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Mangone L, Marinelli F, Bisceglia I, Roncaglia F, Mastrofilippo V, Morabito F, Neri A, Aguzzoli L, Mandato VD. Trends in cervical cancer: A decade‑long analysis of incidence, survival and demographic disparities in a Northern Italian province. Mol Clin Oncol 2024; 21:71. [PMID: 39161775 PMCID: PMC11332319 DOI: 10.3892/mco.2024.2770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/06/2024] [Indexed: 08/21/2024] Open
Abstract
While cervical cancer is relatively uncommon in Western countries, it continues to pose significant concern due to its high mortality rates. Intraepithelial forms [cervical intraepithelial neoplasia (CIN) 2 and CIN 3] are more prevalent in regions with comprehensive screening coverage, particularly in areas that use the Papanicolaou test and HPV detection. The present study aims to characterize the trends of precancerous lesions and infiltrating tumors over a decade, assessing survival rates by age, stage and country of origin. A total of 1,752 CIN 2/3 lesions and 152 infiltrating cancers were recorded in the Reggio Emilia Cancer Registry between January 2008 and December 2018. A clear increase in CIN 2/3 lesions was observed over the years while infiltrating tumors remained rare and the numbers of cancer cases declined. The 5-year survival rate was found to be 67%, with survival closely correlated with stage (88, 82, 74 and 12% for stages I, II, III and IV, respectively) and age (84, 80 and 37% for ages <40, 40-65 and 65+, respectively). Multivariable analysis confirmed an excess risk for advanced stages III (HR 3.1; 95% CI, 1.3-7.3) and IV (HR 19.6; 95% CI, 8.2-46.7), as well as in women 65+ (HR 2.8; 95% CI, 1.0-8.1). Analysis of national origins revealed comparable stage distribution for Italians and non-Italians at stage I (41 vs. 47%), while a notable disparity emerged for stage IV (28 vs. 6%). This difference could be attributed to the average age of Italians compared to non-Italians (59 vs. 49 years). Overall, the present study underscored the importance of continued surveillance and intervention strategies targeting advanced-stage disease, particularly in older populations and among non-Italian patients. Efforts to enhance screening coverage and access to timely interventions remain critical in reducing the burden of cervical cancer and improving survival outcomes.
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Affiliation(s)
- Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, I-42122 Reggio Emilia, Italy
| | - Francesco Marinelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, I-42122 Reggio Emilia, Italy
| | - Isabella Bisceglia
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, I-42122 Reggio Emilia, Italy
| | - Francesca Roncaglia
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, I-42122 Reggio Emilia, Italy
| | - Valentina Mastrofilippo
- Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, I-42122 Reggio Emilia, Italy
| | | | - Antonino Neri
- Scientific Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, I-42122 Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, I-42122 Reggio Emilia, Italy
| | - Vincenzo Dario Mandato
- Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, I-42122 Reggio Emilia, Italy
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Tan N, Wu Y, Li B, Chen W. Burden of cancers in six female organs in China and worldwide. Chin Med J (Engl) 2024:00029330-990000000-01202. [PMID: 39207303 PMCID: PMC11407822 DOI: 10.1097/cm9.0000000000003293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Cancers in female organs remain a substantial burden in China and worldwide. GLOBOCAN 2022 has recently updated the estimates of cancer burden. This study aims to depict the profiles of disease burden and to compare the age-specific rates of cancers in female organs in China with those in other countries. METHODS The latest estimates of incidence and mortality of cancers in female organs from various regions and countries were extracted from the GLOBOCAN 2022 database. We compared the proportion of total cases or deaths for cancers affecting six female organs and other tumor types in China and globally. Correlation analysis was conducted to evaluate the relationship between age-standardized incidence rate (ASIR) or age-standardized mortality rate (ASMR) and the Human Development Index (HDI). Additionally, age-specific rate curves were plotted for ten exemplary countries with different income levels. RESULTS Globally, there are varying burdens of female organ cancers, with higher incidence rates in Northern America and elevated rates of cervical cancer in Africa. Female organ cancers in China remain a significant burden due to their large proportion of the six tumors. A positive correlation between socioeconomic development and the incidence of breast, uterine corpus, ovarian, and vulvar cancers was noted, whereas a negative association between the HDI tiers and mortality rates was found for cervical and vaginal cancers. In 2022, Chinese women aged 50-54 years are experiencing high incidence rates of breast, cervix uteri, corpus uteri, and ovarian cancers. CONCLUSIONS Cancers in female organs continue to be a significant health concern for women in China and worldwide. It is crucial to implement comprehensive prevention strategies tailored to address the increasing trend among younger individuals and reduce regional disparities.
