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Mahmoud I, Al Eid MMA, Mohamed MA, Aladwani AJ, El Amin NEM. Human papillomavirus vaccination and Pap test uptake, awareness, and barriers among young adults in Gulf Cooperation Council countries: A comparative cross-sectional survey. J Infect Public Health 2024; 17:102525. [PMID: 39243689 DOI: 10.1016/j.jiph.2024.102525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/10/2024] [Accepted: 08/22/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination and Pap tests are recognized as effective preventive measures to reduce the incidence of HPV-related diseases among young adults. The objective of this study was to assess HPV vaccination and Pap test uptake, awareness, and barriers among young adults in the Gulf Cooperation Council (GCC) countries, including Bahrain, Kuwait, Oman, Qatar, the Kingdom of Saudi Arabia (KSA), and the United Arab Emirates (UAE). METHODS A comparative cross-sectional study was conducted from January to April 2024, involving 831 young adults aged 18-39 residing in GCC countries. The main outcome measures were HPV vaccination and Pap test uptake rates, awareness of the HPV vaccine and Pap testing, and barriers to vaccination. Data were collected using online platforms. The Chi-square test and Fisher's exact test were used for data analysis. RESULTS The UAE had the highest vaccination rate at 18.9% (50/264), followed by Qatar at 5.8% (6/104), and KSA at 4.6% (10/216), p < 0.001. Individuals with health insurance had higher vaccination rates than those without (11% vs. 5.4%, p = 0.006). Awareness of the HPV vaccine was highest in the UAE (49.6%) and KSA (58.8%), while awareness of Pap smear testing among females was similarly high in these countries (62.4% and 65.9%, respectively). However, actual Pap smear testing rates were highest in Bahrain (15.9%) and Qatar (13.4%). The main barriers to vaccination cited by participants were lack of knowledge (53.6%) and the absence of medical recommendations (13.2%). CONCLUSION The study's findings suggest the need of targeted educational campaigns to increase HPV vaccine uptake among both genders and Pap test participation among females. Additionally, incorporating HPV screening and vaccination into routine national programs in GCC countries and emphasising the crucial role of healthcare providers in influencing vaccination decisions are recommended strategies.
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Affiliation(s)
- Ibrahim Mahmoud
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
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Kassa RN, Shifti DM, Alemu K, Omigbodun AO. Integration of cervical cancer screening into healthcare facilities in low- and middle-income countries: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003183. [PMID: 38743652 PMCID: PMC11093339 DOI: 10.1371/journal.pgph.0003183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/11/2024] [Indexed: 05/16/2024]
Abstract
Cervical cancer is a prevalent disease among women, especially in low- and middle-income countries (LMICs), where most deaths occur. Integrating cervical cancer screening services into healthcare facilities is essential in combating the disease. Thus, this review aims to map evidence related to integrating cervical cancer screening into existing primary care services and identify associated barriers and facilitators in LMICs. The scoping review employed a five-step framework as proposed by Arksey and O'Malley. Five databases (MEDLINE, Maternity Infant Care, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were systematically searched. Data were extracted, charted, synthesized, and summarised. A total of 28 original articles conducted in LMICs from 2000 to 2023 were included. Thirty-nine percent of the reviewed studies showed that cervical cancer screening (CCS) was integrated into HIV clinics. The rest of the papers revealed that CCS was integrated into existing reproductive and sexual health clinics, maternal and child health, family planning, well-baby clinics, maternal health clinics, gynecology outpatient departments, and sexually transmitted infections clinics. The cost-effectiveness of integrated services, promotion, and international initiatives were identified as facilitators while resource scarcity, lack of skilled staff, high client loads, lack of preventive oncology policy, territorial disputes, and lack of national guidelines were identified as barriers to the services. The evidence suggests that CCS can be integrated into healthcare facilities in LMICs, in various primary care services, including HIV clinics, reproductive and sexual health clinics, well-baby clinics, maternal health clinics, and gynecology OPDs. However, barriers include limited health system capacity, workload, waiting times, and lack of coordination. Addressing these gaps could strengthen the successful integration of CCS into primary care services and improve cervical cancer prevention and treatment outcomes.
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Affiliation(s)
- Rahel Nega Kassa
- Pan African University Life and Earth Sciences Institute (including Health and Agriculture), University of Ibadan, Ibadan, Oyo State, Nigeria
- School of Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Akinyinka O. Omigbodun
- College of Medicine, University of Ibadan, University College Hospital, Ibadan, Oyo State, Nigeria
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Huang J, Chan SC, Fung YC, Pang WS, Mak FY, Lok V, Zhang L, Lin X, Lucero-Prisno DE, Xu W, Zheng ZJ, Elcarte E, Withers M, Wong MCS. Global incidence, risk factors and trends of vulvar cancer: A country-based analysis of cancer registries. Int J Cancer 2023; 153:1734-1745. [PMID: 37531169 DOI: 10.1002/ijc.34655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 08/03/2023]
Abstract
Vulvar cancer is an uncommon malignancy. Vulvar cancer alarmed the public health problem in terms of the cost of diagnostic and medical treatments and psychical health of females. Our study aims to provide a thorough analysis of the global disease burden, related risk factors and temporal incidence trends of vulvar cancer in population subgroups. Data from Global Cancer Observatory and the Cancer Incidence in Five Continents Plus were used for the vulvar cancer incidence. Age-standardized rates (ASR) were used to depict the incidence of vulvar cancer. The 10-year trend of incidence was assessed using joinpoint regression with average annual percentage change and 95% confidence intervals in various age groups, while its correlations with risk factors were investigated using linear regression. Higher ASR were found in Western Europe (2.4), Northern America (1.9), Northern Europe (1.9), Australia and New Zealand (1.8) and Eastern Africa (1.4). The associated risk factors of higher vulvar cancer incidence were gross domestic product per capita, Human Development Index, higher prevalence of smoking, alcohol drinking, unsafe sex and human immunodeficiency virus infection. The overall trend of vulvar cancer incidence was increasing. An increasing trend was found in older females while a mixed trend was observed in younger females. The disease burden of vulvar cancer follows a bimodal pattern according to its two histologic pathways, affecting women in both developed and developing regions. Smoking cessation, sex education and human papillomavirus vaccination programs should be promoted among the general population. Subsequent studies can be done to explore the reasons behind the increasing trend of vulvar cancer.
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Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sze Chai Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yat Ching Fung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wing Sze Pang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fung Yu Mak
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Veeleah Lok
- Department of Global Public Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Lin Zhang
- Suzhou Industrial Park Monash Research Institute of Science and Technology, China
- The School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Xu Lin
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Wanghong Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Edmar Elcarte
- College of Nursing, University of the Philippines, Manila, Philippines
| | - Mellissa Withers
- Department of Population and Health Sciences, Institute for Global Health, University of Southern California, Los Angeles, California, USA
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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Seoud M, Jaafar I, Hamadeh R, Ammar W, Atallah D, El-Kak F. Feasibility of implementing cytology-based cervical cancer screening national program in Lebanon: A pilot study. Int J Gynaecol Obstet 2023; 161:86-92. [PMID: 36183305 DOI: 10.1002/ijgo.14489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review our national cervical cancer screening program using existing Ministry of Public Health primary healthcare centers (PHCs) and report the impact of women's knowledge, attitude, behavior, and practices on screening uptake and outcome. METHODS A cross-sectional study on cervical cancer screening offered to sexually active Lebanese women aged 21 years and above visiting PHCs. Exclusions were history of complete hysterectomy, gynecologic cancers, and current pregnancy. Data were collected through a questionnaire and conventional cervical smear performed by trained healthcare providers and sent to one centralized cytopathology laboratory. RESULTS Of 12 273 eligible women, 1.7% had an abnormal cervical smear test including 161 atypical squamous cells (ASC) of undetermined significance, 6 atypical glandular cells of undetermined significance, 16 low-grade squamous intraepithelial lesion (SIL), 17 ASC-cannot rule out high-grade SIL, 11 high-grade SIL, and one invasive carcinoma. Knowledge and attitudes significantly affected participation in screening; women lacking awareness had rarely undergone a cervical smear. CONCLUSION In Lebanon, cytology-based cervical cancer screening is feasible within the PHCs. Positive screen incidence was low. Despite previous campaigns, a low level of knowledge persists, and affects women's com with the screening guidelines. Advocacy and awareness activities by key healthcare providers may help to improve participation.
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Affiliation(s)
- Muhieddine Seoud
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.,Sheikh Shakhbout Medical City-Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Iman Jaafar
- Epidemiology Department, Cancer Center, Scientific Institute of Public Health, Brussels, Belgium
| | | | | | - David Atallah
- Department of Obstetrics and Gynecology, Hotel Dieu de France, Beirut, Lebanon
| | - Faysal El-Kak
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Seoud M, Jaafar I, Ghanem R, Soubhieh C, Adra A, Nassar A, Khalil A. Outcomes of Human Papilloma Virus Vaccination in a Private Women Health Clinic in Lebanon. Obstet Gynecol Int 2022; 2022:7342061. [PMID: 36274656 PMCID: PMC9581706 DOI: 10.1155/2022/7342061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives The study aims to report on the feasibility and associated adverse events of HPV-Vaccination (HPVV) in a private clinic setting in Lebanon and, when available, the results of subsequent cervical cancer screening. Methods Opportunistic HPV vaccination is offered at the Women's Health Center of the AUBMC. We retrospectively reviewed the patients' demographic data, the incidence of adverse events, and their cytological screening. Results A cohort of healthy women (n = 1013) aged 26.2 years (12-54 years) were opportunistically vaccinated with one of two HPV vaccines; 845 (83.4%) received the quadrivalent vaccine (Q4V), and 151 (14.1%) received the bivalent vaccine (B2V). The majority (75.8%) received three doses while 16% received two doses. Out of these women, 26.3% (267) became sexually active postvaccination (NS2), whereas 17% (174) were sexually active prior to vaccination (SA) and the rest 57% (572) reported no sexual activity (NS1). Among the SA group, 26% (46/147) presented with abnormal cytology at time of vaccination. As for the NS2 women, 5% (14/267) had subsequently abnormal screening within 37 (12-103) months following vaccination. Conclusions In this observational study, we report the successful introduction of HPVV with negligible adverse events. The incidence of abnormal cervical cytology was low among our patients.
