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Yim GW, Lee J, Yang K, Lee CH, Huy NVQ, Vo MT, Yoon S. A pilot study of upcycled smartphone-based colposcopy for visual inspection of cervix performed by community healthcare workers in rural Vietnam. Int J Gynaecol Obstet 2024. [PMID: 39175279 DOI: 10.1002/ijgo.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/17/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE This study assessed the feasibility of smartphone-based colposcopy (SBC) for visual inspection of the cervix by community healthcare workers in low-resource areas. METHODS This was a retrospective study conducted in community villages in rural Vietnam, where 177 participants were enrolled for a cervical cancer screening. Cervical images were obtained by pre-trained community healthcare workers using a portable, upcycled SBC (Samsung Galaxy Note 20). Images were taken before and after the visual inspection after acetic acid (VIA) examination. Captured images were stored on a web server through an Android-based application and later reviewed independently by two experienced gynecologists. Image quality was assessed, and kappa statistics were calculated for the measurement of agreement in VIA findings. RESULTS Cervical images of 177 women obtained between July and August 2020 were analyzed. The mean age of women was 42 ± 9.1 years, and 20.3% were postmenopausal. The percentage of adequate visibility of the squamocolumnar junction (SCJ) in the captured images was 83.1%. The kappa value for interobserver reliability was 0.61 for VIA positivity agreement between the two gynecologists. Image clarity was rated as average or above in 77.3%. The reasons for suboptimal clarity were poor focusing (15.3%), inadequate SCJ visibility (18%), and obscuring of the transformation zone due to blood (11.3%), discharge (14.7%), or artifacts such as intrauterine devices or polyps (5.1%). CONCLUSION Upcycled SBC was feasible when performed by pre-trained healthcare workers in a low-resource setting. VIA findings by SBC showed adequate agreement between two independent assessments, suggesting its potential as a method to aid cervical cancer screening.
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Affiliation(s)
- Ga Won Yim
- Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Goyang, Korea
| | - Jiyeon Lee
- International Development, Department of International Studies, Graduate School of International Studies, Seoul National University, Seoul, Korea
| | - Kyungmo Yang
- Circular Economy Lab, Samsung Electronics, Seoul, Korea
| | - Chae Hyeong Lee
- Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Goyang, Korea
| | - Nguyen Vu Quoc Huy
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Minh Tuan Vo
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Sangchul Yoon
- Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul, Korea
- Center for Global Development, Yonsei Institute for Global Health, Seoul, Korea
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Chen W, Xia X, Xie X, Wei Y, Wu R, Cai W, Hong J. Nomogram for prognosis of elderly patients with cervical cancer who receive combined radiotherapy. Sci Rep 2023; 13:13299. [PMID: 37587180 PMCID: PMC10432519 DOI: 10.1038/s41598-023-39764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/30/2023] [Indexed: 08/18/2023] Open
Abstract
This retrospective study identified prognostic factors to help guide the clinical treatment of elderly patients (≥ 65 years) with cervical cancer who had undergone radiotherapy. A personalized model to predict 3- and 5-years survival was developed. A review was conducted of 367 elderly women with cervical cancer (staged II-III) who had undergone radiotherapy in our hospital between January 2012 and December 2016. The Cox proportional hazards regression model was used for survival analysis that considered age, hemoglobin, squamous cell carcinoma antigen, pathologic type, stage, pelvic lymph node metastasis status, and others. A nomogram was constructed to predict the survival rates. The median follow-up time was 71 months (4-118 months). The 3- (5-) years overall, progression-free, local recurrence-free, and distant metastasis-free survival rates were, respectively, 91.0% (84.4%), 92.3% (85.9%), 99.18% (99.01%), and 99.18% (97.82%). The following were significant independent prognostic factors for overall survival: tumor size, pre-treatment hemoglobin, chemotherapy, and pelvic lymph node metastasis. The C-index of the line chart was 0.699 (95% CI 0.652-0.746). The areas under the receiver operating characteristic curves for 3- and 5-years survival were 0.751 and 0.724. The nomogram was in good concordance with the actual survival rates. The independent prognostic factors for overall survival in elderly patients with cervical cancer after radiotherapy were: tumor size, pre-treatment hemoglobin, chemotherapy, and pelvic lymph node metastasis. The novel prognostic nomogram based on these factors showed good concordance with the actual survival rates and can be used to guide personalized clinical treatment.
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Affiliation(s)
- Wenjuan Chen
- Department of Radiation Oncology, Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China.
| | - Xiaoyi Xia
- Department of Radiation Oncology, Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Xingyun Xie
- Department of Radiation Oncology, Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Yuting Wei
- Department of Radiation Oncology, Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Rongrong Wu
- Department of Radiation Oncology, Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Wenjie Cai
- Department of Radiation Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, 362000, China
| | - Jinsheng Hong
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
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Chen W, Xia X, Xie X, Wei Y, Wu R, Cai W, Hong J. Nomogram for prognosis of elderly patients with cervical cancer who receive combined radiotherapy.. [DOI: 10.21203/rs.3.rs-2367005/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Abstract
Objective: This retrospective study identified prognostic factors to help guide the clinical treatment of elderly patients (≥65 y) with cervical cancer who had undergone radiotherapy. A personalized model to predict 3- and 5-year survival was developed.
Methods: A review was conducted of 367 elderly women with cervical cancer (staged II-III) who had undergone radiotherapy in our hospital between January 2012 and December 2016. The Cox proportional hazards regression model was used for survival analysis that considered age, hemoglobin, squamous cell carcinoma antigen, pathologic type, stage, pelvic lymph node metastasis status, and others. A nomogram was constructed to predict the survival rates.
Results: The median follow-up time was 71 months (4-118 mo). The 3- (5-) year overall, progression-free, local recurrence-free, and distant metastasis-free survival rates were, respectively, 91.0% (84.4%), 92.3% (85.9%), 99.18% (99.01%), and 99.18% (97.82%). The following were significant independent prognostic factors for overall survival: tumor size, pre-treatment hemoglobin, chemotherapy, and pelvic lymph node metastasis. The C-index of the line chart was 0.699 (95% CI: 0.652-0.746). The areas under the receiver operating characteristic curves for 3- and 5-year survival were 0.751 and 0.724. The nomogram was in good concordance with the actual survival rates.
Conclusions: The independent prognostic factors for overall survival in elderly patients with cervical cancer after radiotherapy were: tumor size, pre-treatment hemoglobin, chemotherapy, and pelvic lymph node metastasis. The novel prognostic nomogram based on these factors can be an asset for personalized clinical management.