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Affiliation(s)
- Nuopei Tan
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - You Wu
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bin Li
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Castle PE. Looking Back, Moving Forward: Challenges and Opportunities for Global Cervical Cancer Prevention and Control. Viruses 2024; 16:1357. [PMID: 39339834 PMCID: PMC11435674 DOI: 10.3390/v16091357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/30/2024] Open
Abstract
Despite the introduction of Pap testing for screening to prevent cervical cancer in the mid-20th century, cervical cancer remains a common cause of cancer-related mortality and morbidity globally. This is primarily due to differences in access to screening and care between low-income and high-income resource settings, resulting in cervical cancer being one of the cancers with the greatest health disparity. The discovery of human papillomavirus (HPV) as the near-obligate viral cause of cervical cancer can revolutionize how it can be prevented: HPV vaccination against infection for prophylaxis and HPV testing-based screening for the detection and treatment of cervical pre-cancers for interception. As a result of this progress, the World Health Organization has championed the elimination of cervical cancer as a global health problem. However, unless research, investments, and actions are taken to ensure equitable global access to these highly effective preventive interventions, there is a real threat to exacerbating the current health inequities in cervical cancer. In this review, the progress to date and the challenges and opportunities for fulfilling the potential of HPV-targeted prevention for global cervical cancer control are discussed.
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Affiliation(s)
- Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, US National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr., Room 5E410, Rockville, MD 20850, USA
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Zhao C, An J, Li M, Li J, Zhao Y, Wang J, Xie HQ, Wei L. High-Risk Genotypes of Human Papillomavirus at Diverse Anogenital Sites among Chinese Women: Infection Features and Potential Correlation with Cervical Intraepithelial Neoplasia. Cancers (Basel) 2024; 16:2107. [PMID: 38893229 PMCID: PMC11172096 DOI: 10.3390/cancers16112107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Both cervical cancer and cervical intraepithelial neoplasia (CIN) are associated with human papillomavirus (HPV) infection at different anogenital sites, but the infection features of high-risk (HR) HPVs at these sites and their association with cervical lesions have not been well characterized. Given the limitation of cervical HPV 16/18 test in screening patients with high-grade CIN (CIN 2+), studies on whether non-16/18 HR-HPV subtype(s) have potential as additional indicator(s) to improve CIN 2+ screening are needed. METHODS The infection of 15 HR-HPVs in vulva, anus, vagina, and cervix of 499 Chinese women was analyzed, and CIN lesion-associated HR-HPV subtypes were revealed. RESULTS In addition to the well-known cervical-cancer-associated HPV 16, 52, and 58, HPV 51, 53, and 56 were also identified as high-frequency detected subtypes prevalently and consistently present at the anogenital sites studied, preferentially in multi-infection patterns. HPV 16, 52, 58, 56, and 53 were the top five prevalent subtypes in patients with CIN 2+. In addition, we found that cervical HPV 33/35/52/53/56/58 co-testing with HPV 16/18 might improve CIN 2+ screening performance. CONCLUSION This study provided a new insight into HR-HPV screening strategy based on different subtype combinations, which might be used in risk stratification clinically.