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Affiliation(s)
- Muhieddine Seoud
- American University of Beirut Medical Center (AUBMC), Department of Obstetrics and Gynecology, Beirut, Lebanon
| | - Iman Jaafar
- American University of Beirut Medical Center (AUBMC), Department of Obstetrics and Gynecology, Beirut, Lebanon
| | - Rayan Ghanem
- American University of Beirut Medical Center (AUBMC), Department of Obstetrics and Gynecology, Beirut, Lebanon
| | - Christiane Soubhieh
- American University of Beirut Medical Center (AUBMC), Department of Obstetrics and Gynecology, Beirut, Lebanon
| | - Abdallah Adra
- American University of Beirut Medical Center (AUBMC), Department of Obstetrics and Gynecology, Beirut, Lebanon
| | - Anwar Nassar
- American University of Beirut Medical Center (AUBMC), Department of Obstetrics and Gynecology, Beirut, Lebanon
| | - Ali Khalil
- American University of Beirut Medical Center (AUBMC), Department of Obstetrics and Gynecology, Beirut, Lebanon
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Arechkik A, Lahlou L, Obtel M, Kharbach A, Razine R. Cervical cancer in Morocco: A systematic review. Rev Epidemiol Sante Publique 2022; 70:230-242. [DOI: 10.1016/j.respe.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/13/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022] Open
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Dalla V, Panagiotopoulou EK, Deltsidou A, Kalogeropoulou M, Kostagiolas P, Niakas D, Labiris G. Level of Awareness Regarding Cervical Cancer Among Female Syrian Refugees in Greece. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:717-727. [PMID: 32959214 DOI: 10.1007/s13187-020-01873-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
Nowadays, prevention, control and treatment of cervical cancer are a worldwide public health priority. Primary objective of this study was to evaluate the level of awareness of female Syrian refugees who have recently settled in Greece regarding the warning signs and the risk factors of cervical cancer. This is a descriptive, cross-sectional study that was conducted in two facilities of the Hellenic Red Cross. The Cervical Cancer Awareness Measure questionnaire was addressed to 176 female Syrian refugees, aged between 18 and 50. Syrian women presented low awareness both for risk factors and warning signs. The most frequently identified warning signs were vaginal bleeding after menopause (44.3%), vaginal bleeding between menstruation (34.1%) and unexplained weight loss (32.4%). Regarding the risk factors' recognition rates, 74.5% considered the existence of many sexual partners as a risk factor and 61.3% the existence of a sexual partner with many previous sexual partners. Older age, a higher level of education and confidence that any potential symptom would be identified were associated with increased awareness. Our findings confirm former published reports that indicate poor awareness regarding cervical cancer among refugee populations. Full compliance with the guidelines of the World Health Organization for a national cervical cancer screening programme is highly advised in Greece and should address the needs of both native and refugee populations. This research is the first one that underlines the need for raising awareness of cervical cancer among female Syrian refugees in Greece by developing health promotion strategies adjusted to their unique cultural needs.
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Affiliation(s)
- Vasiliki Dalla
- Faculty of Social Sciences, Hellenic Open University, Patras, Greece.
| | | | - Anna Deltsidou
- Faculty of Social Sciences, Hellenic Open University, Patras, Greece
- Department of Midwifery, University of West Attica, Athens, Greece
| | | | - Petros Kostagiolas
- Faculty of Social Sciences, Hellenic Open University, Patras, Greece
- Department of Archives, Library Science and Museology, School of Information Science and Informatics, Ionian University, Corfu, Greece
| | - Dimitris Niakas
- Faculty of Social Sciences, Hellenic Open University, Patras, Greece
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Labiris
- Faculty of Social Sciences, Hellenic Open University, Patras, Greece
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Bartlett R, Robinson T, Anand J, Negussie F, Simons Smith J, Boyle JA. Empathy and journey mapping the healthcare experience: a community-based participatory approach to exploring women's access to primary health services within Melbourne's Arabic-speaking refugee communities. ETHNICITY & HEALTH 2022; 27:584-600. [PMID: 32116007 DOI: 10.1080/13557858.2020.1734780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
Objectives: This community-based participatory research focused on physical and social barriers to healthcare for refugee women in Melbourne, Australia.Design: Women from non-English speaking backgrounds explored the meaning and impact of their health journeys through group surveys, Photovoice and GIS go-alongs. This empathy-building research also explored acceptability, desirability and feasibility of mHealth solutions to improve access to primary healthcare services.Results: Refugee women reported low utilisation of preventive healthcare services including limited awareness of cervical or breast screening.Conclusions: Phone ownership and health information searches online indicate mHealth solutions are feasible and acceptable to improve healthcare access, literacy and autonomy within this population.
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Affiliation(s)
- Rebeccah Bartlett
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Tracy Robinson
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
- School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Orange, Australia
| | - Jennifer Anand
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Fekir Negussie
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jessica Simons Smith
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
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Bennacef AC, Khodja AA, Abou-Bekr FA, Ndao T, Holl R, Benčina G. Costs and Resource Use Among Patients with Cervical Cancer, Cervical Intraepithelial Neoplasia, and Genital Warts in Algeria. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:31-38. [PMID: 35224126 PMCID: PMC8820946 DOI: 10.36469/jheor.2022.31049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
Background: Cervical cancer rates in North Africa have risen in the last 10 years, suggesting that this region might benefit from cervical cancer screening and HPV vaccination programs. To assess the potential benefits of cervical cancer screening and HPV vaccination in North African countries, country-specific data on the prevalence and burden of HPV-related conditions are needed. Objectives: To describe the patterns and estimate the costs of management of cervical cancer, cervical intraepithelial neoplasia (CIN), and genital warts in Algeria. Methods: This was a descriptive analysis of questionnaire data obtained from a panel of 15 oncologists, gynecologists, and dermatologists (n=5 each). Data on diagnostic and treatment patterns, recurrence, and healthcare resource use (HCRU) were obtained. The costs (in Algerian dinars) associated with diagnosis, treatment, and recurrence were estimated. Results: Diagnosis of CIN was obtained by cytology tests or lesion biopsies; for cervical cancer, lesion biopsies, MRI, and CT scans were the most common diagnostic tests. For CIN, 70% of gynecologists and/or oncologists regularly or always used conization as a treatment. Treatments used regularly or always for cervical cancer included chemotherapy (80%), hysterectomy (70%), and radiation (70%). Annual HCRU per institution included 20 outpatient visits and 15 hospitalizations for CIN, and 50 outpatient visits and 11 hospitalizations for cervical cancer. For genital warts, diagnostic tests performed regularly or always included assays for hepatitis B, hepatitis C, HIV, and syphilis; cervical cytology; and colposcopy. Cryotherapy was the universal first-line treatment. Median per-patient costs associated with diagnosis, treatment, and recurrence were 6750, 19 750, and 77 750, respectively, for CIN; 53 750, 650 000, and 431 250, respectively, for cervical cancer; and 16 075, 15 500, and 9250, respectively, for genital warts. Discussion: These results give an estimate of the HCRU and cost of cervical cancer, CIN, and genital warts and highlight the need to assess more precisely the epidemiology of these diseases in Algeria. Conclusions: This study investigated the management of patients with cervical cancer, CIN, or genital warts in Algeria and provided the first estimates of diagnosis and treatment patterns, HCRU, and costs associated with these conditions. These resource use and cost estimates highlight the need to develop prevention strategies for HPV-related pathologies.
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Affiliation(s)
| | | | | | | | - Ryan Holl
- Merck Sharp & Dohme International GmbH, Kriens, Switzerland
| | - Goran Benčina
- Center for Observational and Real-world Evidence, Merck Sharp & Dohme, Madrid, Spain
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Zhao M, Wu Q, Hao Y, Hu J, Gao Y, Zhou S, Han L. Global, regional, and national burden of cervical cancer for 195 countries and territories, 2007-2017: findings from the Global Burden of Disease Study 2017. BMC Womens Health 2021; 21:419. [PMID: 34922503 PMCID: PMC8684284 DOI: 10.1186/s12905-021-01571-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 12/13/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Cervical cancer is one of the most common cancers among women worldwide. The formulation or evaluation on prevention strategies all require an accurate understanding of the burden for cervical cancer burden. We aimed to report the up-to-date estimates of cervical cancer burden at global, regional, and national levels. METHODS Data were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 study. The counts, age-standardized rates, and percentage changes of incidence, disability-adjusted life-years (DALYs), and death attributed to cervical cancer at the global, regional, and national levels in all 195 countries and territories from 21 regions during 2007 to 2017 by age and by Socio-demographic Index (SDI) were measured. All estimates were reported with 95% uncertainty intervals (UIs). RESULTS In 2017, 601,186 (95% UI 554,455 to 625,402) incident cases of cervical cancer were reported worldwide, which caused 8,061,667 (7,527,014 to 8,401,647) DALYs and 259,671 (241,128 to 269,214) deaths. The age-standardized rates for incidence, DALYs and death decreased by - 2.8% (- 7.8% to 0.6%), - 7.1% [- 11.8% to - 3.9%] and - 6.9% [- 11.5% to - 3.7%] from 2007 to 2017, respectively. The highest age-standardized incidence, DALYs and death rates in 2017 were observed in the low SDI quintile, Oceania, Central and Eastern Sub-Saharan Africa. During 2007 to 2017, only East Asia showed increase in these rates despite not significant. At the national level, the highest age-standardized rates for incidence, DALYs, and death in 2017 were observed in Kiribati, Somalia, Eritrea, and Central African Republic; and Georgia showed the largest increases in all these rates during 2007 to 2017. CONCLUSION Although the age-standardized rates for incidence, DALYs, and death of cervical cancer have decreased in most parts of the world from 2007 to 2017, cervical cancer remains a major public health concern in view of the absolute number of cervical cancer cases, DALYs, and deaths increased during this period. The challenge is more prone to in the low SDI quintile, Oceania, Central and Eastern Sub-Saharan Africa, East Asia, and some countries, suggesting an urgent to promote human papillomavirus vaccination in these regions.
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Affiliation(s)
- Miaomiao Zhao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanhua Hao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jingcen Hu
- Department of Global Health, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China
| | - Yuexia Gao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Shan Zhou
- Department of Endocrinology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
| | - Liyuan Han
- Department of Global Health, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China.
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Safaeian F, Ghaemimood S, El-Khatib Z, Enayati S, Mirkazemi R, Reeder B. Burden of Cervical Cancer in the Eastern Mediterranean Region During the Years 2000 and 2017: Retrospective Data Analysis of the Global Burden of Disease Study. JMIR Public Health Surveill 2021; 7:e22160. [PMID: 33978592 PMCID: PMC8156112 DOI: 10.2196/22160] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/27/2020] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cervical cancer is a growing health concern, especially in resource-limited settings. OBJECTIVE The objective of this study was to assess the burden of cervical cancer mortality and disability-adjusted life years (DALYs) in the Eastern Mediterranean Region (EMR) and globally between the years 2000 and 2017 by using a pooled data analysis approach. METHODS We used an ecological approach at the country level. This included extracting data from publicly available databases and linking them together in the following 3 steps: (1) extraction of data from the Global Burden of Disease (GBD) study in the years 2000 and 2017, (2) categorization of EMR countries according to the World Bank gross domestic product per capita, and (3) linking age-specific population data from the Population Statistics Division of the United Nations (20-29 years, 30-49 years, and >50 years) and GBD's data with gross national income per capita and globally extracted data, including cervical cancer mortality and DALY numbers and rates per country. The cervical cancer mortality rate was provided by the GBD study using the following formula: number of cervical cancer deaths × 100,000/female population in the respective age group. RESULTS The absolute number of deaths due to cervical cancer increased from the year 2000 (n=6326) to the year 2017 (n=8537) in the EMR; however, the mortality rate due to this disease decreased from the year 2000 (2.7 per 100,000) to the year 2017 (2.5 per 100,000). According to age-specific data, the age group ≥50 years showed the highest mortality rate in both EMR countries and globally, and the age group of 20-29 years showed the lowest mortality rate both globally and in the EMR countries. Further, the rates of cervical cancer DALYs in the EMR were lower compared to the global rates (2.7 vs 6.8 in 2000 and 2.5 vs 6.8 in 2017 for mortality rate per 100,000; 95.8 vs 222.2 in 2000 and 86.3 vs 211.8 in 2017 for DALY rate per 100,000; respectively). However, the relative difference in the number of DALYs due to cervical cancer between the year 2000 and year 2017 in the EMR was higher than that reported globally (34.9 vs 24.0 for the number of deaths and 23.5 vs 18.1 for the number of DALYs, respectively). CONCLUSIONS We found an increase in the burden of cervical cancer in the EMR as per the data on the absolute number of deaths and DALYs. Further, we found that the health care system has an increased number of cases to deal with, despite the decrease in the absolute number of deaths and DALYs. Cervical cancer is preventable if human papilloma vaccination is taken and early screening is performed. Therefore, we recommend identifying effective vaccination programs and interventions to reduce the burden of this disease.