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Affiliation(s)
- Wenjuan Chen
- Department of Radiation Oncology, Department of Gynecology,Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital
| | - Xiaoyi Xia
- Department of Radiation Oncology, Department of Gynecology,Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital
| | - Xingyun Xie
- Department of Radiation Oncology, Department of Gynecology,Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital
| | - Yuting Wei
- Department of Radiation Oncology, Department of Gynecology,Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital
| | - Rongrong Wu
- Department of Radiation Oncology, Department of Gynecology,Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital
| | - Wenjie Cai
- Department of Radiation Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University
| | - Jingsheng Hong
- Department of Radiotherapy, Cancer Center,The First Affiliated Hospital of Fujian Medical University
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Burrowes S, Holcombe SJ, Leshargie CT, Hernandez A, Ho A, Galivan M, Youb F, Mahmoud E. Perceptions of cervical cancer care among Ethiopian women and their providers: a qualitative study. Reprod Health 2022; 19:2. [PMID: 34983586 PMCID: PMC8725313 DOI: 10.1186/s12978-021-01316-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/04/2021] [Indexed: 01/26/2023] Open
Abstract
Background Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. As the government rolls out the country’s first national cancer control strategy, information on patient and provider experiences in receiving and providing cervical cancer screening, diagnosis, and treatment is critical. Methods This qualitative study aimed to assess the availability of cervical cancer care; explore care barriers and sources of delay; and describe women’s and providers’ perceptions and experiences of care. We analyzed data from 45 informants collected at 16 health centers, district hospitals and referral hospitals in East Gojjam Zone and a support center in Addis Ababa. Thirty providers and ten women receiving care were interviewed, and five women in treatment or post-treatment participated in a focus group discussion. Deductive and inductive codes were used to thematically analyze data. Results Providers lacked equipment and space to screen and treat patients and only 16% had received in-service cervical cancer training. Consequently, few facilities provided screening or preventative treatment. Patients reported low perceptions of risk, high stigma, a lack of knowledge about cervical cancer, and delayed care initiation. All but one patient sought care only when she became symptomatic, and, pre-diagnosis, only half of the patients knew about cervical cancer. Even among those aware of cervical cancer, many assumed they were not at risk because they were not sexually active. Misdiagnosis was another common source of delay experienced by half of the patients. Once diagnosed, women faced multiple-month waits for referrals, and, once in treatment, broken equipment and shortages of hospital beds resulted in additional delays. Barriers to therapeutic treatment included a lack of housing and travel funds. Patient-provider communication of cancer diagnosis was often lacking. Conclusions In-service provider training should be intensified and should include discussions of cervical cancer symptoms. Better distribution of screening and diagnostic supplies to lower-level facilities and better maintenance of treatment equipment at tertiary facilities are also a priority. Expanded cervical cancer health education should focus on stigma reduction and emphasize a broad, wide-spread risk of cervical cancer. Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. This study aimed to assess patient and provider experiences in receiving and providing cervical cancer screening, diagnosis, and treatment. We interviewed 30 midlevel providers and ten women receiving care and held a focus group discussion with five women who were receiving treatment or who had recently completed treatment. Patients reported bottlenecks and delays at each stage of care. Low perception of risk, high stigma, and a lack of knowledge about cervical cancer among both providers and patients, were significant sources of delay in initiating care. Few patients had been aware of cervical cancer before they were diagnosed and of those who were aware, many assumed that they were not at risk because they were not sexually active. Misdiagnosis was another common source of delay. Once diagnosed correctly, women faced multiple-month delays after referrals, and, once in treatment, broken equipment and a shortage of hospital beds resulted in additional delays. The most frequently mentioned barriers to care were a lack of housing and travel funds while receiving treatment in the capital. Patient-provider communication of cancer diagnosis was often poor. Our findings suggest the need to intensify in-service training for providers, focusing initially on alerting them to cervical cancer symptoms. Better distribution of screening and diagnostic supplies to lower-level facilities and better maintenance of treatment equipment at tertiary facilities should also be a priority.
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Affiliation(s)
| | - Sarah Jane Holcombe
- Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - Anthony Ho
- Touro University California, Vallejo, CA, USA
| | | | - Fatuma Youb
- Touro University California, Vallejo, CA, USA
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Dzobo K. What to Do for Increasing Cancer Burden on the African Continent? Accelerating Public Health Diagnostics Innovation for Prevention and Early Intervention on Cancers. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2021; 25:567-579. [PMID: 34399067 DOI: 10.1089/omi.2021.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
No other place illustrates the increasing burden of cancer than in Africa and in particular, sub-Saharan Africa. Many of the individuals to be diagnosed with cancer will be in low-resource settings in the future due to, for example, an increase in populations and aging, and high co-morbidity with infections with viruses such as human immunodeficiency virus (HIV) and human papillomavirus (HPV), as well as the presence of infectious agents linked to cancer development. Due to lack of prevention and diagnostic innovation, patients present with advanced cancers, leading to poor survival and increased mortality. HIV infection-associated cancers such as B cell lymphomas, Kaposi's sarcoma, and HPV-associated cancers such as cervical cancer are particularly noteworthy in this context. Recent reports show that a host of other cancers are also associated with viral infection and these include lung, oral cavity, esophageal, and pharyngeal, hepatocellular carcinoma, and anal and vulvar cancers. This article examines the ways in which diagnostic innovation empowered by integrative biology and informed by public health priorities can improve cancer prevention or early intervention in Africa and beyond. In addition, I argue that because diagnostic biomarkers can often overlap with novel therapeutic targets, diagnostics research and development can have broader value for and impact on medical innovation.
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Affiliation(s)
- Kevin Dzobo
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa.,Institute of Infectious Disease and Molecular Medicine, Division of Medical Biochemistry, Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Huo X, Sun H, Cao D, Yang J, Peng P, Kong L, Chen F, Shen K, Li S. Evaluation of Cervical High-Grade Squamous Intraepithelial Lesions-Correlated Markers as Triage Strategy for Colposcopy After Co-Testing. Onco Targets Ther 2021; 14:2075-2084. [PMID: 33776454 PMCID: PMC7989978 DOI: 10.2147/ott.s300269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/08/2021] [Indexed: 12/09/2022] Open
Abstract
Background Colposcopy was referred in cases with severe abnormalities in co-testing. Although p16/Ki67 dual staining reduced the referral rate, its sensitivity and specificity need to be enhanced. Methods The expressions of p16, Ki-67, SMAD3, YAP1, RELA were evaluated in the colposcopy referral population. The inclusion criteria included 30–60 years and diagnosed with HPV16/18-positive, other HR-HPV-positive with ASCUS, LSIL, AGC (atypical glandular cell) in co-testing. Colposcopies, endocervical curettages of cervical biopsies were also collected. Cases were excluded if there were no biopsies, if the interval between a cervical screening test and biopsies was more than 6 months, or if insufficient tissue was available as a formalin-fixed paraffin-embedded block. The pathology was independently reviewed by two pathologists. Discrepant interpretations were adjudicated by a third pathologist. Results In total, 1194 of 1273 cases who were referred to colposcopy were evaluated in the present study. The sensitivity and specificity of p16+ combined with Ki-67+ for predicting CIN2+ were 62.1% and 89.5%, respectively. p16+ combined with YAP1+ and/or RELA+ provided a sensitivity and specificity of 70.9% and 89.5%, respectively, while 72.8% and 86.4% were achieved by p16+ combined with YAP1+ and/or SMAD3+ and/or RELA+. In HPV16/18+ and LSIL subgroups, the sensitivity and specificity of p16+ combined with Ki-67+ for predicting CIN2+ were 67.7% and 87.6%, respectively, for the former group and 58.6%, 88.8%, respectively, for the latter group. p16+, YAP1+/RELA+ showed a better performance for predicting CIN2+ with a better sensitivity and considerable specificity in the other HPV+ combined with ASCUS group than were achieved by p16+ combined with Ki-67+. RELA+ and the combination of p16 and RELA/YAP1 also provided the Max AUC area. Conclusion Our study shows that RELA and the combination of p16 and RELA/YAP1 achieved better sensitivity and specificity for detecting morphologically CIN2+ lesions.
