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Singh N, Rajput S, Jaiswar SP. Correlation of menstrual hygiene management with cervical intraepithelial neoplasia and cervical cancer. J Cancer Res Ther 2023; 19:1148-1152. [PMID: 37787277 DOI: 10.4103/jcrt.jcrt_1021_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose To find the correlation of menstrual hygiene management (MHM) with cervical intraepithelial neoplasia and cervical cancer. Materials and Methods This case-control study was conducted in a tertiary care teaching hospital for 1 year. One hundred cases (CIN or cervical cancer) and 135 controls (normal cervical cytology, Swede's score below 5, or normal cervical histology) were surveyed about MHM practices through a predesigned, semi-structured questionnaire by interview method. Data were analyzed on SPSS version 17.0 statistical analysis software through Chi-square test and bivariate regression analysis. Results All Poor MHM practices except frequency of change of absorbent were significantly more commonly seen in women with CIN or Cervical cancer as compared to controls (P < 0.001). The bivariate regression analysis showed that old age, illiteracy, and the use of old cloth are significant risk factors for cervical cancer. Conclusion Poor menstrual hygiene practices of using old cloth and disposal in open are significant risk factors of cervical cancer. Good MHM practices should be widely publicized and implemented in the community to reduce the risk of cervical cancer.
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Affiliation(s)
- Nisha Singh
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sapana Rajput
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - S P Jaiswar
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, Uttar Pradesh, India
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2
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Khan A, Das BC, Abiha U, Sisodiya S, Chikara A, Nazir SU, Das AM, Rodrigues AG, Passari AK, Tanwar P, Hussain S, Rashid S, Rashid S. Insights into the role of complement regulatory proteins in HPV mediated cervical carcinogenesis. Semin Cancer Biol 2022; 86:583-589. [PMID: 34087416 DOI: 10.1016/j.semcancer.2021.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 01/27/2023]
Abstract
The persistent infection of high-risk Human papillomavirus (HR-HPV) induced cervical cancer remains a challenge in women worldwide including India. Recent advances in cancer research have paved the way for advanced cancer treatment modalities including immunotherapy by manipulating the function or number of cytotoxic T cells. It is well established that anaphylatoxins like C3a and C5a of complement system influence tumor growth by evading apoptosis leading to progression of cancer. The role of the complement system, particularly the complement regulatory proteins (CRPs) which are important determinants of immune response play a crucial role in carcinogenesis. In a tumor microenvironment (TME) assisted suppression of immune effector cells may be achieved through CRPs. However, recent advances in pharmacogenomics including drug designing and combination of these approaches have provided a holistic understanding of signaling pathways and their crosstalk, to regulate cellular communications.This review describes the role of complement system; particularly CRPs in HPV induced cervical carcinogenesis which may be used for designing anti- HPV or cervical cancer therapeutics.
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Affiliation(s)
- Asiya Khan
- Centre for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida, Uttar Pradesh, India; Laboratory Oncology Unit, Rotary Cancer Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Bhudev C Das
- Amity Institute of Molecular Medicine & Stem Cell Research (AIMMSCR), Health & Allied Sciences Amity University, Noida, India
| | - Umme Abiha
- Centre for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida, Uttar Pradesh, India
| | - Sandeep Sisodiya
- Division of Molecular Oncology & Molecular Diagnostics, ICMR-National Institute of Cancer Prevention and Research, Ministry of Health & Family Welfare, Noida, India; Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - Atul Chikara
- Division of Molecular Oncology & Molecular Diagnostics, ICMR-National Institute of Cancer Prevention and Research, Ministry of Health & Family Welfare, Noida, India; Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - Sheeraz Un Nazir
- Division of Molecular Oncology & Molecular Diagnostics, ICMR-National Institute of Cancer Prevention and Research, Ministry of Health & Family Welfare, Noida, India
| | - Ankan M Das
- Amity Institute of Public Health, Amity University, Noida, India
| | - Alexandre Gomes Rodrigues
- Alpha & Omega Labor, Messe-Alle, 23, 04158, Leipzig, Germany; University of Veterinary Medicine Hannover, Bischofsholer Damm 15, 30173, Hannover, Germany
| | - Ajit Kumar Passari
- Departmento de Biología Molecular y Biotecnología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Pranay Tanwar
- Laboratory Oncology Unit, Rotary Cancer Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Showket Hussain
- Division of Molecular Oncology & Molecular Diagnostics, ICMR-National Institute of Cancer Prevention and Research, Ministry of Health & Family Welfare, Noida, India.
| | - Sabia Rashid
- Queen Elizabeth Hospital & King's College Hospital, Stadium Road, London, United Kingdom.
| | - Shazia Rashid
- Centre for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida, Uttar Pradesh, India.
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3
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Tesfaye B, Tilahun T, Dechasa Heyi W, Oljira R. Associated factors of positive visual inspection of cervix with acetic acid test among women screened for cervical cancer at public health facilities in Woliso town, Southwest Shoa, Ethiopia: A case-control study. SAGE Open Med 2022; 10:20503121221108227. [PMID: 35814309 PMCID: PMC9260562 DOI: 10.1177/20503121221108227] [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: 03/16/2022] [Accepted: 05/25/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives: Screening for precancerous cervical lesions and providing access to effective
treatment can significantly improve the likelihood of survival. To identify
associated factors of positive visual inspection of the cervix with acetic
acid test for precancerous cervical lesions among women screened for
cervical cancer at public health facilities in Woliso Town, Southwest Shoa,
Ethiopia. Methods: A facility-based unmatched case–control study was conducted on 86 cases and
172 controls. Cases were women who had a positive result for the visual
inspection of the cervix with acetic acid test, and controls were women with
a negative result. Data were collected using a pretested structured
questionnaire and organized using SPSS version 20. Descriptive analysis and
logistic regressions were performed. The adjusted odds ratio with a 95%
confidence interval was used, and statistical significance was declared at
p-value <0.05. Results: The study found that women aged 40–44 years (adjusted odds ratio = 4.11, 95%
confidence interval (1.20–14.50)), greater or equal to five deliveries
(adjusted odds ratio = 2.78, 95% confidence interval (1.39–5.56)), age at
first birth less than 20 (adjusted odds ratio = 5.45, 95% confidence
interval (1.41–21.04), age at first sexual intercourse less than 18
(adjusted odds ratio = 4.73, 95%, confidence interval (1.79–12.48)), ever
used condom (adjusted odds ratio = 11.06, 95% confidence interval
(3.93–31.14), having a history of sexually transmitted diseases (adjusted
odds ratio = 4.05, 95% confidence interval (2.15–7.76), having a history of
multiple sexual partners (adjusted odds ratio = 4.81, 95% confidence
interval (1.37–16.90)), and being human immunodeficiency virus positive
(adjusted odds ratio = 3.85, 95% confidence interval (1.68–8.83)) were
associated factors of positive visual inspection with acetic acid test for
precancerous cervical lesions. Conclusion: Given the above-associated factors of positive visual inspection with acetic
acid test for precancerous cervical lesions, the health facilities should
target women with these factors and timely screen them with the application
of acetic acid on the cervix.
