The Hallmarks of Cervical Cancer: Molecular Mechanisms Induced by Human Papillomavirus.

Human papillomaviruses (HPVs) and, specifically, high-risk HPVs (HR-HPVs) are identified as necessary factors in the development of cancer of the lower genital tract, with CaCU standing out as the most prevalent tumor. This review summarizes ten mechanisms activated by HR-HPVs during cervical carcinogenesis, which are broadly associated with at least seven of the fourteen distinctive physiological capacities of cancer in the newly established model by Hanahan in 2022. These mechanisms involve infection by human papillomavirus, cellular tropism, genetic predisposition to uterine cervical cancer (CaCU), viral load, viral physical state, regulation of epigenetic mechanisms, loss of function of the E2 protein, deregulated expression of E6/E7 oncogenes, regulation of host cell protein function, and acquisition of the mesenchymal phenotype.

Human Papillomavirus Prevalence and Associated Factors in Indigenous Women in Ecuador: A Cross-Sectional Analytical Study.

Cervical cancer (CC) is the second leading cause of death from malignancy in women in Ecuador. Human papillomavirus (HPV) is the main causative agent of CC. Although several studies have been conducted on HPV detection in Ecuador, there are limited data on indigenous women. This cross-sectional study aimed to analyze the prevalence of HPV and associated factors in women from the indigenous communities of Quilloac, Saraguro and Sevilla Don Bosco. The study included 396 sexually active women belonging to the aforementioned ethnicities. A validated questionnaire was used to collect socio-demographic data, and real-time Polymerase Chain Reaction (PCR) tests were used to detect HPV and other sexually transmitted infections (STIs). These communities are located in the southern region of Ecuador and face geographical and cultural barriers to accessing health services. The results showed that 28.35% of women tested positive for both types of HPV, 23.48% for high-risk (HR) HPV, and 10.35% for low-risk (LR) HPV. Statistically significant associations were found between HR HPV and having more than three sexual partners (OR 1.99, CI 1.03-3.85) and Chlamydia trachomatis infection (OR 2.54, CI 1.08-5.99). This study suggests that HPV infection and other sexually transmitted pathogens are common among indigenous women, highlighting the need for control measures and timely diagnosis in this population.

Barriers and facilitators to cervical cancer screening among under-screened women in Cuenca, Ecuador: the perspectives of women and health professionals.

BACKGROUND: Cervical cancer screening is a cost-effective method responsible for reducing cervical cancer-related mortality by 70% in countries that have achieved high coverage through nationwide screening strategies. However, there are disparities in access to screening. In Ecuador, although cervical cancer is the second most common cancer in women, only 58.4% of women of reproductive age have ever been screened for cervical cancer. METHODOLOGY: A qualitative study was performed to understand the current barriers to screening and to identify strategies that could increase uptake in Azuay province, Ecuador. Seven focus group discussions (FGDs) were conducted with under-screened women and health professionals (HPs). The FGDs were recorded and transcribed. Content analysis was done using the socio-ecological framework to categorize and analyse the data. RESULTS: Overall, 28 women and 27 HPs participated in the study. The two groups perceived different barriers to cervical cancer screening. The HPs considered barriers to be mainly at the policy level (lack of a structured screening plan; lack of health promotion) and the individual level (lack of risk perception; personal beliefs). The women identified barriers mainly at organizational level, such as long waiting times, lack of access to health centres, and inadequate patient-physician communication. Both groups mentioned facilitators at policy level, such as national campaigns promoting cervical cancer screening, and at community and individual level, including health literacy and women's empowerment. CONCLUSIONS: The women considered access to health services the main barrier to screening, while the HPs identified a lack of investment in screening programmes and cultural patterns at the community level as major obstacles. To take an integrated approach to cervical cancer prevention, the perspectives of both groups should be taken into account. Additionally, new strategies and technologies, such as self-administered human papillomavirus (HPV) testing and community participation, should be implemented to increase access to cervical cancer screening.