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Affiliation(s)
- Xiao Huo
- Center of Basic Medical Research, Peking University Third Hospital Institute of Medical Innovation and Research, Beijing, People's Republic of China
| | - Hengzi Sun
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Peng Peng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Linghua Kong
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Fei Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shuhong Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
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The patent buyout price for human papilloma virus (HPV) vaccine and the ratio of R&D costs to the patent value. PLoS One 2021; 16:e0244722. [PMID: 33428667 PMCID: PMC7799842 DOI: 10.1371/journal.pone.0244722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
Human papillomavirus (HPV) is responsible for almost all of the 570,000 new cases of cervical cancer and approximately 311,000 deaths per year. HPV vaccination is an integral component of the World Health Organization’s (WHO) global strategy to fight the disease. However, high vaccine prices enforced through patent protection are limiting vaccine expansion, particularly in low- and middle-income countries. By limiting market power, patent buyouts could reduce vaccine prices and raise HPV vaccination rates while keeping innovation incentives. We estimate the global patent buyout price as the present discounted value (PDV) of the future profit stream over the remaining patent length for Merck’s HPV vaccines (Gardasil-4 and 9), which hold 87% of the global HPV vaccine market, in the range of US$ 15.6–27.7 billion (in 2018 US$). The estimated PDV of the profit stream since market introduction amounts to US$ 17.8–42.8 billion and the estimated R&D cost to US$ 1.05–1.21 billion. Thus, we arrive at a ratio of R&D costs to the patent value of the order of 2.5–6.8%. We relate this figure to typical estimates of the probability of success (POS) for clinical trials of vaccines to discuss if patent protection provides Merck with extraordinarily strong price setting power.
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Socio-demographic Characteristics and Use of Pap Smear for Cervical Cancer Screening Among Women of Eastern Part of India. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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9
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Sun H, Shen K, Cao D. Progress in immunocytochemical staining for cervical cancer screening. Cancer Manag Res 2019; 11:1817-1827. [PMID: 30863187 PMCID: PMC6391129 DOI: 10.2147/cmar.s195349] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer is one of the most common gynecological malignancies. In recent years, the implementation of cervical cancer screening has resulted in the effective control of cervical cancer incidence. However, many deficiencies still exist in the current screening techniques and strategies. With advancements in cervical cancer screening research, immunochemical staining to determine cervical cytology has shown a broader application prospect in the early screening for cervical cancer, especially for triage in cervical cancer screening.
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Affiliation(s)
- Hengzi Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, ;
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, ;
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, ;
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Degarege A, Krupp K, Fennie K, Srinivas V, Li T, Stephens DP, Madhivanan P. An integrative behavior theory derived model to assess factors affecting HPV vaccine acceptance using structural equation modeling. Vaccine 2019; 37:945-955. [PMID: 30655176 DOI: 10.1016/j.vaccine.2019.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/13/2018] [Accepted: 01/02/2019] [Indexed: 01/20/2023]
Abstract
The study examined factors that affect parental intention-to-vaccinate adolescent daughters with HPV vaccine in Mysore district, India. A cross-sectional study was conducted among 1609 parents of adolescent girls attending schools in Mysore District between February 2010 and October 2011. A validated questionnaire was used to assess parental attitudes, beliefs related with HPV infection, cervical cancer, HPV vaccine and vaccination in general. Structural equation modeling was used to estimate parameters and assess whether a model based on the integrative behavior theory would fit the current data. More than two-thirds (78.0%) of parents would accept vaccinating their daughters with HPV vaccine. Intention to HPV vaccination significantly increased with increase in the perception of parents about the benefits (standardized regression coefficient (β) = 0.39) or sources of information about HPV vaccine (β = 0.24), but intention decreased significantly with an increase in the perception about barriers to HPV vaccination β = -0.44). The effect of beliefs about severity of HPV infection or cervical cancer (β = 0.20), and beliefs about benefits (β = 0.20) or barriers (β = -0.25) to vaccination in general on intention to HPV vaccination were significantly mediated by parental attitudes and source of information about the vaccine. Geographical location significantly moderated the awareness about HPV on beliefs about severity of HPV infection or cervical cancer (β = 0.33), and the effect of religion on norms related to HPV vaccination (β = 0.19). Fit of the model to the data was acceptable. This study identified modifiable parental attitudes about HPV vaccine and beliefs related with HPV infection, cervical cancer and vaccination, which predicted parental intention-to-vaccinate their daughters with HPV vaccine in India. Health education interventions tailored to counter parental negative attitudes and beliefs about HPV vaccine and vaccination in general would be important for the community to promote HPV vaccination.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA; Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Karl Krupp
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA; Public Health Research Institute of India, Mysore, India
| | - Kristopher Fennie
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA
| | | | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA
| | - Dionne P Stephens
- Department of Psychology, College of Arts, Sciences & Education, Florida International University, Miami, USA
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA; Public Health Research Institute of India, Mysore, India.
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11
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Dutta T, Meyerson B, Agley J. African cervical cancer prevention and control plans: A scoping review. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2018.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Canon C, Effoe V, Shetty V, Shetty AK. Knowledge and Attitudes Towards Human Papillomavirus (HPV) Among Academic and Community Physicians in Mangalore, India. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:382-391. [PMID: 26880357 DOI: 10.1007/s13187-016-0999-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cervical cancer is the most common cancer found in Indian women. Two human papillomavirus (HPV) vaccines were approved for use in India in 2006; however, neither has become readily accepted. Physician attitudes and recommendations are crucial in the uptake of HPV vaccines among adolescent women in the USA; thus, we ought to investigate provider attitudes and practices related to HPV vaccination in India via a survey administered to 210 Indian physicians. Of the 210 physicians, 46 % were community physicians and 54 % were academic physicians. The correct response to HPV knowledge questions was identified around 50 % of the time in 6/11 questions. Only 47 % of the physicians knew that there was an HPV vaccine approved for use in India. Only 11 % and 15 % of physicians strongly agree that the HPV vaccine will lead to long-lasting immunity and has a safe side effect profile, respectively. A total of 30 % of those surveyed reported that they would recommend the HPV vaccine to their patients, while 73 % agreed that the cost of the HPV vaccine is a major barrier to acceptance. After multivariate analysis, there were two significant variables independently associated with a physician's decision to recommend HPV vaccine. These variables were as follows: "whether the vaccine was freely available from the government sector" and "uncertainty about whether HPV must be persistent to cause cervical cancer vs not." Given the lack of knowledge among practicing physicians in Mangalore, increasing the education about HPV infection and HPV vaccination towards health care providers has the potential to increase vaccine recommendations.
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Affiliation(s)
- Chelsea Canon
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Valery Effoe
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Veena Shetty
- Department of Microbiology, K.S. Hegde Medical Academy and Nitte University, Deralakatte, Mangalore, Karnataka, India
| | - Avinash K Shetty
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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Masalu N, Serra P, Amadori D, Kahima J, Majinge C, Rwehabura J, Nanni O, Bravaccini S, Puccetti M, Tumino R, Bucchi L. Setting up a community-based cervical screening service in a low-income country: a pilot study from north-western Tanzania. Int J Public Health 2017; 62:755-762. [PMID: 28424832 PMCID: PMC5585293 DOI: 10.1007/s00038-017-0971-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 11/29/2022] Open
Abstract
Objectives To report the results of a pilot study for a service for cervical cancer screening and diagnosis in north-western Tanzania. Methods The pilot study was launched in 2012 after a community-level information campaign. Women aged 15–64 years were encouraged to attend the district health centres. Attendees were offered a conventional Pap smear and a visual inspection of the cervix with acetic acid (VIA). Results The first 2500 women were evaluated. A total of 164 women (detection rate 70.0/1000) were diagnosed with high-grade cervical intraepithelial neoplasia and invasive cervical cancer. The performance of VIA was comparable to that of Pap smear. The district of residence, a history of untreated sexually transmitted disease, an HIV-negative status (inverse association), and parity were independently associated with the detected prevalence of disease. The probability of invasive versus preinvasive disease was lower in HIV-positive women and in women practicing breast self-examination. Conclusions The diagnostic procedure had an acceptable level of quality. Factors associated with the detected prevalence of disease will allow for a more targeted promotion of the service. Cervical screening should be coordinated with sexually transmitted disease and HIV infection control activities.