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Affiliation(s)
- Chao Zhao
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
| | - Jiahui An
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Mingzhu Li
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
| | - Jingran Li
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
| | - Yun Zhao
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
| | - Heidi Qunhui Xie
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lihui Wei
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
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Liu Y, Shi W, Mubarik S, Wang F. Assessment of secular trends of three major gynecologic cancers burden and attributable risk factors from 1990 to 2019: an age period cohort analysis. BMC Public Health 2024; 24:1349. [PMID: 38764017 PMCID: PMC11103856 DOI: 10.1186/s12889-024-18858-3] [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: 10/31/2023] [Accepted: 05/15/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND This study aims to assess the long-term trends in the burden of three major gynecologic cancers(GCs) stratified by social-demographic status across the world from 1990 to 2019. To assess the trends of risk factor attributed mortality, and to examine the specific effects of age, period, cohort behind them in different regions. METHODS We extracted data on the mortality, disability-adjusted life years(DALYs), and age-standardized rates(ASRs) of cervical cancer(CC), uterine cancer(UC), and ovarian cancer(OC) related to risks from 1990 to 2019, as GCs burden measures. Age-period-cohort analysis was used to analyze trends in attributable mortality rates. RESULTS The number of deaths and DALYs for CC, UC and OC increased since 1990 worldwide, while the ASDRs decreased. Regionally, the ASDR of CC was the highest in low SDI region at 15.05(11.92, 18.46) per 100,000 in 2019, while the ASDRs of UC and OC were highest in high SDI region at 2.52(2.32,2.64), and 5.67(5.16,6.09). The risk of CC death caused by unsafe sex increased with age and then gradually stabilized, with regional differences. The period effect of CC death attributed to smoking showed a downward trend. The cohort effect of UC death attributed to high BMI decreased in each region, especially in the early period in middle, low-middle and low SDI areas. CONCLUSIONS Global secular trends of attributed mortality for the three GCs and their age, period, and cohort effects may reflect the diagnosis and treatment progress, rapid socioeconomic transitions, concomitant changes in lifestyle and behavioral patterns in different developing regions. Prevention and controllable measures should be carried out according to the epidemic status in different countries, raising awareness of risk factors to reduce future burden.
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Affiliation(s)
- Yiran Liu
- The Second Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Wenqi Shi
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Sumaira Mubarik
- Department of PharmacoTherapy-Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands.
| | - Fang Wang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China.
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, China.
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Zhang W, Fine JL, Pei X, Cao Y, Liu Y, Yan J, Ban Z, Zhang T, Wei Y, Zhao X, Wang B, Zhao C, Zeng X. Characteristics and utility of high-resolution optical coherence microscopy images of endocervical canal lesions. Am J Clin Pathol 2024:aqae052. [PMID: 38704601 DOI: 10.1093/ajcp/aqae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/06/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVES To investigate optical coherence microscopy (OCM) imaging features and the application value of these high-resolution images for identifying endocervical canal lesions (ECLs), which is a clinical dilemma in cervical cancer screening programs. METHODS In total, 520 OCM images were obtained by scanning the cervical canal lesions with an ultra-high-resolution OCM system (204 specimens from 73 patients). The OCM morphologic characteristics of ECLs were observed and summarized, and then 3 researchers performed a diagnostic test of OCM images of cervical canal lesions. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, 95% confidence interval of each parameter, and interinvestigator agreement (κ) were calculated. RESULTS Normal endocervix, cysts, squamous metaplasia, high-grade squamous intraepithelial lesions involving glands, and invasive carcinoma had distinct OCM characteristics, which correlated well with corresponding H&E histologic sections. The accuracy, sensitivity, and specificity of the 3 researchers were 90.6%, 89.3% (95% CI, 86.5%-91.7%) and 91.6% (95% CI, 89.2%-93.5%), respectively. The positive predictive value was 90.1% (95% CI, 87.3%-92.4%), and the negative predictive value was 90.9% (95% CI, 88.5%-92.9%), with almost perfect agreement (κ = 0.874). CONCLUSIONS The application of the OCM system in cervical canal lesions is feasible and could help improve detection of occult ECLs in cervical cancer screening programs. This study lays the foundation for further research on OCM in cervical canal lesions in vivo, which also has a potential impact on projecting pathologic evaluation beyond what is currently possible, perhaps globally.
