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McClellan SP, Unger-Saldaña K, Espinosa-Tamez P, Suazo-Zepeda E, Potter MB, Barquet-Muñoz SA, Torres-Ibarra L, Lamadrid-Figueroa H, Lajous M. The Cervical Cancer Treatment Gap in Mexico Under Seguro Popular, 2006-2016. Health Syst Reform 2023; 9:2272371. [PMID: 37944505 DOI: 10.1080/23288604.2023.2272371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/14/2023] [Indexed: 11/12/2023] Open
Abstract
From 2005 to 2019, the Mexican government financed cervical cancer treatment for individuals without social security insurance through Seguro Popular's Fund for Protection against Catastrophic Health Expenses. To better understand the impact of this program on access to treatment, we estimated the cervical cancer treatment gap (the proportion of patients with cervical cancer in this population who did not receive treatment). To calculate the expected number of incident cervical cancer cases we used national surveys with information on insurance affiliation and incidence estimates from the Global Burden of Disease study. We used a national claims database to determine the number of cases whose treatment was financed by Seguro Popular. From 2006 to 2016, the national cervical cancer treatment gap changed from 0.61 (95% CI 0.59 to 0.62) to 0.45 (95% CI 0.43 to 0.48), with an average yearly reduction of -0.012 (95% CI -0.024 to -0.001). The gap was greater in states with higher levels of marginalization and in the youngest and oldest age groups. Although the cervical cancer treatment gap among individuals eligible for Seguro Popular decreased after the introduction of public financing for treatment, it remained high. Seguro Popular was eliminated in 2019; however, individuals without social security have continued to receive cancer care financed by the government in the same healthcare facilities. These results suggest that barriers to care persisted after the introduction of public financing for treatment. These barriers must be reduced to improve cervical cancer care in Mexico, particularly in states with high levels of marginalization.
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Affiliation(s)
- Sean P McClellan
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Karla Unger-Saldaña
- Epidemiology Research Unit, National Institute of Cancer, Mexico City, Mexico
| | - Priscilla Espinosa-Tamez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Erick Suazo-Zepeda
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | - Michael B Potter
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Leticia Torres-Ibarra
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | | | - Martín Lajous
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Danquah KO, Adankwah E, Dadzie HE, Gyamfi D, Adjei EA, Ossei Sampene PP, Morhe E. Prolonged Duration of Air-Dry Fixation of Cervical Smears Produces Superior Cytomorphological Staining Quality over Conventional Wet-Fixed Smears. Acta Cytol 2023; 67:528-532. [PMID: 37231771 DOI: 10.1159/000530924] [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: 07/12/2022] [Accepted: 03/21/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Immediate fixation of smears in 95% alcohol for Pap staining is commonly used for cytopathological diagnosis of cancers and other diseases. Few research studies have investigated the comparative outcomes of alcohol wet fixation and rehydration of air-dried smears, indicating that air-dried rehydrated (ARF) smears are viable alternative to wet-fixed (WF) smears. However, there are no or few investigations on the effects of long durations of air-drying fixation on cytomorphological staining quality. MATERIALS AND METHODS 124 cervical smears were obtained from the Family Planning Unit of Komfo Anokye Teaching Hospital in Kumasi, Ghana. Quadruple smears were WF and air-dried for 2 h, 4 h, and 8 h prior to rehydration with normal saline and fixation (ARF). All the smears were stained with Papanicolaou stain, examined microscopically for their cytomorphological features, and scored. Cytomorphological scores were statistically analyzed using SPSS software. RESULTS No significant difference in cytolysis, cell border, nuclear border, chromatin, and cellularity between WF and ARF was observed. However, significant differences in cytoplasmic staining quality (p value <0.001) and the absence of RBCs (p value <0.001) were observed in the 4-h ARF. The absence of RBCs in the ARF smears rendered a clearer background than in the wet fixation. CONCLUSIONS ARF, Pap-stained smears showed comparably superior cytomorphological features to those of WF smears. The 8-h ARF smears produce crispy chromatin and excellent background, making them suitable for bloody cytological samples.
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Affiliation(s)
- Kwabena Owusu Danquah
- Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernest Adankwah
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Headtlove E Dadzie
- Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Daniel Gyamfi
- Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Paul Poku Ossei Sampene
- Department of Pathology, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Morhe
- Department of Obstetrics and Gynaecology, Family Planning Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Chávez-Torres M, Gómez-Palacio-Schjetnan M, Reyes-Terán G, Briceño O, Ávila-Ríos S, Romero-Mora KA, Pinto-Cardoso S. The vaginal microbiota of women living with HIV on suppressive antiretroviral therapy and its relation to high-risk human papillomavirus infection. BMC Microbiol 2023; 23:21. [PMID: 36658503 PMCID: PMC9850673 DOI: 10.1186/s12866-023-02769-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Few studies have investigated the vaginal microbiota (VM) in women living with HIV (WLWH) in the context of high-risk human papillomavirus (HR-HPV) infection, even though WLWH are at an increased risk of HPV-related malignancies, including cervical cancer. To explore the impact of HIV and HPV infection on the VM in WLWH, we determined the prevalence of HR-HPV infection and cervical cytologic abnormalities in a cohort of 44 WLWH and 39 seronegative-women (SNW), characterized the vaginal microbiota by 16S sequencing, assessed genital inflammation and systemic immune activation by multiplex bead assay and flow cytometry, respectively. Finally, we explored relationships between bacterial richness and diversity, the top 20 bacterial genera, genital inflammation and systemic immune activation. RESULTS We found that HR-HPV prevalence was similar between WLWH and SNW. High-grade squamous intraepithelial lesions (HSIL) were only detected in WLWH negative for HR-HPV infection. In regression analyses, no risk factors were identified. Women co-infected with HIV and HR-HPV had the highest level of systemic immune activation, and these levels were significantly different compared with SNW without HR-HPV infection. Lactobacillus iners was the dominant Lactobacillus species in WLWH and SNW alike. CONCLUSION We found no evidence of differences in vaginal microbial richness and diversity, microbial community structure, and genital inflammation by HIV, HPV, or HIV and HPV status.
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Affiliation(s)
- Monserrat Chávez-Torres
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
| | - Maria Gómez-Palacio-Schjetnan
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
| | - Gustavo Reyes-Terán
- grid.415745.60000 0004 1791 0836Comisión Coordinadora de Institutos Nacionales de Salud Y Hospitales de Alta Especialidad, Secretaría de Salud, Ciudad de México, México
| | - Olivia Briceño
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
| | - Santiago Ávila-Ríos
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
| | - Karla Alejandra Romero-Mora
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
| | - Sandra Pinto-Cardoso
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
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Piña-Sánchez P. Human Papillomavirus: Challenges and Opportunities for the Control of Cervical Cancer. Arch Med Res 2022; 53:753-769. [PMID: 36462952 DOI: 10.1016/j.arcmed.2022.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Viruses are the most abundant and genetically diverse entities on the planet, infect all life forms and have evolved with their hosts. To date, 263 viral species have been identified that infect humans, of which only seven are considered type I oncogenic. Human papillomavirus (HPV) is the main virus associated with cancer and is responsible for practically all cases of cervical carcinoma. Screening tests for early detection have been available since the 1960s. Undoubtedly, the entailment between knowledge of HPV biology and the natural history of cervical cancer has contributed to the significant advances that have been made for its prevention since the 21st century, with the development of prophylactic vaccines and improved screening strategies. Therefore, it is possible to eradicate invasive cervical cancer as a worldwide public health problem, as proposed by the WHO with the 90-70-90 initiative based on vaccination coverage, screening, and treatment, respectively. In addition, the emerging knowledge of viral biology generates opportunities that will contribute to strengthening prevention and treatment strategies in HPV-associated neoplasms.
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Affiliation(s)
- Patricia Piña-Sánchez
- Laboratorio Molecular de Oncología, Unidad de Investigación Oncológica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Arango-Bravo EA, Cetina-Pérez LDC, Galicia-Carmona T, Castro-Eguiluz D, Gallardo-Rincón D, Cruz-Bautista I, Duenas-Gonzalez A. The health system and access to treatment in patients with cervical cancer in Mexico. Front Oncol 2022; 12:1028291. [PMID: 36530977 PMCID: PMC9748554 DOI: 10.3389/fonc.2022.1028291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/14/2022] [Indexed: 08/30/2023] Open
Abstract
Cervical cancer (CC) is tightly related to a low Human Development Index. Mexico is an upper-middle-income country with 126 million inhabitants, and its public health system aims to provide universal health coverage. Currently, employment-based social insurance covers approximately 60% of the population, and the scope of the remaining 40% is on course via the "IMSS-Bienestar" Institute. However, the annual government spending on health remains at 3% of the Gross Domestic Product, which is well below the 6% recommended by the Organization for Economic Cooperation and Development. CC is the second in incidence and mortality among women. Regarding primary prevention with the Human Papilloma Virus-vaccine, the current coverage for girls aged 9 to 14 years is only around 7%. Among secondary prevention with screening, the program is yet to cover the total number of women at risk; nevertheless, the age-standardized CC mortality rate has decreased from 12 per 100,000 women in 1979 to 5.7 per 100,000 women in 2020 due in part to increased screening coverage. Still, around two-thirds of patients present with locally advanced disease at diagnosis. Data from our country demonstrate that even socially disadvantaged CC patients achieve "standard" survival outcomes if treatment is granted. Nevertheless, there is a shortage in almost every aspect regarding CC treatment, including oncologists, chemotherapy units, medical physicists, radiation technicians, and both teletherapy and brachytherapy facilities. In conclusion, advances in the public health system in Mexico are urgently required to achieve CC control and reduce the mortality from this neoplasia that mainly targets socially disadvantaged women.