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Affiliation(s)
- Nestory Masalu
- Oncology Unit, Bugando Medical Centre (BMC), Mwanza, Tanzania
| | - Patrizia Serra
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dino Amadori
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Jackson Kahima
- Pathology Unit, Bugando Medical Centre (BMC), Mwanza, Tanzania
| | | | - Joyce Rwehabura
- Oncology Unit, Bugando Medical Centre (BMC), Mwanza, Tanzania
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Rosario Tumino
- Cancer Registry and Histopathology Unit, Civic MP Arezzo Hospital, ASP Ragusa, Ragusa, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
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Sophonnithiprasert T, Mahabusarakam W, Nakamura Y, Watanapokasin R. Goniothalamin induces mitochondria-mediated apoptosis associated with endoplasmic reticulum stress-induced activation of JNK in HeLa cells. Oncol Lett 2016; 13:119-128. [PMID: 28123531 PMCID: PMC5245090 DOI: 10.3892/ol.2016.5381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/24/2016] [Indexed: 12/24/2022] Open
Abstract
Goniothalamin, a natural occurring styryl-lactone isolated from Goniothalamus macrophyllus (Blume) Hook. f. & Thomson var. macrophyllus, can trigger cancer cell death in various types of cancer cell. The present study focused on elucidation of the mitochondria-mediated apoptosis associated with endoplasmic reticulum (ER) stress-induced activation of c-Jun NH2-terminal kinase (JNK) by goniothalamin in HeLa cervical cancer cells. Cell viability was determined using an MTT assay, and DNA condensation and loss of mitochondrial membrane potential were determined using Hoechst 33342 and JC-1 staining, respectively. Flow cytometry was used for cell cycle and phosphatidyl-serine exposure analyses. Apoptotic-associated ER stress signaling pathways were determined using immunoblotting, reverse transcription-polymerase chain reaction (RT-PCR) and RT-quantitative PCR analyses. The results suggested that goniothalamin suppressed cell proliferation in a time- and dose-dependent manner. The induction of apoptosis was confirmed by increased DNA condensation, loss of mitochondrial membrane potential and cell surface phosphatidyl-serine presentation. The cell cycle analysis demonstrated that the goniothalamin-treated HeLa cells were in G2/M arrest. Determination of the caspase cascade and apoptotic proteins indicated the induction of apoptosis through the intrinsic pathway. In addition, the levels of phosphorylated JNK and the transcription factor, C/EBP homologous protein (CHOP), an ER stress-associated apoptotic molecule, were increased in the goniothalamin-treated cells. These data indicated that goniothalamin exerted a cytotoxic effect against HeLa cells via the induction of mitochondria-mediated apoptosis, associated with ER stress-induced activation of JNK.
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Affiliation(s)
- Thanet Sophonnithiprasert
- Department of Biochemistry, Faculty of Medicine, Srinkharinwirot University, Bangkok 10110, Thailand
| | - Wilawan Mahabusarakam
- Department of Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Yukio Nakamura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan
| | - Ramida Watanapokasin
- Department of Biochemistry, Faculty of Medicine, Srinkharinwirot University, Bangkok 10110, Thailand
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15
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JAM3 methylation status as a biomarker for diagnosis of preneoplastic and neoplastic lesions of the cervix. Oncotarget 2016; 6:44373-87. [PMID: 26517242 PMCID: PMC4792563 DOI: 10.18632/oncotarget.6250] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022] Open
Abstract
DNA methylation is clinically relevant to important tumorigenic mechanisms. This study evaluated the methylation status of candidate genes in cervical neoplasia and determined their diagnostic performance in clinical practice. Cervical cancer and normal cervix tissue was used to select the top 5 discriminating loci among 27 loci in 4 genes (CCNA1, CADM1, DAPK1, JAM3), and one locus of JAM3 (region M4) was identified and confirmed with 267 and 224 cervical scrapings from 2 independent colposcopy referral studies. For patients with atypical squamous cells of unknown significance and those with low-grade squamous intraepithelial lesion, with JAM3-M4 compared to a triage marker of hrHPV testing, the specificity for cervical intraepithelial neoplasia 3 CIN3 and cancer cases (CIN3+) / no neoplasia and CIN1 (CIN1-) was significantly increased, from 21.88 to 81.82 and 15.38 to 85.18, respectively. The corresponding positive predictive value (PPV) was increased from 26.47 to 57.14 and 18.52 to 63.64, respectively. For hrHPV-positive patients, compared to a triage marker of cytology testing, JAM3-M4 showed increased specificity and PPV, from 30.67 to 87.65 and 38.82 to 82.14, respectively. We assessed whether JAM3-M4 could distinguish productive from transforming CIN2; the coincidence rate of JAM3-M4 and P16 was as high as 60.5%.
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16
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Naber SK, de Kok IMCM, Matthijsse SM, van Ballegooijen M. The potential harms of primary human papillomavirus screening in over-screened women: a microsimulation study. Cancer Causes Control 2016; 27:569-81. [PMID: 26970740 PMCID: PMC4796367 DOI: 10.1007/s10552-016-0732-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is well acknowledged that HPV testing should not be performed at young age and at short intervals. Cytological screening practices have shown that over-screening, i.e., from a younger age and at shorter intervals than recommended, is hard to avoid. We quantified the consequences of a switch to primary HPV screening for over-screened women, taking into account its higher sensitivity but lower specificity than cytology. METHODS The health effects of using the HPV test instead of cytology as the primary screening method were determined with the MISCAN-Cervix model. We varied the age women start screening and the interval between screens. In the sensitivity analyses, we varied the background risk of cervical cancer, the HPV prevalence, the discount rate, the triage strategy after cytology, and the test characteristics of both cytology and the HPV test. RESULTS For women screened 5 yearly from age 30, 32 extra deaths per 100,000 simulated women were prevented when switching from primary cytology to primary HPV testing. For annual screening from age 20, such a switch resulted in 6 extra deaths prevented. It was associated with 9,044 more positive primary screens in the former scenario versus 76,480 in the latter. Under all conditions, for women screened annually, switching to HPV screening resulted in a net loss of quality-adjusted life years. CONCLUSION For over-screened women, the harms associated with a lower test specificity outweigh the life years gained when switching from primary cytology to primary HPV testing. The extent of over-screening should be considered when deciding on inclusion of primary HPV screening in cervical cancer screening guidelines.