Knowledge and Perceptions about Cervical Cancer and HPV Screening in Women in Rural Areas of Ecuador: A Qualitative Research Study.

BACKGROUND: Cervical cancer continues to be a major health problem in developing countries. Educational programs, as well as Pap and HPV screening and vaccination, are important tools to reduce the morbidity and mortality rates associated with this disease. The objective of this study is to explore the diverse knowledge and perceptions about cervical cancer and the different diagnostic tests for HPV of populations living in the rural parish "El Valle". METHOD: A qualitative study was conducted through eight focus groups, which included 46 participants from mixed ethnic groups. A phenomenological analysis was performed. RESULTS: Four topics and seven sub-topics were identified. By analyzing all the narratives, it was possible to identify that the perception of cervical cancer was focused on its severity, secondary to its infectious process and screening periodicity. However, despite the diverse knowledge, indigenous people do not relate it to the human papilloma virus; in addition, there is also certain resistance to undergo the Pap smear test, for reasons such as inaccessibility and its sampling process. CONCLUSIONS: It is necessary to develop educational programs for the prevention of cervical cancer and to implement diagnostic alternatives to reach populations with precarious accessibility, as well as women who refuse to undergo the Pap smear test.

Evaluation of Urine and Vaginal Self-Sampling versus Clinician-Based Sampling for Cervical Cancer Screening: A Field Comparison of the Acceptability of Three Sampling Tests in a Rural Community of Cuenca, Ecuador.

Self-sampling methods for HPV testing have been demonstrated to be highly sensitive and specific. The implementation of these methods in settings with a lack of infrastructure or medical attention has been shown to increase the coverage of cervical cancer screening and detect cervical abnormalities in the early stages. The aim of this study is to compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for Pap smear and HPV testing. After the sample collection, a questionnaire to qualify the device, technique, and individual acceptability was applied, and the additional overall preference of three sample tests was evaluated. Results: The characteristics of the participants were as follows: median age of 35 years; 40.8% were married; 46.7% had a primary level of education; median age of sexual onset of 17.6 years. Compared with clinician sampling, both vaginal self-sampling, OR 20.12 (7.67-52.8), and urine sampling, OR 16.63 (6.79-40.72), were more comfortable; granted more privacy: vaginal self-sampling, OR 8.07 (3.44-18.93), and urine sampling, OR 19.5 (5.83-65.21); were less painful: vaginal self-sampling, OR 0.07 (0.03-0.16), and urine sampling, OR 0.01 (0-0.06); were less difficult to apply: vaginal self-sampling, OR 0.16 (0.07-0.34), and urine sampling, OR 0.05 (0.01-0.17). The overall preference has shown an advantage for vaginal self-sampling, OR 4.97 (2.71-9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: Self-sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appear to be a limitation on its acceptability. However, the training and education of the community could increase the uptake of these methods.

Radiomics Diagnostic Tool Based on Deep Learning for Colposcopy Image Classification.

BACKGROUND: Colposcopy imaging is widely used to diagnose, treat and follow-up on premalignant and malignant lesions in the vulva, vagina, and cervix. Thus, deep learning algorithms are being used widely in cervical cancer diagnosis tools. In this study, we developed and preliminarily validated a model based on the Unet network plus SVM to classify cervical lesions on colposcopy images. Methodology: Two sets of images were used: the Intel & Mobile ODT Cervical Cancer Screening public dataset, and a private dataset from a public hospital in Ecuador during a routine colposcopy, after the application of acetic acid and lugol. For the latter, the corresponding clinical information was collected, specifically cytology on the PAP smear and the screening of human papillomavirus testing, prior to colposcopy. The lesions of the cervix or regions of interest were segmented and classified by the Unet and the SVM model, respectively. Results: The CAD system was evaluated for the ability to predict the risk of cervical cancer. The lesion segmentation metric results indicate a DICE of 50%, a precision of 65%, and an accuracy of 80%. The classification results' sensitivity, specificity, and accuracy were 70%, 48.8%, and 58%, respectively. Randomly, 20 images were selected and sent to 13 expert colposcopists for a statistical comparison between visual evaluation experts and the CAD tool (p-value of 0.597). Conclusion: The CAD system needs to improve but could be acceptable in an environment where women have limited access to clinicians for the diagnosis, follow-up, and treatment of cervical cancer; better performance is possible through the exploration of other deep learning methods with larger datasets.