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Affiliation(s)
- Bahiru Tesfaye
- Public Health Expert, MEAL Regional Project, Save the Children, Ambo, Ethiopia
| | - Temesgen Tilahun
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Worku Dechasa Heyi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Rut Oljira
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Tekalegn Y, Sahiledengle B, Woldeyohannes D, Atlaw D, Degno S, Desta F, Bekele K, Aseffa T, Gezahegn H, Kene C. High parity is associated with increased risk of cervical cancer: Systematic review and meta-analysis of case-control studies. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221075904. [PMID: 35114865 PMCID: PMC8819811 DOI: 10.1177/17455065221075904] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Cervical cancer is the fourth most common cancer among women. High parity has
long been suspected with an increased risk of cervical cancer. Evidence from
the existing epidemiological studies regarding the association between
parity and cervical cancer is variable and inconsistent. Therefore, the
objective of this systematic review and meta-analysis was to synthesize the
best available evidence on the epidemiological association between parity
and cervical cancer. Methods: Case–control studies reporting the association between parity and cervical
cancer were systematically searched in databases like MEDLINE/PubMed,
HINARI, Google scholar, Science direct, and Cochrane Libraries. All studies
fulfilling the inclusion criteria and published between 2000 and 7 March
2020 were included in this meta-analysis. This study reported according to
PRISMA guideline. Cochran’s Q-statistics and
I2 tests were performed to assess
heterogeneity among included studies. Egger’s regression analysis was
performed to assess publication bias. A random-effect meta-analysis model
was used to compute pooled odds ratio of the association between parity and
cervical cancer. Results: A total of 6685 participants (3227 patients and 3458 controls) were
incorporated in the 12 studies included in this meta-analysis. The
meta-analysis revealed that women with high parity had 2.65 times higher
odds of developing cervical cancer compared to their counterparts (odds
ratio = 2.65, 95% confidence interval = 2.08–3.38). Conclusion: High parity is positively associated with cervical cancer. Strong
epidemiological studies are recommended to further explore the mechanisms
and role of parity in the causation of cervical cancer.
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Affiliation(s)
- Yohannes Tekalegn
- Department of Public Health, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Biniyam Sahiledengle
- Department of Public Health, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Demelash Woldeyohannes
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, School of Medicine, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Sisay Degno
- Department of Human Anatomy, School of Medicine, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Fikreab Desta
- Department of Public Health, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Kebebe Bekele
- Department of Surgery, School of Medicine, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Tesfaye Aseffa
- Department of Nursing, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Habtamu Gezahegn
- Department of Human Physiology, School of Medicine, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Chala Kene
- Department of Midwifery, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
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Manzanares-Leal GL, Coronel-Martínez JA, Rodríguez-Morales M, Rangel-Cuevas I, Bustamante-Montes LP, Sandoval-Trujillo H, Ramírez-Durán N. Preliminary Identification of the Aerobic Cervicovaginal Microbiota in Mexican Women With Cervical Cancer as the First Step Towards Metagenomic Studies. Front Cell Infect Microbiol 2022; 12:838491. [PMID: 35186803 PMCID: PMC8847610 DOI: 10.3389/fcimb.2022.838491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/13/2022] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer (CC) is considered a public health problem. Recent studies have evaluated the possible relationship between the cervicovaginal microbiome and gynecologic cancer but have not studied the relationship between aerobic bacterial communities and neoplasia. The study aimed to identify the cultivable aerobic bacterial microbiota in women with cervical cancer as a preliminary approach to the metagenomic study of the cervicovaginal microbiome associated with cervical cancer in Mexican women. An observational cross-sectional study was conducted, including 120 women aged 21-71 years, divided into two study groups, women with locally advanced CC (n=60) and women without CC (n=60). Sociodemographic, gynecological-obstetric, sexual, and habit data were collected. Cervicovaginal samples were collected by swabbing, from which standard microbiological methods obtained culturable bacteria. The strains were genetically characterized by PCR-RFLP of the 16S rRNA gene and subsequently identified by sequencing the same gene. Variables regularly reported as risk factors for the disease were found in women with CC. Differences were found in the prevalence and number of species isolated in each study group. Bacteria commonly reported in women with aerobic vaginitis were identified. There were 12 species in women with CC, mainly Corynebacterium spp. and Staphylococcus spp.; we found 13 bacterial species in the group without cancer, mainly Enterococcus spp. and Escherichia spp. The advanced stages presented a more significant number of isolates and species. This study provided a preliminary test for cervicovaginal metagenomic analysis, demonstrating the presence of aerobic cervicovaginal dysbiosis in women with CC and the need for more in-depth studies.
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Affiliation(s)
- Gauddy Lizeth Manzanares-Leal
- Laboratory of Medical and Environmental Microbiology, School of Medicine, Universidad Autonoma del Estado de Mexico, Toluca, Mexico
| | | | | | - Iván Rangel-Cuevas
- Gynecology Department, Maternal and Child Hospital, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico
| | | | - Horacio Sandoval-Trujillo
- Department of Biological Systems, Universidad Autonoma Metropolitana-Xochimilco, Mexico City, Mexico
| | - Ninfa Ramírez-Durán
- Laboratory of Medical and Environmental Microbiology, School of Medicine, Universidad Autonoma del Estado de Mexico, Toluca, Mexico
- *Correspondence: Ninfa Ramírez-Durán,
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Total Antioxidant Capacity and Lipid Peroxidation Status in Cervical Cancer Patients Compared with Women Without Cervical Cancer in Bangladesh. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00560-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract
Purpose
Over the past several decades, research has suggested reactive oxygen species act as cofactors for cervical cancer development. The aim of this study is to evaluate the antioxidant and lipid peroxidation status in cervical cancer patients in Bangladesh.
Methods
From December 2017 to 2018, a cross-sectional observational study was conducted on 50 cervical cancer patients and 50 controls. Plasma levels of lipid peroxidation and total antioxidant capacity were measured. The Student’s t test was used for statistical analysis. P values less than 0.05 were taken as a level of significance.
Results
There was a significant reduction in total antioxidant levels in patients with cervical cancer, 972.77 ± 244.22 SD µmol equivalent to ascorbic acid/L, compared to normal controls, 1720.13 ± 150.81 SD µmol equivalent to ascorbic acid/L (P < 0.001). Levels of lipid peroxidation were found to be significantly higher in cervical cancer, 7.49 ± 2.13 SD µmol/L, than in women without cervical cancer, 3.28 ± 0.58 SD µmol/L (P < 0.001). The cervical cancer patients had significantly higher levels of oxidative stress index (0.83 ± 0.31) in comparison to controls (0.19 ± 0.04) (P < 0.001).