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Affiliation(s)
- Eder A. Arango-Bravo
- Department of Clinical Research, Instituto Nacional de Cancerología, Mexico, Mexico
- Integral program for the care of locally advanced and metastatic cervical cancer (MICAELA), Instituto Nacional de Cancerología, Mexico, Mexico
- Department of Medical Oncology, Instituto Nacional de Cancerología, Mexico, Mexico
| | - Lucely del Carmen Cetina-Pérez
- Department of Clinical Research, Instituto Nacional de Cancerología, Mexico, Mexico
- Integral program for the care of locally advanced and metastatic cervical cancer (MICAELA), Instituto Nacional de Cancerología, Mexico, Mexico
- Department of Medical Oncology, Instituto Nacional de Cancerología, Mexico, Mexico
- Department of Oncology, Hospital Médica Sur, Mexico, Mexico
| | - Tatiana Galicia-Carmona
- Department of Clinical Research, Instituto Nacional de Cancerología, Mexico, Mexico
- Integral program for the care of locally advanced and metastatic cervical cancer (MICAELA), Instituto Nacional de Cancerología, Mexico, Mexico
- Department of Medical Oncology, Instituto Nacional de Cancerología, Mexico, Mexico
| | | | - Dolores Gallardo-Rincón
- Investigador por México CONACYT- Department of Clinical Research, Instituto Nacional de Cancerología, Mexico, Mexico
| | | | - Alfonso Duenas-Gonzalez
- Instituto de Investigaciones Biomedicas, Universidad Nacional Autonoma de Mexico, Mexico, Mexico
- Division of Basic Research, Instituto Nacional de Cancerologia, Mexico, Mexico
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6
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Honarvar Z, Zarisfi Z, Salari Sedigh S, Masoumi Shahrbabak M. Comparison of conventional and liquid-based Pap smear methods in the diagnosis of precancerous cervical lesions. J OBSTET GYNAECOL 2022; 42:2320-2324. [PMID: 35579303 DOI: 10.1080/01443615.2022.2049721] [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: 10/18/2022]
Abstract
Cervical cancer is one of the five most common cancers among women. The present study aimed to compare conventional and liquid-based Pap smear methods in 2018 in Kerman, Iran. This was a cross-sectional study. Pap smear samples (conventional Pap smear (CN) and liquid-based cytology (LBC)) were collected from five health centres in Kerman. Samples were classified into two groups of liquid and CNs, and each group was classified into normal, abnormal (including, atypical squamous cells of undetermined significance (ASCUS+), atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H+), low-grade squamous intraepithelial lesion (LSIL+), high-grade squamous intraepithelial lesion (HSIL+) and cancer+) and unsatisfactory. Descriptive data analysis and chi-square/Fisher's exact test were performed in SPSS 20 (SPSS Inc., Chicago, IL). Totally, 31,513 women were screened by two CN and LBC. The mean age of subjects was 39.73 ± 9.58 years. The unsatisfactory smears (1.4% versus 0.02%; p=.001) and ASCUS+ (45.1% versus 39.4%; p=.007) were more reported by conventional tests, while LSIL+ (33.1% versus 38.9%; p=.005) was reported by the LBC test. Among women who were younger than 40 years, the CIN2+ that was found by LBC was significantly more than the CN method (37.4% versus 31.7, p=.04) and among older women (older than 40 years) the CIN1+ was significantly more as well (18% versus 13.6%, p=.05). The present study showed that, although LBC had many advantages, CN is still useful. Further studies are to be suggested as a clinical trial in another population with a large number of participants to compare the diagnosing methods of cervical cancers. Impact StatementWhat is already known on this subject? The conventional Pap smear (CN) and liquid-based cytology (LBC) methods are the most common methods for screening cervical cancers. Previously, in some studies, LBC was reported as a better method and in some studies, traditional method was preferred. Conflicting results were found in previous articles.What do the results of this study add? LBC compared to CN could find truer abnormal cases. The superiority of the LBC method is seen in cases such as reducing unsatisfactory cases, etc. LBC compared to CN could find more CIN+. Also, LBC could find more CIN1+ among women older than 40 years and more CIN+ ≥2 among younger women.What are the implications of these findings for clinical practice and/or further research? Although LBC has many advantages and it is easier, CN is still useful and both methods are suitable for cervical abnormality and cancer detection. CN cannot be declared an outdated method.
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Affiliation(s)
- Zahra Honarvar
- Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Zarisfi
- Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Saideh Salari Sedigh
- Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Masoumi Shahrbabak
- Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Hurtado-Salgado E, Cárdenas-Cárdenas L, Salmerón J, Luna-Gordillo R, Ortiz-Panozo E, Allen-Leigh B, Saavedra-Lara N, Franco EL, Lazcano-Ponce E. Comparative performance of the human papillomavirus test and cytology for primary screening for high-grade cervical intraepithelial neoplasia at the population level. Int J Cancer 2021; 150:1422-1430. [PMID: 34921727 DOI: 10.1002/ijc.33905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
The World Health Organization recommends high-risk human papillomavirus (hrHPV)-based screening for women 39 to 49 years, based on the greater accuracy of hrHPV-based screening for cervical cancer detection. Many cervical cancer screening programs have incorporated hrHPV testing and multiple early cervical cancer detection strategies have been evaluated, mostly under controlled conditions. However, there are few evaluations of combined hrHPV and cytology strategies post-implementation at the population level. Our study sought to estimate the relative yield of hrHPV testing compared to cervical cytology, as a primary screening test for cervical intraepithelial neoplasia grade 2+ (CIN2+), used at the population level. We analyzed screening data from Mexico's public cervical cancer prevention program from 2010 to 2015 in women 35 to 64 years. The study population consisted of two cohorts: one from a total of 2 881 962 cytology-based screening tests and another from a total of 2 004 497 hrHPV-based screening tests, which are concurrent in time. We performed a relative yield analysis using Poisson regression models to compare the effectiveness of hrHPV testing for CIN2+ with cervical cytology. A total of 4 886 459 records were analyzed, including 23 999 biopsies; 0.12% (n = 6166) had a CIN2+ histologic diagnosis. hrHPV testing with cytological triage detects twice as many CIN2+ cases as screening using cytology alone.
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Affiliation(s)
- Erika Hurtado-Salgado
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Luz Cárdenas-Cárdenas
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Jorge Salmerón
- Political, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Betania Allen-Leigh
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - Nenetzen Saavedra-Lara
- School of Public Health of Mexico, National Institute of Public Health, Cuernavaca, Mexico
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
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8
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Singini MG, Sitas F, Bradshaw D, Chen WC, Motlhale M, Kamiza AB, de Villiers CB, Lewis CM, Mathew CG, Waterboer T, Newton R, Muchengeti M, Singh E. Ranking lifestyle risk factors for cervical cancer among Black women: A case-control study from Johannesburg, South Africa. PLoS One 2021; 16:e0260319. [PMID: 34879064 PMCID: PMC8654217 DOI: 10.1371/journal.pone.0260319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Aside from human papillomavirus (HPV), the role of other risk factors in cervical cancer such as age, education, parity, sexual partners, smoking and human immunodeficiency virus (HIV) have been described but never ranked in order of priority. We evaluated the contribution of several known lifestyle co-risk factors for cervical cancer among black South African women. METHODS We used participant data from the Johannesburg Cancer Study, a case-control study of women recruited mainly at Charlotte Maxeke Johannesburg Academic Hospital between 1995 and 2016. A total of 3,450 women in the study had invasive cervical cancers, 95% of which were squamous cell carcinoma. Controls were 5,709 women with cancers unrelated to exposures of interest. Unconditional logistic regression models were used to calculate adjusted odds ratios (ORadj) and 95% confidence intervals (CI). We ranked these risk factors by their population attributable fractions (PAF), which take the local prevalence of exposure among the cases and risk into account. RESULTS Cervical cancer in decreasing order of priority was associated with (1) being HIV positive (ORadj = 2.83, 95% CI = 2.53-3.14, PAF = 17.6%), (2) lower educational attainment (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 16.2%), (3) higher parity (3+ children vs 2-1 children (ORadj = 1.25, 95% CI = 1.07-1.46, PAF = 12.6%), (4) hormonal contraceptive use (ORadj = 1.48, 95% CI = 1.24-1.77, PAF = 8.9%), (5) heavy alcohol consumption (ORadj = 1.44, 95% CI = 1.15-1.81, PAF = 5.6%), (6) current smoking (ORadj = 1.64, 95% CI = 1.41-1.91, PAF = 5.1%), and (7) rural residence (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 4.4%). CONCLUNSION This rank order of risks could be used to target educational messaging and appropriate interventions for cervical cancer prevention in South African women.
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Affiliation(s)
- Mwiza Gideon Singini
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Freddy Sitas
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales Sydney, Australia
- Menzies Centre of Health Policy, School of Public Health, University of Sydney, Australia
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Melitah Motlhale
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Abram Bunya Kamiza
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chantal Babb de Villiers
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King’s College, London, United Kingdom
| | - Christopher G. Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King’s College, London, United Kingdom
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- University of York, York, United Kingdom
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- * E-mail:
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9
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Ramírez-Palacios P, Chen A, Flores YN, Crespi CM, Lazcano-Ponce E, Alvarez-Escobedo D, Torres-Ibarra L, Rivera-Paredez B, León-Maldonado L, Hernández-López R, Mendiola-Pastrana IR, Méndez-Hernández P, Cuzick J, Carmona E, Figueroa H, Montiel-Cordero F, Meneses-León J, Rao J, Salmerón J. Benefit of double-reading cytology smears as a triage strategy among high-risk human papillomavirus-positive women in Mexico. Cancer Cytopathol 2020; 128:715-724. [PMID: 32520446 DOI: 10.1002/cncy.22303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The goal of this study was to determine whether the detection of histologically confirmed cases of cervical high-grade squamous intraepithelial lesions or worse (HSIL+) can be increased by having each liquid-based cytology (LBC) slide read by 2 cytotechnologists as part of routine screening. METHODS Over 36,212 women aged 30 to 64 years participated in the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening and Triage (FRIDA) Study in Mexico between 2013 and 2016. For each participant, 2 cervical samples were collected at the same clinic visit, one to test for high-risk human papillomavirus (hrHPV) and the other for LBC, which was used to triage those with a hrHPV positive result. LBC slides were evaluated by 7 cytotechnologists, with each slide read independently by 2 blinded cytotechnologists. All women with atypical cells of undetermined significance or a worse result were referred to colposcopy for further evaluation and diagnosis. Three pathologists evaluated the biopsy specimens to confirm the final HSIL+ diagnosis. The HSIL+ detection rates for the single versus double reading were estimated and compared. RESULTS A total of 3,914 women with a positive hrHPV result were triaged with LBC. The first and second cytology readings resulted in 43 HSIL+ cases detected; the double-reading strategy detected 9 additional HSIL+ cases, resulting in a total of 52 HSIL+ cases. The HSIL+ detection rate increased from 10.99/1000 with a single reading to 13.29/1000 with the double-reading strategy (P = .004). CONCLUSION A 20.9% increase in HSIL+ cases detected was achieved with a double reading of the LBC slides in this sample of hrHPV-positive women.
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Affiliation(s)
- Paula Ramírez-Palacios
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Mexico
| | - Aiyu Chen
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California
| | - Yvonne N Flores
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Mexico
- Department of Health Policy and Management and Kaiser Permanente Center for Health Equity, Fielding School of Public Health, University of California, Los Angeles, California
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
| | - Catherine M Crespi
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Daniel Alvarez-Escobedo
- Unidad de Medicina Familiar, Hospital General Regional No. 1, Instituto Mexicano del Seguro Social, Cuernavaca, Mexico
| | - Leticia Torres-Ibarra
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Berenice Rivera-Paredez
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Rubí Hernández-López
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Indira R Mendiola-Pastrana
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Pablo Méndez-Hernández
- Departamento de Calidad y Educación en Salud, Secretaria de Salud Tlaxcala, Santa Ana Chiautempan, Mexico
- Facultad de Ciencias de la Salud, Universidad Autónoma de Tlaxcala, Zacatelco, Mexico
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
| | | | - Héctor Figueroa
- Laboratorio de Citología, Laboratorio Estatal de Salud Pública, Tlaxcala, México
| | | | - Joacim Meneses-León
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jianyu Rao
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, California
| | - Jorge Salmerón
- Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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10
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Oyervides-Muñoz MA, Pérez-Maya AA, Sánchez-Domínguez CN, Berlanga-Garza A, Antonio-Macedo M, Valdéz-Chapa LD, Cerda-Flores RM, Trevino V, Barrera-Saldaña HA, Garza-Rodríguez ML. Multiple HPV Infections and Viral Load Association in Persistent Cervical Lesions in Mexican Women. Viruses 2020; 12:E380. [PMID: 32244347 PMCID: PMC7232502 DOI: 10.3390/v12040380] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 12/04/2022] Open
Abstract
Persistent high-risk human papillomavirus (HR-HPV) infections play a major role in the development of invasive cervical cancer (CC), and screening for such infections is in many countries the primary method of detecting and preventing CC. HPV typing can be used for triage and risk stratification of women with atypical squamous cells of undetermined significance (ASC-US)/low-grade cervical lesions (LSIL), though the current clinical practice in Mexico is to diagnose CC or its preceding conditions mainly via histology and HR-HPV detection. Additional information regarding these HPV infections, such as viral load and co-infecting agents, might also be useful for diagnosing, predicting, and evaluating the possible consequences of the infection and of its prevention by vaccination. The goal of this follow-up hospital case study was to determine if HPV types, multiple HPV infections, and viral loads were associated with infection persistence and the cervical lesion grade. A total of 294 cervical cytology samples drawn from patients with gynecological alterations were used in this study. HPV types were identified by real-time PCR DNA analysis. A subset of HPV-positive patients was reevaluated to identify persistent infections. We identified HPV types 16, 18, and 39 as the most prevalent. One hundred five of the patients (59%) were infected with more than one type of HPV. The types of HPV associated with multiple HPV infections were 16, 18, and 39. In the follow-up samples, 38% of patients had not cleared the initially detected HPV infection, and these were considered persistent. We found here an association between multiple HPV infections and high viral loads with and infection persistence. Our findings suggest there are benefits in ascertaining viral load and multiple HPV infections status of HR-HPV infections for predicting the risk of persistence, a requirement for developing CC. These findings contribute to our understanding of HPV epidemiology and may allow screening programs to better assess the cancer-developing risks associated with individual HR-HPV infections.