Role of Self-Sampling for Cervical Cancer Screening: Diagnostic Test Properties of Three Tests for the Diagnosis of HPV in Rural Communities of Cuenca, Ecuador.

BACKGROUND: HPV primary screening has shown effectiveness for cancer prevention; however, gynaecological examination is considered uncomfortable. Self-sampling methods increase the acceptance of screening. The aim of this study is to compare the sensitivity and specificity of clinician sampling versus vaginal and urine self-sampling for HPV diagnosis. METHODS: A diagnostic test study was conducted in a rural parish of Cuenca, Ecuador. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for HPV testing. The latter was considered as the golden standard. All three samples were processed with the same amplification and hybridization protocol for HPV detection (Hybribio) following the manufacturer's instructions. RESULTS: Characteristics of the participants were: median age 35 years; 40.8% married; 46.7% had a primary level of education; and median age of sexual onset, 17.6 years. The prevalence of any type of HPV with clinician sampling was 15.0%, 17.5% with urine sampling and 18.3% with vaginal self-sampling. Self-sampling sensitivity reached 94.4% (IC 74.2-99.9), and specificity 92.1% (IC 85.2-95.9). Urine sampling had a sensitivity of 88.8% (IC 67.2, 96.9), and specificity 94.1% (IC 67.2-96.9). The negative predictive value was 98.9% (IC 94.2-99.8) for vaginal self-sampling and 97.6% (IC 92.6-99.4) for urine sampling. CONCLUSIONS: This study shows that vaginal and urine self-sampling methods have similar sensitivity and specificity compared with clinician sampling for the diagnosis of HPV. The correlation between HPV genotypes among the three tests is satisfactory.

Minireview: Situación actual del cáncer de cuello uterino en Ecuador, 2019 / Minireview: Current situation of cervical cancer in Ecuador, 2019

El cáncer de cuello uterino (CCU) es una neoplasia producida principalmente por el virus del papiloma humano (VPH), mismo que se adquiere a través del contacto sexual. El CCU tiene mayor prevalencia en países de ingresos medios y bajos, el 88% de muertes por esta causa a nivel mundial, se producen en países en vías de desarrollo, tales como el Ecuador. El proyecto ELEVATE (Early detection of cervical cancer in hard-to-reach populations of women through portable and point- of-care HPV testing), financiado por la Unión Europea, busca caracterizar el contexto nacional de esta enfermedad; con esta finalidad, se realizó una búsqueda sistemática de artículos científicos y de literatura gris, producida en el Ecuador, utilizando motores de búsqueda especializados, y repositorios virtuales institucionales, de universidades e instancias gubernamentales.(au)

Cervical cancer is a neoplasm mainly caused by the human papillomavirus (HPV), which is acquired through sexual contact. Cervical cancer is more prevalent in low and middle income countries; 88% of worldwide deaths from this cause, occur in developing countries, such as Ecuador. The ELEVATE project (Early detection of cervical cancer in hard-to-reach populations of women through portable and point-of-care HPV testing), funded by the European Union, seeks to characterize the national context of this disease; with this purpose, we carried out a systematic search for scientific articles and gray literature, produced in Ecuador, using specialized search engines, and virtual repositories from universities and government institutions.(au)