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Affiliation(s)
- Steffie K Naber
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Inge M C M de Kok
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Suzette M Matthijsse
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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17
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HPV detection-based cervical cancer screening program in low-resource setting: lessons learnt from a community-based demonstration project in India. Cancer Causes Control 2015; 27:351-8. [DOI: 10.1007/s10552-015-0708-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
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18
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Krishnan S, Dhillon PK, Bhadelia A, Schurmann A, Basu P, Bhatla N, Birur P, Colaco R, Dey S, Grover S, Gupta H, Gupta R, Gupta V, Lewis MA, Mehrotra R, McMikel A, Mukherji A, Naik N, Nyblade L, Pati S, Pillai MR, Rajaraman P, Ramesh C, Rath GK, Reithinger R, Sankaranarayanan R, Selvam J, Shanmugam MS, Shridhar K, Siddiqi M, Squiers L, Subramanian S, Travasso SM, Verma Y, Vijayakumar M, Weiner BJ, Reddy KS, Knaul FM. Report from a symposium on catalyzing primary and secondary prevention of cancer in India. Cancer Causes Control 2015; 26:1671-84. [PMID: 26335262 PMCID: PMC4596898 DOI: 10.1007/s10552-015-0637-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/16/2015] [Indexed: 12/25/2022]
Abstract
Purpose Oral, breast, and cervical cancers are amenable to early detection and account for a third of India’s cancer burden. We convened a symposium of diverse stakeholders to identify gaps in evidence, policy, and advocacy for the primary and secondary prevention of these cancers and recommendations to accelerate these efforts.
Methods Indian and global experts from government, academia, private sector (health care, media), donor organizations, and civil society (including cancer survivors and patient advocates) presented and discussed challenges and solutions related to strategic communication and implementation of prevention, early detection, and treatment linkages. Results Innovative approaches to implementing and scaling up primary and secondary prevention were discussed using examples from India and elsewhere in the world. Participants also reflected on existing global guidelines and national cancer prevention policies and experiences. Conclusions Symposium participants proposed implementation-focused research, advocacy, and policy/program priorities to strengthen primary and secondary prevention efforts in India to address the burden of oral, breast, and cervical cancers and improve survival.
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Affiliation(s)
- Suneeta Krishnan
- Research Triangle Institute Global India Pvt. Ltd, Suite 405, Paharpur Business Center, 21 Nehru Place, New Delhi, 110019, India.
| | - Preet K Dhillon
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Sector 44, Gurgaon, 122002, India.
| | - Afsan Bhadelia
- Harvard Global Equity Initiative, Harvard University, 651 Huntington Avenue, Room 632, Boston, MA, 02115, USA
| | - Anna Schurmann
- Independent Public Health Consultant, 2C Alsa Terraces, 26 Langford Gardens, Bangalore, 560025, India
| | - Partha Basu
- Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata, 700026, India
| | - Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Praveen Birur
- Biocon Foundation, 20th KM Hosur Road, Electronic City, Bangalore, 560100, India
| | - Rajeev Colaco
- RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Subhojit Dey
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, India
| | - Surbhi Grover
- University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Harmala Gupta
- CanSupport, KanakDurgaBastiVikasKendra, Sector 12 R. K. Puram, Near New CGHS Dispensary, New Delhi, 110022, India
| | - Rakesh Gupta
- Rajasthan Cancer Foundation, B-113, 10 B Scheme, Gopalpura Bypass, Jaipur, 302018, India
| | - Vandana Gupta
- V Care Foundation, A102, Om Residency, J W Road, Near Tata Memorial Hospital, Parel (East), Mumbai, 400012, India
| | - Megan A Lewis
- RTI International, 3040 Cornwallis Rd., PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Ravi Mehrotra
- Institute of Cytology and Preventive Oncology (ICMR), I-7, Sector-39, Noida, 201301, India
| | - Ann McMikel
- American Cancer Society, Inc., 250 Williams Street NW, Atlanta, GA, 30303, USA
| | - Arnab Mukherji
- Center for Public Policy, IIM Bangalore, Bannerghatta Road, Bangalore, 560076, India
| | - Navami Naik
- American Cancer Society, Inc., 250 Williams Street NW, Atlanta, GA, 30303, USA
| | - Laura Nyblade
- RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Sanghamitra Pati
- Indian Institute of Public Health Bhubaneswar, Public Health Foundation of India, Infocity Road, Patia, Bhubaneswar, 751024, India
| | - M Radhakrishna Pillai
- Rajiv Gandhi Centre for Biotechnology (Government of India, Ministry for Science and Technology), Millennium Avenue, Jagathy, Thiruvananthapuram, 695014, India
| | - Preetha Rajaraman
- Center for Global Health, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20892-9760, USA
| | | | - G K Rath
- All India Institute of Medical Science, Gautam Nagar, Ansari Nagar East, New Delhi, 110029, India
| | | | - Rengaswamy Sankaranarayanan
- International Agency for Research on Cancer (WHO-IARC), 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Jerard Selvam
- Tamil Nadu Health Systems Project, 3rd Floor, DMS Annex New Building 259 Anna Salai, Teynampet, Chennai, 600006, India
| | - M S Shanmugam
- Tamil Nadu Health Systems Project, 3rd Floor, DMS Annex New Building 259 Anna Salai, Teynampet, Chennai, 600006, India
| | - Krithiga Shridhar
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Sector 44, Gurgaon, 122002, India
| | - Maqsood Siddiqi
- Cancer Foundation of India, 47/2D, Selimpur Road, Kolkata, 700031, India
| | - Linda Squiers
- RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Sujha Subramanian
- RTI International, 1440 Main Street, Suite 310, Waltham, MA, 02451-1623, USA
| | - Sandra M Travasso
- St. Johns Research Institute, 100 Feet Road, Koramangala, Bangalore, 560034, India
| | - Yogesh Verma
- S.T.N.M Hospital, NH 31A, Gangtok, Sikkim, 737101, India
| | - M Vijayakumar
- Kidwai Memorial Institute of Oncology, Dr. M.H Marigowda Road, Bangalore, 560029, India
| | - Bryan J Weiner
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7411, USA
| | - K Srinath Reddy
- Public Health Foundation of India, Delhi NCR, Plot No. 47, Sector 44, Gurgaon, Haryana, 122 003, India
| | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard University, 651 Huntington Avenue, Room 632, Boston, MA, 02115, USA
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Demment MM, Peters K, Dykens JA, Dozier A, Nawaz H, McIntosh S, Smith JS, Sy A, Irwin T, Fogg TT, Khaliq M, Blumenfeld R, Massoudi M, De Ver Dye T. Developing the Evidence Base to Inform Best Practice: A Scoping Study of Breast and Cervical Cancer Reviews in Low- and Middle-Income Countries. PLoS One 2015; 10:e0134618. [PMID: 26325181 PMCID: PMC4556679 DOI: 10.1371/journal.pone.0134618] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/12/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast and cervical cancers have emerged as major global health challenges and disproportionately lead to excess morbidity and mortality in low- and middle-income countries (LMICs) when compared to high-income countries. The objective of this paper was to highlight key findings, recommendations, and gaps in research and practice identified through a scoping study of recent reviews in breast and cervical cancer in LMICs. METHODS We conducted a scoping study based on the six-stage framework of Arskey and O'Malley. We searched PubMed, Cochrane Reviews, and CINAHL with the following inclusion criteria: 1) published between 2005-February 2015, 2) focused on breast or cervical cancer 3) focused on LMIC, 4) review article, and 5) published in English. RESULTS Through our systematic search, 63 out of the 94 identified cervical cancer reviews met our selection criteria and 36 of the 54 in breast cancer. Cervical cancer reviews were more likely to focus upon prevention and screening, while breast cancer reviews were more likely to focus upon treatment and survivorship. Few of the breast cancer reviews referenced research and data from LMICs themselves; cervical cancer reviews were more likely to do so. Most reviews did not include elements of the PRISMA checklist. CONCLUSION Overall, a limited evidence base supports breast and cervical cancer control in LMICs. Further breast and cervical cancer prevention and control studies are necessary in LMICs.