Conclusion
There was an increased oxidative stress index due to imbalance between lipid peroxidation generation and total antioxidant capacity in cervical cancer patients. Further studies are needed to explore the role of oxidative stress as a cofactor for cervical carcinogenesis.
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7
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Pandey A, Chandra S, Nautiyal R, Shrivastav V. Expression of p16 INK4a and human papillomavirus 16 with associated risk factors in cervical premalignant and malignant lesions. South Asian J Cancer 2020; 7:236-239. [PMID: 30430091 PMCID: PMC6190388 DOI: 10.4103/sajc.sajc_118_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Human papilloma virus (HPV) which is causative factor for cervical cancer may interact with p16 leading to malignant transformation of cervical epithelial cells. The present study was conducted to assess the immunoexpression of p16 INK4a in premalignant and malignant lesions of cervix and to correlate it with HPV 16 expression. It was also intended to study the various risk factors which may be associated with cervical cancer in this north Himalayan region of India. Material and Methods: The study included 50 cases of premalignant and malignant cervical lesions and 50 controls diagnosed on histopathology over a period of one year. All the relevant clinical details were noted and both cases and controls were subjected to HPV 16 and p16 INK4a immunohistochemical staining. Results: 67% of subjects (including cases and controls) and 94% of the cases were positive for HPV 16 expression. p16 INK4a expression was negative in all the controls, positive in 96% of invasive cancer, 66.6% in HSIL and 37.5% in LSIL. Conclusion: Cervical cancer is associated with low socio economic status, illiteracy, smoking, early age of marriage and conception in north Himalayan region of India. HPV 16 infection is positive in both cases and controls indicating high prevalence of HPV 16 in this region. Neoplastic transformation by HPV is identified by over expression of p16 INK4a in premalignant and malignant cases. The immunopositivity of p16 INK4a increases with the severity of cervical lesions and thus may play an important role in stratification of premalignant and malignant lesions.
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Affiliation(s)
- Abha Pandey
- Department of Pathology, Himalaya Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Smita Chandra
- Department of Pathology, Himalaya Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Ruchira Nautiyal
- Department of Obstetrics and Gynaecology, Himalaya Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Vikas Shrivastav
- Department of Pathology, Himalaya Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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8
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Medina-Jiménez AK, Monroy-Torres R. Repurposing Individualized Nutritional Intervention as a Therapeutic Component to Prevent the Adverse Effects of Radiotherapy in Patients With Cervical Cancer. Front Oncol 2020; 10:595351. [PMID: 33364195 PMCID: PMC7754884 DOI: 10.3389/fonc.2020.595351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022] Open
Abstract
Worldwide, cervical cancer was the fourth leading cause of cancer death among women, while in Mexico was the second cause (5.28%). Cancer patients receiving chemotherapy and radiotherapy have a high risk of malnutrition secondary to the disease and treatment, affects the patient's overall, with adverse effects on gastrointestinal symptoms. These use affects the medical therapy. The aim of the present study was to evaluate the benefits on individualized nutritional therapy on decrease weight loss and gastrointestinal adverse effects and to consider these outcomes in pharmacology research, especially in repurposing drugs. We conducted a longitudinal design with two comparation groups with medical diagnosis of cervical cancer and received radiotherapy weekly, 1) the intervention group (nutritional intervention and counseling -INC-) with 20 participants and 2) control group (retrospective cohort -CG-) with 9 participants. Weekly body composition, dietary intake, adverse effects (gastrointestinal symptoms), glucose, hemoglobin, and blood pressure were analyzed during 4 to 5 weeks. Both groups had weight loss weekly (p = 0.013 and p = 0.043 respectively) but the CG vs INC presented loss fat-free mass ≥500g in 67 and of 37% respectively. By the end of the intervention a 25% of the INC group had <10 g/dL of hemoglobin vs 60% for the CG. To compare the dietary intake of vitamins (A and folic acid), fiber (p = 0.006), iron (p = 0.03) and energy (mainly carbohydrates) (p = 0.04) were according to the recommendations in INC group (p>0.05). The number needed to treat was 4 (95% CI, 2 to 13). The nutritional intervention and counseling weekly during radiotherapy in cervical cancer to maintain/improve muscle mass, hemoglobin, and dietary intake above 70% of the recommendations for INC group compared to the evidence. Adequate nutritional status was maintained and decrease the rate of complications, mainly gastrointestinal symptoms, in INC group. The efficacy of drug repurposing can improve through individualized nutritional therapy for preventing adverse effects of radiotherapy in patients with cervical cancer.
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Affiliation(s)
- Ana Karen Medina-Jiménez
- Laboratory of Environmental Nutrition and Food Safety, Medicine and Nutrition Department, University of Guanajuato, Guanajuato, Mexico
- Observatorio Universitario de Seguridad Alimentaria y Nutricional del Estado de Guanajuato, Guanajuato, Mexico
| | - Rebeca Monroy-Torres
- Laboratory of Environmental Nutrition and Food Safety, Medicine and Nutrition Department, University of Guanajuato, Guanajuato, Mexico
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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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10
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Lohia N, Prashar M, Singh S, Bhatnagar S, Viswanath S, Anand S, Ranjan R. Epidemiological and Survival Trends in Patients of Cancer of Uterine Cervix Treated with Definitive Concurrent Chemoradiotherapy: Observations from a North Indian Hospital-Based Cancer Registry. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0288-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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11
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Shin SS, Carpenter CL, Ekstrand ML, Wang Q, Grover S, Zetola NM, Yadav K, Sinha S, Nyamathi AM. Cervical cancer awareness and presence of abnormal cytology among HIV-infected women on antiretroviral therapy in rural Andhra Pradesh, India. Int J STD AIDS 2019; 30:586-595. [PMID: 30813859 DOI: 10.1177/0956462419825950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cervical cancer is a leading cause of death among women in low- and middle-income countries, and women living with HIV are at high risk for cervical cancer. The objective of this study was to estimate the prevalence and correlates of cervical cancer and pre-cancer lesions and to examine cervical cancer knowledge among women living with HIV receiving antiretroviral therapy in rural Andhra Pradesh, India. We conducted cytology-based screening and administered a standardized questionnaire among 598 HIV-infected women. We found 5 (0.8%), 39 (6.5%), 29 (4.9%), and 4 (0.7%) had atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and squamous cervical carcinoma (SCC), respectively. In multivariable logistic regression analysis, ASCUS/LSIL was independently associated with age >16 years old at first sexual encounter and smokeless tobacco use. We found no factors associated with HSIL/SCC. In total, 101 women (16.9%) had heard of cervical cancer and 28 (27.7%) of them correctly identified HIV infection as a risk factor. In light of the high prevalence of pre-cancer lesions and low level of cervical cancer knowledge in our study population, focused interventions are needed to improve cervical cancer literacy and prevention among rural women living with HIV.
