Besides, the polymorphism rs5742909 elevated the disease onset in total analysis under the contrasts of TT vs. CC, TT + CT vs. CC, TT vs. CC + CT, T vs. C and CT vs. CC (OR = 2.66, 95 % CI = 1.75-4.04; OR = 1.54, 95 % CI = 1.24-1.91; OR = 2.13, 95 % CI = 1.12-4.03; OR = 1.44, 95 % CI = 1.17-1.78; OR = 1.49, 95 % CI = 1.22-1.83).

CONCLUSION

CD152 polymorphisms rs231775 and rs3087243 significantly decrease the risk of cervical cancer, while rs5742909 may increase the disease risk.

Comparison of Diagnostic Methods in Detection of Squamous Cell Abnormalities in Iranian Women with Abnormal Pap's Smear Test and Associated Demographic and Issues

Background & Objective

Premalignant lesions of cervix have increased dramatically in recent years. Early diagnosis and management of abnormalities have an effective role in preventing the invasion of the disease and also in timely treatment. This study aimed to compare diagnostic methods in the detection of squamous cell abnormalities with abnormal Pap smear test.

Methods

This cross-sectional study was performed on 1000 women with abnormal Pap smears in 2007-2018. Sampling was performed with simple method. All samples were subjected to an immediate assessment of colposcopy and histopathology if suspected. The checklist included demographic information as well as symptoms, cytopathology, colposcopy and histopathology findings. Data analysis was performed using descriptive and statistical analysis (P<0.05).

Results

A significant relationship between histopathology and Pap smear findings was found (P=0.009), also there was a significant correlation between histopathology and colposcopy findings (P=0.001). However, there was no significant relationship between clinical symptoms and histopathology findings (p=0.8). Sensitivity , specificity , positive and negative predictive value of Pap smear were 43%, 65.9%, 75.4%, 32.2% and of colposcopy were 74.7%, 39.5%, 75%, 39.1%, and of clinical symptoms were 72.6%, 28.1%, 71.1%, 29.7%, respectively.

Conclusion

Pap smear findings have the appropriate diagnostic accuracy in comparison with colposcopy and histopathology findings for screening and diagnosis of squamous intra-epithelial lesions. Also, there was higher sensitivity of colposcopy compared with Pap smear to detect cervical lesions. Therefore, it is advisable to use these methods simultaneously.

Women's Cancer Care in Iran

Breast cancer (BC) and cervical cancer (CC) are the first and fifth common cancers in Iranian women. Although age-standardized incidence rate of BC and CC in Iran is low, the mortality to incidence ratio is high due to late diagnosis. Except an old and a quite comprehensive cancer registry, women's cancer care encounter many challenges in Iran. Lack of a customized national and inclusive protocol to control cancer care along with the fragmented health system is the first and foremost cancer care challenge. Many high-risk women miss the opportunity of early diagnosis and treatment because of poor knowledge, low accessibility, or affordability to health care, stigma, and spouse negligence. Although the most effective BC screening method is mammography, it is not equally available for all Iranian women. Furthermore, the cost of BC is very high and screening is accompanied by stigmatized sociocultural beliefs. Unfortunately, while Iran has a good primary care system, low coverage of clinical breast examination and poor knowledge of women indicate that this system has not operated effective. Also due to the limited resources, the Pap smear test has not been applied to the majority of Iranian women. Despite the high basic health insurance coverage in Iran, it does not cover diagnostic test and full treatment of cancers which intensified underutilization of cancer care. In conclusion, developing a national policy and guideline for full coverage of early diagnosis of BC or CC should be prioritized. In this regard, health insurance companies should be committed to including BC and CC screening and care for their basic service packages. The second strategy could be training skillful, responsible, and motivated health-care providers. They are able to decrease the stigmatized view of doing mammography. Survivorship care including follow-up care, posttreatment issues, and psychosocial support should also be considered.