Caracterización del Comportamiento Sexual y Reproductivo y Acceso A los Servicios de Salud, de los Estudiantes de la Facultad de Ciencias Médicas de la Universidad de Cuenca / Characterization of Sexual and Reproductive Behavior and Access to Health Services, of the Students of the Faculty of Medical Sciences of the University of Cuenca

ANTECEDENTES: La población universitaria es principal-mente joven y por lo tanto expuesta a factores que puede generar efectos adversos en salud sexual y re-productiva, que conllevan a un bajo rendimiento académico e inclusive a la deserción estudiantil. OBJETIVO: Caracterizar el comportamiento sexual y re-productivo y las necesidades en salud de los en estudiantes de la Facultad de Ciencias Médicas de la Universidad de Cuenca. METODOLOGÍA: Tipo de estudio descriptivo. Universo: 3 265 estudiantes de la Facultad de Ciencias Médicas de la Universidad de Cuenca, en el período lectivo septiembre 2014- Febrero 2015. Muestra: fue aleatorizada por conglomerados (carrera y cursos) en las tres escue-las de la facultad de Ciencias Médicas. RESULTADOS: De los estudiantes encuestados, el 44.7% fueron de la escuela de medicina de 27.7% de enfermería, 27.7% tecnología médica; 68.6% mujeres y 31.4% varones, con una edad media de 21 años para ambos grupos; la mayoría son solteros 87.7%, mestizos 94.1% y heterosexuales 97.2%, que residen en zona urbana 81.5%. El 45.7% de las mujeres y el 70.1% de los varones son sexualmente activos, 15% son padres de familia, el 81,6% ha usado un método anticonceptivo MAC, sin embargo el uso consistente es de 55.1%. 66.2% de los encuestados ha acudido a un médico el último año; el 77.3% maneja suficiente información para la prevención de un embarazo y el 79.7% para la prevención de ITS. CONCLUSIONES: Pese a que los estudiantes tienen in-formación en sexualidad y acceden a los servicios de salud, los efectos adversos en salud sexual y reproduc-tiva son identificados como un problema que conlleva a deserción estudiantil y bajo rendimiento académico. Las principales soluciones para combatir los efectos adversos, incluyen: mejorar la calidad de información, fortalecer el acceso a servicios integrales de salud, generar espacios saludables.

OBJECTIVE: To characterize sexual and reproductive be-havior and health needs of students in the Faculty of Medical Sciences of the University of Cuenca. METHOD: descriptive study type. Universe: 3265 students of the Faculty of Medical Sciences of the University of Cuenca, in the academic year in September 2014 in February 2015. Sample: was randomized by cluster (ca-reer and courses) in the three schools of the Faculty of Medical Sciences. RESULTS: Of all the surveyed students, 44.7% were from medical school, nursing 27.7%, 27.7% medical technology; 68.6% female and 31.4% male, with a mean age of 21 years; most are unmarried 87.7%, 94.1% are heterosexual, mestizos 97.2% residing in urban areas 81.5%. 45.7% of the women and 70.1% of males are sexually active, 15% are parents, 81.6% have used a contraceptive, however the consistent use of contra-ceptives is 55.1%. 66.2% of respondents have visited a doctor last year; 77.3% handle sufficient information for the prevention of pregnancy and 79.7% for STD prevention. CONCLUSIONS: Although students have information on sexuality and access to health services, adverse effects on sexual and reproductive health are identified as a problem that leads to student dropout and low aca-demic performance. The main solutions to combat the adverse effects include: improving the quality of infor-mation, enhance access to comprehensive health ser-vices, generating healthy spaces.