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Affiliation(s)
- Sanghyuk S Shin
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | | | - Maria L Ekstrand
- 3 Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Qiao Wang
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Surbhi Grover
- 4 Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,5 Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Nicola M Zetola
- 4 Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,5 Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Kartik Yadav
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Sanjeev Sinha
- 6 Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Adeline M Nyamathi
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
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Yogi V, Mandloi V, Singh O, Ahirwar M, Yadav S, Ghori HU. A comparative study of nab-paclitaxel versus cisplatin concurrent chemoradiotherapy in locally advanced cervical cancer. CLINICAL CANCER INVESTIGATION JOURNAL 2019. [DOI: 10.4103/ccij.ccij_59_19] [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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13
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Khanna D, Khargekar N, Budukh A. Knowledge, attitude, and practice about cervical cancer and its screening among community healthcare workers of Varanasi district, Uttar Pradesh, India. J Family Med Prim Care 2019; 8:1715-1719. [PMID: 31198742 PMCID: PMC6559093 DOI: 10.4103/jfmpc.jfmpc_143_19] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Context: Cervical cancer is most common type of cancer in women of rural India. More than 60-70% of cancers are diagnosed in later stages with poor survival rate. Screening helps in early detection of cervical cancer and better survival. Awareness and attitude of women towards cervical cancer screening may determine health-seeking behavior. As per operational framework of cancer screening in India, community health workers will be key mobilizers for encouraging women to undergo cervical cancer screening. Aim: This study aims to assess the knowledge, attitude and practice (KAP) of cervical cancer and its screening amongst community health workers of Varanasi district, Uttar Pradesh. Settings and Design: Descriptive, cross-sectional study was done to assess the socio demographic profile and KAP for cervical cancer and its screening of community health workers. Scoring for awareness and attitude for cervical cancer screening was done. Statistical Analysis Used: Descriptive statistics such as mean±SD, frequency and proportion were used for socio-demographic data and KAP of study population. Determinants of knowledge and practice for screening was determined using Chi-square test. P value < 0.05 was considered statistically significant. Results: We observed that despite of good knowledge and perception less than 10 percent of workers have undergone screening. Significant association was seen between level of knowledge and practice of screening. Conclusion: It is of utmost importance that narrowing of existing gap between the perception and practice of cervical cancer screening should be initiated through introducing more educational programs for workers and encouraging them to participate in screening campaigns.
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Affiliation(s)
- Divya Khanna
- Department of Preventive Oncology, Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, Uttar Pradesh, India
| | - Naveen Khargekar
- Department of Preventive Oncology, Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, Uttar Pradesh, India
| | - Atul Budukh
- Center for Cancer Epidemiology, Tata Memorial Center, Mumbai, Maharashtra, India
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A study on risk factors of cervical cancer among patients attending a tertiary care hospital: A case-control study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2018. [DOI: 10.1016/j.cegh.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Level and determinants of precancerous symptoms of cervical cancer in unscreened population of Uttar Pradesh and Rajasthan, India: A pilot study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2017. [DOI: 10.1016/j.cegh.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Implementing community-based cervical cancer screening programs using visual inspection with acetic acid in India: A systematic review. Cancer Epidemiol 2017; 49:161-174. [PMID: 28704717 DOI: 10.1016/j.canep.2017.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 11/20/2022]
Abstract
The objective of this review was to systematically appraise the existing published literature about community-based cervical cancer screening programs that have used visual inspection methods using acetic acid (VIA) in India. All peer reviewed journal articles till December 2015 were searched per PRISMA guidelines. Articles reporting results from cervical cancer screening programs in community-based settings, conducted in India, and using VIA were included in this review. The search resulted in 20 articles to be included in the review with a total of 313,553 women at 12 unique urban and rural sites across India. Seventeen (85%) studies were cross-sectional and three studies were randomized controlled trials; most studies compared accuracy of VIA with other screening tests such as visual inspection using Lugol's Iodine (VILI), HPV DNA, and cytology. Of studies that reported test accuracy for CIN Grade 2+, the VIA sensitivity values ranged from 16.6-82.6% and specificity ranged from 82.1-96.8%. Women between age groups of 30-59 years were recruited using motivational one-on-one counseling and local support staff. All studies conducted diagnostic follow-up using colposcopy and guided biopsies, when necessary. Three major themes were identified that facilitated implementation of screening programs in a community-based setting: standardized training that maintained competency of test providers; collaborations with community-based organizations that used health education for recruitment of participants; and employing the screen-and-treat method to reduce loss to follow-up. Summarized evidence presented in this review could substantially influence future implementation and sustainment of cervical cancer screening programs at a national level.
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Dahiya N, Bachani D, Acharya AS, Sharma DN, Gupta S, Haresh KP. Socio-Demographic, Reproductive and Clinical Profile of Women Diagnosed with Advanced Cervical Cancer in a Tertiary Care Institute of Delhi. J Obstet Gynaecol India 2017; 67:53-60. [PMID: 28242969 PMCID: PMC5306097 DOI: 10.1007/s13224-016-0907-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/12/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cervical cancer is one of the leading cancers among Indian women with estimated 123,000 new cases and 67,477 deaths in 2012. Cervical cancer is a multi-etiological disease. Factors such as low socioeconomic status, tobacco use, sexual and reproductive factors, HIV and other sexually transmitted diseases and long-term oral contraceptive use have been suggested as determinants. Assessment of socio-demographic profile and reproductive history gives a better picture of the determinants of cervical carcinoma in low-resource settings. METHODS This hospital-based cross-sectional study was undertaken at a tertiary healthcare institute at New Delhi, India. Sixty-seven newly diagnosed women with advanced cervical cancer (stage 2B-4B), who were undertaking radio- and/or chemotherapy, were included to assess their socio-demographic, reproductive and clinical profile. RESULTS The mean age of women at the time of detection of cervical cancer was 52.28 ± 11.29 years (range 30-75 years). More than 60 % of patients were illiterate and belonged to middle socioeconomic status. Thirty-nine percentage of the study subjects had their first sexual experience before 15 years of age. Nearly 54 % women had 5 or more pregnancies. Nearly 73 % of women had all deliveries at home. Majority (69 %) of women had symptoms suggestive of reproductive tract infection. Among them, unusual discharge from vagina (73.13 %) followed by bleeding after menopause (55.10 %) and pain in abdomen (44.77 %) were the most common presenting complaints. Pallor was present in nearly two-third (63.93 %) study subjects. More than half (56.72 %) study subjects had moderate anemia, and 7.46 % had severe anemia before treatment. Mean hemoglobin level of the study subjects was 10.35 ± 1.72 gm% before treatment and 9.69 ± 1.29 gm% after treatment. This difference was statistically significant. Around 97 % of the study subjects had squamous cell carcinoma of the cervix. Majority (53.73 %) of the study subjects were in stage 3B of cervical cancer. Combination of radiotherapy and chemotherapy was the most common (77.67 %) modality of treatment. CONCLUSIONS AND RECOMMENDATIONS Illiteracy, low socioeconomic status, early sexual debut, high fertility, home delivery, reproductive tract infections, use of insanitary clothes during menstruation and anemia were observed in majority of women with advanced cancer cervix. Presence of these factors indicates possible risk of cervical cancer and should be kept in mind when women seek health services. Early diagnosis through high risk or opportunistic screening and timely management of cervical cancer needs to be ensured for better outcomes.