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Affiliation(s)
- Wei Zhang
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jeffrey L Fine
- Department of Pathology, UPMC Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - Xiaoyin Pei
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yushan Cao
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yixuan Liu
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxiang Yan
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhenying Ban
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Zhang
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Wei
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Baojin Wang
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengquan Zhao
- Department of Pathology, UPMC Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - Xianxu Zeng
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Li S, Huang M, Zhu Y, Zeng H, Zhang F. Temporal trends in incidence and mortality of cervical cancer in China from 1990 to 2019 and predictions for 2034. Eur J Cancer Prev 2024; 33:252-261. [PMID: 37997908 DOI: 10.1097/cej.0000000000000849] [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
OBJECTIVE This study aimed to analyze long-term trends of cervical cancer (CC) burden in China based on the GBD 2019 data and provide information and data support for formulating corresponding policies to control CC. METHODS Incidence and mortality rate data of CC in China were described using GBD 2019 data. The Joinpoint regression analysis and age-period-cohort model were implemented to describe temporal trends of CC in China over the past 30 years. ARIMA model was used to predict trends of disease burden of CC in China for the next 15 years. RESULTS From 1990 to 2019, the relative percentage change in age-standardized incidence rate (ASIR) of CC in Chinese women was 30.91 (95% UI: -50.13 to 96.78), and the relative percentage change in age-standardized mortality rate (ASMR) was -12.37 (95% UI: -63.54 to 28.52). The age-period-cohort model had different impacts on incidence and mortality rates. Overall annual percentage change (APC) (net drift) in incidence risk was 1.22 (95% CI: 0.87-1.57), and the overall APC (net drift) in mortality risk was -0.143 (95% CI: -0.38 to 0.09). The ARIMA model predicted ASIR and ASMR trends of CC for the next 15 years. CONCLUSION From 1990 to 2019, the overall incidence risk of CC in Chinese has shown an upward trend, with an earlier occurrence in the high-incidence age groups, while mortality risk showed a downward trend. It is anticipated that over the next 15 years, the incidence rate will decrease, while the mortality rate will initially rise before decreasing.
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Affiliation(s)
- Shuang Li
- Department of Oncology, The First People's Hospital Affiliated to Yangtze University, Jingzhou City, Hubei Province, China
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Olakunde BO, Itanyi IU, Olawepo JO, Liu L, Bembir C, Idemili-Aronu N, Lasebikan NN, Onyeka TC, Dim CC, Chigbu CO, Ezeanolue EE, Aarons GA. Comparative effectiveness of implementation strategies for Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS study): protocol for a cluster randomized hybrid type III trial in Nigeria. Implement Sci 2024; 19:25. [PMID: 38468266 PMCID: PMC10926605 DOI: 10.1186/s13012-024-01349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/03/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Despite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria. METHODS Our proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites (k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions. DISCUSSION The assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV. TRIAL REGISTRATION Prospectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic. CLINICALTRIALS gov/ct2/show/study/NCT06128304.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Ijeoma U Itanyi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - John O Olawepo
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - Lin Liu
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Chinenye Bembir
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Ngozi Idemili-Aronu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Sociology and Anthropology, University of Nigeria Nsukka, Enugu, Nigeria
| | - Nwamaka N Lasebikan
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Oncology Center, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Tonia C Onyeka
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Cyril C Dim
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Chibuike O Chigbu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Echezona E Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- HealthySunrise Foundation, Las Vegas, NV, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093-0812, USA.
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA.
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA.