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Affiliation(s)
- Margaret M. Demment
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
| | - Karen Peters
- Division of Community Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - J. Andrew Dykens
- Department of Family Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Ann Dozier
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America
| | - Haq Nawaz
- Department of Medicine, Griffin Hospital & Yale University-Griffin Prevention Research Center, New Haven, Connecticut, United States of America
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America
| | - Jennifer S. Smith
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Angela Sy
- School of Nursing and Dental Hygiene, University of Hawai’i at Mānoa, Honolulu, Hawaii, United States of America
| | - Tracy Irwin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Thomas T. Fogg
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
| | - Mahmooda Khaliq
- Department of Community and Family Health, University of South Florida, Tampa, Florida, United States of America
| | - Rachel Blumenfeld
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mehran Massoudi
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Timothy De Ver Dye
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- * E-mail:
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20
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Rajaraman P, Anderson BO, Basu P, Belinson JL, Cruz AD, Dhillon PK, Gupta P, Jawahar TS, Joshi N, Kailash U, Kapambwe S, Katoch VM, Krishnan S, Panda D, Sankaranarayanan R, Selvam JM, Shah KV, Shastri S, Shridhar K, Siddiqi M, Sivaram S, Seth T, Srivastava A, Trimble E, Mehrotra R. Recommendations for screening and early detection of common cancers in India. Lancet Oncol 2015; 16:e352-61. [PMID: 26149887 DOI: 10.1016/s1470-2045(15)00078-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 12/16/2022]
Abstract
Cancers of the breast, uterine cervix, and lip or oral cavity are three of the most common malignancies in India. Together, they account for about 34% of more than 1 million individuals diagnosed with cancer in India each year. At each of these cancer sites, tumours are detectable at early stages when they are most likely to be cured with standard treatment protocols. Recognising the key role that effective early detection and screening programmes could have in reducing the cancer burden, the Indian Institute for Cytology and Preventive Oncology, in collaboration with the US National Cancer Institute Center for Global Health, held a workshop to summarise feasible options and relevant evidence for screening and early detection of common cancers in India. The evidence-based recommendations provided in this Review are intended to act as a guide for policy makers, clinicians, and public health practitioners who are developing and implementing strategies in cancer control for the three most common cancers in India.
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Affiliation(s)
- Preetha Rajaraman
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA.
| | - Benjamin O Anderson
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Partha Basu
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Jerome L Belinson
- Preventive Oncology International and Department of Surgery, Women's Health Institute, Lerner School of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Anil D' Cruz
- Department of Head and Neck Services, Tata Memorial Hospital, Mumbai, India
| | - Preet K Dhillon
- Centre for Control of Chronic Conditions, Public Health Foundation of India, Gurgaon, India
| | - Prakash Gupta
- Healis-Sekhsaria Institute for Public Health, Navi Mumbai, India
| | | | - Niranjan Joshi
- Healthcare Technology Innovation Centre, IIT Madras Research Park, Chennai, India
| | - Uma Kailash
- Institute of Cytology and Preventive Oncology, Noida, India
| | - Sharon Kapambwe
- Africa Centre of Excellence for Women's Cancer Control, Centre for Infectious Disease Research, Lusaka, Zambia
| | | | - Suneeta Krishnan
- Women's Global Health Imperative, Research Triangle Institute International, San Francisco, CA, USA
| | - Dharitri Panda
- Institute of Cytology and Preventive Oncology, Noida, India
| | - R Sankaranarayanan
- Early Detection & Prevention Section and Screening Group, International Agency for Research on Cancer, Lyon, France
| | | | - Keerti V Shah
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Surendra Shastri
- Department of Preventive Oncology, Tata Memorial Center, Mumbai, India
| | - Krithiga Shridhar
- Centre for Control of Chronic Conditions, Public Health Foundation of India, Gurgaon, India
| | | | - Sudha Sivaram
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Tulika Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Edward Trimble
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Ravi Mehrotra
- Institute of Cytology and Preventive Oncology, Noida, India
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Thulaseedharan JV, Malila N, Esmy PO, Muwonge R, Hakama M, Sankaranarayanan R. Risk of invasive cancer among women visually screened and colposcopy triaged by trained nurses in rural South India. Int J Gynaecol Obstet 2015; 129:104-8. [PMID: 25661324 DOI: 10.1016/j.ijgo.2014.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/11/2014] [Accepted: 01/22/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate the long-term risk of cervical cancer among women screened by visual inspection with acetic acid (VIA) and to evaluate the benefit of additional colposcopy triage in rural south India. METHODS A retrospective analysis was conducted among 31 343 women who had undergone VIA at Dindigul district, India between January 1, 2000, and August 5, 2003, as part of a randomized screening trial. Women with positive VIA test results were offered colposcopy triage by trained nurses. Cervical cancer incidence data during follow-up (January 1, 2000, to December 31, 2012) were obtained from a regional cancer registry. RESULTS Among 3021 screen-positive women free of cancer at baseline, 2974 women underwent colposcopy; colposcopic abnormalities suggestive of precancerous lesions were detected among 2792 of these women (93.9%). Compared with the women with negative VIA screening results, the hazard ratio (HR) of cervical cancer during follow-up among the VIA-positive women without colposcopic abnormalities was 6.5 (95% confidence interval [CI], 1.6-27.1). The risk was similar among VIA-positive women with colposcopic abnormalities but without histological confirmation (HR5.2; 95% CI, 1.9-14.6). CONCLUSION The high risk of cancer among women without colposcopic abnormalities who tested positive by VIA suggested that screening without triage is potentially effective.
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Affiliation(s)
- Jissa V Thulaseedharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India; School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland
| | - Nea Malila
- School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland; Finnish Cancer Registry, Pieni Roobertinkatu, Helsinki, Finland
| | - Pulikottil O Esmy
- Christian Fellowship Community Health Centre, Ambilikkai, Tamil Nadu, India
| | - Richard Muwonge
- Screening Group, International Agency for Research on Cancer, Lyon, France.
| | - Matti Hakama
- School of Health Sciences, University of Tampere, Tampereen Yliopisto, Finland; Finnish Cancer Registry, Pieni Roobertinkatu, Helsinki, Finland
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Tanriverdi O, Yeniceri N. Importance of meta-analysis and practical obstacles in oncological and epidemiological studies: statistics very close but also far! Asian Pac J Cancer Prev 2015; 16:1303-6. [PMID: 25735371 DOI: 10.7314/apjcp.2015.16.3.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Studies of epidemiological and prognostic factors are very important for oncology practice. There is a rapidly increasing amount of research and resultant knowledge in the scientific literature. This means that health professionals have major challenges in accessing relevant information and they increasingly require best available evidence to make their clinical decisions. Meta-analyses of prognostic and other epidemiological factors are very practical statistical approaches to define clinically important parameters. However, they also feature many obstacles in terms of data collection, standardization of results from multiple centers, bias, and commentary for intepretation. In this paper, the obstacles of meta-analysis are briefly reviewed, and potential problems with this statistical method are discussed.