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Affiliation(s)
- Neha Dahiya
- Department of Community Medicine, Lady Hardinge Medical College & Associated Hospitals, New Delhi, 110001 India
| | - Damodar Bachani
- Department of Community Medicine, Lady Hardinge Medical College & Associated Hospitals, New Delhi, 110001 India
| | - Anita S. Acharya
- Department of Community Medicine, Lady Hardinge Medical College & Associated Hospitals, New Delhi, 110001 India
| | - D. N. Sharma
- Department of Radiation Oncology, IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - K. P. Haresh
- Department of Radiation Oncology, IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Dykens JA, Linn AM, Irwin T, Peters KE, Pyra M, Traoré F, Touré Diarra M, Hasnain M, Wallner K, Linn P, Ndiaye Y. Implementing visual cervical cancer screening in Senegal: a cross-sectional study of risk factors and prevalence highlighting service utilization barriers. Int J Womens Health 2017; 9:59-67. [PMID: 28184171 PMCID: PMC5291333 DOI: 10.2147/ijwh.s115454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Senegal ranks 15th in the world in incidence of cervical cancer, the number one cause of cancer mortality among women in this country. The estimated participation rate for cervical cancer screening throughout Senegal is very low (6.9% of women 18-69 years old), especially in rural areas and among older age groups (only 1.9% of women above the age of 40 years). There are no reliable estimates of the prevalence of cervical dysplasia or risk factors for cervical dysplasia specific to rural Senegal. The goals of this study were to estimate the prevalence of cervical dysplasia in a rural region using visual inspection of the cervix with acetic acid (VIA) and to assess risk factors for cervical cancer control. PATIENTS AND METHODS We conducted a cross-sectional study in which we randomly selected 38 villages across the Kédougou region using a three-stage clustering process. Between October 2013 and March 2014, we collected VIA screening results for women aged 30-50 years and cervical cancer risk factors linked to the screening result. RESULTS We screened 509 women; 5.6% of the estimated target population (9,041) in the region. The point prevalence of cervical dysplasia (positive VIA test) was 2.10% (95% confidence interval [CI]: 0.99-3.21). Moreover, 287 women completed the cervical cancer risk factor survey (56.4% response rate) and only 38% stated awareness of cervical cancer; 75.9% of the screened women were less than 40 years of age. CONCLUSION The overall prevalence of dysplasia in this sample was lower than anticipated. Despite both overall awareness and screening uptake being less than expected, our study highlights the need to address challenges in future prevalence estimates. Principally, we identified that the highest-risk women are the ones least likely to seek screening services, thus illustrating a need to fully understand demand-side barriers to accessing health services in this population. Targeted efforts to educate and motivate older women to seek screenings are needed to sustain an effective cervical cancer screening program.
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Affiliation(s)
- J Andrew Dykens
- Department of Family Medicine, College of Medicine; Center for Global Health; Institute for Health Research and Policy; Cancer Center, Hospital and Health Sciences System, University of Illinois at Chicago, IL, USA
| | - Annē M Linn
- Master's International Graduate School Program, Peace Corps, Dakar, Senegal; Rutgers School of Nursing, Newark, NJ
| | | | - Karen E Peters
- School of Public Health, University of Illinois at Chicago, IL, USA
| | - Maria Pyra
- School of Public Health, University of Illinois at Chicago, IL, USA
| | - Fatoumata Traoré
- Regional Ministry of Health and Social Affairs, Kédougou, Senegal
| | | | - Memoona Hasnain
- Department of Family Medicine, College of Medicine; Foundation for Advancement of International Medical Education and Research, Philadelphia, PA, USA
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Jain A, Ganesh B, Bobdey SC, Sathwara JA, Saoba S. Sociodemographic and Clinical Profile of Cervical Cancer Patients Visiting in a Tertiary Care Hospital in India. Indian J Med Paediatr Oncol 2017; 38:291-295. [PMID: 29200676 PMCID: PMC5686969 DOI: 10.4103/ijmpo.ijmpo_20_16] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Cancer of the cervix is the most common genital tract malignancy in the female and is a major public health problem in the developing countries. Study of the sociodemographic and clinical profile of patients is the first step in planning control measures and treatment facilities. Aims The aims of the study were to determine the sociodemographic and clinical profile of cervical cancer patients and study their association with other tumor-related factors. Settings and Design This is a record-based retrospective study from a single institution. Subjects and Methods The data on sociodemographic and clinical factors of 765 cervical cancer patients visited and treated at tertiary care cancer hospital in Mumbai in 1 year period were analyzed. Statistical Analysis Data were analyzed using descriptive statistics. Kruskal-Wallis and Chi-square test were used to assess relationship between variables. Results The median age of the cohort was 54 years and interquartile range was 16 years. Nearly 53.6% of patients were illiterate. About 88.10% of patient's had squamous cell carcinoma. Only 13% of cases had early stage disease and 77% of patient's had not taken any treatment before coming to the hospital. Of the total, about 26% patients also had concomitant comorbidities, of which hypertension was found to be the leading comorbid condition. Stage of disease was found to be significantly (P < 0.05) associated with age and educational status. Conclusion This study highlights certain important baseline characteristics of cervical cancer patients. This basic information on profile of patients can help plan and optimum utilization of hospital services, especially in resource-poor countries like India.