Conocimiento Actitudes y Prácticas Sobre el Aborto Voluntario y Terapéutico en Especialistas en Ginecología y Obstetricia que Laboran en Hospitales Públicos del Cantón Cuenca / Knowledge Attitudes and Practices About Voluntary and Therapeutic Abortion in Specialists in Gynecology and Obstetrics who Work in Public Hospitals of the Cuenca Canton

ANTECEDENTES: El código integral penal señala que el aborto provocado no será punible cuando se realice para evitar un peligro en la salud de la mujer y cuando el embarazo es consecuencia de una violación en una mujer que padezca de discapacidad mental. OBJETIVOS: Identificar los conocimientos actitudes y prácticas de los ginecólogos de los hospitales públicos de Cuenca, sobre el aborto voluntario y terapéutico; identificar si existe relación entre la edad, el género, los años de ejercicio profesional y las concepciones religiosas de los ginecólogos, sobre el conocimiento de la legislación sobre el aborto y su apertura hacia el aborto voluntario y terapéutico. METODOLOGÍA: Un total de 27 ginecólogos, que traba-jan en hospitales públicos del cantón Cuenca fueron encuestados; se seleccionaron los profesionales que la-boran en centros con internación por la mayor posibilidad de que ellos puedan tener contacto con paciente que requieren abortos terapéuticos, o hayan atendido pacientes con abortos provocados. RESULTADOS: La muestra fue constituida por 27 especia-listas en ginecología y obstetricia, con una edad media de 37 años, el 77.8% de los encuestados de sexo mascu-lino y el 22.2% femenino; el tiempo medio de ejercicio profesional fue 7.36; el 91.7% de los profesionales profe-sa una religión, el 88.9% considera importante la religión en su vida. El 81.5% sabe que el aborto terapéutico es legal en el Ecuador, sin embargo, el 29.6% puede citar correctamente las causales en las cuales el aborto no es punible. El 63% considera que se debe despenalizar el aborto en el Ecuador en todas las causales. El 22.2% ha realizado un aborto terapéutico; 81%, ha visto una paciente con un aborto provocado durante el último año. En la presente investigación no se pudo demostrar asociación entre la edad, el género, años de ejercicio profesional y las concepciones religiosas de los ginecólogos, sobre el conocimiento de la legislación acerca del aborto y su apertura sobre el aborto voluntario y terapéutico. CONCLUSIONES: El conocimiento sobre las causales en las cuales el aborto no es punible, es bajo entre los ginecólogos de los servicios públicos de salud; un pequeño porcentaje de ellos, tiene experiencia en la ejecución de un aborto terapéutico, sin embargo, el 63% tiene una actitud positiva hacia la despenalización del aborto en todas sus causales.

BACKGROUND: The penal integral code says that indu-ced abortion is not punishable when it is performed to avoid a hazard on the women health and when the pregnancy is a consequence of a rape to a woman who suffers mental disabilities. OBJECTIVE: This research objective is to identify the knowledge, attitudes and practices of gynecologists from public hospitals in Cuenca on voluntary and the-rapeutic abortion; also it aims to identify the correlation between: age, gender, and years of practice and reli-gious conceptions of gynecologists about the knowle-dge of the legislation on abortion and openness to the voluntary and therapeutic abortion. METHODOLOGY: A total of 27 gynecologists who work in public hospitals in Cuenca were surveyed; professionals who are working in centers with internship were selec-ted because they may have a higher contact with pa-tients that require therapeutic abortions, or have seen patients with induced abortions.RESULTS: The sample was composed of 27 specialists in gynecology and obstetrics, with an average age of 37 years, the 77.8% male and 22.2% female; the average time of professional practice was 7.36; the 91.7% of pro-fessionals profess a religion, the 88.9% consider the reli-gion how something important in their life. The 81.5% of respondents know that therapeutic abortion is legal in Ecuador; however, the 29.6% can quote correctly the grounds on which abortion is not punishable. The 63% of participants believe that abortion should be decrimina-lized in Ecuador in all grounds. The 22.2% (n = 6) of the professionals surveyed have made a therapeutic abor-tion; the 81% of respondents, has seen a patient with an induced abortion during the last year. In this research the association between age, gender, years of practice and religious conceptions of gynecologists, knowledge of legislation about abortion and its opening on volun-tary and therapeutic abortion could not be proven. CONCLUSIONS: The knowledge about the grounds on which abortion is not punishable, it is low among gyne-cologists of public health services; a small percentage of them have experience in performing a therapeu-tic abortion, however, the 63% have a positive attitu-de towards the decriminalization of abortion in all its grounds.