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Affiliation(s)
- Fereshteh Safaeian
- Public Health Graduate Studies, The Bahá'í Institute for Higher Education, Tehran, Iran
| | - Shidrokh Ghaemimood
- Public Health Graduate Studies, The Bahá'í Institute for Higher Education, Tehran, Iran
| | - Ziad El-Khatib
- World Health Programme, Université du Québec en Abitibi-Témiscamingue, Québec, QC, Canada
| | - Sahba Enayati
- Internal Medicine and Cardiology, Kompetenzcenter Gesundheit, St Stephan, Wels, Austria
| | - Roksana Mirkazemi
- Public Health Graduate Studies, The Bahá'í Institute for Higher Education, Tehran, Iran
| | - Bruce Reeder
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
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Ali SM, Clark MT, Khedher Ghalib A, Skirton H, Donaldson C. "We don't have up to date knowledge about the disease" Practical challenges encountered in delivery of cervical cancer screening in Iraq. Eur J Cancer Care (Engl) 2021; 30:e13457. [PMID: 33932055 DOI: 10.1111/ecc.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
This qualitative study aimed to explore the lived experience of medical doctors in delivering cervical cancer screening in a city in Iraq. METHODS An applied grounded theory approach explored the reported experiences of doctors in the field. A purposive sample of 12 gynaecologists and one general practitioner (GP) working in two main hospitals participated: Semi-structured interviews took place from June to September 2015. Thematic coding of data was peer reviewed and included participant reading of transcripts and translations from Arabic to English. Theory generation involved synthesis of a prior literature review and interview findings. RESULTS Gynaecologist and GP experiences showed overwhelming gaps in cervical cancer experience and screening. Iraqi women mainly presented for help with late-stage cancer. Practical barriers included cultural stigma, low priority for women's health needs, lack of knowledgeable leadership and perceived shortage of adequately trained staff. CONCLUSION There is an urgent need for culturally appropriate cervical cancer prevention policies and strategies in Iraq, focused on evidence-based population-based cervical screening to identify and prevent advanced cervical cancer among women. Regional educational initiatives should be encouraged and primary healthcare systems supported to undertake screening.
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Affiliation(s)
| | - Maria T Clark
- Department of Post Qualifying Practice, Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | | | - Heather Skirton
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Craig Donaldson
- School of Biomedical Sciences, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
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Alsous MM, Ali AA, Al-Azzam SI, Abdel Jalil MH, Al-Obaidi HJ, Al-Abbadi EI, Hussain ZK, Jirjees FJ. Knowledge and awareness about human papillomavirus infection and its vaccination among women in Arab communities. Sci Rep 2021; 11:786. [PMID: 33436959 PMCID: PMC7804285 DOI: 10.1038/s41598-020-80834-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/18/2020] [Indexed: 11/14/2022] Open
Abstract
Cervical cancer (CC) is one of the most common types of cancer that affect females worldwide with hundreds of thousands of women dying annually due to this disease, mainly in developing countries. Infection with human papillomavirus (HPV) is the main risk factor for this cancer. There are no public awareness and national immunization programs in most Arab countries. This study aimed to investigate the knowledge and awareness about the HPV vaccine among females in four Arab countries and their acceptance to receive the vaccine. A cross-sectional study was conducted in several Arab countries: Jordan, Qatar, the United Arab Emirates (UAE), and Iraq. Respondents that fulfilled the desired criteria and were willing to participate in the study were asked to fill out the survey. Knowledge and awareness were assessed using 13 questions. Ethical approvals were given from the four countries. A total of 3658 individuals participated in the study; however, 2804 responses were included in the analysis and more than one third of participants (n = 1007) were aged between 18 and 25 years old. This study revealed poor awareness and knowledge of the participants about HPV and its vaccine among all four countries' participants with relatively better knowledge among participants from the UAE. Participants who are younger (18-25 years old), have a postgraduate education, have an education or career related to the medical field, or had a Pap smear in the last three years tend to have higher knowledge about the HPV vaccine compared to others. Poor knowledge and awareness findings in this study were expected, considering the lack of public education campaigns regarding the HPV virus coupled with the absence of the HPV vaccination from the national immunization schedule in three participating countries (Jordan, Qatar, and Iraq). It is recommended that there is a need to provide national educational campaigns about the HPV vaccine to the public in all Arab populations.
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Affiliation(s)
- Mervat M Alsous
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan.
| | - Ahlam A Ali
- Medical Biology Centre, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Sayer I Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mariam H Abdel Jalil
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Hala J Al-Obaidi
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Esraa I Al-Abbadi
- Qatar National Cancer Registry, National Cancer Program, Ministry of Public Health, Doha, Qatar
| | - Zainab K Hussain
- Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq
| | - Feras J Jirjees
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
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14
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Kassie AM, Abate BB, Kassaw MW, Aragie TG, Geleta BA, Shiferaw WS. Impact of knowledge and attitude on the utilization rate of cervical cancer screening tests among Ethiopian women: A systematic review and meta-analysis. PLoS One 2020; 15:e0239927. [PMID: 33290426 PMCID: PMC7723289 DOI: 10.1371/journal.pone.0239927] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Cervical cancer is a major public health problem, particularly in resource-limited settings. The use of vaccination and screening tests has reduced the burden of cervical cancer in developed countries. However, the situation is quite the reverse in developing countries, including Ethiopia. Hence, this study aimed to estimate the pooled impact of knowledge and attitude on the prevalence of cervical cancer screening service utilization rates among Ethiopian women. METHODS Studies that examined cervical cancer screening service utilization among women in Ethiopia were searched from five international databases. Cochran's Q chi-square and the I-squared test statistics were used to check the presence of heterogeneity among the included studies. The funnel plot and Egger's regression tests were also used to assess the presence of publication bias. A weighted DerSimonian and Laird random-effects model was employed. Subgroup analysis was performed by the study population concerning the prevalence of cervical cancer screening service utilization rates. Sensitivity analysis was also conducted to assess the effect of a single study on the pooled estimates. Data analysis was performed using STATA™ Version 14 software. RESULTS A total of 44 studies with 28,186 study participants were included. The estimated pooled prevalence of cervical cancer screening service utilization was 8.11% (95% CI: 7.26, 8.97). After adjustment for publication bias with the trim and fill analysis, the estimated prevalence rate appeared to be 5.47% (95% CI: 4.66, 6.28). The prevalence of cervical cancer screening service utilization was higher among HIV-positive women, 16.85%, and in studies conducted among health care workers, 10.24%, than the general population. The pooled effect of knowledge on the utilization of cervical cancer screening tests among Ethiopian women was statistically significant (AOR = 3.20, 95% CI: 1.63, 6.31). Similarly, the pooled estimated odds of utilizing cervical cancer screening tests were 6.1 times higher (AOR = 6.09, 95% CI: 1.09, 34.36) among women who had a favorable attitude towards the screening tests. CONCLUSION Knowledge and attitude had a significant impact on the prevalence of cervical cancer screening test utilization rates among women in Ethiopia. However, the prevalence of cervical cancer screening service utilization among Ethiopian women is very low. Hence, large-scale awareness programs and situation-based strategies need to be designed to increase the uptake of cervical cancer screening services in the country.
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Affiliation(s)
- Ayelign Mengesha Kassie
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Mesfin Wudu Kassaw
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Teshome Gebremeskel Aragie
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Bonsa Amsalu Geleta
- Department of Nursing, College of Health Sciences, Metu University, Metu, Oromia Regional State, Ethiopia
| | - Wondimeneh Shibabaw Shiferaw
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Amhara Regional State, Ethiopia
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15
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Liverani CA, Di Giuseppe J, Giannella L, Delli Carpini G, Ciavattini A. Cervical Cancer Screening Guidelines in the Postvaccination Era: Review of the Literature. JOURNAL OF ONCOLOGY 2020; 2020:8887672. [PMID: 33204265 PMCID: PMC7661145 DOI: 10.1155/2020/8887672] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/09/2020] [Accepted: 10/24/2020] [Indexed: 12/15/2022]
Abstract
Cervical cancer is relatively rare in high-income countries, where organized screening programs are in place, as well as opportunistic ones. As the human papillomavirus (HPV) vaccination rates increase, the prevalence of cervical precancers and cancers is going to decrease rapidly very soon, even if, in the most optimistic scenario, it is unlikely that optimal vaccination coverage will be achieved. Then, the optimal screening paradigm for cervical cancer prevention in the postvaccination era is still debated. Screening guidelines are being developed with the aim of reducing the number of tests a woman needs during her lifetime, in order to receive the maximum benefit from screening, while decreasing potential harms that may result with the use of a screening strategy (overdiagnosis, overtreatment, anxiety, and costs). With this purpose in mind, new management guidelines for cervical cancer screening abnormalities are recommendations based on risks, not on results. This review aims to summarize the process that led to the introduction of the HPV DNA test in screening programs and the different screening strategies. Moreover, it aims to introduce the new risk-based guidelines for the future, where full HPV genotyping can resize the risk on the basis of specific high-risk genotypes. In the same way, the data regarding HPV vaccination could be introduced as soon as women vaccinated with the nonavalent vaccine reach the screening age, with the recommendation of a prolonged screening interval.
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Affiliation(s)
| | - Jacopo Di Giuseppe
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona 60100, Italy
| | - Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona 60100, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona 60100, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona 60100, Italy
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16
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Medhin LB, Tekle LA, Achila OO, Said S. Incidence of Cervical, Ovarian and Uterine Cancer in Eritrea: Data from the National Health Laboratory, 2011-2017. Sci Rep 2020; 10:9099. [PMID: 32499531 PMCID: PMC7272439 DOI: 10.1038/s41598-020-66096-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/15/2020] [Indexed: 12/24/2022] Open
Abstract
The main objective of this study was to investigate the incidence of cervical (C53), ovarian (C56) and uterine (C54-55) cancers in pathology department of the National Health Laboratory of Eritrea between 2011 and 2017. All tumour positive cases from cervix, ovary and uterus diagnosed between 2011 and 2017 were analyzed, based on the data from the pathology department available in National Health Laboratory. We summarized the results by using crude incidence rates (CIR) and age-standardized rates (ASRs). Annual percentage changes (APCs) for each site were calculated and compared according to ten-year age difference and year of occurrence. Between 2011 and 2017, 883 cases of cervical, ovarian and uterine tumours were reported in Eritrea. Malignant and benign tumours/entities comprising 269 and 614, respectively. The ASR for malignant tumours was highest in women aged between 60-69 (6.84 per 100 000). Total ASR for specific gynecological cancers (cervical, ovarian, uterine) was 19.32 per 100 000 females. The ASR for cervical cancer over the study period was 8.7 per 100 000. The ASR for ovarian and uterine cancers were 6.75 per 100 000 and 5.14 per 100 000, respectively. Over the study period, the incidence of these cancers was largely stable with no significant change in incidence rates recorded. In sum, the ASR for cervical cancer is relatively low compared to the rates reported in the region. Further, the ASR for ovarian and uterine cancers is nearly similar to the rates observed in this region. The study also provides ample evidence on the need for research targeted at uncovering the true burden of gynecological cancers in Eritrea. Potential solutions will require the establishment of high-quality population-based cancer registries (PBCRs) and long-term commitment to improvements in research platforms, training, screening, diagnosis, and the overall management of cancers in the country.