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Affiliation(s)
- Aanchal Jain
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Balasubramaniam Ganesh
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Saurabh C Bobdey
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jignasa A Sathwara
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sushma Saoba
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Muwonge R, Ngo Mbus L, Ngoma T, Gombe Mbalawa C, Dolo A, da Ganda Manuel M, Nouhou H, Nacoulma M, Mwaiselage J, Koulibaly M, Bayo S, Nsonde Malanda J, De Vuyst H, Herrero R, Sankaranarayanan R, Keita N. Socio-demographic and reproductive determinants of cervical neoplasia in seven sub-Sahara African countries. Cancer Causes Control 2016; 27:1437-1446. [PMID: 27822586 DOI: 10.1007/s10552-016-0823-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since most human papilloma virus (HPV) infections regress without any intervention, HPV is a necessary but may not be a solely sufficient cause of cervical intraepithelial neoplasia (CIN) and cervical cancer. Hence, the influence of cofactors on progression from cervical HPV infection to high-grade CIN and invasive cervical cancer has been a subject of intensive research. OBJECTIVE We assessed the effect of socio-demographic and sexual reproductive factors on the prevalence of invasive cervical cancer and CIN diagnosed in cross-sectional cervical cancer screening projects carried out in seven sites of different sub-Saharan countries. METHODS Between January 2000 and August 2007, healthy women aged 25-59 who participated in the screening projects were interviewed for socio-demographic, reproductive, and behavioral characteristics, investigated for disease confirmation with colposcopy, and had biopsies directed from colposcopically abnormal areas by trained local physicians. Odds ratios (ORs) and their 95% confidence intervals (CIs) from logistic regression analyses were used to assess the effect of women characteristics on CIN 1, CIN 2-3, CIN 3, and invasive cancer outcome measures. RESULTS Among 47,361 women screened and investigated for disease confirmation, CIN 1 was diagnosed in 1,069 (2.3%), CIN 2 in 517 (1.1%), CIN 3 in 175 (0.5%), and invasive cancer in 485 (1.0%). The site-specific prevalence of CIN 2-3 lesions ranged from 0.3 to 5.1% and from 0.2 to 1.9% for invasive cancers. Risk factors for CIN 2-3 were being widowed or separated versus currently married (OR 1.3, 95% CI 1.0-1.7 a); and having had at least four pregnancies versus zero or one pregnancy (OR at least 1.4-fold, 95% CI 1.1-1.8). Risk factors for invasive cancer were being widowed or separated versus currently married (OR 2.0, 95% CI 1.3-3.1); and having had at least three pregnancies versus zero or one pregnancy (OR at least 3.0-fold, 95% CI 2.1-4.2). Additionally, cervical cancer risk increased with increasing age, age at menarche, and age at marriage, while the risk decreased with increasing level of education and in those with some form of employment compared to housewives. CONCLUSION The exposure of the exocervix and/or the increased levels of estrogen and progesterone for more prolonged periods during pregnancy in multiparous women and the vulnerability of widowed/separated women in society might result in increased risk of cervical neoplasia more so among women exposed to HPV infection. High parity probably explains the persistently high rates of cervical cancer in sub-Saharan Africa.
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Affiliation(s)
- Richard Muwonge
- Screening Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France.
| | - Louise Ngo Mbus
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Twalib Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Amadou Dolo
- Département de Gynécologie-Obstétrique, Hôpital Gabriel Touré, Bamako, Mali
| | | | - Hassan Nouhou
- Faculté des Sciences de la Santé, Université de Niamey, Niamey, Niger
| | - Marius Nacoulma
- Département de Gynécologie-Obstétrique, Centre Hospitalier National Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Julius Mwaiselage
- Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | - Moussa Koulibaly
- Centre National d'Anatomie Pathologique, CHU Donka, Conakry, Guinea
| | | | | | - Hugo De Vuyst
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Rengaswamy Sankaranarayanan
- Screening Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Namory Keita
- Service de Gynécologie/Obstétrique, CHU Donka, Conakry, Guinea
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Strategies for reducing risk of cervical cancer in adolescents in developing countries – A view point. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2016. [DOI: 10.1016/j.injms.2015.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Misra JS, Srivastava AN, Das V. Single life time cytological screening in high risk women as an economical and feasible approach to control cervical cancer in developing countries like India. Asian Pac J Cancer Prev 2015; 16:859-62. [PMID: 25735373 DOI: 10.7314/apjcp.2015.16.3.859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In view of funding crunches and inadequate manpower in cytology in developing countries like India, single lifetime screening for cervical cancer has been suggested. In this study, an attempt was made to identify high risk groups of women for this screening to make it more effective for early detection. Cytological data were derived from the ongoing routine cervical cytology screening program for women attending Gynaecology Out Patient Department of Queen Mary's Hospital of K.G.Medical University, Lucknow, India during a span of 35 years (April 1971 - December 2005). Cervical smears in a total of 38,256 women were cytologically evaluated. The frequencies of squamous intraepithelial lesions of cervix (SIL) and carcinoma cervix were found to be 7.0% and 0.6%, respectively, in the series. Predisposing factors related to cervical carcinogenesis were analyzed in detail to establish the most vulnerable groups of women for single life time screening. The incidence of SIL and carcinoma cervix was found to be maximal in women above the age of 40 years irrespective of parity and in multiparous women (with three or more children) irrespective of age. The incidence of cervical cytopathologies was significantly higher in symptomatic women, the frequency of SIL being alarmingly higher in women complaining of contact bleeding and that of carcinoma cervix in older women with postmenopausal bleeding. It is consequently felt that single life time screening must include the three groups of women delineated above. Such selective screening appears to be the most economical, cost effective and feasible approach to affordably control the menace of cervical cancer in developing countries like India.
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Affiliation(s)
- Jata Shankar Misra
- Department of Pathology, Era's Lucknow Medical College, Lucknow, India E-mail :
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Nandi M, Mandal A, Asthana AK. Retrospective analysis of patients with cancer of the cervix attending a radiotherapy outpatient department: experience from a university-based hospital in eastern Uttar Pradesh, India. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2015. [DOI: 10.1080/20742835.2015.1083680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Onsuz MF, Hidiroglu S, Sarioz A, Metintas S, Karavus M. Knowledge, attitudes and behaviors of women over 20 years old on cervix cancer in Istanbul, Turkey. Asian Pac J Cancer Prev 2015; 15:8801-7. [PMID: 25374211 DOI: 10.7314/apjcp.2014.15.20.8801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of the study was to evaluate knowledge, attitudes and behaviors of Turkish women over 20 years old on cervix cancer. MATERIALS AND METHODS This descriptive study was performed at a primary care center covering 246 women using a questionnaire composed of 3 sections and 38 questions. The data were analyzed using descriptive statistics, chi-square test in univariate analysis and multivariate hierarchical logistic regression analysis. RESULTS Of the 93.7% women who knew about cervical cancer, 68.0% of them had heard pap smear test and 46.1% had actually undergone a Pap smear once or more throughout their lives. According to the results of the hierarchical logistic regression analysis about factors affecting the Pap smear test; in Model 1, increase in age and education levels, in Model 2 and Model 3 increase in age and cervical cancer information points were determined. The most important information source for cervical cancer was TV-radio/media (59.9%) and health care workers (62.8%) for pap smear test. CONCLUSIONS Although most women have heard of cervical cancer, knowledge about cervical cancer and also Pap smear screening rate are significantly lower. Having Pap smear test for women was affected by age and knowledge level about cervical cancer. Informing women about cervical cancer would be an important intervention.