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Mirzadeh P, Oye-Somefun A, Ardern CI, Buick CJ. Association between human papillomaviruses, metabolic syndrome, and all-cause death; analysis of the U.S. NHANES 2003-2004 to 2015-2016. PLoS One 2024; 19:e0299479. [PMID: 38452108 PMCID: PMC10919642 DOI: 10.1371/journal.pone.0299479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) is the most common sexually transmitted infection, attributed to 4.5% of all cancers worldwide. Co-infection with the metabolic syndrome (MetS), a common cluster of cardiometabolic risk factors, has been shown to increase the persistence of HPV. The purpose of this study was to estimate the association between HPV and MetS on mortality risk. METHODS Data for the current study was drawn from seven consecutive cycles (2003-2004 to 2015-2016) of the U.S. NHANES. The final analytic sample consisted of 5,101 individuals aged 18-65y with HPV and MetS information with follow-up to Dec. 31st, 2019. Baseline HPV status was assessed by either vaginal swab, penile swab or oral rinse and used to classify participants as: no HPV (n = 1,619), low (n = 1,138), probable (n = 672), and high-risk (n = 1,672; 22% type 16, and 10% type 18) HPV using IARC criteria. MetS was assessed by the Harmonized criteria. RESULTS The average follow-up was 9.4 y with 240 all-cause deaths (no HPV: n = 46 deaths; low-risk: n = 60 deaths; probable: n = 37 deaths, and; high-risk: n = 97 deaths). HPV status alone revealed no associations with mortality in fully adjusted models. Cross-classification into discrete MetS/HPV strata yielded an increased risk of mortality in females with high-risk HPV/MetS relative to the no MetS/no HPV group. CONCLUSIONS In this study, low, probable, and high-risk HPV and MetS were differentially related to mortality risk in men and women. Further work is necessary to separate the temporal, age, vaccination, and sex effects of HPV diagnosis in these relationships using prospective studies with detailed histories of HPV infection and persistence.
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Affiliation(s)
- Parmis Mirzadeh
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | - Akinkunle Oye-Somefun
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | - Chris I. Ardern
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | - Catriona J. Buick
- School of Nursing, Faculty of Health, York University, Toronto, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
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Anjam Majoumerd A, Hosseini S, Hosseini SMH, Roshandel G, Rahmanian V, Hazar N. Epidemiology of cervical cancer in Iran in 2016: A nationwide study of incidence and regional variation. Cancer Rep (Hoboken) 2024; 7:e1973. [PMID: 38214217 PMCID: PMC10849997 DOI: 10.1002/cnr2.1973] [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: 07/31/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024] Open
Abstract
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.
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Affiliation(s)
| | - Saeed Hosseini
- Center for Healthcare Data Modeling, Department of Biostatistics and Epidemiology, School of Public HealthShahid Sadoughi University of Medical SciencesYazdIran
- Department of Epidemiology, School of Public HealthIran University of Medical SciencesTehranIran
| | | | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and HepatologyGolestan University of Medical SciencesGorganIran
| | - Vahid Rahmanian
- Department of Public HealthTorbat Jam Faculty of Medical SciencesTorbat JamIran
| | - Narjes Hazar
- Diabetes Research CenterShahid Sadoughi University of Medical SciencesYazdIran
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11
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Liu CK, Huang KG, Chen MJ, Lu CH, Hwang SF, Sun L, Hsu ST. The Current Trend of Fertility Preservation in Patients with Cervical Cancer. Gynecol Minim Invasive Ther 2024; 13:4-9. [PMID: 38487609 PMCID: PMC10936714 DOI: 10.4103/gmit.gmit_34_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 03/17/2024] Open
Abstract
Although the incidence of most cancers increases with age, a considerable number of patients receive a diagnosis of cancer during their reproductive years. Young women wishing to get pregnant after cancer treatment should be provided consultation for fertility preservation and possible options. In patients with cervical cancer, hysterectomy is often inevitable because the uterus is located too close to the cervix. For young patients with cervical cancer who desire to get pregnant and whose lesion is confined to the cervix, sparing the uterus and, partially, the cervix should be prioritized as much as possible, while simultaneously ensuring favorable oncologic outcomes. In this review, we explore how to choose an adequate fertility-preserving procedure to achieve a balance between favorable oncologic outcomes and fertility and management during pregnancy after a radical trachelectomy in women with early-stage cervical cancer. For patients who require hysterectomy or radiation, evaluation of the ovarian condition and laparoscopic ovarian transposition followed by the use of artificial reproduction techniques and pregnancy by surrogacy should be discussed as options to achieve a successful pregnancy.