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Affiliation(s)
| | - Lia Alem Tekle
- Microbiology, National Health Laboratory, Asmara, Eritrea
| | - Oliver Okoth Achila
- Biochemistry, Orotta School of Medicine and Health Sciences, Asmara, Eritrea
| | - Salih Said
- Microbiology, National Health Laboratory, Asmara, Eritrea
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17
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Badre-Esfahani S, Larsen MB, Seibæk L, Petersen LK, Blaakær J, Andersen B. Low attendance by non-native women to human papillomavirus vaccination and cervical cancer screening - A Danish nationwide register-based cohort study. Prev Med Rep 2020; 19:101106. [PMID: 32426214 PMCID: PMC7226879 DOI: 10.1016/j.pmedr.2020.101106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background Cervical cancer is preventable through human papillomavirus vaccination and cervical cancer screening. However, possibly due to systemic, individual (e.g. low socio-economic staus) and socio-cultural barriers, it is likely that non-natives, especially non-westerns, are more prone to attend neither vaccination nor screening (combined non-attendance). This is disturbing as the non-native population in Denmark is predicted to rise to 21% by 2060. We aimed to investigate differences in combined non-attendance by nativity and region of origin, and to analyse the association between country of origin and combined non-attendance adjusted for socio-economic status. Setting 1.6.2007–31.12.2016 Denmark. Methods Logistic regression was performed to estimate crude and adjusted odds ratios with 95% confidence intervals for combined non-attendance. Results 170,158 women were included. Overall combined non-attendance was 11.8% [11.7–12.0]; 10.0% [9.8–10.1] for native women and 27.1% [26.4–27.7] for non-native women, with highest degrees among Middle-Eastern and North-Africans (30.1% [29.2–30.9]). Even when adjusted for socio-economics, women from Middle-East and North-Africa had substantially higher odds of combined non-attendance than natives (adj. OR = 7.5 [6.3–8.9] for Somali women). Conclusion Denmark has a relatively low degree of combined non-attendance. However, cervical cancer preventive programmes seem to be better tailored to the needs of native women and do not appear to cater sufficiently to the needs of the fast-growing non-native populations, particularly not to the needs of Middle-Eastern and North African women. In order to secure more just cervical cancer prevention, future studies are recommended to develop tailored intervention sensitive to the need of non-native women.
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Affiliation(s)
- S Badre-Esfahani
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers, NO, Denmark.,Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M B Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers, NO, Denmark
| | - L Seibæk
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - L K Petersen
- Department of Gynaecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 2, DK-5000 Odense C, Denmark.,OPEN Open Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - J Blaakær
- Department of Gynaecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 2, DK-5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - B Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers, NO, Denmark
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18
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Mengesha A, Messele A, Beletew B. Knowledge and attitude towards cervical cancer among reproductive age group women in Gondar town, North West Ethiopia. BMC Public Health 2020; 20:209. [PMID: 32046681 PMCID: PMC7014652 DOI: 10.1186/s12889-020-8229-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/16/2020] [Indexed: 12/29/2022] Open
Abstract
Background Cervical cancer is the second most commonly diagnosed cancer and the third leading cause of cancer death in women worldwide. Nearly 83% of the world’s new cases and 85% of all cervical cancer-related deaths occur in developing countries. It is primarily caused by human papilloma virus (HPV); a sexually transmitted pathogen that could be prevented with safe sexual practice and using vaccines among others. The aim of the study was to assess the knowledge and attitude of reproductive age group women towards cervical cancer and its prevention in Gondar town. Methods A descriptive community based cross-sectional study was carried out. An interviewer-administered questionnaire was employed for data collection. A multistage sampling technique was employed to select the study participants. Descriptive statistics like frequency, mean and percentage were computed using SPSS version 20 software program. Results Seven hundred and seventy women (n = 770) participated with a response rate of 100%. More than half, (65.1%) of the participants claim hearing of cervical cancer. However, majority (> 80%) of them lack knowledge that HPV is a causative agent of cervical cancer which is extremely worrying as the most important way to prevent cervical cancer is blocking HPV infection. Of those who had heard of it, only 107 (21.4%) said they have heard about Pap smear test. From them, less than half, 47 (43.9%) said that an apparently healthy woman should undergo the test at least three times in her life. This means in addition to the lack of information about the test, majority of those who had heard about it didn’t know how many times they should have the test in their life. Overall, only 153 (19.87%) of the participants were found having a good knowledge of cervical cancer and its prevention. Conclusion The overall knowledge of women towards cervical cancer was inadequate. On the other hand, those who had heard about it had a somewhat encouraging attitude. Mass media was the major source of information. But, any public health problem cannot be solved in isolation. Hence, initiating large-scale awareness campaigns is recommended.
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Affiliation(s)
- Ayelign Mengesha
- College of Health Sciences, Department of Nursing, Woldia University, Weldia, Ethiopia.
| | - Anteneh Messele
- School of Nursing and Midwifery, Department of Nursing, University of Gondar, Gondar, Ethiopia
| | - Biruk Beletew
- College of Health Sciences, Department of Nursing, Woldia University, Weldia, Ethiopia
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19
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Badre-Esfahani S, Larsen MB, Seibæk L, Petersen LK, Blaakær J, Støvring H, Andersen B. Non-Adherence To Childhood HPV Vaccination Is Associated With Non-Participation In Cervical Cancer Screening - A Nationwide Danish Register-Based Cohort Study. Clin Epidemiol 2019; 11:969-980. [PMID: 31814770 PMCID: PMC6853196 DOI: 10.2147/clep.s203023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 09/05/2019] [Indexed: 01/13/2023] Open
Abstract
Background The combination of organized cervical cancer screening and childhood HPV vaccination programs has the potential to eliminate cervical cancer in the future. However, only women participating in both programs gain the full protection, and combined non-attenders remain at high risk of developing cervical cancer. Our aim was to analyze the association between non-adherence to HPV vaccination and non-participation in cervical cancer screening for the total population and stratified by native background and parental education. Participants Women born in 1993 eligible for both childhood HPV vaccination and first cervical cancer screening. Analysis Logistic regression models were used to estimate the odds ratio (OR) of non-participation in cervical cancer screening with 95% confidence intervals (CI). Stratified and adjusted logistic regression models were used along with the Wald test in order to test for interaction. Results 24,828 women were included in the study. Among vaccinated women, 61.4% participated in cervical cancer screening; only 39.0% of unvaccinated women participated in cervical cancer screening. Unvaccinated and unscreened women were often non-native and had the lowest socio-economic status, whereas vaccinated and screened women were often native and had the highest socio-economic status. The adjusted OR for non-participation in cervical cancer screening was 2.07 [95% CI: 1.88–2.28] for unvaccinated compared to vaccinated women. After stratifying by country of origin, unvaccinated natives had the highest adjusted OR of not participating in cervical cancer screening compared to non-native women from both western and non-western countries (adjusted ORs of 2.2 [95% CI: 2.0–2.4], 1.3 [95% CI: 0.6–2.8], and 1.5 [95% CI: 1.1–2.0], respectively) (Wald test p=0.019). Conclusion Among natives, non-adherence to HPV vaccination and non-participation in screening seem to be signs of generally poor health-preventive behavior, whereas among non-natives from non-western countries, non-attendance in HPV vaccination and cervical cancer screening seem to be influenced by unrelated factors. Therefore, a differentiated and culturally sensitive approach is needed to enhance overall cervical cancer preventive behavior across different nativities.
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Affiliation(s)
- Sara Badre-Esfahani
- Department of Clinical Medicine, Aarhus University, Aarhus C DK-8000, Denmark.,Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Mette Bach Larsen
- Department of Clinical Medicine, Aarhus University, Aarhus C DK-8000, Denmark
| | - Lene Seibæk
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Lone Kjeld Petersen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense C DK-5000, Denmark
| | - Jan Blaakær
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense C DK-5000, Denmark
| | - Henrik Støvring
- Department of Public Health, Aarhus University, Aarhus C DK-8000, Denmark
| | - Berit Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus C DK-8000, Denmark
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20
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Gultekin M, Karaca MZ, Kucukyildiz I, Dundar S, Keskinkilic B, Turkyilmaz M. Mega Hpv laboratories for cervical cancer control: Challenges and recommendations from a case study of Turkey. PAPILLOMAVIRUS RESEARCH 2019; 7:118-122. [PMID: 30878532 PMCID: PMC6426700 DOI: 10.1016/j.pvr.2019.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/21/2018] [Accepted: 03/10/2019] [Indexed: 12/31/2022]
Abstract
Cervical cancer is the fourth most common cancer among women in the world. It is estimated that one woman dies every 2 min from cervical cancer. Nearly all cervical cancers are preventable by early detection and treatment through screening or HPV vaccination. In 2018, World Health Organization (WHO) made a global call for action toward the elimination of cervical cancer. Cervical cancer screening involves a complex organized program, which begins with a call/recall system based on personal invitation of eligible women, followed by participation in screening, and leading to diagnosis, treatment, and management as appropriate. An effective cervical screening program with high coverage is dependent on each country's infrastructure and human resource capacity. Efforts to develop an effective program is particularly challenging in low and middle income countries (LMIC) where resources are limited. For an effective strategy, Turkey redesigned the country's cervical screening program. The local call/recall system and centralized monitoring system of individual women were re-vamped with an automated evaluation system. The revised screening program includes the use of primary HPV testing with a well-defined protocol outlining the algorithms of management (i.e., screening intervals and referral), a single nationwide centralized diagnostic laboratory, and a sustainable agreement with the HPV diagnostics industry. This system allows for traceable, real-time monitoring of screening visits and specimens. Turkey reports on the first four years of this re-vamped organized program and shares lessons learnt from the implementation of this new program.
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Affiliation(s)
- Murat Gultekin
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Ankara, Turkey.
| | | | | | - Selin Dundar
- Turkish Ministry of Health, Public Health Institute, Department of Cancer Control, Turkey
| | - Bekir Keskinkilic
- Turkish Ministry of Health, Public Health Institute, Department of Cancer Control, Turkey
| | - Murat Turkyilmaz
- Turkish Ministry of Health, Public Health Institute, Department of Cancer Control, Turkey
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William W, Ware A, Basaza-Ejiri AH, Obungoloch J. A review of image analysis and machine learning techniques for automated cervical cancer screening from pap-smear images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 164:15-22. [PMID: 30195423 DOI: 10.1016/j.cmpb.2018.05.034] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 04/17/2018] [Accepted: 05/29/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Early diagnosis and classification of a cancer type can help facilitate the subsequent clinical management of the patient. Cervical cancer ranks as the fourth most prevalent cancer affecting women worldwide and its early detection provides the opportunity to help save life. To that end, automated diagnosis and classification of cervical cancer from pap-smear images has become a necessity as it enables accurate, reliable and timely analysis of the condition's progress. This paper presents an overview of the state of the art as articulated in prominent recent publications focusing on automated detection of cervical cancer from pap-smear images. METHODS The survey reviews publications on applications of image analysis and machine learning in automated diagnosis and classification of cervical cancer from pap-smear images spanning 15 years. The survey reviews 30 journal papers obtained electronically through four scientific databases (Google Scholar, Scopus, IEEE and Science Direct) searched using three sets of keywords: (1) segmentation, classification, cervical cancer; (2) medical imaging, machine learning, pap-smear; (3) automated system, classification, pap-smear. RESULTS Most of the existing algorithms facilitate an accuracy of nearly 93.78% on an open pap-smear data set, segmented using CHAMP digital image software. K-nearest-neighbors and support vector machines algorithms have been reported to be excellent classifiers for cervical images with accuracies of over 99.27% and 98.5% respectively when applied to a 2-class classification problem (normal or abnormal). CONCLUSION The reviewed papers indicate that there are still weaknesses in the available techniques that result in low accuracy of classification in some classes of cells. Moreover, most of the existing algorithms work either on single or on multiple cervical smear images. This accuracy can be increased by varying various parameters such as the features to be extracted, improvement in noise removal, using hybrid segmentation and classification techniques such of multi-level classifiers. Combining K-nearest-neighbors algorithm with other algorithm(s) such as support vector machines, pixel level classifications and including statistical shape models can also improve performance. Further, most of the developed classifiers are tested on accurately segmented images using commercially available software such as CHAMP software. There is thus a deficit of evidence that these algorithms will work in clinical settings found in developing countries (where 85% of cervical cancer incidences occur) that lack sufficient trained cytologists and the funds to buy the commercial segmentation software.