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Aggarwal R, Misra S, Guleria C, Suri V, Mangat N, Sharma M, Nijhawan R, Minz R. Characterization of Toll-like receptor transcriptome in squamous cell carcinoma of cervix: A case-control study. Gynecol Oncol 2015; 138:358-62. [PMID: 26024767 DOI: 10.1016/j.ygyno.2015.05.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/23/2015] [Accepted: 05/25/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Human papillomavirus (HPV) is a proven etiological agent for cervical cancer However, not all HPV infections result in cervical cancer. The mechanisms of host immune system to prevent/control HPV infection remain poorly understood. Toll-like receptors (TLRs) are a system of innate immune defense. HPV has been demonstrated to modulate TLR expression and interfere in TLR signaling pathways, leading to persistent viral infection and carcinogenesis. The aim was to study the relative gene expression of TLRs in cervical squamous cell carcinoma (SCC). METHODS Gene expression profile of TLRs 1 to 9 was examined in 30 cervical SCCs and an equal number of normal cervical tissue samples using a PCR array platform. Gene expression studies for TLRs 3 and 7 were validated by western blotting. RESULTS HPV was detected in all cases and in none of the controls (p<0.0001). HPV16 was the preponderant (83.3%) subtype. A significant downregulation in the relative gene expression of TLR3 (p<0.0001), TLR4 (p<0.0005) and TLR5 (p<0.0001) was observed in cases. A significant upregulation for TLR1 was observed (p=0.006). Although TLRs 2, 7, 8 and 9 were upregulated and TLR6 was downregulated, it was not significant. The western blot performed with antibodies against TLRs 3 and 7 confirmed the findings of the gene expression studies. CONCLUSIONS A significant downregulation in the gene expression of TLRs 3, 4 and 5 and upregulation of TLR1 was observed in cervical SCC as compared to controls. Study results evoke the proposition for investigating TLRs 3, 4 and 5 agonists for therapeutic exploration.
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Affiliation(s)
- Ritu Aggarwal
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sunayana Misra
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Charu Guleria
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navdeep Mangat
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhulika Sharma
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Raje Nijhawan
- Department of Cytology and Gynecologic Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjana Minz
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Cervical cancer is on the declining trend in India according to the population-based registries; yet it continues to be a major public health problem for women in India. Multifactorial causation, potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. This paper attempts to review the available knowledge regarding the epidemiology and pattern of cervical cancer; types of HPV (human papilloma virus) prevalent among cervical cancer patients and among women in general, high-risk groups such as commercial sex workers, and HIV (human immunodeficiency virus)-positive women; and the role of the national program on cancer in control efforts. The peak age of incidence of cervical cancer is 55-59 years, and a considerable proportion of women report in the late stages of disease. Specific types of oncogenic HPV-16, 18 have been identified in patients with cervical cancer. Other epidemiological risk factors are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness. A multipronged approach is necessary which can target areas of high prevalence identified by registries with a combination of behavior change communication exercises and routine early screening with VIA. Sensitizing the people of the area, including menfolk, is necessary to increase uptake levels. Vaccination against types 16 and 18 can also be undertaken after taking into confidence all stakeholders, including the parents of adolescent girls. Preventing and treating cervical cancer and reducing the burden are possible by targeting resources to the areas with high prevalence.
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Affiliation(s)
- Aswathy Sreedevi
- Community Medicine, AIMS, Kochi, Amrita Vishwa Vidyapeetham, Kerala, India
| | - Reshma Javed
- Community Medicine, AIMS, Kochi, Amrita Vishwa Vidyapeetham, Kerala, India
| | - Avani Dinesh
- Community Medicine, AIMS, Kochi, Amrita Vishwa Vidyapeetham, Kerala, India
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Tao L, Han L, Li X, Gao Q, Pan L, Wu L, Luo Y, Wang W, Zheng Z, Guo X. Prevalence and risk factors for cervical neoplasia: a cervical cancer screening program in Beijing. BMC Public Health 2014; 14:1185. [PMID: 25410572 PMCID: PMC4256817 DOI: 10.1186/1471-2458-14-1185] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 11/06/2014] [Indexed: 11/26/2022] Open
Abstract
Background Cervical cancer is the second most common cancer and cause of cancer-related death for women worldwide. The aims of this study were to investigate the prevalence of cervical neoplasia and examine factors associated with high-grade cervical squamous intraepithelial lesions (HSIL) among women taking part in a cervical cancer screening program in Beijing. Methods Women aged 25–65 years were screened using the ThinPrep cytologic test and gynecologic examination. Univariate and multivariate logistic regressions were conducted to investigate factors associated with HSIL. Results Among 728,704 women screened, the prevalence of cervical intraepithelial neoplasia (CIN) I, II, III was 50.2, 34.0, and 36.4 per 100,000, respectively. Prevalence of cervical cancer was 12.2 per 100,000. Risk factors for HSIL included being in age group of 46–55 years (adjusted odds ratio [aOR] = 1.15, 95% CI: 1.07–1.44, compared with the 25–35 age group), bleeding after intercourse (aOR = 2.08, 95% CI: 1.40–3.10), and presence of trichomonas vaginalis infection (aOR = 2.62, 95% CI: 1.35–5.07), cervical inflammation (aOR = 4.22, 95% CI: 3.39–5.26), and genital warts (aOR = 3.89, 95% CI: 2.54–7.70). High education level (college and above compared with junior middle school or lower) was found to be protective (aOR = 0.79, 95% CI: 0.37–0.90). Conclusions The prevalence of cervical neoplasia is relatively high in Beijing. Women aged 46–55 years, those with a lower education level, those reporting bleeding after intercourse, and those affected by Trichomonas vaginalis infection, cervical inflammation and genital warts are at higher risk for HSIL. Particular efforts should be made to ensure these women are included in cervical cancer screening programs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Xiuhua Guo
- School of Public Health, Capital Medical University, Beijing, China.
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Antic LG, Vukovic DS, Vasiljevic MD, Antic DZ, Aleksopulos HG. Differences in risk factors for cervical dysplasia with the applied diagnostic method in Serbia. Asian Pac J Cancer Prev 2014; 15:6697-701. [PMID: 25169511 DOI: 10.7314/apjcp.2014.15.16.6697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the etiology of cervical cancer not only HPV infection is important, but also other factors such as demographic influences and sexual and reproductive health attitudes, as well as others related to preventive measure usage (or non usage). The aim of this study was to examine factors associated with cervical dysplasia in asymptomatic women who were examined by routine cytology and cervical biopsy for early detection of cervical cancer. MATERIALS AND METHODS Socio-demographic and other characteristics were obtained from medical files of 85 examinees with pathologic cytologic findings (Pap test) and histopathologic (HP) findings after biopsy. RESULTS According to the Pap test result, a greater probability for development of cervical dysplasia was noted with examinees having a larger number of sexual partners (OR= 5.01, 95% CI 1.04-24.10), and those who are afraid of the Pap finding. Risk factors for development of cervical dysplasia according to the bioptic finding were early beginning with sexual activities, presence of any STD in personal medical history and fear of the Pap test finding. CONCLUSIONS The only risk factor found to be important for both methods was fear of the Pap testing finding.