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Affiliation(s)
- Chih-Ku Liu
- Department of Obstetrics, Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taiwan
| | - Ming-Jer Chen
- Department of Obstetrics, Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Chien-Hsing Lu
- Department of Obstetrics, Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei City, Taiwan
- Ph.D. Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Sheau-Feng Hwang
- Department of Obstetrics, Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Lou Sun
- Department of Obstetrics, Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Tien Hsu
- Department of Obstetrics, Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
- Center for General Education, Ling Tung University, Taichung, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, China Medical University, Taichung, Taiwan
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12
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Xue Q, Enyang W, Tingting G, Xiaolin M, Qipeng M, Song G. Anti-tumour and radiosensitising effects of PARP inhibitor on cervical cancer xenografts. J OBSTET GYNAECOL 2023; 43:2171783. [PMID: 36786286 DOI: 10.1080/01443615.2023.2171783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This study evaluated the radiosensitising effect of niraparib; a poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitor on HeLa cervical cancer cells in nude mice and explored its possible mechanism. Twenty-four 3-5-week-old female BALB/c nude mice, inoculated with HeLa cells into the right hind leg, were randomly assigned into eight groups with three mice per group and treated. The tumour volume was significantly reduced under niraparib + radiotherapy combination as compared to monotherapy and untreated mice. The tumour growth was significantly delayed by 23.33-39 days when treated with combination therapy (p<.05). Further, univariate analysis revealed prolonged time for tumour growth when radiotherapy was followed by niraparib (I.G.) rather than niraparib (I.P.) (p=.003). Combination therapy reduced levels of PARP-1 precursor, PARP-1 splicer, PAR and RAD51 protein with high expression of γ-H2AX/CC3 and low expression of Ki-67. Niraparib in combination with radiotherapy can enhance the formation of DNA double strand breaks in HeLa cells and up regulate the expression of γ-H2AX/CC3.IMPACT STATEMENTWhat is already known on this subject? Asia has the highest incidence of cervical cancer (58.2%). Poly(adenosine diphosphate-ribose) polymerases (PARPs) are family of enzymes involved in single-strand break (SSB) and double-strand break (DSB) repair pathways. Niraparib is an effective inhibitor of both PARP-1 and PARP-2 and has the ability to cross the blood-brain barrier.What the results of this study add? Our study demonstrated that the combination of niraparib and radiotherapy can significantly enhance the cytotoxicity induced by radiotherapy. The inhibition effect of radiotherapy combined with niraparib on the tumour growth of mice was prominent, thereby establishing the radio-sensitisation activity of niraparib.What are the implications of these findings for clinical practice and/or further research? Niraparib can improve the cytotoxic effect of radiotherapy by increasing the formation of DSBs and up regulating the expression of apoptotic protein in HeLa cells.
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Affiliation(s)
- Qin Xue
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wang Enyang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Gong Tingting
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ma Xiaolin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ma Qipeng
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Gao Song
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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13
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Nhangave AV, Evaristo B, Osório D, Muhiwa A, Nacarapa E, Ramos JM, Munyangaju I. Knowledge about Cervical Cancer Prevention and Screening in Women with Cervical Cancer Attending Gynecological Services in Southern Mozambique. Niger J Clin Pract 2023; 26:1616-1620. [PMID: 38044763 DOI: 10.4103/njcp.njcp_893_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/09/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Mozambique has high rates of cervical cancer and cancer-related deaths among women. A high rate of refusal and low acceptance of treatment is observed among cervical cancer patients. The extent of their knowledge of the disease is unknown. OBJECTIVES To assess knowledge about this disease (prevention, risk factors, and the possibilities of early diagnosis) in women with cervical cancer attended in gynecological services in Gaza province, Mozambique. MATERIALS AND METHODS This cross-sectional study took place in the city of Xai-Xai at the Provincial Hospital of Xai-Xai (HPXX) in the southern province of Gaza (Mozambique). Non-probability convenience sampling was used. Eligible patients (women) aged 35-50 years, diagnosed with cervical cancer and followed at the HPXX in the second quarter of 2021 (n = 60), took part in the survey during their scheduled consultations. Descriptive statistics were calculated using SPSS statistical software (version 16). RESULTS The study included 60 women, 39 (65%) HIV positive. More than half (55.0%) believed that having a single sexual partner was an effective form of prevention; 50.0% reported that excessive alcohol consumption and having many sexual partners could cause the disease, and 46.7% affirmed that having many children increased the risk. Thirty-eight (63.3%) women reported that early diagnosis of cervical cancer was important for receiving prompt treatment, and 54 (90.0%) said regular visits to the gynecologist were important for an early diagnosis. Thirty-five (58.3%) mentioned acetic acid screening as a diagnostic test. CONCLUSIONS There are significant gaps in awareness of cervical cancer among high-risk groups.