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Affiliation(s)
- Wasswa William
- Department of Biomedical Sciences and Engineering, Mbarara University of Science and Technology, Uganda.
| | - Andrew Ware
- Faculty of Computing, Engineering and Science, University of South Wales, UK
| | | | - Johnes Obungoloch
- Department of Biomedical Sciences and Engineering, Mbarara University of Science and Technology, Uganda
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Turner SA, Deharvengt SJ, Lyons KD, Espinal JAP, LaRochelle EP, Bejarano S, Kennedy L, Tsongalis GJ. Implementation of Multicolor Melt Curve Analysis for High-Risk Human Papilloma Virus Detection in Low- and Middle-Income Countries: A Pilot Study for Expanded Cervical Cancer Screening in Honduras. J Glob Oncol 2018; 4:1-8. [PMID: 30241169 PMCID: PMC6180764 DOI: 10.1200/jgo.17.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cervical cancer is a leading cause of cancer-related mortality in low- and middle-income countries (LMICs) and screening in LMICs is extremely limited. We aimed to implement on-site high-risk human papillomavirus (hrHPV) DNA testing in cohorts of women from an urban factory and from a rural village. METHODS A total of 802 women were recruited for this study in partnership with La Liga Contra el Cancer through the establishment of women's health resource fairs at two locations in Honduras: a textile factory (n = 401) in the city of San Pedro Sula and the rural village of El Rosario (n = 401) in Yoro. Participants received a routine cervical examination during which three sterile cytobrushes were used to collect cervical samples for testing. hrHPV genotyping was performed using a hrHPV genotyping assay and a real-time polymerase chain reaction instrument. RESULTS hrHPV status across all participants at both sites was 13% hrHPV positive and 67% hrHPV negative. When hrHPV status was compared across all three testing sites, hrHPV-positive rates were approximately equal among the factory (13%), village (12%), and confirmatory testing at Dartmouth-Hitchcock Medical Center (Lebanon, NH; 14%). hrHPV genotype was compared across sites, with HPV16 showing the highest infection rate (15%), followed by HPV59 (12%), and HPV68 (11%). There was a low prevalence of HPV18 observed in both populations compared with the hrHPV-positive population in the United States. CONCLUSION In collaboration with oncologists and pathologists from La Liga Contra el Cancer, we were able to provide a continuum of care once health-fair testing was performed. We established a method and implementation plan for hrHPV testing that is sustainable in LMICs.
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Affiliation(s)
- Scott A. Turner
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Sophie J. Deharvengt
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Kathleen Doyle Lyons
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Jorge Arturo Plata Espinal
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Ethan P.M. LaRochelle
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Suyapa Bejarano
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Linda Kennedy
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Gregory J. Tsongalis
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
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Anwar SL, Tampubolon G, Van Hemelrijck M, Hutajulu SH, Watkins J, Wulaningsih W, for the PILAR Research Network. Determinants of cancer screening awareness and participation among Indonesian women. BMC Cancer 2018; 18:208. [PMID: 29506486 PMCID: PMC5838961 DOI: 10.1186/s12885-018-4125-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/12/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cancer screening awareness and participation may be lower in low- and middle-income countries that lack established national screening programmes compared with those that do. We evaluated potential determinants of awareness about and participation in breast and cervical cancer screening, and breast self-examination (BSE) in women using survey data from Indonesia. METHODS From the fifth Indonesian Family Life Survey (2014-2015), a total of 5397 women aged 40 and older without any history of cancer who responded to questionnaires concerning Pap smears, mammography, and BSE were included. Multilevel modelling was used to assess potential determinants in relation to awareness about Pap smears and mammography, and participation in Pap smears and BSE practice. Multivariable analyses were performed to identify independent predictors of cancer screening. RESULTS Of the 5397 respondents, 1058 (20%) women were aware of Pap smears, of which 297 had never had the procedure. Only 251 (5%) participants were aware of mammography. A total of 605 (12%) of women reported they performed BSE. Higher education and household expenditure were consistently associated with higher odds of awareness about Pap smears and mammography (e.g. odds ratio [OR] of being aware of Pap smear and mammography: 7.82 (95% CI: 6.30-9.70) and 7.70 (6.19-9.58), respectively, for high school graduates compared to women with less educational attainment in the multivariable models), and participation in Pap smears and BSE. We also identified enabling factors linked with greater cancer screening awareness and participation, including health insurance, shorter distance to health services, and social participation. CONCLUSION There are socioeconomic disparities in cancer screening awareness and participation among Indonesian women. Our findings may help inform targeted health promotion and screening for cancer in the presence of limited resources.
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Affiliation(s)
- Sumadi L. Anwar
- Division of Surgical Oncology Department of Surgery, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, 55281 Indonesia
- PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD UK
| | - Gindo Tampubolon
- Cathie Marsh Institute for Social Research, University of Manchester, M13 9PL, Manchester, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, King’s College London, London, SE1 9RT UK
| | - Susanna H. Hutajulu
- Division of Medical Haematology and Oncology Department of Internal Medicine, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, 55281 Indonesia
| | - Johnathan Watkins
- PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD UK
| | - Wahyu Wulaningsih
- PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD UK
- MRC Unit for Lifelong Health and Ageing, University College London, Place London WC1B 5JU, Bedford, 33 UK
| | - for the PILAR Research Network
- Division of Surgical Oncology Department of Surgery, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, 55281 Indonesia
- PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD UK
- Cathie Marsh Institute for Social Research, University of Manchester, M13 9PL, Manchester, UK
- Translational Oncology and Urology Research, King’s College London, London, SE1 9RT UK
- Division of Medical Haematology and Oncology Department of Internal Medicine, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, 55281 Indonesia
- MRC Unit for Lifelong Health and Ageing, University College London, Place London WC1B 5JU, Bedford, 33 UK
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Gereige JD, Zhang L, Boehmer U. The Sexual Health of Women in Lebanon: Are There Differences by Sexual Orientation? LGBT Health 2017; 5:45-53. [PMID: 29130791 DOI: 10.1089/lgbt.2017.0031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE From studies conducted in Western countries (United States, United Kingdom, and Australia), we know that the sexual health of sexual minority women (SMW) differs in key ways from that of heterosexual women (HSW). To date, the sexual health of SMW living in the Middle East and North Africa region has not been studied. The purpose of this study was to compare the sexual health of SMW and HSW living in Lebanon. METHODS SMW and HSW living in Lebanon (N = 95) completed an anonymous, self-administered survey. SMW's risk perceptions and health promoting and sexual behaviors were compared to those of HSW. We examined differences by sexual orientation by using t tests and Fisher's exact tests. RESULTS The 45 SMW and 50 HSW had similar demographic characteristics. Significantly more SMW had heard of human papillomavirus, but only 22% of women from both groups knew of its association with abnormal Papanicolaou tests. Cervical cancer screening rates were similar in SMW and HSW, although remarkably low (42%) compared with rates in Western countries. Significantly more SMW (18%) reported difficulty with access to care than HSW (0%). Forty-four percent of SMW reported discomfort in disclosing their sexual orientation to their healthcare provider and 61% reported that healthcare providers lacked sensitivity toward lesbian, gay, bisexual, and transgender needs. Unwanted sexual contact occurred more frequently in SMW (53%) than HSW (23%). CONCLUSION The sexual health of women is affected by sociocultural factors. SMW living in Lebanon have unique health needs that should be addressed within their sociocultural context.
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Affiliation(s)
- Jessica D Gereige
- 1 Department of Internal Medicine, Massachusetts General Hospital , Boston, Massachusetts.,2 Harvard Medical School , Boston, Massachusetts
| | - Li Zhang
- 3 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Ulrike Boehmer
- 4 Department of Community Health Sciences, Boston University School of Public Health , Boston, Massachusetts
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Trends in the Incidence of Cervical Cancer in Jordan, 2000-2013. JOURNAL OF ONCOLOGY 2017; 2017:6827384. [PMID: 28932241 PMCID: PMC5592005 DOI: 10.1155/2017/6827384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 07/14/2017] [Accepted: 07/30/2017] [Indexed: 12/29/2022]
Abstract
Objectives To determine the incidence of cervical cancer in Jordan and assess its trend in over a 14-year period (2000–2013). Methods This descriptive study was based on secondary analysis of cervical cancer data that are registered in the Jordan Cancer Registry (JCR). Results A total of 591 women were diagnosed with cervical cancer in Jordan during the period 2000–2013. The age at diagnosis ranged between 15 and 97 years, with a median of 50 years. The average age standardized rate (ASR) was 2.0/100,000 women. The incidence of cervical cancer started to decrease after 2006 but it remained relatively constant between 2008 and 2013. Over the 14-year period, ASR for cervical cancer decreased by 28.6% from 2.1 per 100,000 women in 2000 to 1.5 per 100,000 women in 2013. About 46.5% of the cases were of squamous cell carcinoma morphology. Early cancer constituted about 60% of the cases, regional cases constituted 9.6%, and distant metastatic cases constituted 10.7%. Conclusions The incidence of cervical cancer in Jordan is low compared to regional estimates and remained relatively constant between 2008 and 2013. Implementation of screening measures could lead to better case finding, early diagnosis, and prevention of cervical cancer.