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Affiliation(s)
- Mariel A. Oyervides-Muñoz
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero S/N, Mitras Centro Monterrey, 64460 Nuevo León, Mexico; (M.A.O.-M.); (A.A.P.-M.); (C.N.S.-D.)
| | - Antonio A. Pérez-Maya
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero S/N, Mitras Centro Monterrey, 64460 Nuevo León, Mexico; (M.A.O.-M.); (A.A.P.-M.); (C.N.S.-D.)
| | - Celia N. Sánchez-Domínguez
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero S/N, Mitras Centro Monterrey, 64460 Nuevo León, Mexico; (M.A.O.-M.); (A.A.P.-M.); (C.N.S.-D.)
| | - Anais Berlanga-Garza
- Departamento de Ginecología y Obstetricia, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero S/N, Mitras Centro, 64460 Nuevo León, Mexico; (A.B.-G.); (M.A.-M.); (L.D.V.-C.)
| | - Mauro Antonio-Macedo
- Departamento de Ginecología y Obstetricia, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero S/N, Mitras Centro, 64460 Nuevo León, Mexico; (A.B.-G.); (M.A.-M.); (L.D.V.-C.)
| | - Lezmes D. Valdéz-Chapa
- Departamento de Ginecología y Obstetricia, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero S/N, Mitras Centro, 64460 Nuevo León, Mexico; (A.B.-G.); (M.A.-M.); (L.D.V.-C.)
| | - Ricardo M. Cerda-Flores
- Facultad de Enfermería, Universidad Autónoma de Nuevo León, Av. Dr. José Eleuterio González 1500, Mitras Centro, 64460 Nuevo León, Mexico;
| | - Victor Trevino
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 3000 Av. Morones Prieto, Colonia Los Doctores, 64710 Nuevo León, Mexico;
| | - Hugo A. Barrera-Saldaña
- Vitagénesis SA. Blvd. Puerta del Sol 1005. Colinas de San Jerónimo. Monterrey, 64630 Nuevo León, Mexico
| | - María L. Garza-Rodríguez
- Centro Universitario contra el Cancer, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero S/N, Mitras Centro, 64460 Nuevo León, Mexico
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11
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Bristow CC, Brown B, Marg L, Iñiguez RI, Meckel-Parker K, Silverman JG, Magis-Rodriguez C, Gaines TL, Brouwer KC. Prevalence and correlates of cervical abnormalities among female sex workers in Tijuana, Mexico. Int J STD AIDS 2019; 30:861-867. [PMID: 31159713 PMCID: PMC6901098 DOI: 10.1177/0956462419841464] [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] [Indexed: 11/15/2022]
Abstract
Objectives: In Tijuana, Mexico, sex work is regulated by the municipal health department and includes regular testing for HIV and other sexually transmitted infections (STIs) for registered female sex workers (FSWs). However, Pap testing is missing from current sexual health assessments. We aimed to answer the following research questions: 1.) What is the prevalence of cervical abnormalities among a sample of FSWs in Tijuana, Mexico? 2.) What are the correlates of cervical abnormalities among a sample of FSWs in Tijuana, Mexico? Study design: From 2013-2014, a cohort of 300 FSWs in Tijuana, Mexico were recruited using modified time-location sampling. Participants were given Pap, HIV, and STI tests. Results: The prevalence of an abnormal Pap was 11.7% (35/300). FSWs ever registered with municipal health services were less likely to have an abnormal Pap result (4.8% vs 14.4%, p=0.03), were more likely to report a previous Pap test (88.1% vs 70.4%, p=.001), and were more likely to report a sexual health checkup in the last year (60.7% vs 37.0%, p<0.001) than those who had never been registered. Conclusions: FSWs remain at risk for cervical abnormalities, including those registered with the municipality. We conducted Pap testing for female sex workers in Tijuana, Mexico and found that over 11% had abnormal Pap test results.
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Affiliation(s)
- Claire C Bristow
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego
| | - Brandon Brown
- Department of Social Medicine and Population Health, University of California Riverside School of Medicine
| | - Logan Marg
- Department of Sociology, University of California Riverside
| | | | - Kristen Meckel-Parker
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego
| | - Jay G. Silverman
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego
| | - Carlos Magis-Rodriguez
- Centro Nacional para la prevención y el Control del VIH/SIDA (CENSIDA), Mexico City, Mexico
| | - Tommi L. Gaines
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego
| | - Kimberly C. Brouwer
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego
- Department of Family Medicine and Public Health, University of California San Diego
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12
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Campos-Romero A, Anderson KS, Longatto-Filho A, Luna-Ruiz Esparza MA, Morán-Portela DJ, Castro-Menéndez JA, Moreno-Camacho JL, Calva-Espinosa DY, Acosta-Alfaro MA, Meynard-Mejía FA, Muñoz-Gaitán M, Alcántar-Fernández J. The burden of 14 hr-HPV genotypes in women attending routine cervical cancer screening in 20 states of Mexico: a cross-sectional study. Sci Rep 2019; 9:10094. [PMID: 31300693 PMCID: PMC6626130 DOI: 10.1038/s41598-019-46543-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/01/2019] [Indexed: 11/23/2022] Open
Abstract
In Mexico, HPV vaccines available immunize against genotypes 16/18 and 16/18/6/11; however, there is limited surveillance about carcinogenic subtypes in different states of the country that allow evaluating the effectiveness of vaccination and cervical cancer screening programs. Here, we report the regional and age-specific prevalence of 14 hr-HPV genotypes as well as their prevalence in abnormal cytology (from ASCUS to cervical cancer) among Mexican women which were undergoing from cervical cancer screening in the Salud Digna clinics in 20 states of the country. This study includes women with social security from the majority of public health institutions (IMSS, ISSSTE, SEMAR, and PEMEX), and women without social security. For cervical cancer screening, we used the SurePath liquid-based cytology and the BD Onclarity HPV Assay. From December 1, 2016, to August 2, 2018, the hr-HPV prevalence among 60,135 women was 24.78%, the most prevalent types were HPV 16 (4.13%), HPV 31 (4.12%) and HPV 51 (3.39%), while HPV 18 (1.70%) was less prevalent among infected women. Interestingly, the genotypes not covered by current vaccines in Mexico were commonly found in precancerous lesions, evidencing their carcinogenic potential, so it is necessary to increase their surveillance and inclusion in cervical cancer screening triage.
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Affiliation(s)
| | - Karen S Anderson
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, 85287, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, 85287, USA
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Life and Health Sciences Research Institute, ICVS, School of Medicine, Minho University, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Department of Pathology, LIM14, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - David J Morán-Portela
- National Reference Center, Salud Digna, 80300, Culiacan, Sinaloa, Mexico
- Clinical Laboratory Department, Salud Digna, Culiacan, 80000, Sinaloa, Mexico
| | - Javier A Castro-Menéndez
- National Reference Center, Salud Digna, 80300, Culiacan, Sinaloa, Mexico
- Clinical Laboratory Department, Salud Digna, Culiacan, 80000, Sinaloa, Mexico
| | - José L Moreno-Camacho
- National Reference Center, Salud Digna, 80300, Culiacan, Sinaloa, Mexico
- Clinical Laboratory Department, Salud Digna, Culiacan, 80000, Sinaloa, Mexico
| | | | | | - Freddy A Meynard-Mejía
- Medical Sciences Faculty, Universidad Nacional Autonoma de Nicaragua, Managua, Nicaragua
| | - Marlene Muñoz-Gaitán
- Medical Sciences Faculty, Universidad Nacional Autonoma de Nicaragua, Managua, Nicaragua
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13
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Vale DB, Sauvaget C, Murillo R, Muwonge R, Zeferino LC, Sankaranarayanan R. Correlation of Cervical Cancer Mortality with Fertility, Access to Health Care and Socioeconomic Indicators. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2019; 41:249-255. [PMID: 30912091 PMCID: PMC10309279 DOI: 10.1055/s-0039-1683859] [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: 12/11/2017] [Accepted: 02/06/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The present study aimed to examine which development indicators are correlated with cervical cancer (CC) mortality rates in Brazil. METHODS This was an ecological study that correlated mortality rates and indicators, such as human development index (HDI), gross domestic product (GDP) per capita, illiteracy rate, fertility rate, screening coverage, proportion of private health insurance use, density of physicians, and density of radiotherapy centers. The mortality rates were obtained from the Brazilian national registry, while the indicators were based on official reports from the Ministry of Health. Univariate and multivariate linear regression was used. RESULTS Among the states of Brazil, the average age-specific CC mortality rate from 2008 to 2012 varied from 4.6 to 22.9 per 100,000 women/year. In the univariate analysis, HDI, proportion of private health insurance use, density of physicians, and density of radiotherapy centers were inversely correlated with the mortality rates. Fertility rate was positively correlated with the mortality rates. In the multivariate analysis, only fertility rate was significantly associated with the CC mortality rate (coefficient of correlation: 9.38; 95% confidence interval [CI]: 5.16-13.59). CONCLUSION A decrease in the fertility rate, as expected when the level of development of the regions increases, is related to a decrease in the mortality rate of CC. The results of the present study can help to better monitor the quality assessment of CC programs both among and within countries.