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Affiliation(s)
- Ozgur Tanriverdi
- Department of Medical Oncology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey E-mail :
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Nigam A, Saxena P, Acharya AS. HPV vaccination and HPV DNA testing: Need of the hour. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2015. [DOI: 10.1016/j.injms.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nahvijou A, Sari AA, Zendehdel K, Marnani AB. Management of precancerous cervical lesions in iran: a cost minimizing study. Asian Pac J Cancer Prev 2014; 15:8209-13. [PMID: 25339007 DOI: 10.7314/apjcp.2014.15.19.8209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer is a common, preventable and manageable disease in women worldwide. OBJECTIVES This study was conducted to determine the cost of follow-up for suspicious precancerous cervical lesions within a screening program using Pap smear or HPV DNA test through the decision tree. MATERIALS AND METHODS Patient follow-up processes were determined using standard guidelines and consultation with specialists to design a decision tree model. Costs of treatment in both public and private sectors were identified according to the national tariffs in 2010 and determined based on decision tree and provided services (visits to specialists, colposcopy, and conization) with two modalities: Pap smear and HPV DNA test. The number of patients and the mean cost of treatment in each sector were calculated. The prevalence of lesions and HPV were obtained from literature to estimate the cost of treatment for each woman in the population. RESULTS Follow-up costs were determined using seven processes for Pap smear and 11 processes for HPV DNA test. The total cost of using Pap smear and HPV DNA process for each woman in the population was 36.1$ and 174 $ respectively. CONCLUSIONS The follow-up process for patients with suspicious cervical lesions needs to be included in the existing screening program. HPV DNA test is currently more expensive than Pap smear, it is suggested that we manage precancerous cervical lesions with this latter test.
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Affiliation(s)
- Azin Nahvijou
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran E-mail :
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25
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McGraw SL, Ferrante JM. Update on prevention and screening of cervical cancer. World J Clin Oncol 2014; 5:744-752. [PMID: 25302174 PMCID: PMC4129537 DOI: 10.5306/wjco.v5.i4.744] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/11/2014] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
Cervical cancer is the third most common cause of cancer in women in the world. During the past few decades tremendous strides have been made toward decreasing the incidence and mortality of cervical cancer with the implementation of various prevention and screening strategies. The causative agent linked to cervical cancer development and its precursors is the human papillomavirus (HPV). Prevention and screening measures for cervical cancer are paramount because the ability to identify and treat the illness at its premature stage often disrupts the process of neoplasia. Cervical carcinogenesis can be the result of infections from multiple high-risk HPV types that act synergistically. This imposes a level of complexity to identifying and vaccinating against the actual causative agent. Additionally, most HPV infections spontaneously clear. Therefore, screening strategies should optimally weigh the benefits and risks of screening to avoid the discovery and needless treatment of transient HPV infections. This article provides an update of the preventative and screening methods for cervical cancer, mainly HPV vaccination, screening with Pap smear cytology, and HPV testing. It also provides a discussion of the newest United States 2012 guidelines for cervical cancer screening, which changed the age to begin and end screening and lengthened the screening intervals.
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Sohrabi A, Mirab-Samiee S, Modarressi MH, Izadimood N, Azadmanesh K, Rahnamaye-Farzami M. Development of In-House Multiplex Real Time PCR for Human Papillomavirus Genotyping in Iranian Women with Cervical Cancer and Cervical Intraepithelial Neoplasia. Asian Pac J Cancer Prev 2014; 15:6257-61. [DOI: 10.7314/apjcp.2014.15.15.6257] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Krishnan S, Madsen E, Porterfield D, Varghese B. Advancing cervical cancer prevention in India: implementation science priorities. Oncologist 2014; 18 Suppl:13-25. [PMID: 24334478 DOI: 10.1634/theoncologist.18-s2-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cervical cancer is the leading cause of cancer mortality in India, accounting for 17% of all cancer deaths among women aged 30 to 69 years. At current incidence rates, the annual burden of new cases in India is projected to increase to 225,000 by 2025, but there are few large-scale, organized cervical cancer prevention programs in the country. We conducted a review of the cervical cancer prevention research literature and programmatic experiences in India to summarize the current state of knowledge and practices and recommend research priorities to address the gap in services. We found that research and programs in India have demonstrated the feasibility and acceptability of cervical cancer prevention efforts and that screening strategies requiring minimal additional human resources and laboratory infrastructure can reduce morbidity and mortality. However, additional evidence generated through implementation science research is needed to ensure that cervical cancer prevention efforts have the desired impact and are cost-effective. Specifically, implementation science research is needed to understand individual- and community-level barriers to screening and diagnostic and treatment services; to improve health care worker performance; to strengthen links among screening, diagnosis, and treatment; and to determine optimal program design, outcomes, and costs. With a quarter of the global burden of cervical cancer in India, there is no better time than now to translate research findings to practice. Implementation science can help ensure that investments in cervical cancer prevention and control result in the greatest impact.
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28
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Ekalaksananan T, Malat P, Pientong C, Kongyingyoes B, Chumworathayi B, Kleebkaow P. Local Cervical Immunity in Women with Low-grade Squamous Intraepithelial Lesions and Immune Responses After Abrasion. Asian Pac J Cancer Prev 2014; 15:4197-201. [DOI: 10.7314/apjcp.2014.15.10.4197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pramesh CS, Badwe RA, Borthakur BB, Chandra M, Raj EH, Kannan T, Kalwar A, Kapoor S, Malhotra H, Nayak S, Rath GK, Sagar TG, Sebastian P, Sarin R, Shanta V, Sharma SC, Shukla S, Vijayakumar M, Vijaykumar DK, Aggarwal A, Purushotham A, Sullivan R. Delivery of affordable and equitable cancer care in India. Lancet Oncol 2014; 15:e223-33. [DOI: 10.1016/s1470-2045(14)70117-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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30
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Mvundura M, Tsu V. Estimating the costs of cervical cancer screening in high-burden Sub-Saharan African countries. Int J Gynaecol Obstet 2014; 126:151-5. [PMID: 24792401 DOI: 10.1016/j.ijgo.2014.02.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/17/2014] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate the capital investment and recurrent costs of national cervical cancer screening and precancer treatment programs in 23 high-incidence countries in Sub-Saharan Africa in order to provide estimates of the investment required to tackle the burden of cervical cancer in this region. These 23 countries account for 64% of the annual cervical cancer deaths in this region. METHODS Secondary data were used to estimate the financial costs of equipment purchases and economic costs of screening and treating eligible women over a 10-year period. Screening would be by visual inspection with acetic acid and treatment by cryotherapy or loop electrosurgical excision procedure. RESULTS Approximately US $59 million would be required to purchase treatment equipment if cryotherapy were placed at every screening facility. Approximately 20 million women would be screened over 10 years. Cost per woman screened in a screen-and-treat program was either US $3.33 or US $7.31, and cost per woman treated was either US $38 or US $71 depending on the location of cryotherapy equipment. CONCLUSION It would take less than US $10 per woman screened to significantly decrease the cervical cancer deaths that will occur in Sub-Saharan Africa over the next 10 years.
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Affiliation(s)
| | - Vivien Tsu
- PATH, Reproductive Health Global Program, Seattle, USA
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31
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HPV Vaccination in India: Critical Appraisal. ISRN OBSTETRICS AND GYNECOLOGY 2014; 2014:394595. [PMID: 25006481 PMCID: PMC3967597 DOI: 10.1155/2014/394595] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/03/2014] [Indexed: 11/18/2022]
Abstract
Cervical cancer is the third most common cancer in women worldwide. The role of human papilloma virus (HPV) in the genesis of cervical carcinoma is well documented. The HPV 16 and 18 are found to be most commonly associated with invasive cervical carcinoma. The advent of cervical carcinoma vaccine has advanced the hopes that eradication of cervical carcinoma might be possible in future. The scenario of prevention of cervical carcinoma is completely different in developed and developing countries. The implementation of the vaccination as a routine in India is still controversial. Here we have tried to critically analyse these issues in Indian context. However it is clear that cervical cancer vaccine is not an immediate panacea and cannot replace the cervical cancer screening which is mandatory in Indian context.