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Chiang YC, Chen YY, Hsieh SF, Chiang CJ, You SL, Cheng WF, Lai MS, Chen CA. Screening frequency and histologic type influence the efficacy of cervical cancer screening: A nationwide cohort study. Taiwan J Obstet Gynecol 2017; 56:442-448. [DOI: 10.1016/j.tjog.2017.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 10/19/2022] Open
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Optomagnetic Imaging Spectroscopy Application in Cervical Dysplasia and Cancer Detection: Comparation of Stained and Unstained Papanicolaou Smears. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0255-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Salem MR, Amin TT, Alhulaybi AA, Althafar AS, Abdelhai RA. Perceived Risk of Cervical Cancer and Barriers to Screening among Secondary School Female Teachers in Al Hassa, Saudi Arabia. Asian Pac J Cancer Prev 2017; 18:969-979. [PMID: 28545195 PMCID: PMC5494247 DOI: 10.22034/apjcp.2017.18.4.969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: No previous studies had addressed the perceived risk of cervical cancer (CC) and its influence on screening practices and perceived barriers in Saudi Arabia. Methods: This cross-sectional study was conducted on 506 randomly selected Saudi female secondary school teachers in Al Hassa, Saudi Arabia to assess their level of knowledge about risk factors and signs of CC in relation to perceived risk and to characterize CC screening compliance using a self-administered questionnaire. Results: Of the included female Saudi teachers, 65.4% and 63.4% were considered less-knowledgeable about CC risk factors and early signs and symptoms respectively. Only 17.2% reported being previously examined for CC. The majority of participants perceived themselves to be at an average or below average risk of CC. Residing in urban areas was the strongest predictor of CC screening (Odds ratio ‘OR’= 3.39; 95% confidence intervals ‘CI= 1.76-6.46; P=0.001). Awareness of risk factors was significantly associated with higher awareness of signs of CC (OR 2.5; 95% CI=, P=0.001). Exploratory factor analysis showed that personal fears (of screening being embarrassing) was the major factor that hindered CC screening with a high loading eigenvalue of 4.392, explaining 30.8% of the barriers toward utilization, followed by health care related factors. Conclusion: Secondary school teachers in Al Hassa, Saudi Arabia showed low perceived risk, poor awareness about risk factors, signs and symptoms of CC and limited uptake of screening practices. This underlines the need for education programs on CC targeting this group.
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Affiliation(s)
- Marwa Rashad Salem
- Public Health and Community Medicine, Faculty of Medicine, Cairo University, Egypt.
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Kulhánová I, Bray F, Fadhil I, Al-Zahrani AS, El-Basmy A, Anwar WA, Al-Omari A, Shamseddine A, Znaor A, Soerjomataram I. Profile of cancer in the Eastern Mediterranean region: The need for action. Cancer Epidemiol 2017; 47:125-132. [PMID: 28268206 DOI: 10.1016/j.canep.2017.01.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/22/2016] [Accepted: 01/29/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Many countries in the Eastern Mediterranean region (EMR) are undergoing marked demographic and socioeconomic transitions that are increasing the cancer burden in region. We sought to examine the national cancer incidence and mortality profiles as a support to regional cancer control planning in the EMR. METHODS GLOBOCAN 2012 data were used to estimate cancer incidence and mortality by country, cancer type, sex and age in 22 EMR countries. We calculated age-standardized incidence and mortality rates (per 100,000) using direct method of standardization. RESULTS The cancer incidence and mortality rates vary considerably between countries in the EMR. Incidence rates were highest in Lebanon (204 and 193 per 100,000 in males and females, respectively). Mortality rates were highest in Lebanon (119) and Egypt (121) among males and in Somalia (117) among females. The profile of common cancers differs substantially by sex. For females, breast cancer is the most common cancer in all 22 countries, followed by cervical cancer, which ranks high only in the lower-income countries in the region. For males, lung, prostate, and colorectal cancer in combination represent almost 30% of the cancer burden in countries that have attained very high levels of human development. CONCLUSIONS The most common cancers are largely amenable to preventive strategies by primary and/or secondary prevention, hence a need for effective interventions tackling lifestyle risk factors and infections. The high mortality observed from breast and cervical cancer highlights the need to break the stigmas and improve awareness surrounding these cancers.
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Affiliation(s)
- Ivana Kulhánová
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Ibtihal Fadhil
- WHO, Regional Office of the Eastern Mediterranean, Cairo, Egypt
| | | | - Amani El-Basmy
- Epidemiology and Cancer Registry Department, Kuwait Cancer Control Center, Kuwait
| | - Wagida A Anwar
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Ali Shamseddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ariana Znaor
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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Ginsburg O, Badwe R, Boyle P, Derricks G, Dare A, Evans T, Eniu A, Jimenez J, Kutluk T, Lopes G, Mohammed SI, Qiao YL, Rashid SF, Summers D, Sarfati D, Temmerman M, Trimble EL, Padela AI, Aggarwal A, Sullivan R. Changing global policy to deliver safe, equitable, and affordable care for women's cancers. Lancet 2017; 389:871-880. [PMID: 27814964 DOI: 10.1016/s0140-6736(16)31393-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/16/2016] [Accepted: 08/04/2016] [Indexed: 10/20/2022]
Abstract
Breast and cervical cancer are major threats to the health of women globally, particularly in low-income and middle-income countries. Radical progress to close the global cancer divide for women requires not only evidence-based policy making, but also broad multisectoral collaboration that capitalises on recent progress in the associated domains of women's health and innovative public health approaches to cancer care and control. Such multisectoral collaboration can serve to build health systems for cancer, and more broadly for primary care, surgery, and pathology. This Series paper explores the global health and public policy landscapes that intersect with women's health and global cancer control, with new approaches to bringing policy to action. Cancer is a major global social and political priority, and women's cancers are not only a tractable socioeconomic policy target in themselves, but also an important Trojan horse to drive improved cancer control and care.
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Affiliation(s)
- Ophira Ginsburg
- Women's College Research Institute, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; World Health Organization, Geneva, Switzerland.
| | | | - Peter Boyle
- International Prevention Research Institute, Lyon, France; University of Strathclyde Institute of Global Public Health @iPRI, Glasgow, UK
| | | | - Anna Dare
- Centre for Global Health Research & Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tim Evans
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
| | | | - Jorge Jimenez
- Pontificia Universidad, Católica de Chile, Santiago, Chile
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University, Ankara, Turkey
| | - Gilberto Lopes
- Oncoclinicas Group, São Paulo, Brazil; University of Miami, Miller School of Medicine, Coral Gables, FL, USA
| | - Sulma I Mohammed
- Purdue Center for Cancer Research, Purdue University, West Lafayette, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - You-Lin Qiao
- Department of Cancer Epidemiology, National Cancer Centre, Chinese Academy of Medical Sciences, Beijing, China; Peking Union Medical College, Beijing, China
| | - Sabina Faiz Rashid
- James P Grant School of Public Health at BRAC University, Dhaka, Bangladesh
| | - Diane Summers
- UNICEF, South Asia Regional Office, Kathmandu, Nepal
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Marleen Temmerman
- World Health Organization, Geneva, Switzerland; Ghent University, Ghent, Belgium; Aga Khan University, East Africa, Nairobi, Kenya
| | | | - Aasim I Padela
- Initiative on Islam and Medicine and Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ajay Aggarwal
- London School of Hygiene & Tropical Medicine, London, UK; Institute of Cancer Policy, Kings Health Partners Comprehensive Cancer Centre, King's Centre for Global Health, King's Health Partners and King's College London, UK
| | - Richard Sullivan
- Institute of Cancer Policy, Kings Health Partners Comprehensive Cancer Centre, King's Centre for Global Health, King's Health Partners and King's College London, UK
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Sharma M, Seoud M, Kim JJ. Cost-effectiveness of increasing cervical cancer screening coverage in the Middle East: An example from Lebanon. Vaccine 2016; 35:564-569. [PMID: 28017434 DOI: 10.1016/j.vaccine.2016.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/12/2016] [Accepted: 12/09/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Most cervical cancer (CC) cases in Lebanon are detected at later stages and associated with high mortality. There is no national organized CC screening program so screening is opportunistic and limited to women who can pay out-of-pocket. Therefore, a small percentage of women receive repeated screenings while most are under-or never screened. We evaluated the cost-effectiveness of increasing screening coverage and extending intervals. METHODS We used an individual-based Monte Carlo model simulating HPV and CC natural history and screening. We calibrated the model to epidemiological data from Lebanon, including CC incidence and HPV type distribution. We evaluated cytology and HPV DNA screening for women aged 25-65years, varying coverage from 20 to 70% and frequency from 1 to 5years. RESULTS At 20% coverage, annual cytologic screening reduced lifetime CC risk by 14% and had an incremental cost-effectiveness ratio of I$80,670/year of life saved (YLS), far exceeding Lebanon's gross domestic product (GDP) per capita (I$17,460), a commonly cited cost-effectiveness threshold. By comparison, increasing cytologic screening coverage to 50% and extending screening intervals to 3 and 5years provided greater CC reduction (26.1% and 21.4, respectively) at lower costs compared to 20% coverage with annual screening. Screening every 5years with HPV DNA testing at 50% coverage provided greater CC reductions than cytology at the same frequency (23.4%) and was cost-effective assuming a cost of I$18 per HPV test administered (I$12,210/YLS); HPV DNA testing every 4years at 50% coverage was also cost-effective at the same cost per test (I$16,340). Increasing coverage of annual cytology was not found to be cost-effective. CONCLUSION Current practice of repeated cytology in a small percentage of women is inefficient. Increasing coverage to 50% with extended screening intervals provides greater health benefits at a reasonable cost and can more equitably distribute health gains. Novel HPV DNA strategies offer greater CC reductions and may be more cost-effective than cytology.
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Affiliation(s)
- Monisha Sharma
- University of Washington, Department of Epidemiology, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Muhieddine Seoud
- Department of Obstetrics and Gynecology, Gynecologic Oncology, American University of Beirut, Beirut, Lebanon
| | - Jane J Kim
- Harvard T. H. Chan School of Public Health, Center for Health Decision Science, Boston, MA 02115, USA
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Human Papillomavirus Genotype Distribution in Invasive Cervical Cancer in Pakistan. Cancers (Basel) 2016; 8:cancers8080072. [PMID: 27483322 PMCID: PMC4999781 DOI: 10.3390/cancers8080072] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 11/16/2022] Open
Abstract
Few studies have assessed the burden of human papillomavirus (HPV) infection in Pakistan. We aim to provide specific information on HPV-type distribution in invasive cervical cancer (ICC) in the country. A total of 280 formalin-fixed paraffin-embedded tissue blocks were consecutively selected from Shaukat Khanum Memorial Cancer Hospital and Research Centre (Lahore, Pakistan). HPV-DNA was detected by SPF10 broad-spectrum PCR followed by DNA enzyme immunoassay and genotyping by LiPA25. HPV-DNA prevalence was 87.5% (95%CI: 83.0–91.1), with 96.1% of cases histologically classified as squamous cell carcinoma. Most of the HPV-DNA positive cases presented single infections (95.9%). HPV16 was the most common type followed by HPV18 and 45. Among HPV-DNA positive, a significantly higher contribution of HPV16/18 was detected in Pakistan (78.4%; 72.7–83.3), compared to Asia (71.6%; 69.9–73.4) and worldwide (70.8%; 69.9–71.8) and a lower contribution of HPVs31/33/45/52/58 (11.1%; 7.9–15.7 vs. 19.8%; 18.3–21.3 and 18.5%; 17.7–19.3). HPV18 or HPV45 positive ICC cases were significantly younger than cases infected by HPV16 (mean age: 43.3, 44.4, 50.5 years, respectively). A routine cervical cancer screening and HPV vaccination program does not yet exist in Pakistan; however, the country could benefit from national integrated efforts for cervical cancer prevention and control. Calculated estimations based on our results show that current HPV vaccine could potentially prevent new ICC cases.