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Affiliation(s)
- Diama Bhadra Vale
- International Agency for Research on Cancer, Section of Early Detection and Prevention, Lyon, France
- Department of Tocoginecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Catherine Sauvaget
- International Agency for Research on Cancer, Section of Early Detection and Prevention, Lyon, France
| | - Raul Murillo
- International Agency for Research on Cancer, Section of Early Detection and Prevention, Lyon, France
| | - Richard Muwonge
- International Agency for Research on Cancer, Section of Early Detection and Prevention, Lyon, France
| | - Luiz Carlos Zeferino
- Department of Tocoginecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
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14
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Cruz-Jiménez L, Torres-Mejía G, Mohar-Betancourt A, Campero L, Ángeles-Llerenas A, Ortega-Olvera C, Martínez-Matsushita L, Reynoso-Noverón N, Duggan C, Anderson BO. Factors associated with ever use of mammography in a limited resource setting. A mixed methods study. Int J Qual Health Care 2018; 30:520-529. [PMID: 29648641 DOI: 10.1093/intqhc/mzy053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 03/01/2018] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate facilitators and barriers influencing mammography screening participation among women. Design Mixed methods study. Setting Three hospital catchment areas in Hidalgo, Mexico. Participants Four hundred and fifty-five women aged 40-69 years. Intervention Three hundred and eighty women completed a survey about knowledge, beliefs and perceptions about breast cancer screening, and 75 women participated in semi-structured, in-person interviews. Survey data were analyzed using logistic regression; semi-structured interviews were transcribed and analyzed using elements of the grounded theory method. Main Outcome Measure Women were categorized as never having had mammography or having had at least one mammogram in the past. Results From survey data, having had a Pap in the past year was associated with ever having had breast screening (odds ratio = 2.15; 95% confidence interval 1.30-3.54). Compared with never-screened women, ever-screened women had better knowledge of Mexican recommendations for the frequency of mammography screening (49.5% vs 31.7% P < 0.001). A higher percentage of never-screened women perceived that a mammography was a painful procedure (44.5% vs 33.8%; P < 0.001) and feared receiving bad news (38.4% vs 22.2%; P < 0.001) compared with ever-screened women. Women who participated in semi-structured, in-person interviews expressed a lack of knowledge about Mexican standard mammographic screening recommendations for age for starting mammography and its recommended frequency. Women insured under the 'Opportunities' health insurance program said that they are referred to receive Pap tests and mammography. Conclusions Local strategies to reduce mammogram-related pain and fear of bad news should work in tandem with national programs to increase access to screening.
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Affiliation(s)
- L Cruz-Jiménez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - G Torres-Mejía
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - A Mohar-Betancourt
- Unidad de Epidemiología, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - L Campero
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - A Ángeles-Llerenas
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - C Ortega-Olvera
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - L Martínez-Matsushita
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - N Reynoso-Noverón
- Unidad de Epidemiología, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - C Duggan
- The Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Public Health Sciences, Fred Hutchinson Cancer Research Center, WA, USA
| | - B O Anderson
- The Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Public Health Sciences, Fred Hutchinson Cancer Research Center, WA, USA
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15
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Delgado-Balderas JR, Garza-Rodriguez ML, Gomez-Macias GS, Barboza-Quintana A, Barboza-Quintana O, Cerda-Flores RM, Miranda-Maldonado I, Vazquez-Garcia HM, Valdez-Chapa LD, Antonio-Macedo M, Dean M, Barrera-Saldaña HA. Description of Genetic Variants in BRCA Genes in Mexican Patients with Ovarian Cancer: A First Step towards Implementing Personalized Medicine. Genes (Basel) 2018; 9:genes9070349. [PMID: 29997359 PMCID: PMC6071230 DOI: 10.3390/genes9070349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 02/08/2023] Open
Abstract
Gynecologic cancers are among the leading causes of death worldwide, ovarian cancer being the one with the highest mortality rate. Olaparib is a targeted therapy used in patients presenting mutations in BRCA1 and BRCA2 genes. The aim of this study was to describe BRCA1 and BRCA2 gene variants in Mexican patients with ovarian cancer. Sequencing of BRCA1 and BRCA2 genes from tumors of 50 Mexican patients with ovarian cancer was made in a retrospective, non-randomized, and exploratory study. We found genetic variants in 48 of 50 cases. A total of 76 polymorphic variants were found in BRCA1, of which 50 (66%) had not been previously reported. Furthermore, 104 polymorphic variants were found in BRCA2, of which 63 (60%) had not been reported previously. Of these polymorphisms, 5/76 (6.6%) and 4/104 (3.8%) were classified as pathogenic in BRCA1 and BRCA2, respectively. We have described the genetic variants in BRCA1 and BRCA2 of tumors from Northeast Mexican patients with sporadic ovarian cancers. Our results showed that the use of genetic testing helps recognize patients that carry pathogenic variants which could be beneficial for personalized medicine treatments.
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Affiliation(s)
- Jesus Rolando Delgado-Balderas
- Biochemistry and Molecular Medicine Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey 64460, Mexico.
| | - Maria Lourdes Garza-Rodriguez
- Biochemistry and Molecular Medicine Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey 64460, Mexico.
| | - Gabriela Sofia Gomez-Macias
- Pathology Department, Hospital Universitario "Dr. Jose Eleuterio-Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey 64460, Mexico.
| | | | - Oralia Barboza-Quintana
- Pathology Department, Hospital Universitario "Dr. Jose Eleuterio-Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey 64460, Mexico.
| | | | - Ivett Miranda-Maldonado
- Pathology Department, Hospital Universitario "Dr. Jose Eleuterio-Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey 64460, Mexico.
| | | | - Lezmes Dionicio Valdez-Chapa
- Gynecology and Obstetrics Department, Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Monterrey 64460, Mexico.
| | - Mauro Antonio-Macedo
- Gynecology and Obstetrics Department, Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Monterrey 64460, Mexico.
| | - Michael Dean
- Laboratory of Translational Genomics, DCEG, National Cancer Institute, Bethesda, MD 20892, USA.
| | - Hugo A Barrera-Saldaña
- Biochemistry and Molecular Medicine Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey 64460, Mexico.
- Vitagenesis SA de CV, Monterrey 64630, Mexico.
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16
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Salazar-Campos JE, González-Enciso A, Díaz-Molina R, Lara-Hernández ME, Coronel-Martínez J, Pérez-Plasencia C, de León DC. Cervicouterine Cancer Screening - TruScreen™ vs. Conventional Cytology: Pilot Study. J Cytol 2018; 35:143-148. [PMID: 30089942 PMCID: PMC6060572 DOI: 10.4103/joc.joc_111_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Cervicouterine cancer (CC) is a health problem worldwide and is the fourth most common cancer in women, with a greater proportion of individuals affected by advanced stages of the disease in developing countries. Objective: To determine the sensitivity and specificity of the TruScreen™ opto-electronic device vs. conventional cytology in CC screenings. Methodology: This is a prospective observational study that included individuals who presented for the first time at the Dysplasia Clinic of the Instituto Nacional de Cancerología from March 1 through April 30, 2016, and those referred due to abnormal conventional cytology. The patients were evaluated with the TruScreen™ device, conventional cytology, colposcopy and, if necessary, cervical biopsy. The results were analyzed by descriptive statistics as well as the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the TruScreen™, using conventional cytology as the standard. Results: Thirty-two patients were included who met the inclusion criteria. The average age of the patients was 40 years (range, 23–61 years). For the diagnosis of high-grade intraepithelial lesions, the TruScreen™ device showed a 43% sensitivity, a 92% specificity, a PPV of 60%, and a NPV of 85%, whereas evaluation via cervical biopsy exhibited a 33% sensitivity, an 86% specificity, a 33% PPV, and an 86% NPV. The Kappa agreement index of the TruScreen™ with the colposcopies was 0.70. Conclusions: TruScreen™ demonstrated low sensitivity and high specificity compared with conventional cytology, which had a high NPV.
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Affiliation(s)
- J E Salazar-Campos
- Department of Gynecology, National Cancer Institute (INCan), Mexico City, Mexico
| | | | - R Díaz-Molina
- School of Medicine, Autonomous University of Baja California (UABC), Mexicali, BC, Mexico
| | - M E Lara-Hernández
- Department of Gynecology, National Cancer Institute (INCan), Mexico City, Mexico
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Zamora Guerra Y, Córdova Ramírez S. Cytological diagnosis of cervical adenocarcinoma and cytohistological agreement at General Hospital of Mexico “Dr. Eduardo Liceaga”. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2018. [DOI: 10.1016/j.hgmx.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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18
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Allen-Leigh B, Uribe-Zúñiga P, León-Maldonado L, Brown BJ, Lörincz A, Salmeron J, Lazcano-Ponce E. Barriers to HPV self-sampling and cytology among low-income indigenous women in rural areas of a middle-income setting: a qualitative study. BMC Cancer 2017; 17:734. [PMID: 29121873 PMCID: PMC5679364 DOI: 10.1186/s12885-017-3723-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Data is needed about barriers to self-collection of Human Papillomavirus (HPV) samples and cytology among low-income, disadvantaged women living in rural areas of lower-income countries as these women are at increased risk of cervical cancer mortality. Methods Individual interviews (n = 29), focus groups (n = 7, 5–11 participants) and discussion groups (n = 2, 18–25 participants) were organized with women from three indigenous ethnic groups residing in rural areas in Mexico, after they were provided with free, self-sampled HPV tests. These groups are low-income, underserved by healthcare and have historically been on the receiving end of racism and social exclusion. Descriptive, qualitative content analysis was done, including two cycles of coding. Results Interview and focus/discussion group data indicate women had limited understanding of HPV’s role in cervical cancer etiology. They identified HPV’s existence, that cytology detects cervical cancer, the need for regular testing and that cervical cancer is sexually transmitted. Organizational barriers to clinic-based cytology included irregular supplies of disposable speculums, distance to clinics and lack of clear communication by healthcare personnel. Women considered self-collected HPV-testing easy, less embarrassing and less painful than cytology, an opportunity for self-care and most felt they understood how to take a self-sample after a 20-min explanation. Some women feared hurting themselves when taking the self-sample or that they would take the sample incorrectly, which they worried would make the test useless. Attending HPV-testing in groups facilitated use by allowing women to discuss their doubts and fears before doing self-collection of the sample or to ask other women who were the first to do the self-sampling what the experience had been like (whether it hurt and how easy it was). Lack of indoor bathrooms was a barrier to doing HPV self-sampling at home, when those homes were resource-poor (one-room dwellings). Conclusions Low-income, indigenous Mexican women residing in rural, underserved areas identified their need for cervical cancer screening but encountered multiple barriers to cytology-based screening. They found a number of advantages of HPV self-sampled tests. Employing self-collected HPV-testing instead of cytology could resolve some but not all gender-related, organizational or technical quality-of-care issues within cervical cancer detection and control programs. Electronic supplementary material The online version of this article (10.1186/s12885-017-3723-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Betania Allen-Leigh
- Public Health Methods Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - Patricia Uribe-Zúñiga
- National Center for the Prevention and Control of HIV and AIDS (CENSIDA), Mexico City, Mexico
| | - Leith León-Maldonado
- CONACYT, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Brandon J Brown
- Center for Healthy Communities, Department of Social Medicine and Population Health, UCR School of Medicine, UC Irvine, Riverside, California, USA
| | - Attila Lörincz
- Center for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jorge Salmeron
- Center for Population Health Research, National Institute of Public Health, Av. Universidad #655, Colonia Sta. Ma. Ahuacatitlán, 62508, Cuernavaca, Morelos, Mexico.,Epidemiology and Health Services Research Unit, Mexican Social Security Institute (IMSS), Cuernavaca, Morelos, Mexico
| | - Eduardo Lazcano-Ponce
- Center for Population Health Research, National Institute of Public Health, Av. Universidad #655, Colonia Sta. Ma. Ahuacatitlán, 62508, Cuernavaca, Morelos, Mexico.