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Affiliation(s)
- A V Nhangave
- Research Department, Gaza Provincial Research Nucleus, Provincial Health Directorate, Xai-Xai - Gaza Province, Mozambique
| | - Blc Evaristo
- Business Administration and Management, Gwaza Muthini Higher Institute of Management and Entrepreneurship, Vila de Marracuene, Maputo Province, Mozambique
| | - D Osório
- Clinical Research, Tinpswalo Association, Vincentian Association to Fight AIDS and TB, F2C3+JPR Av. De Trabalho, Chokwe, Gaza Province, Mozambique
| | - A Muhiwa
- Clinical Research, Tinpswalo Association, Vincentian Association to Fight AIDS and TB, F2C3+JPR Av. De Trabalho, Chokwe, Gaza Province, Mozambique
| | - E Nacarapa
- Clinical Research, Tinpswalo Association, Vincentian Association to Fight AIDS and TB, F2C3+JPR Av. De Trabalho, Chokwe, Gaza Province, Mozambique
| | - J M Ramos
- Department of Clinical Medicine, Alicante General University Hospital and University Miguel Hernandez de Elche, Avinguda de la Universitat d'Elx, Elche, Alicante, Spain
| | - I Munyangaju
- Clinical Research, Tinpswalo Association, Vincentian Association to Fight AIDS and TB, F2C3+JPR Av. De Trabalho, Chokwe, Gaza Province, Mozambique
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Tampakoudis G, Anastasiou OE. Burden of HPV-Related Hospitalization in Germany from 2000 to 2021. Viruses 2023; 15:1857. [PMID: 37766265 PMCID: PMC10538031 DOI: 10.3390/v15091857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
HPV has been linked to the development of precancerous and cancerous lesions. The aim of this study was to evaluate the burden of HPV-related hospitalization in Germany from 2000 to 2021 and the potential impact of the COVID-19 pandemic on it. METHODS We performed a retrospective query using data from the German Statistical Office from 2000 to 2021, including hospital admission, inpatient mortality and hospital stay length data on cervical cancer/dysplasia, female genitourinary tract, anal, penile, head and neck cancers. RESULTS The HPV-attributable hospitalization rate per 100,000 inhabitants in Germany has decreased over time, from 89 cases in 2000 to 60 in 2021, with an average annual percent change (AAPC) of -1.93 (CI -2.08--1.79, p < 0.05). The same trend was observed for the average hospital stay, which declined from 9 to 7 days, with an AAPC of -1.33 (CI -1.52--1.21, p < 0.05). An undulating but overall slightly declining pattern was observed for the inpatient mortality (AAPC -0.92, CI -1.21--0.64, p < 0.05). We observed a reduction in the hospitalization rates for invasive and non-invasive cervical cancer, which was observed in almost all age groups and in all German federal states. CONCLUSION Our study provides a comprehensive analysis of the trends in HPV-related hospitalizations over the past two decades. The decline in hospitalization rates for cervical cancer and dysplasia suggests the potential efficacy of the HPV vaccination and screening programs.