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Finocchario-Kessler S, Wexler C, Maloba M, Mabachi N, Ndikum-Moffor F, Bukusi E. Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective. BMC Womens Health 2016; 16:29. [PMID: 27259656 PMCID: PMC4893293 DOI: 10.1186/s12905-016-0306-6] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/21/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Women living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa. METHODS We searched online databases and the Internet for published articles and cervical cancer reports in African countries. Inclusion criteria included publication between 2004 and 2014, cervical cancer-related content pertinent to one of the four public health categories (primary, secondary, tertiary prevention or quality of life), and conducted in or specifically relevant to countries or regions within the African continent. The study design, geographic region/country, focus of research, and key findings were documented for each eligible article and summarized to illustrate the weight and research coverage in each area. Publications with more than one focus (e.g. secondary and tertiary prevention) were categorized by the primary emphasis of the paper. Research specific to HIV-infected women or focused on feasibility issues was delineated within each of the four public health categories. RESULTS A total of 380 research articles/reports were included. The majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). The number of publication focusing on primary prevention (23.4 %), particularly HPV vaccination, increased significantly in the past decade. Research regarding the treatment of precancerous lesions and invasive cervical cancer is emerging (17.6 %), but infrastructure and feasibility challenges in many countries have impeded efforts to provide and evaluate treatment. Studies assessing aspects of quality of life among women living with cervical cancer are severely limited (4.1 %). Across all categories, 11.3 % of publications focused on cervical cancer among HIV-infected women, while 17.1 % focused on aspects of feasibility for cervical cancer control efforts. CONCLUSIONS Cervical cancer research in African countries has increased steadily over the past decade, but more is needed. Tertiary prevention (i.e. treatment of disease with effective medicine) and quality of life of cervical cancer survivors are two severely under-researched areas. Similarly, there are several countries in Africa with little to no research ever conducted on cervical cancer.
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Affiliation(s)
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA
| | - May Maloba
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Florence Ndikum-Moffor
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, USA
| | - Elizabeth Bukusi
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
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Zouheir Y, Daouam S, Hamdi S, Alaoui A, Fechtali T. Knowledge of Human Papillomavirus and Acceptability to Vaccinate in Adolescents and Young Adults of the Moroccan Population. J Pediatr Adolesc Gynecol 2016; 29:292-8. [PMID: 26612116 DOI: 10.1016/j.jpag.2015.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/12/2015] [Indexed: 01/05/2023]
Abstract
STUDY OBJECTIVE Human papillomavirus (HPV) infection is estimated to play an etiologic role in 99.7% of cervical cancer. Vaccines can prevent up to 70% of the cervical cancer caused by HPV 16 and 18. The present study was designed to define the knowledge of HPV and HPV vaccine acceptability among Moroccan youth. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A nationwide anonymous questionnaire with a sample of 688 adolescents (12-17 years) and 356 young adults (18-30 years) was organized, that asked about HPV, origin of cervical cancer, Papanicolaou (Pap) test, and acceptability of HPV vaccine. Data were analyzed using univariate and multivariate logistic regression methods. RESULTS Overall, a low frequency (213/1044 = 20%) of HPV knowledge was observed among the studied population. A multivariate model analysis showed that age, educational level, and knowledge of the Pap test remained significantly associated factors with HPV knowledge. Additionally, only 27% (282/1044) of participants were willing to accept HPV vaccination. Highest acceptability was observed among young adults compared with adolescents (166/356 = 46.6% vs 116/688 = 16.9%). Sixty-two percent (103/165) of male participants accepted the HPV vaccine compared with only 20.4% (179/879) of female participants. Educational level, type of school, and knowledge of the Pap test were associated factors with HPV vaccine acceptability in a multivariate model analysis. CONCLUSION The present study showed a low level of HPV knowledge and HPV vaccine acceptability among Moroccan youth. Promotion of activities and sensitization are required to maximize public awareness in the future. This objective can be achieved with the use of media, active efforts by health care providers, and introduction of sexual education in school programs.
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Affiliation(s)
- Yassine Zouheir
- Laboratory of Neurosciences, Integrated Diseases and Natural Substances, Faculty of Sciences and Technics, Hassan II University, Mohammedia, Morocco.
| | | | - Salsabil Hamdi
- Laboratory of Neurosciences, Integrated Diseases and Natural Substances, Faculty of Sciences and Technics, Hassan II University, Mohammedia, Morocco
| | - Abdelaaziz Alaoui
- Laboratory of Biotechnology, Valorisation and Protection of AgroResources, Faculty of Science and Technology, Cadi Ayyad University, Marrakech, Morocco
| | - Taoufiq Fechtali
- Laboratory of Neurosciences, Integrated Diseases and Natural Substances, Faculty of Sciences and Technics, Hassan II University, Mohammedia, Morocco
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Selmouni F, Sauvaget C, Belakhel L, Lucas E, Khouchoua M, Sankaranarayanan R. Organization and evaluation of a pilot cervical cancer screening program in Morocco. Int J Gynaecol Obstet 2016; 132:25-8. [PMID: 26434670 DOI: 10.1016/j.ijgo.2015.06.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/05/2015] [Accepted: 09/11/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate a pilot program for early detection of cervical cancer using visual inspection with acetic acid (VIA) and the loop electrosurgical excision procedure (LEEP) in one region of Morocco. METHODS A descriptive analysis of the screening outcome measures of 43 participating primary care units and one reference center for LEEP was conducted in Meknès-Tafilalet between January 1, 2011, and December 31, 2013. Data on the number of participants, VIA results, colposcopy, and treatment were used in analyses. RESULTS Of the 308 197 women in the target age group (30-49 years), 18 586 (6.0%) were screened by VIA. Positive screening test results were recorded for 1628 (8.8%) women, of whom 1144 (70.3%) received diagnostic confirmation by colposcopy. Of the 87 (7.6%) women with cervical intraepithelial neoplasia, only 16 (18.4%) underwent LEEP; three cases of invasive cervical cancer were diagnosed. CONCLUSION Issues with implementation of the screening program were found, including low compliance and a low treatment rate of cervical intraepithelial neoplasia by LEEP. By contrast, high rates of colposcopy referral were observed. Screen-and-treat by ablative methods (e.g. thermocoagulation) should be considered to increase treatment rates at national scale-up.
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Affiliation(s)
- Farida Selmouni
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain; Department of Scientific Research, Continuous Training and Cooperation, Higher Institute of Nursing Professions and Techniques of Health of Rabat, Rabat, Morocco
| | - Catherine Sauvaget
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
| | - Latifa Belakhel
- Department of Scientific Research, Continuous Training and Cooperation, Higher Institute of Nursing Professions and Techniques of Health of Rabat, Rabat, Morocco
| | - Eric Lucas
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Mohamed Khouchoua
- Department of Infrastructure and Provincial Ambulatory Actions, Regional Direction of Health Meknès-Tafilalet, Meknès, Morocco
| | - Rengaswamy Sankaranarayanan
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
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Fakhreldin M, Elmasry K. Improving the performance of reflex Human Papilloma Virus (HPV) testing in triaging women with atypical squamous cells of undetermined significance (ASCUS): A restrospective study in a tertiary hospital in United Arab Emirates (UAE). Vaccine 2015; 34:823-30. [PMID: 26747717 DOI: 10.1016/j.vaccine.2015.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cervical cancer is the second commonest cancer in women worldwide. Infection with oncogenic types of human Papillomavirus (HPV) is the most important risk factor for developing cervical cancer. Reflex High risk HPV (HR-HPV) testing is of significant value in the assessment of Papanicolaou (Pap) smear results where ASCUS are identified. OBJECTIVE To improve the performance of reflex HR-HPV testing in triage of ASCUS and analyze the factors impacting it. METHODOLOGY In this study, we generated a database of 9641 women who had cervical smears collected during the study period from the cytopathology record in a large tertiary hospital in UAE. These included 297 smears with ASCUS diagnosis. All cases were retrospectively followed up with a mean duration of 2.44 years. We analyzed data according to the outcome based on several follow-up Pap smear analysis as the reference assessment. RESULTS We detected HR-HPV infection in 17.9% of cases. 9.1% <25, 28.8% 25-34 and 62.1% ≥35 years old. HR-HPV prevalence was higher among premenopausal women (20.7%) compared to postmenopausal women (9.5%) (P-value=0.044). The rate of progression to high grade lesions was also higher (28.7%) in the premenopausal group compared to (12.8%) in the postmenopausal group. Reflex HPV testing had an overall sensitivity of 41.1%, specificity of 88.2%, positive predictive value (PPV) of 62.1%, and negative predictive value (NPV) of 75.9% in detection of cervical lesions. These figures were higher on combining premenopausal status and complaint of abnormal bleeding or discharge/itching (66.7%, 93.3%, 66.8% and 93.3% respectively). CONCLUSIONS The sensitivity, specificity and NPV of reflex HPV testing in the triage of ASCUS cases can be more accurate in premenopausal women upon adding age group and presenting complaint as a triage item. This improves the performance of reflex HPV testing and the subsequent selection of high risk patients for colposcopy.
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Affiliation(s)
- Marwa Fakhreldin
- Department of Obstetrics and Gynecology, Corniche Hospital, Abu Dhabi, United Arab Emirates.
| | - Karim Elmasry
- Department of Obstetrics and Gynecology, Mafraq Hospital, Abu Dhabi, United Arab Emirates
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Catarino R, Petignat P, Dongui G, Vassilakos P. Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices. World J Clin Oncol 2015; 6:281-290. [PMID: 26677441 PMCID: PMC4675913 DOI: 10.5306/wjco.v6.i6.281] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/03/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
Cervical cancer (CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas, the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies, researchers have attempted to find new strategies that are adapted to low- and middle-income countries (LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus (HPV) testing is more effective than cytology for CC screening. Therefore, highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages, HPV-based screening has a low positive predictive value for CC, so that HPV-positive women need to be triaged with further testing to determine optimal management. Visual inspection tests, cytology and novel biomarkers are some options. In this review, we provide an overview of current and emerging screening approaches for CC. In particular, we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care (POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress, but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.
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Majidi A, Ghiasvand R, Hadji M, Nahvijou A, Mousavi AS, Pakgohar M, Khodakarami N, Abedini M, Amouzegar Hashemi F, Rahnamaye Farzami M, Shahsiah R, Sajedinejhad S, Mohagheghi MA, Nadali F, Rashidian A, Weiderpass E, Mogensen O, Zendehdel K. Priority Setting for Improvement of Cervical Cancer Prevention in Iran. Int J Health Policy Manag 2015; 5:225-32. [PMID: 27239863 DOI: 10.15171/ijhpm.2015.201] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 11/06/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide. Organized cervical screening and vaccination against human papilloma virus (HPV) have been successful interventions for prevention of invasive cervical cancer (ICC). Because of cultural and religious considerations, ICC has low incidence in Iran and many other Muslim countries. There is no organized cervical screening in these countries. Therefore, ICC is usually diagnosed in advanced stages with poor prognosis in these countries. We performed a priority setting exercise and suggested priorities for prevention of ICC in this setting. METHODS We invited experts and researchers to a workshop and asked them to list important suggestions for ICC prevention in Iran. After merging similar items and removing the duplicates, we asked the experts to rank the list of suggested items. We used a strategy grid and Go-zone analysis to determine final list of priorities for ICC prevention in Iran. RESULTS From 26 final items suggested as priorities for prevention of ICC, the most important priorities were developing national guidelines for cervical screening and quality control protocol for patient follow-up and management of precancerous lesions. In addition, we emphasized considering insurance coverage for cervical screening, public awareness, and research priorities, and establishment of a cervical screening registry. CONCLUSION A comprehensive approach and implementation of organized cervical screening program is necessary for prevention of ICC in Iran and other low incidence Muslim countries. Because of high cost for vaccination and low incidence of cervical cancer, we do not recommend HPV vaccination for the time being in Iran.