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Dávila SPE, Champion JD, Monsiváis MGM, Tovar M, Arias MLF. Mexican Adolescents' Self-Reports of Parental Monitoring and Sexual Communication for Prevention of Sexual Risk Behavior. J Pediatr Nurs 2017; 35:83-89. [PMID: 28728775 DOI: 10.1016/j.pedn.2017.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Assess perceptions of parental monitoring and sexual communication for sexual health promotion among adolescents who are Mexican. DESIGN AND METHODS Adolescents (N=153, n=85 females, n=68 males) between 14years (n=80) and 15 years (n=73) were recruited at a public high school in Monterrey in the state of Nuevo Leon, Mexico. All participants were living with a parent(s). Descriptive statistical analyses were conducted to assess sociodemographic characteristics of the group. Chi-square analyses were conducted to identify potential group differences among the adolescents by age, gender and sexual activity regarding responses to each item of the Spanish Version Parental Monitoring and Sexual Communication Scale (a=0.88). RESULTS Eleven percent of adolescents self-reported sexual activity. Significant group differences by age, gender and sexual activity were identified concerning parental monitoring and sexual communication including: less parental monitoring with older age (14 versus 15 year olds); more parental monitoring for females than males; less monitoring for sexually active adolescents; greater sexual communication for males than females, and among adolescents who were sexually active. CONCLUSIONS An assessment of adolescents' perceptions of parental monitoring and sexual communication is useful for development of strategies concerning sexual health promotion in Mexico. PRACTICE IMPLICATIONS The Spanish Version Parental Monitoring and Sexual Communication Scale can be used for assessment and modification of interventions for adolescent populations in Mexico. Information obtained from this assessment can be used to assist parents to enhance positive outcomes for parental monitoring and sexual communication with their children.
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Affiliation(s)
| | - Jane Dimmitt Champion
- Lee and Joseph D. Jamail Endowed Professorship in Nursing, School of Nursing, The University of Texas at Austin, Austin, TX, United States.
| | | | - Marlene Tovar
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
| | - Maria Luisa Flores Arias
- Facultad de enfermería, Universidad de Guanajuato, Lascurain de Retana 5, Centro Guanajuato, Guanajuato 36000, Mexico
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Terán-Hernández M, Ramis-Prieto R, Calderón-Hernández J, Garrocho-Rangel CF, Campos-Alanís J, Ávalos-Lozano JA, Aguilar-Robledo M. Geographic variations in cervical cancer risk in San Luis Potosí state, Mexico: A spatial statistical approach. Int J Equity Health 2016; 15:161. [PMID: 27681081 PMCID: PMC5041341 DOI: 10.1186/s12939-016-0448-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 09/16/2016] [Indexed: 12/04/2022] Open
Abstract
Background Worldwide, Cervical Cancer (CC) is the fourth most common type of cancer and cause of death in women. It is a significant public health problem, especially in low and middle-income/Gross Domestic Product (GDP) countries. In the past decade, several studies of CC have been published, that identify the main modifiable and non-modifiable CC risk factors for Mexican women. However, there are no studies that attempt to explain the residual spatial variation in CC incidence In Mexico, i.e. spatial variation that cannot be ascribed to known, spatially varying risk factors. Methods This paper uses a spatial statistical methodology that takes into account spatial variation in socio-economic factors and accessibility to health services, whilst allowing for residual, unexplained spatial variation in risk. To describe residual spatial variations in CC risk, we used generalised linear mixed models (GLMM) with both spatially structured and unstructured random effects, using a Bayesian approach to inference. Results The highest risk is concentrated in the southeast, where the Matlapa and Aquismón municipalities register excessive risk, with posterior probabilities greater than 0.8. The lack of coverage of Cervical Cancer-Screening Programme (CCSP) (RR 1.17, 95 % CI 1.12–1.22), Marginalisation Index (RR 1.05, 95 % CI 1.03–1.08), and lack of accessibility to health services (RR 1.01, 95 % CI 1.00–1.03) were significant covariates. Conclusions There are substantial differences between municipalities, with high-risk areas mainly in low-resource areas lacking accessibility to health services for CC. Our results clearly indicate the presence of spatial patterns, and the relevance of the spatial analysis for public health intervention. Ignoring the spatial variability means to continue a public policy that does not tackle deficiencies in its national CCSP and to keep disadvantaging and disempowering Mexican women in regard to their health care.
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Affiliation(s)
- Mónica Terán-Hernández
- Geography Graduate Programme, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México. .,Universidad Autónoma de San Luis Potosí (UASLP), Campus Poniente, 130 Av. Niño Artillero, Zona Universitaria, San Luis Potosí, S. L. P., 78210, Mexico.
| | - Rebeca Ramis-Prieto
- Department of Environmental Epidemiology and Cancer, National Centre for Epidemiology, Carlos III Institute of Health (ISCIII), C/Monforte de Lemos 5, Pab. 12, 28029, Madrid, Spain
| | - Jaqueline Calderón-Hernández
- Centre of Applied Research in Environmental and Health, Coordination of Innovation and Application in Science and Technology, Universidad Autónoma de San Luis Potosí (UASLP), Unidad de Posgrado 550 Av. Sierra Leona, Lomas 2ª sección, San Luis Potosí, S.L.P., 78210, Mexico
| | | | - Juan Campos-Alanís
- Faculty of Geography, Universidad Autónoma del Estado de México (UAEM), Cerro de Coatepec s/n Ciudad Universitaria, CP 50110, Toluca, Mexico
| | - José Antonio Ávalos-Lozano
- Regional Laboratory of Variability, Climate Change and Environmental Risk Assessment, Universidad Autónoma de San Luis Potosí (UASLP), Unidad de Posgrado 550 Av. Sierra Leona, Lomas 2ª sección, San Luis Potosí, S.L.P. 78210, Mexico
| | - Miguel Aguilar-Robledo
- Faculty of Social Sciences and Humanities, Universidad Autónoma de San Luis Potosí (UASLP), Campus Oriente, 101-A Av. Industrias, Fracc. Talleres, San Luis Potosí, S.L.P. 78399, Mexico
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Di J, Rutherford S, Chu C. Review of the Cervical Cancer Burden and Population-Based Cervical Cancer Screening in China. Asian Pac J Cancer Prev 2016; 16:7401-7. [PMID: 26625735 DOI: 10.7314/apjcp.2015.16.17.7401] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Cervical cancer continues to be a serious public health problem in the developing world, including China. Because of its large population with geographical and socioeconomic inequities, China has a high burden of cervical cancer and important disparities among different regions. In this review, we first present an overview of the cervical cancer incidence and mortality over time, and focus on diversity and disparity in access to care for various subpopulations across geographical regions and socioeconomic strata in China. Then, we describe population-based cervical cancer screening in China, and in particular implementation of the National Cervical Cancer Screening Program in Rural Areas (NACCSPRA) and the challenges that this program faces. These include low screening coverage, shortage of qualified health care personnel and limited funds. To improve prevention of cervical cancer and obtain better cancer outcomes, the Chinese government needs to urgently consider the following key factors: reducing disparities in health care access, collecting accurate and broadly representative data in cancer registries, expanding target population size and increasing allocation of government funding for training of personnel, improving health education for women, enhancing quality control of screening services and improving a system to increase follow up for women with positive results.
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Affiliation(s)
- Jiangli Di
- Centre for Environment and Population Health, Environment School, Griffith University , Brisbane, Australia E-mail :
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Guerrero N, Zhang X, Rangel G, Gonzalez-Fagoaga JE, Martinez-Donate A. Cervical and Breast Cancer Screening Among Mexican Migrant Women, 2013. Prev Chronic Dis 2016; 13:E104. [PMID: 27513995 PMCID: PMC4993116 DOI: 10.5888/pcd13.160036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Information on cervical and breast cancer screening among Latinas in the United States is limited. Even less information is available on screening practices of migrant women who engage in circular migration. We examined rates of cervical and breast cancer screening and the extent to which sociodemographics and other characteristics explain screening practices of Mexican migrant women who return to Mexico from the United States. METHODS We used data from a cross-sectional probability survey of Mexico-born migrant women who returned, through Tijuana, to Mexico from the United States in 2013. The sample consisted of women who returned involuntarily (via deportation) or voluntarily; 177 reported authorized documentation status, and 36 reported unauthorized documentation status in the previous 12 months. Descriptive statistics were calculated and logistic regressions were estimated. RESULTS Of 36 undocumented migrant women, 8 (22.2%) had a Papanicolaou test and 11 (30.6%) had a mammogram in the previous year; of 177 documented migrants, 83 (46.9%) had a Papanicolaou test and 68 (38.4%) had a mammogram. Undocumented migrants were less likely than documented migrants to receive a Papanicolaou test (odds ratio [OR] = 0.29; 95% confidence interval [CI], 0.12-0.67); the likelihood was similar after adjustment for sociodemographic, migration, and acculturation factors (adjusted OR = 0.33; 95% CI, 0.12-0.90). Having health insurance (adjusted OR = 4.17; 95% CI, 1.80-9.65) and a regular source of health care (adjusted OR = 2.83; 95% CI, 1.05-7.65) were significant predictors of receiving a mammogram but not a Papanicolaou test. CONCLUSION Public health programs are needed to improve access to cervical and breast cancer screenings for Latina migrant women in general and undocumented circular migrants in particular.
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Affiliation(s)
- Natalie Guerrero
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Xiao Zhang
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Gudelia Rangel
- Mexico Section, U.S.-Mexico Border Health Commission, Tijuana, Mexico
| | | | - Ana Martinez-Donate
- Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt Hall 458, Philadelphia, PA 19104.
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León-Maldonado L, Wentzell E, Brown B, Allen-Leigh B, Torres-Ibarra L, Salmerón J, Billings DL, Thrasher JF, Lazcano-Ponce E. Perceptions and Experiences of Human Papillomavirus (HPV) Infection and Testing among Low-Income Mexican Women. PLoS One 2016; 11:e0153367. [PMID: 27149525 PMCID: PMC4858263 DOI: 10.1371/journal.pone.0153367] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HPV infection causes cervical cancer, a major contributor to morbidity and mortality among low-income Mexican women. Human papillomavirus (HPV) DNA testing is now a primary screening strategy in Mexico's early cervical cancer detection program (ECDP). Research on Mexican women's perceptions of HPV and testing is necessary for establishing culturally appropriate protocols and educational materials. Here, we explore perceptions about HPV and HPV-related risk factors among low-income Mexican ECDP participants. METHODS We conducted semi-structured interviews with 24 ECDP participants from two primary care health clinics in Michoacán state, Mexico. Interviews addressed women's understandings of and experiences with HPV and HPV testing. Analysis was inductive and guided by the Health Belief Model with a focus on gender. RESULTS Women's confusion about HPV and HPV screening caused emotional distress. They understood HPV to be a serious disease that would always cause severe symptoms, often characterizing it as analogous to HIV or inevitably carcinogenic. Women also attributed it to men's sexual behaviors, specifically infidelity and poor hygiene. Women described both sexes' desire for sex as natural but understood men's negative practices of masculinity, like infidelity, as the causes of women's HPV infection. Some women believed dirty public bathrooms or heredity could also cause HPV transmission. CONCLUSIONS These results are consistent with prior findings that geographically and economically diverse populations lack clear understandings of the nature, causes, or symptoms of HPV, even among those receiving HPV testing. Our findings also reveal that local cultural discourse relating to masculinity, along with failure to provide sufficient education to low-income and indigenous-language speaking patients, exacerbate women's negative emotions surrounding HPV testing. While negative emotions did not deter women from seeking testing, they could be ameliorated with better health education and communication.