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Affiliation(s)
- Ljiljana Gojko Antic
- Department for Medical Nurses-Midwives, College of Health Studies in Cuprija, Cuprija, Serbia E-mail :
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López-Hernández D. Epidemiological association between body fat percentage and cervical cancer: a cross-sectional population-based survey from Mexico. Arch Med Res 2013; 44:454-8. [PMID: 24051040 DOI: 10.1016/j.arcmed.2013.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Various studies have reported a direct association of cervical cancer risk with obesity and weight but not with the body fat percentage (BFP). The aim of this study was to analyze various anthropometric measures as potential risk factors for cervical cancer. METHODS A total of 20,236 women were included in a cross-sectional population-based survey. Obesity was defined according to the World Health Organization criteria, and central obesity was ≥80 cm; the BFP was defined using the Deurenberg equation (BFP = 1.2 [BMI] + 0.23 [age] - 10.8 [sex] - 5.4). The odds ratio (OR) was estimated from the chi square test and logistic regression models. RESULTS The prevalence of cervical cancer increased from 514 (95% confidence interval [CI] 321, 707) and 680 (95% CI 494, 866) to 732 (95% CI 535, 928) per 100,000 inhabitants in subjects with a normal weight, subjects who were overweight and subjects who were obese, respectively. Moreover, an association between cervical cancer and BFP (OR 1.027; CI 95% 1.006, 1.048; p = 0.012) was observed, and the risk increased with a BFP ≥45% (OR 2.369; CI 95% 1.284, 4.369; p = 0.006). CONCLUSIONS These data suggest a trend between the body mass index and the increasing prevalence of cervical cancer. In addition, the data showed a significant association between the BFP and cervical cancer, and this epidemiological association was higher as the BFP increased.
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Rejoinder: Need for a data-driven discussion on the socioeconomic patterning of cardiovascular health in India. Int J Epidemiol 2013; 42:1438-43. [DOI: 10.1093/ije/dyt181] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Eze JN, Emeka-Irem EN, Edegbe FO. A six-year study of the clinical presentation of cervical cancer and the management challenges encountered at a state teaching hospital in southeast Nigeria. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2013; 7:151-8. [PMID: 23843724 PMCID: PMC3700941 DOI: 10.4137/cmo.s12017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cervical cancer is still a major contributor to cancer-related mortality amongst women living in poor, rural communities of developing countries. The objective of this study is to establish the clinical presentation of cervical cancer and the management challenges encountered in Abakaliki, southeast Nigeria, with a view to finding intervention strategies. This study is a retrospective descriptive assessment of cases of clinically diagnosed cervical cancer managed at a state teaching hospital over six years. Of 76 cases managed, 61 (80.3%) cases notes were available for study. The mean age and parity of patients were 53.8 years and 6.8 years, respectively. The majority (75.4%) were illiterate. All had been married, but 42.6% were widowed. The main occupations were farming or petty trading. One patient (1.6%) had had a single Pap smear in her life. The major presenting complaints were abnormal vaginal bleeding (86.9%), offensive vaginal discharge (41.0%), and weight loss. Twenty patients (32.8%) were lost to follow-up prior to staging. Of the remaining 41 patients, 16 (39.0%) had stage III disease and 17.1% stage IV. Fifteen patients (24.6%) with late stage disease accepted referral, and were referred for radiotherapy. Those who declined were discharged home on request, though 4 (9.8%) died in the hospital. There was no feedback from referred patients confirming that they went and benefitted from the referral. The presentation followed known trends. Illiteracy, poverty, early marriages, high parity, widowhood, non-use of screening methods, late presentation, non-acceptance of referral, and lack of communication after referral were some of the major challenges encountered. These underscore the needs for health education and awareness creation, women educational and economic empowerment, legislation against early marriages and in protection of widows, and creation of a well-staffed and well-equipped dedicated gynecologic oncology unit to forestall further referral.
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Affiliation(s)
- Justus N Eze
- Department of Obstetrics and Gynaecology, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria. ; Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaiki, Ebonyi State, Nigeria
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Das D, Rai AK, Kataki AC, Barmon D, Deka P, Sharma JD, Sarma A, Shrivastava S, Bhattacharyya M, Kalita AK, Sharma M, Ahmed S. Nested Multiplex PCR Based Detection of Human Papillomavirus in Cervical Carcinoma Patients of North- East India. Asian Pac J Cancer Prev 2013; 14:785-90. [DOI: 10.7314/apjcp.2013.14.2.785] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kritpetcharat O, Wutichouy W, Sirijaichingkul S, Kritpetcharat P. Comparison of Pap smear screening results between Akha hill tribe and urban women in Chiang Rai province, Thailand. Asian Pac J Cancer Prev 2013; 13:5501-4. [PMID: 23317207 DOI: 10.7314/apjcp.2012.13.11.5501] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Cervical cancer is an important woman's health problems worldwide, especially in low socio-economic countries. The aim of this study was to compare the Pap smear screening results between Akha hill tribe and urban women who live in Chiang Rai province, Thailand. Screening was conducted for 1,100 Akha women and 1,100 urban women who came to have the Pap smear at Chiangrai Prachanukroh Hospital and 1 private cytology laboratory from January to June 2008. The demographic characteristics and factors related to abnormal Pap smears of these women were gathered using closed model questionnaires. Abnormal Rap smears were defined according to the Bethesda 2001 system. The results showed that the prevalence of abnormal Pap smears was 12.2% in Akha women and 4.5% in urban women. The highest prevalence of Pap abnormalities was found in the 41-50 years age group in both populations (4.5% in Akha and 1.7% in urban women). In both populations, abnormal Pap smears were found in <21 years age groups. From the questionnaires, the possible risk factors related to the higher prevalence of abnormal Pap smears in Akha women were early age at marriage (≤17 years), high frequency pregnacies and high parity and no/low education level. In conclusion, cervical cancer control by education and early detection by Pap smear screening is necessary for hill tribe women. More Pap smear screening service units should be set to improve the coverage for the risk group women who got married in young age, especial in ethnic groups.
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Affiliation(s)
- Onanong Kritpetcharat
- Department of Pathology, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
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