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Affiliation(s)
- Georgios Tampakoudis
- Maternal-Fetal Medicine and Obstetrics Saint Luke’s Hospital, 55236 Thessaloniki, Greece;
- First Department of Obstetrics and Gynaecology Papageorgiou General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Olympia E. Anastasiou
- Institute for Virology, Essen University Hospital, University of Duisburg-Essen, 45147 Essen, Germany
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15
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Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, Arbyn M, Basu P, Bray F, Vaccarella S. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health 2023; 11:e197-e206. [PMID: 36528031 PMCID: PMC9848409 DOI: 10.1016/s2214-109x(22)00501-0] [Citation(s) in RCA: 337] [Impact Index Per Article: 337.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tracking progress and providing timely evidence is a fundamental step forward for countries to remain aligned with the targets set by WHO to eliminate cervical cancer as a public health problem (ie, to reduce the incidence of the disease below a threshold of 4 cases per 100 000 women-years). We aimed to assess the extent of global inequalities in cervical cancer incidence and mortality, based on The Global Cancer Observatory (GLOBOCAN) 2020 estimates, including geographical and socioeconomic development, and temporal aspects. METHODS For this analysis, we used the GLOBOCAN 2020 database to estimate the age-specific and age-standardised incidence and mortality rates of cervical cancer per 100 000 women-years for 185 countries or territories aggregated across the 20 UN-defined world regions, and by four-tier levels of the Human Development Index (HDI). Time trends (1988-2017) in incidence were extracted from the Cancer Incidence in Five Continents (CI5) plus database. Mortality estimates were obtained using the most recent national vital registration data from WHO. FINDINGS Globally in 2020, there were an estimated 604 127 cervical cancer cases and 341 831 deaths, with a corresponding age-standardised incidence of 13·3 cases per 100 000 women-years (95% CI 13·3-13·3) and mortality rate of 7·2 deaths per 100 000 women-years (95% CI 7·2-7·3). Cervical cancer incidence ranged from 2·2 (1·9-2·4) in Iraq to 84·6 (74·8-94·3) in Eswatini. Mortality rates ranged from 1·0 (0·8-1·2) in Switzerland to 55·7 (47·7-63·7) in Eswatini. Age-standardised incidence was highest in Malawi (67·9 [95% CI 65·7 -70·1]) and Zambia (65·5 [63·0-67·9]) in Africa, Bolivia (36·6 [35·0-38·2]) and Paraguay (34·1 [32·1-36·1]) in Latin America, Maldives (24·5 [17·0-32·0]) and Indonesia (24·4 [24·2-24·7]) in Asia, and Fiji (29·8 [24·7-35·0]) and Papua New Guinea (29·2 [27·3-31·0]) in Melanesia. A clear socioeconomic gradient exists in cervical cancer, with decreasing rates as HDI increased. Incidence was three times higher in countries with low HDI than countries with very high HDI, whereas mortality rates were six times higher in low HDI countries versus very high HDI countries. In 2020 estimates, a general decline in incidence was observed in most countries of the world with representative trend data, with incidence becoming stable at relatively low levels around 2005 in several high-income countries. By contrast, in the same period incidence increased in some countries in eastern Africa and eastern Europe. We observed different patterns of age-specific incidence between countries with well developed population-based screening and treatment services (eg, Sweden, Australia, and the UK) and countries with insufficient and opportunistic services (eg, Colombia, India, and Uganda). INTERPRETATION The burden of cervical cancer remains high in many parts of the world, and in most countries, the incidence and mortality of the disease remain much higher than the threshold set by the WHO initiative on cervical cancer elimination. We identified substantial geographical and socioeconomic inequalities in cervical cancer globally, with a clear gradient of increasing rates for countries with lower levels of human development. Our study provides timely evidence and impetus for future strategies that prioritise and accelerate progress towards the WHO elimination targets and, in so doing, address the marked variations in the global cervical cancer landscape today. FUNDING French Institut National du Cancer, Horizon 2020 Framework Programme for Research and Innovation of the European Commission; and EU4Health Programme.
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Affiliation(s)
- Deependra Singh
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France.
| | - Jerome Vignat
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | | | - Marzieh Eslahi
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Ophira Ginsburg
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France; Center for Global Health, US National Cancer Institute, Bethesda, MD, USA
| | - Beatrice Lauby-Secretan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Partha Basu
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Salvatore Vaccarella
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
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