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Affiliation(s)
- Leith León-Maldonado
- CONACYT, Instituto Nacional de Cancerología, Ciudad de México, México
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Emily Wentzell
- Department of Anthropology, The University of Iowa, Iowa City, IA, United States of America
| | - Brandon Brown
- Department of Social Medicine and Population Health, School of Medicine, University of California, Riverside, CA, United States of America
| | - Betania Allen-Leigh
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Torres-Ibarra
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Jorge Salmerón
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
| | - Deborah L. Billings
- Department of Health, Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - James F. Thrasher
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Department of Health, Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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Sanchez GI, Bravo LE, Hernandez-Suarez G, Tous S, Alemany L, de Sanjose S, Bosch FX, Muñoz N. Secular trends of HPV genotypes in invasive cervical cancer in Cali, Colombia 1950-1999. Cancer Epidemiol 2016; 40:173-8. [PMID: 26771314 DOI: 10.1016/j.canep.2015.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/12/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Aim To estimate relative contribution and time trends of HPV types in cervical cancer in Cali, Colombia over a 50 years' period. METHODS Paraffin blocks of 736 cervical cancer histological confirmed cases were retrieved from the pathology laboratory at Hospital Universitario del Valle (Cali, Colombia) and HPV genotyped using SPF10-PCR/DEIA/LiPA25 (version 1) assay. Marginal effect of age and year of diagnosis in secular trends of HPV type prevalence among HPV+ cases were assessed by robust Poisson regression analysis. RESULTS 64.7% (95%CI: 59.9-69.2) of squamous cell carcinomas (SCCs) were attributed to HPV 16 and 18, 78.2% (95%CI: 74-82) to HPV 16, 18, 31, 33 and 45 and 84.8% (95%CI: 81-88.1) to HPV 16, 18, 31, 33, 45, 52 and 58 while ninety-three percent of adenocarcinomas (ADCs) were attributed to HPV 16, 18 and 45 only. The prevalence of specific HPV types did not change over the 50-year period. A significant downward trend of prevalence ratios of HPV16 (P=0.017) and α7 but HPV 18 (i.e., HPV 39, 45, 68, 70, P=0.024) with increasing age at diagnosis was observed. In contrast, the prevalence ratio to other HPV genotypes of α9 but HPV 16 genotypes (i.e., HPV 31, 33, 35, 52, 58, 67, P=0.002) increased with increasing age at diagnosis. CONCLUSION No changes were observed in the relative contribution of HPV types in cervical cancer in Cali, Colombia during the 50 years. In this population, an HPV vaccine including the HPV 16, 18, 31, 33, 45, 52 and 58 genotypes may have the potential to prevent ∼85% and 93% of SCC and ADC cases respectively.
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Affiliation(s)
- Gloria Ines Sanchez
- Group Infection and Cancer, School of Medicine and Corporación Académica para el Estudio de Patologías Tropicales, Universidad de Antioquia (UdeA), Medellín, Colombia.
| | - Luis Eduardo Bravo
- Registro Poblacional de Cancer de Cali, Universidad del Valle, Cali, Colombia
| | | | - Sara Tous
- IDIBELL, Institut Català d'Oncologia-Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Alemany
- IDIBELL, Institut Català d'Oncologia-Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Silvia de Sanjose
- IDIBELL, Institut Català d'Oncologia-Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - F Xavier Bosch
- IDIBELL, Institut Català d'Oncologia-Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nubia Muñoz
- Grupo Epidemiologia, Instituto Nacional de Cancerologia, Bogotá, Colombia
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Yunes-Díaz E, Ruiz PAD, Lazcano-Ponce E. Assessment of the Validity and Reproducibility of the Pap Smear in Mexico: Necessity of a Paradigm Shift. Arch Med Res 2015; 46:310-6. [PMID: 26054968 DOI: 10.1016/j.arcmed.2015.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS An assessment was performed of the quality of Pap readings in 19 cytology laboratories (CLs) in Mexico from the Cervical Cancer Screening Program. METHODS Nine CLs were affiliated with the Health Ministry (SSA), and ten were affiliated with the Mexican Social Security Institute (IMSS). Two sets of 200 cervical cytology specimens were prepared, one set for each institution. Fourteen percent of the specimens were positive and six were inappropriate for diagnosis (3%). All cervical cytology specimens were processed in the cytopathology laboratory at the General Hospital of Mexico, and histopathology was available for each positive case. RESULTS Thirty percent of the SSA reading centers had a sensitivity of at least 80%; however, not one of the ten IMSS laboratories evaluated reached this figure. Some reading centers had a sensitivity <65%, meaning that nearly half of the specimens with a cytology consistent with cervical neoplasm were not identified. DISCUSSION Given these results, it is a priority to effect a paradigm shift combining various screening tests to improve adherence to standards and enhanced cost-effectiveness of the early detection of cervicouterine cancer (CC) in Mexico.
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Affiliation(s)
- Elsa Yunes-Díaz
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Patricia Alonso-de Ruiz
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Eduardo Lazcano-Ponce
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico.
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Guardado-Estrada M, Juárez-Torres E, Román-Bassaure E, Medina-Martinez I, Alfaro A, Benuto RE, Dean M, Villegas-Sepulveda N, Berumen J. The distribution of high-risk human papillomaviruses is different in young and old patients with cervical cancer. PLoS One 2014; 9:e109406. [PMID: 25295590 PMCID: PMC4190176 DOI: 10.1371/journal.pone.0109406] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 09/10/2014] [Indexed: 11/19/2022] Open
Abstract
Despite numerous human papillomavirus (HPV) frequency studies in women with cervical cancer (CC), little is known of HPV frequency trends according to patient age. In this work, we compare the mean age and frequency distribution by age of CC patients positive for different HPVs. This study included 462 CC patients. HPVs were detected by PCR and typed using DNA sequencing. A total of 456 patients (98.7%) were positive for HPV: 418 (90.5%) had single and 38 (8.2%) had double HPV infections. HPV16 (46.5%), HPV18 (10.4%), HPV45 (6.7%), and HPV31 (4.1%) were the most frequent viral types in single-infected patients. The mean ages of single-infected patients with HPV16 (49.2±13.3), HPV18 (47.9±12.2), HPV45 (47.9±11.7), or HPV39 (42.6±8.9) were significantly lower than the mean ages of patients singly (53.9±12.7; p<0.001, t-test) or doubly (55.4±12.7; p<0.05, t-test) infected with the remaining HPVs. Three different trends were identified: one for HPV16, another for HPVs18/45/39, and a third for the rest of HPVs. The frequency trend of HPV16 shows two peaks. The first (63.2%) was found in the youngest women (≤35 years), followed by a decreasing trend until the age of 55-60 years (31.1%). The second peak arose at 61-65 years (52.5%), followed by a decreasing trend. The trend for HPVs18/45/39 declined from the youngest (19.3%) to the oldest (>70 years; 12.8%) women. In contrast, the trend for the remaining HPVs increased from the youngest (15.8%) to the oldest (46.2%) women. Unlike other life-style factors, low-risk sexual behavior was associated with late onset of CC independent of low-oncogenic HPV types (p<0.05, Wald chi-square statistic). The data indicate that most CCs in young women depend on the presence of high-oncogenic HPVs. In contrast, almost half of CCs in older patients had low-oncogenic HPVs, suggesting they could depend on the presence of other factors.
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Affiliation(s)
- Mariano Guardado-Estrada
- Unidad de Medicina Genómica, Facultad de Medicina, Universidad Nacional Autónoma de México/Hospital General de México, México, D.F. México
| | - Eligia Juárez-Torres
- Unidad de Medicina Genómica, Facultad de Medicina, Universidad Nacional Autónoma de México/Hospital General de México, México, D.F. México
| | | | - Ingrid Medina-Martinez
- Unidad de Medicina Genómica, Facultad de Medicina, Universidad Nacional Autónoma de México/Hospital General de México, México, D.F. México
| | - Ana Alfaro
- Unidad de Medicina Genómica, Facultad de Medicina, Universidad Nacional Autónoma de México/Hospital General de México, México, D.F. México
| | | | - Michael Dean
- Laboratory of Experimental Immunology, National Cancer Institute, Frederick, Maryland, United States of America
| | - Nicolás Villegas-Sepulveda
- Departamento de Biomedicina Molecular, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional. México, D.F. México
| | - Jaime Berumen
- Unidad de Medicina Genómica, Facultad de Medicina, Universidad Nacional Autónoma de México/Hospital General de México, México, D.F. México
- Departamento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México. México, D.F. México
- * E-mail:
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Cervantes CAD, Botero MA. Average years of life lost due to breast and cervical cancer and the association with the marginalization index in Mexico in 2000 and 2010. CAD SAUDE PUBLICA 2014; 30:1093-102. [DOI: 10.1590/0102-311x00113813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/04/2013] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to calculate average years of life lost due to breast and cervical cancer in Mexico in 2000 and 2010. Data on mortality in women aged between 20 and 84 years was obtained from the National Institute for Statistics and Geography. Age-specific mortality rates and average years of life lost, which is an estimate of the number of years that a person would have lived if he or she had not died prematurely, were estimated for both diseases. Data was disaggregated into five-year age groups and socioeconomic status based on the 2010 marginalization index obtained from the National Population Council. A decrease in average years of life lost due to cervical cancer (37.4%) and an increase in average years of life lost due breast cancer (8.9%) was observed during the period studied. Average years of life lost due to cervical cancer was greater among women living in areas with a high marginalization index, while average years of life lost due to breast cancer was greater in women from areas with a low marginalization index.
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Sogukpinar N, Saydam BK, Can HO, Hadimli A, Bozkurt OD, Yucel U, Kocak YC, Akmese ZB, Demir D, Ceber E, Ozenturk G. Assessment of cervical cancer risk in women between 15 and 49 years of age: case of Izmir. Asian Pac J Cancer Prev 2014; 14:2119-25. [PMID: 23679329 DOI: 10.7314/apjcp.2013.14.3.2119] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to determine risk factors for cervical cancer for women in Izmir. METHODS This cross-sectional, descriptive field covered a population of 4319 women of reproductive age (15-49) (household registration in the Mukhtar's office-2007). A total of 1,637 women were included in the sample given a four-part questionnaire through face-to-face interview by visiting the women in their homes in order to determine socio-demographic factors, obstetric history, genital hygiene and the use of family planning methods. In addition, during the data collection process, the women were given group training in order to raise awareness of cervical cancer. The number and percentage distributions of the data were calculated. RESULTS While the average age of the women was 31.9±9.77 (Min: 15.00-Max: 49.00), education level of 43.4% of them was elementary school only. It was determined that 70.3% of the women experienced at least one pregnancy, 71.0% had vaginal delivery and 75.9% used a contraceptive method. In the study it was determined that among the cervical cancer related risks vaginal delivery, vaginal lavage and having three or more pregnancies had the highest rates, while having sexual intercourse before 16 years of age and having more than one sexual partner constituted lower rates. The rate of the women who stated not having a smear in the last three years was 82.4%. CONCLUSIONS Considering the case in terms of having Pap smear test, women's awareness on the risk factors and early diagnosis of cervical cancer was found to be low. Due to this reason, awareness of women has to be raised through education.
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Affiliation(s)
- Neriman Sogukpinar
- Department of Midwifery, Ege University Izmir Ataturk School of Health, Bornova, Izmir, Turkey
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Martínez-Donate AP, Vera-Cala LM, Zhang X, Vedro R, Angulo R, Atkinson T. Prevalence and correlates of breast and cervical cancer screening among a Midwest community sample of low-acculturated Latinas. J Health Care Poor Underserved 2013; 24:1717-38. [PMID: 24185166 PMCID: PMC3959859 DOI: 10.1353/hpu.2013.0165] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Low adherence to cervical and breast cancer (CBC) screening recommendations contributes to high CBC mortality among Latinas. PURPOSE To estimate the prevalence of, and factors associated with, last 12-month Pap smear and mammogram receipt among a Midwest community sample of low-acculturated Latinas. METHODS We conducted a cross-sectional study with 278 Latina immigrants in Dane County, Wisconsin. Participants completed a self-administered questionnaire. We estimated multivariate logistic regression models to identify factors associated with CBC screening receipt. RESULTS Rates of last 12-month Pap smear and mammogram receipt were 56.8% and 39.4%, respectively. Age, knowledge of screening recommendations, and having a regular health care provider were independently associated with both Pap smear and mammogram receipt. Having ever used Planned Parenthood and fear of cancer were uniquely correlated with Pap smear and mammogram receipt, respectively. CONCLUSIONS Modifiable individual, structural, and cultural factors contribute to suboptimal rates of CBC screening among low-acculturated Latino immigrants.