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Affiliation(s)
- Azam Majidi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghiasvand
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Maryam Hadji
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam-Sadat Mousavi
- Department of Genecology Oncology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Pakgohar
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Khodakarami
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Deputy of Public Health, Maternal Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Farnaz Amouzegar Hashemi
- Radiotherapy Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Shahsiah
- Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Sajedinejhad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mohagheghi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nadali
- Faculty of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.,Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.,Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
| | - Ole Mogensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Cancer Model Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
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Giordano L, Bisanti L, Salamina G, Ancelle Park R, Sancho-Garnier H, Espinas J, Berling C, Rennert G, Castagno R, Dotti M, Jaramillo L, Segnan N. The EUROMED CANCER network: state-of-art of cancer screening programmes in non-EU Mediterranean countries. Eur J Public Health 2015; 26:83-9. [PMID: 26072520 DOI: 10.1093/eurpub/ckv107] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The EUROMED CANCER Network project aims to support non-EU Mediterranean countries in the development of cancer early detection and screening policies. METHODS Through a structured questionnaire information from 15 countries (Albania, Algeria, Bosnia and Herzegovina (BiH), Croatia, Egypt, Jordan, UN Interim Administration Mission in Kosovo, Lebanon, Montenegro, Morocco, Palestinian National Authority, Serbia, Syria, Tunisia and Turkey) were collected on cancer epidemiology and control. RESULTS Large differences between countries are evident. Breast cancer (BC) is the commonest cancer among women, though the incidence rate is much lower in non-EU than in EU Mediterranean countries. Conversely, cervical cancer (CC) is much more common in the former than in the latter countries. Colorectal cancer (CRC) is more frequent in Northern than in Eastern and Southern Mediterranean shores. Population-based cancer registries are available in few countries but most of them lack information on disease staging. Opportunistic screening for CC and BC is unevenly spread across and within countries; organised screening programmes are rare and do not meet international recommendations. BC and CC early detection is extensively considered a priority, while a few countries included CRC into their agenda. CONCLUSIONS Collected data witnesses inadequacy of health information system and, in general, of the strategies for cancer control in the involved countries. A uniform approach for strengthening cancer control is not realistic neither feasible. Tailored preventive actions for cancer early detection have to be started concurrently with the development of a reliable health information system and, specifically, with cancer registration.
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Affiliation(s)
| | - Luigi Bisanti
- 1 Cancer Prevention Center of Piedmont, Turin, Italy
| | | | | | | | | | | | - Gad Rennert
- 7 National Cancer Control Centre, Haifa, Israel
| | | | - Marta Dotti
- 1 Cancer Prevention Center of Piedmont, Turin, Italy
| | | | - Nereo Segnan
- 1 Cancer Prevention Center of Piedmont, Turin, Italy
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Farshbaf-Khalili A, Salehi-Pourmehr H, Shahnazi M, Yaghoubi S, Gahremani-Nasab P. Cervical cancer screening in women referred to healthcare centres in Tabriz, Iran. Niger Med J 2015; 56:28-34. [PMID: 25657490 PMCID: PMC4314856 DOI: 10.4103/0300-1652.149167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cervical cancer is the second most common cancer among Iranian women and among the few cancers that could be easily diagnosed in the pre-malignant stage. We aimed to assess the status of cervical cancer screening in women referred to health care centres in Tabriz, northwest Iran. MATERIALS AND METHODS This descriptive-analytical study was done on 441 women referred to health care centres of Tabriz, northwest Iran. The centres were selected using the multi-stage cluster sampling method. The participants were selected from the active records of those centres. A questionnaire regarding the socio-demographic characteristics and cervical cancer screening and reasons for referring or not referring for screening was completed by the participants A P < 0.05 was considered as significant. RESULTS Out of the participants 49.4% of women had done the Pap smear test while 50.6% had never done this test. The main reason why women had not performed cervical cancer screening was being unaware of the importance of it (46.1%). Logistic regression analysis with adjustment showed a significant relationship between screening and awareness scores (OR = 1.17, CI = 95%:1.12-1.23), when the effect of other confounding factors [total awareness scores, risk factors (marriage or having sexual intercourse at a young age, history of obvious cervical infection, cautery, cryotherapy or repeated curettage), age and type of family planning] in screening was controlled. CONCLUSION Suitable and continuous educational programmes especially for high risk women should be implemented through the health care services. Preparing educational brochures and pamphlets and providing adequate training on the necessity of early referral and marriage counseling could also be effective in improving woman's awareness and performance.
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Affiliation(s)
- Azizeh Farshbaf-Khalili
- Faculty of Nursing and Midwifery, Research Center of Npmc, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahnaz Shahnazi
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Yaghoubi
- Faculty of Nursing and Midwifery, Tabriz Branch of Islamic Azad University, Tabriz, Iran
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Bansal D, Elmi AA, Skariah S, Haddad P, Abu-Raddad LJ, Al Hamadi AH, Mohamed-Nady N, Affifi NM, Ghedira R, Hassen E, Al-Thani AAJ, Al-Ansari AAHM, Sultan AA. Molecular epidemiology and genotype distribution of Human Papillomavirus (HPV) among Arab women in the State of Qatar. J Transl Med 2014; 12:300. [PMID: 25424736 PMCID: PMC4251937 DOI: 10.1186/s12967-014-0300-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human Papilloma Virus (HPV) infection is the major cause of cervical cancer worldwide. With limited data available on HPV prevalence in the Arab countries, this study aimed to identify the prevalence and genotypic distribution of HPV in the State of Qatar. METHODS 3008 cervical samples, exclusively of women with Arabic origin residing in Qatar were collected from the Women's Hospital and Primary Health Care Corporation in Doha, State of Qatar. HPV DNA detection was done using GP5+/6+ primers based real time-polymerase chain reaction (RT-PCR) assay followed by the usage of HPV type specific primers based RT- PCR reactions and Sanger sequencing for genotype identification. RESULTS Similar prevalence rates of HPV infection was identified in both Qatari and non-Qatari women at 6.2% and 5.9% respectively. HPV prevalence rate of 5.8% and 18.4% was identified in women with normal cytology and in women with abnormal cytology respectively. HPV 81, 11 and 16, in decreasing order were the most commonly identified genotypes. HPV 81 was the most frequent low-risk genotype among women with both normal (74.0%) and abnormal (33.3%) cytology. HPV 16 (4.6%) was identified as the predominant high-risk HPV genotype among women with normal cytology and HPV 16, HPV 18, and HPV 56 (22.2% each) were the most common identified high-risk genotypes in women with abnormal cytology. CONCLUSIONS The overall HPV prevalence in Arab women in Qatar was identified as 6.1% with an increased HPV prevalence seen in women with abnormal cytology results and no significant trends seen with age. In contrast to Western countries, we report a varied genotypic profile of HPV with a high prevalence of low-risk HPV genotype 81 among the Arab women residing in Qatar.
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Affiliation(s)
- Devendra Bansal
- Department of Microbiology and Immunology, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
| | - Asha A Elmi
- Department of Microbiology and Immunology, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
| | - Sini Skariah
- Department of Microbiology and Immunology, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
| | - Pascale Haddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
| | - Aysha H Al Hamadi
- Department of laboratory Medicine and Pathology, Cytopathology, Hamad Medical Corporation, Doha, Qatar.
| | - Nady Mohamed-Nady
- Department of Obstetrics & Gynecology, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
| | | | - Randa Ghedira
- Laboratoire d'Immuno-Oncologie Moléculaire Faculté de Médecine de Monastir, 5019, Monastir, Tunisia.
| | - Elham Hassen
- Laboratoire d'Immuno-Oncologie Moléculaire Faculté de Médecine de Monastir, 5019, Monastir, Tunisia.
| | - Asma A J Al-Thani
- Health Sciences Department, Biomedical Sciences Program, University of Qatar, Doha, Qatar.
| | | | - Ali A Sultan
- Department of Microbiology and Immunology, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
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Williams JH, Carter SM, Rychetnik L. 'Organised' cervical screening 45 years on: How consistent are organised screening practices? Eur J Cancer 2014; 50:3029-38. [PMID: 25282406 DOI: 10.1016/j.ejca.2014.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
Abstract
Organised screening programmes have been remarkably successful in reducing incidence and mortality from cervical cancer, while opportunistic screening varies in its effectiveness. Experts recommend that cervical screening or HPV testing be carried out only in the context of an organised programme. We sought to answer the following study questions: What does it mean for a cervical screening programme to be organised? Is there a place for opportunistic screening (in an organised programme)? We reviewed 154 peer-reviewed papers on organised and opportunistic approaches to cervical screening published between 1970 and 2014 to understand how the term 'organised' is used, formally and in practice. We found that despite broad recognition of a prescriptive definition of organisation, in practice the meaning of organisation is much less clear. Our review revealed descriptions of organised programmes that differ significantly from prescribed norms and from each other, and a variety of ways that opportunistic and organised programmes intersect. We describe the breadth of the variation in cervical cancer screening programmes and examine the relationships and overlaps between organised and opportunistic screening. Implications emerging from the review include the need to better understand the breadth of organisation in practice, the drivers and impacts of opportunistic screening and the impact of opportunistic screening on population programme outcomes. Appreciation of the complexity of cervical screening programmes will benefit both screeners and women as programmes are changed to reflect a partially vaccinated population, new evidence and new technologies.
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Affiliation(s)
- Jane H Williams
- Centre for Values, Ethics and the Law in Medicine (VELiM), K25, School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine (VELiM), K25, School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Lucie Rychetnik
- School of Medicine, University of Notre Dame, NSW 2010, Australia; Centre for Values, Ethics and the Law in Medicine (VELiM), K25, School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia.
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Extended Middle East and North Africa: summary recommendations for the prevention of human papillomavirus infections and related cancers including cervical cancer. Vaccine 2013; 31 Suppl 6:G78-9. [PMID: 24331823 DOI: 10.1016/j.vaccine.2012.11.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Seoud M. Extended Middle East and North Africa: cervical cancer and human papillomavirus: can we make the case for prevention in this "relatively" low prevalence region? Vaccine 2013; 31 Suppl 6:vii-viii. [PMID: 24331825 DOI: 10.1016/j.vaccine.2012.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/10/2012] [Accepted: 05/11/2012] [Indexed: 11/15/2022]
Affiliation(s)
- Muhieddine Seoud
- Professor and Vice Chairman, Department Obstetrics and Gynecology, Gynecologic Oncology, American University of Beirut, Medical Centre, Hamra District, P.O. Box: 113-6044, Beirut, Lebanon.
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45
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Vaccarella S, Bruni L, Seoud M. Burden of Human Papillomavirus Infections and Related Diseases in the Extended Middle East and North Africa Region. Vaccine 2013; 31 Suppl 6:G32-44. [DOI: 10.1016/j.vaccine.2012.06.098] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 11/16/2022]
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Kim JJ, Sharma M, O'Shea M, Sweet S, Diaz M, Sancho-Garnier H, Seoud M. Model-Based Impact and Cost-Effectiveness of Cervical Cancer Prevention in the Extended Middle East and North Africa (EMENA). Vaccine 2013; 31 Suppl 6:G65-77. [DOI: 10.1016/j.vaccine.2012.06.096] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 05/30/2012] [Accepted: 06/04/2012] [Indexed: 10/25/2022]
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