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Krishnan S, Madsen E, Porterfield D, Varghese B. Advancing cervical cancer prevention in India: implementation science priorities. Oncologist 2013; 18:1285-97. [PMID: 24217555 PMCID: PMC3868423 DOI: 10.1634/theoncologist.2013-0292] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/04/2013] [Indexed: 12/31/2022] Open
Abstract
Cervical cancer is the leading cause of cancer mortality in India, accounting for 17% of all cancer deaths among women aged 30 to 69 years. At current incidence rates, the annual burden of new cases in India is projected to increase to 225,000 by 2025, but there are few large-scale, organized cervical cancer prevention programs in the country. We conducted a review of the cervical cancer prevention research literature and programmatic experiences in India to summarize the current state of knowledge and practices and recommend research priorities to address the gap in services. We found that research and programs in India have demonstrated the feasibility and acceptability of cervical cancer prevention efforts and that screening strategies requiring minimal additional human resources and laboratory infrastructure can reduce morbidity and mortality. However, additional evidence generated through implementation science research is needed to ensure that cervical cancer prevention efforts have the desired impact and are cost-effective. Specifically, implementation science research is needed to understand individual- and community-level barriers to screening and diagnostic and treatment services; to improve health care worker performance; to strengthen links among screening, diagnosis, and treatment; and to determine optimal program design, outcomes, and costs. With a quarter of the global burden of cervical cancer in India, there is no better time than now to translate research findings to practice. Implementation science can help ensure that investments in cervical cancer prevention and control result in the greatest impact.
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Affiliation(s)
- Suneeta Krishnan
- RTI International, Research Triangle Park, North Carolina, USA
- St. John's Research Institute, Bangalore, India
| | - Emily Madsen
- RTI International, Research Triangle Park, North Carolina, USA
| | - Deborah Porterfield
- RTI International, Research Triangle Park, North Carolina, USA
- Department of Social Medicine, School of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Beena Varghese
- St. John's Research Institute, Bangalore, India
- Public Health Foundation of India, New Delhi, India
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Exploiting biospectroscopy as a novel screening tool for cervical cancer: towards a framework to validate its accuracy in a routine clinical setting. Bioanalysis 2013; 5:2697-711. [DOI: 10.4155/bio.13.233] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Biospectroscopy is an emerging field that harnesses the platform of physical sciences with computational analysis in order to shed novel insights on biological questions. An area where this approach seems to have potential is in screening or diagnostic clinical settings, where there is an urgent need for new approaches to objectively interrogate large numbers of samples in an objective fashion with acceptable levels of sensitivity and specificity. This review outlines the benefits of biospectroscopy in screening for precancer lesions of the cervix due to its ability to separate different grades of dysplasia. It evaluates the feasibility of introducing this technique into cervical screening programs on the basis of its ability to identify biomarkers of progression within derived spectra (‘biochemical‑cell fingerprints’).
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The Clinical Role of HPV Testing in Primary and Secondary Cervical Cancer Screening. Obstet Gynecol Int 2013; 2013:610373. [PMID: 23935630 PMCID: PMC3713364 DOI: 10.1155/2013/610373] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/14/2013] [Indexed: 11/24/2022] Open
Abstract
Traditional population-based cervical screening programs, based on cytology, have successfully reduced the burden of cervical cancer. Nevertheless limitations remain and new screening methods are emerging. Despite vaccination against the 2 most oncogenic types (HPV 16/18), cervical cancer screening will have to continue as an essential public health strategy. As the acquisition of an HR-HPV infection is critical in the progression to (pre-)cancerous cervical lesions, recent research has focused on HR-HPV detection. The sensitivity of HPV testing in primary and secondary prevention outweighs that of cytology, at the cost of slightly lower specificity. Although most of the HR-HPV infections are cleared after conization, new evidence from numerous studies encourages the implementation of HR-HPV testing and genotyping to improve posttreatment surveillance. An HR-HPV test 6 months after conization is a promising useful clinical marker to detect persistence and prevent progression. This review highlights the clinical role of HPV testing in primary and secondary cervical cancer screening.
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Cui C, Wang Y, Wang Y, Zhao M, Peng S. Alsterpaullone, a Cyclin-Dependent Kinase Inhibitor, Mediated Toxicity in HeLa Cells through Apoptosis-Inducing Effect. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2013; 2013:602091. [PMID: 23577282 PMCID: PMC3610382 DOI: 10.1155/2013/602091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 02/13/2013] [Indexed: 06/02/2023]
Abstract
Alsterpaullone, a small molecule cyclin-dependent kinase (CDK) inhibitor, regulates the cell cycle progression. Beyond death-inducing properties, we identified the effect of alsterpaullone on cycle procedure and apoptosis of HeLa cell. It was found that alsterpaullone inhibited HeLa cells in a time-dependent (0-72 h) and dose-dependent (0-30 μ M) manner. In the presence of alsterpaullone, HeLa cells were arrested in G2/M prior to undergoing apoptosis via a mechanism that is involved in the regulation of various antiapoptotic genes, DNA-repair, transcription, and cell cycle progression. Compared to controls, alsterpaullone effectively prevented HeLa cells from entering S-phase. These potential therapeutic efficacies could be correlated with the activation of caspase-3.
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Affiliation(s)
- Chunying Cui
- College of Pharmaceutical Sciences, Capital Medical University, Beijing 100069, China
| | - Yuji Wang
- College of Pharmaceutical Sciences, Capital Medical University, Beijing 100069, China
| | - Yaonan Wang
- Medical Experiment and Test Center, Capital Medical University, Beijing 100069, China
| | - Ming Zhao
- College of Pharmaceutical Sciences, Capital Medical University, Beijing 100069, China
| | - Shiqi Peng
- College of Pharmaceutical Sciences, Capital Medical University, Beijing 100069, China
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Abstract
Developing countries suffer the highest burden of cervical cancers but have the lowest resources. Effective cervical cytology screening programme, along with a network of diagnostic and therapeutic colposcopy centres, like developed countries, is almost impossible to be reproduced in developing countries. Visual inspection methods [e.g., Visual inspection with Lugol’s iodine (VILI) and Visual Inspection with Acetic Acid (VIA)] which are cheaper, require less expertise and have the advantage of possible treatment in one setting have been shown to be effective alternatives. The sensitivity to detect CIN2+, by VIA and VILI, have been shown to be 80% and 91% respectively, with a specificity rate of 92% and 85% respectively. Screening by human papillomavirus (HPV) testing has high sensitivity (96.4%) but low specificity (94.1%) to detect CIN2+, when compared to Pap Smear (sensitivity, 55.4% and specificity, 96.8%). A single lifetime HPV testing in a large unscreened population has been shown to significantly reduce cervical cancer incidence and mortality when compared to cervical cytology, VIA or no screening. HPV testing of self-collected vaginal specimens also helps to overcome religious and socio-cultural barriers towards pelvic examination amongst women in developing countries. Current HPV testing methods are expensive, skill/infrastructure demanding and takes time to produce results. A cheaper HPV test, called careHPV™, which is able to provide results within 2.5 h and requires minimal skill/infrastructure to operate, was designed for use in developing countries. One stop screen and treat facilities using VIA or rapid HPV testing, and cryotherapy, can overcome non-compliance to follow-up which is a major issue in developing countries. Cure rates of 81.4% for CIN1, 71.4% for CIN2 and 68.0% for CIN3 at 6 mo after treatment have been reported. Incorporating telemedicine with cervicography of VIA or VILI or even telecolposcopy, has great potential in cervical cancer screening, especially in countries with vast geographical areas.
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