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Primary cervical cancer screening and triage using an mRNA human papillomavirus assay and visual inspection. Int J Gynecol Cancer 2013; 23:513-8. [PMID: 23334437 DOI: 10.1097/igc.0b013e318280f3bc] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Mexican Cervical Cancer Screening Study II (MECCS II) seeks to develop a highly sensitive and highly specific screening program able to be adapted to all socioeconomic levels in Mexico. The objectives of MECCS II are (1) to compare the sensitivity and specificity for cervical intraepithelial neoplasia (CIN) 3 or cancer of self-collected vaginal specimens tested for high-risk types of the human papillomavirus (HR-HPV) by APTIMA with those tested for HR-HPV by Hybrid Capture 2 (HC2); and (2) determine the efficacy of cryotherapy in the treatment of HR-HPV-positive and acetic acid-aided visual inspection (VIA)-positive and -negative women after VIA triage. METHODS The study was conducted in rural Mexico. Women aged 30 to 50 years, nonpregnant, with no history of hysterectomy or pelvic irradiation and varied histories of screening, participated. A direct endocervical sample was tested for cytology, HC2, and APTIMA assay (AHPV). Subjects positive on any test were recalled for triage VIA, biopsies, and immediate cryotherapy. Tests were compared using McNemar test. RESULTS Two thousand forty-nine patients have complete results. Mean age of the patients was 39.2 years; 7.7% presented with ≥atypical squamous cells of uncertain significance (ASCUS), 1.8% ≥low-grade squamous intraepithelial neoplasia, and 0.5% ≥high-grade squamous intraepithelial neoplasia. Two percent of patients had ≥CIN2, and 0.78% had ≥CIN3 (including 2 with invasive disease). The sensitivity of ThinPrep (>ASCUS), HC2, and AHPV for >CIN3 for direct endocervical collection was 87.5%, 100%, and 100%, respectively. The specificity of ThinPrep (>ASCUS), HC2, and AHPV for >CIN3 was 94.1%, 92.2%, and 93.5%, respectively. Specificities of HC2 and AHPV differed significantly. The overall percentage of agreement among HPV assays (HC2 vs APTIMA) is 97%. Four hundred sixty-nine women returned for VIA. Two hundred ninety-one women were treated with cryotherapy. CONCLUSIONS The specificity of the APTIMA assay along with high sensitivity is an advantage for primary screening. Follow-up evaluation will be important to determine the true impact of potential undertreatment in the screening algorithm. Self-sampling applications are explored.
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Conde-Ferraez L, Suarez Allen RE, Carrillo Martinez JR, Ayora-Talavera G, Gonzalez-Losa MDR. Factors associated with cervical cancer screening amongst women of reproductive age from Yucatan, Mexico. Asian Pac J Cancer Prev 2013; 13:4719-24. [PMID: 23167409 DOI: 10.7314/apjcp.2012.13.9.4719] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This study aimed to analyse the participation of women of reproductive age in a cancer screening program, and survey reasons for non-screening in a region from Mexico with high cervical cancer mortality. A total of 281 obstetric patients from a previous HPV study in a social security hospital during 2008-2009 were included. Reasons for not participating in the screening were directly asked. HPV positive patients were invited to participate in an informative workshop, and they filled in a knowledge questionnaire. The women ranged in age from 14-47 years; 123 (43.8%) had never participated in screening, of which 97 (78.9%) had their first sexual intercourse 2 to 10 years ago, resulting in 25% HPV positive. Screening history was strongly associated with 2 or more gestations (OR= 10.07, p=0.00) and older age (OR=6.69 p=0.00). When 197 women were contacted and interviewed, reasons referred for non-screening were ignorance, lack of interest or time, recent sexual onset, shame and fear. More than 50% of the workshop participants showed knowledge of HPV, while 38.9% and 25% knew about Pap smear and cervical cancer. A high percentage of women of reproductive age have never had a Pap smear. Promoting the screening program in medical facilities seems to be important in this population. New approaches to inform vulnerable individuals on the benefits of screening need to be implemented, especially for young women.
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Affiliation(s)
- Laura Conde-Ferraez
- Centro de Investigaciones Regionales, Universidad Autonoma de Yucatan (UADY), Yucatan, Mexico.
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de Almeida FM, de Oliveira JC, Martins E, Curado MP, de Freitas R, Moreira MAR. Monitoring the profile of cervical cancer in a developing city. BMC Public Health 2013; 13:563. [PMID: 23759074 PMCID: PMC3691764 DOI: 10.1186/1471-2458-13-563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 05/31/2013] [Indexed: 11/24/2022] Open
Abstract
Background Medical records are frequently consulted to verify whether the treatment and guiding principles were correct. Determine incidence and mortality trends of in situ and invasive neoplasms of the uterine cervix, in the period 1988–2004 in Goiânia, Brazil. Methods The incident cases were identified through the Population-Based Cancer Registry of Goiânia. Population data were collected from census data of the Brazilian Institute of Geography and Statistics. For mortality analysis, data were extracted from the Mortality Information System. The Poisson Regression was utilized to determine the annual incidence and mortality rates. Results A total of 4446 cases of in situ and invasive neoplasms of the uterine cervix were identified. No significant reductions were verified in invasive cervical cancer rates (p = 0.386) during the study period, while in situ carcinomas presented an annual increasing trend of 13.08% (p < 0.001). A decreasing trend was observed for mortality (3.02%, p = 0.017). Conclusion No reduction was observed for the incidence of invasive cancer of the uterine cervix; however, increasing trends were verified for in situ lesions with a consequent reduction in mortality rates. These increasing trends may be the result of recently-implemented screening programs or due to improvements in the notification system.
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Affiliation(s)
- Fábio Marques de Almeida
- Faculdade de Medicina da Universidade Federal de Goiás, Rua 235 c/1a avenida, s/n-S, Universitário, CEP 74605-020, Goiânia, Goiás, Brazil.
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Patterns and trends in cancer mortality in Colombia 1984–2008. Cancer Epidemiol 2013; 37:233-9. [DOI: 10.1016/j.canep.2013.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/06/2013] [Accepted: 02/11/2013] [Indexed: 12/20/2022]
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Kahesa C, Kjaer S, Mwaiselage J, Ngoma T, Tersbol B, Dartell M, Rasch V. Determinants of acceptance of cervical cancer screening in Dar es Salaam, Tanzania. BMC Public Health 2012; 12:1093. [PMID: 23253445 PMCID: PMC3551792 DOI: 10.1186/1471-2458-12-1093] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 11/17/2012] [Indexed: 01/20/2023] Open
Abstract
Objective To describe how demographic characteristics and knowledge of cervical cancer influence screening acceptance among women living in Dar es Salaam, Tanzania. Methods Multistage cluster sampling was carried out in 45 randomly selected streets in Dar es Salaam. Women between the ages of 25–59 who lived in the sampled streets were invited to a cervical cancer screening; 804 women accepted and 313 rejected the invitation. Information on demographic characteristics and knowledge of cervical cancer were obtained through structured questionnaire interviews. Results Women aged 35–44 and women aged 45–59 had increased ORs of 3.52 and 7.09, respectively, for accepting screening. Increased accepting rates were also found among single women (OR 2.43) and among women who had attended primary or secondary school (ORs of 1.81 and 1.94). Women who had 0–2 children were also more prone to accept screening in comparison with women who had five or more children (OR 3.21). Finally, knowledge of cervical cancer and awareness of the existing screening program were also associated with increased acceptance rates (ORs of 5.90 and 4.20). Conclusion There are identifiable subgroups where cervical cancer screening can be increased in Dar es Salaam. Special attention should be paid to women of low education and women of high parity. In addition, knowledge and awareness raising campaigns that goes hand in hand with culturally acceptable screening services will likely lead to an increased uptake of cervical cancer screening.
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Affiliation(s)
- Crispin Kahesa
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen K, Denmark
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Frenk J, Gómez-Dantés O, Langer A. A comprehensive approach to women's health: lessons from the Mexican health reform. BMC WOMENS HEALTH 2012; 12:42. [PMID: 23228037 PMCID: PMC3543236 DOI: 10.1186/1472-6874-12-42] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 12/05/2012] [Indexed: 11/24/2022]
Abstract
Background This paper discusses the way in which women’s health concerns were addressed in Mexico as part of a health system reform. Discussion The first part sets the context by examining the growing complexity that characterizes the global health field, where women’s needs occupy center stage. Part two briefly describes a critical conceptual evolution, i.e. from maternal to reproductive to women’s health. In the third and last section, the novel “women and health” (W&H) approach and its translation into policies and programs in the context of a structural health reform in Mexico is discussed. W&H simultaneously focuses on women’s health needs and women’s critical roles as both formal and informal providers of health care, and the links between these two dimensions. Summary The most important message of this paper is that broad changes in health systems offer the opportunity to address women’s health needs through innovative approaches focused on promoting gender equality and empowering women as drivers of change.
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Affiliation(s)
- Julio Frenk
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Herrera DG, Schiefelbein EL, Smith R, Rojas R, Mirchandani GG, McDonald JA. Cervical cancer screening in the US-Mexico border region: a binational analysis. Matern Child Health J 2012; 16 Suppl 2:298-306. [PMID: 22965734 PMCID: PMC4535702 DOI: 10.1007/s10995-012-1130-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cervical cancer mortality is high along the US-Mexico border. We describe the prevalence of a recent Papanicolaou screening test (Pap) among US and Mexican border women. We analyzed 2006 cross-sectional data from Mexico's National Survey of Health and Nutrition and the US Behavioral Risk Factor Surveillance System. Women aged 20-77 years in 44 US border counties (n = 1,724) and 80 Mexican border municipios (n = 1,454) were studied. We computed weighted proportions for a Pap within the past year by age, education, employment, marital status, health insurance, health status, risk behaviors, and ethnicity and adjusted prevalence ratios (APR) for the US, Mexico, and the region overall. Sixty-five percent (95 %CI 60.3-68.6) of US women and 32 % (95 %CI 28.7-35.2) of Mexican women had a recent Pap. US residence (APR = 2.01, 95 %CI 1.74-2.33), marriage (APR = 1.31, 95 %CI 1.17-1.47) and insurance (APR = 1.38, 95 %CI 1.22-1.56) were positively associated with a Pap test. Among US women, insurance and marriage were associated (APR = 1.21, 95 %CI 1.05-1.38 and 1.33, 95 %CI 1.10-1.61, respectively), and women aged 20-34 years were about 25 % more likely to have received a test than older women. Insurance and marriage were also positively associated with Pap testing among Mexican women (APR = 1.39, 95 %CI 1.17-1.64 and 1.50; 95 %CI 1.23-1.82, respectively), as were lower levels of education (≤8th grade or 9th-12th grade versus some college) (APR = 1.74; 95 %CI 1.21-2.52 and 1.60; 95 %CI 1.03-2.49, respectively). Marriage and insurance were associated with a recent Pap test on both sides of the border. Binational insurance coverage increases and/or cost reductions might bolster testing among unmarried and uninsured women, leading to earlier cervical cancer diagnosis and potentially lower mortality.
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Affiliation(s)
- Dyanne G. Herrera
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, Applied Epidemiology Fellowship Program, Council of State and Territorial Epidemiologists, Washington, DC, USA
| | - Emily L. Schiefelbein
- Applied Epidemiology Fellowship Program, Council of State and Territorial Epidemiologists, Washington, DC, USA, Office of Program Decision Support, Texas Department State Health Services, Austin, TX, USA
| | - Ruben Smith
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rosalba Rojas
- Center for Research in Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Gita G. Mirchandani
- Office of Program Decision Support, Texas Department State Health Services, Austin, TX, USA
| | - Jill A. McDonald
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Knaul FM, González-Pier E, Gómez-Dantés O, García-Junco D, Arreola-Ornelas H, Barraza-Lloréns M, Sandoval R, Caballero F, Hernández-Avila M, Juan M, Kershenobich D, Nigenda G, Ruelas E, Sepúlveda J, Tapia R, Soberón G, Chertorivski S, Frenk J. The quest for universal health coverage: achieving social protection for all in Mexico. Lancet 2012; 380:1259-79. [PMID: 22901864 DOI: 10.1016/s0140-6736(12)61068-x] [Citation(s) in RCA: 275] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries.
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Kulasingam S, Havrilesky L. Health economics of screening for gynaecological cancers. Best Pract Res Clin Obstet Gynaecol 2011; 26:163-73. [PMID: 22138003 DOI: 10.1016/j.bpobgyn.2011.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 10/06/2011] [Accepted: 10/21/2011] [Indexed: 12/20/2022]
Abstract
In this chapter, we summarise findings from recent cost-effectiveness analyses of screening for cervical cancer and ovarian cancer. We begin with a brief summary of key issues that affect the cost-effectiveness of screening, including disease burden, and availability and type of screening tests. For cervical cancer, we discuss the potential effect of human papilloma virus vaccines on screening. Outstanding epidemiological and cost-effectiveness issues are included. For cervical cancer, this includes incorporating the long-term effect of treatment (including adverse birth outcomes in treated women who are of reproductive age) into cost-effectiveness models using newly available trial data to identify the best strategy for incorporating human papilloma virus tests. A second issue is the need for additional data on human papilloma virus vaccines, such as effectiveness of reduced cancer incidence and mortality, effectiveness in previously exposed women and coverage. Definitive data on these parameters will allow us to update model-based analyses to include more realistic estimates, and also potentially dramatically alter our approach to screening. For ovarian cancer, outstanding issues include confirming within the context of a trial that screening is effective for reducing mortality and incorporating tests with high specificity into screening into screening algorithms for ovarian cancer.
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Affiliation(s)
- Shalini Kulasingam
- Division of Epidemiology, School of Public Health, University of Minnesota, 1300 S. 2nd St. WBOB Suite 300, Minneapolis, MN, USA.
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Flores YN, Bishai DM, Lorincz A, Shah KV, Lazcano-Ponce E, Hernández M, Granados-García V, Pérez R, Salmerón J. HPV testing for cervical cancer screening appears more cost-effective than Papanicolau cytology in Mexico. Cancer Causes Control 2010; 22:261-72. [PMID: 21170578 PMCID: PMC3025113 DOI: 10.1007/s10552-010-9694-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 11/10/2010] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To determine the incremental costs and effects of different HPV testing strategies, when compared to Papanicolau cytology (Pap), for cervical cancer screening in Mexico. METHODS A cost-effectiveness analysis (CEA) examined the specific costs and health outcomes associated with (1) no screening; (2) only the Pap test; (3) only self-administered HPV; (4) only clinician administered HPV; and (5) clinician administered HPV plus the Pap test. The costs of self- and clinician-HPV testing, as well as with the Pap test, were identified and quantified. Costs were reported in 2008 US dollars. The health outcome associated with these screening strategies was defined as the number of high-grade cervical intraepithelial neoplasia or cervical cancer cases detected. This CEA was performed using the perspective of the Mexican Institute of Social Security (IMSS) in Morelos, Mexico. RESULTS Screening women between the ages of 30-80 for cervical cancer using clinical-HPV testing or the combination of clinical-HPV testing, and the Pap is always more cost-effective than using the Pap test alone. CONCLUSIONS This CEA indicates that HPV testing could be a cost-effective screening alternative for a large health delivery organization such as IMSS. These results may help policy-makers implement HPV testing as part of the IMSS cervical cancer screening program.
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Affiliation(s)
- Yvonne N Flores
- Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México.
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Lazcano-Ponce E, Lörincz AT, Salmerón J, Fernández I, Cruz A, Hernández P, Mejia I, Hernández-Ávila M. A pilot study of HPV DNA and cytology testing in 50,159 women in the routine Mexican Social Security Program. Cancer Causes Control 2010; 21:1693-700. [DOI: 10.1007/s10552-010-9598-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 05/29/2010] [Indexed: 11/30/2022]
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Lazcano-Ponce E, Allen-Leigh B. Innovation in cervical cancer prevention and control in Mexico. Arch Med Res 2010; 40:486-92. [PMID: 19853189 DOI: 10.1016/j.arcmed.2009.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
Abstract
Disparities related to cervical cancer continue to exist in Mexico, including insufficient screening coverage, problems with quality control and a resulting greater risk of mortality among women from marginalized areas. A lack of opportunities and requirements for continuing education and accreditation of healthcare personnel involved in the screening program is also an issue. HPV DNA testing and HPV vaccines are recent technological innovations that offer a potential solution to the continued negative impact of cervical cancer among Mexican women. This essay attempts to answer questions such as: Why should HPV testing be integrated into the early detection program in Mexico? How can HPV testing best be integrated into the program in Mexico? How-from a public health perspective that seeks to reduce disparities-can HPV vaccination best be implemented in Mexico? HPV testing allows increased positive predictive value while also reducing costly and unnecessary overtreatment of low-grade abnormalities, and HPV vaccines offer the possibility of primary prevention of cervical cancer. The strategy proposed for Mexico includes primary prevention with HPV vaccination for girls aged between 12 and 16 years (before sexual initiation), Pap testing with excellent quality control for women 24-34 years of age and high-risk HPV DNA testing for women 35 years and older. HPV samples would be either clinically collected or self-collected and women with positive HPV test results would receive follow-up high-quality Pap testing. This approach is creative and focuses on reducing disparities and providing high-quality care that is also cost effective.
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Affiliation(s)
- Eduardo Lazcano-Ponce
- Center for Population Health Research, National Institute of Public Health, Mexico, D.F., Mexico
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Lazcano-Ponce E, Pérez G, Cruz-Valdez A, Zamilpa L, Aranda-Flores C, Hernández-Nevarez P, Viramontes JL, Salgado-Hernández J, James M, Lu S, Sattler C, Haupt RM, Hernández-Avila M. Impact of a quadrivalent HPV6/11/16/18 vaccine in Mexican women: public health implications for the region. Arch Med Res 2010; 40:514-24. [PMID: 19853193 DOI: 10.1016/j.arcmed.2009.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/08/2009] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Recognition of human papillomavirus (HPV) as a necessary cause of cervical cancer (CC) led to new perspectives for its control and the demonstration of an effective primary prevention strategy through vaccination. We undertook this study to evaluate the safety, efficacy and immunogenicity of a quadrivalent HPV6/11/16/18 vaccine in Mexican women. METHODS A total of 679 Mexican women between 18 and 23 years old participated in two Phase III double-blind, randomized, placebo-controlled clinical trials of a quadrivalent HPV 6/11/16/18 vaccine. Women were enrolled who tested negative for pregnancy and reported having four or less sexual partners during their lifetime. Vaccine or placebo was administered at day 1, month 2 and month 6. RESULTS Among Mexican women who were naïve to the respective vaccine type at enrollment, the quadrivalent vaccine was highly efficacious, preventing 100% of HPV6/11/16/18-related cervical intraepithelial neoplasia grade 2/3, adenocarcinoma in situ, condyloma and vaginal intraepithelial neoplasia. Statistical significance was not reached for every endpoint due to the limited sample size. Vaccination was generally well tolerated and immunogenic. DISCUSSION To widely administer the vaccine, collaborative efforts should be coordinated among public, private and local community sectors. In light of the scarce knowledge of many health professionals with respect to the primary prevention of CC, it will be necessary to educate health providers on the advantages and specific recommendations of HPV vaccines and secondary prevention. Decision making should be based on scientific evidence, allowing health professionals to provide an organized social response that supports the universal right to health.
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Affiliation(s)
- Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública de México, México, D.F., Mexico.
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Reynales-Shigematsu LM, Rodrigues ER, Lazcano-Ponce E. Cost-effectiveness analysis of a quadrivalent human papilloma virus vaccine in Mexico. Arch Med Res 2010; 40:503-13. [PMID: 19853192 DOI: 10.1016/j.arcmed.2009.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 06/19/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Cervical cancer is one of the main causes of death in women in low- and middle-income countries. Despite technological and scientific advances that allow an early detection of precancerous lesions and curative treatment of cervical cancer, Mexico and other Latin American countries have only been able to obtain a small decrease in the mortality rates for this kind of cancer. How to implement and sustain effective public health strategies for cervical cancer prevention, such as increasing cytology-based screening program coverage and implementing HPV-DNA testing and vaccination, are important questions. The aim of this study is to perform a cost-effectiveness analysis of the introduction of a quadrivalent (HPV 6/11/16/18) HPV vaccine into the public health system and evaluate the epidemiological and economic benefits on prevention of cervical cancer in Mexico. METHODS A Markov model is used to simulate the natural history of HPV infection in a cohort of Mexican women to evaluate the cost-effectiveness of the cervical cancer screening strategy used in Mexico as well as the benefits of other potential strategies such as 1) vaccination only, 2) conventional cytology-based screening program only and 3) vaccination followed by screening. For the strategies that involve screening we have chosen screening intervals of 3 and 5 years. The model produces results that are reasonably close to the epidemiological data related to HPV and cervical cancer in Mexico. RESULTS The quadrivalent HPV vaccine could reduce the probability of persistent HPV-16/18 infection by at least 60%, which would result in a near-proportional reduction in HPV-16/18-associated invasive cervical cancer and CIN 3. CONCLUSIONS The strategy of using only vaccination ($45 USD for three doses) as a preventive measure was a very cost-effective strategy in Mexico ($68USD/LYS). The strategy of vaccination with traditional screening of Pap test every 3 years produced higher cost by a lower performance of cervical cytology in Mexico, at a cost of $15,935 USD per life-year. The cost-effectiveness of the vaccination strategy was highly sensitive to age of vaccination, duration of vaccine efficacy, and cost of vaccination. The Mexican model predicts that a quadrivalent HPV vaccine will reduce the incidence of high- and low-risk-associated cervical cancer. A program of vaccination as a preventive strategy is likely cost effective. The results of this study could be of great value in decision-making for the implementation of an HPV vaccine as a public health policy in Mexico provided that the cost of each dose will be, at most, $15 dollars (USD) dollars, combined with HPV testing, the new strategy of national secondary prevention program.
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Cortés J, Vilaplana E, Miranda P, Ferret G, Andía D, Ramón y Cajal JM, Antonio Vidart J. Vacuna frente al virus del papiloma humano y cribado de cáncer de cuello de útero. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s0304-5013(09)71474-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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