Percepciones Sobre la Salud Sexual y Reproductiva de las Mujeres Indígenas Kichwas y Shuaras. Ecuador, 2016 / Perceptions on the Sexual and Reproductive Health of Kichwa and Shuara Indigenous Women. Ecuador, 2016

El cáncer de cuello uterino (CCU), es un problema de salud aún no resuelto en los países en vías de desarrollo; esta patología es la principal causa de muerte por cáncer ginecológico en el Ecuador. La cobertura del tamizaje preventivo está influenciada por concepciones culturales de la población, que tienen asidero en las percepciones de cada etnia sobre el proceso etiológico del complejo salud-enfermedad. OBJETIVO: Interpretar las percepciones que tienen las mujeres de los pueblos y nacionalidades indígenas Shuar de Sevilla Don Bosco y Kichwas de Quilloac y Saraguro, acerca de la salud sexual y reproductiva, las infecciones de transmisión sexual, CCU y condiciones asociadas. METODOLOGÍA: Se realizó un estudio cualitativo fenomenológico, mediante 17 grupos focales, 13 historias de vida, con un total de 102 personas entrevistadas. RESULTADOS: Los relatos de las mujeres, entendidos como construcciones colectivas de sus respectivos grupos étnicos, en el contexto de una cultura hegemónica occidental, patriarcal y machista, hacen referencia principalmente a procesos destructivos de su salud sexual y reproductiva, manifestados como infidelidad y promiscuidad masculina, así como la falta de protección con preservativos, lo cual incide en la prevalencia de infecciones de transmisión sexual y CCU. CONCLUSIONES: Las mujeres tienen conciencia sobre un concepto amplio de la salud, que incluye nociones de salud sexual y reproductiva; sin embargo, refieren obstáculos en su ejercicio pleno relacionados con inequidades de clase, género, etnia y generacional, expresados como procesos destructivos de su salud.

Cervical cancer is a health problem unresolved in de-veloping countries; this disease is the leading cause of death from gynecologic cancer in Ecuador. Coverage of preventive screening is influenced by cultural con-ceptions of the population, which are based on the per-ceptions of each ethnic group on the etiologic process health-disease complex. OBJECTIVE: To interpret the perceptions of women of in-digenous peoples and nationalities Shuar of Sevilla Don Bosco and Kichwas of Quilloac and Saraguro, about sexual and reproductive health, sexually transmitted in-fections, cervical cancer and associated conditions. METHODOLOGY: A qualitative, phenomenological study was conducted through 17 focus groups and 13 stories of life study. A total of 102 people interviewed. RESULTS: The stories of women understood as collective constructions of their respective ethnic groups in the context of a Western, patriarchal and maleness hege-monic culture, mainly refer to destructive processes of sexual and reproductive health, manifested as infideli-ty and male promiscuity and as the lack of protection with condoms, which affects the prevalence of sexually transmitted infections and Cervical Cancer. CONCLUSIONS: Women have awareness of a broad concept of health, including notions of sexual and re-productive health; however, relate obstacles in their full exercise, related to inequalities of class, gender, and generational etnia1 expressed as destructive processes of their health.

Percepción de los graduados de la carrera de medicina de la Universidad de Cuenca 2003-2012, sobre la formación en la relación y comunicación médico-paciente / Perception of the medical career graduates of the University of Cuenca 2003 - 2012, on training in the relationship medical communication ­ patient

Objetivo: Identificar la percepción de los médicos graduados en la Facultad de Ciencias Médicas, respecto a su formación en el tema de Relación y Comunicación Médico Paciente.Diseño: es un estudio descriptivo transversal. Metodología: A través de encuesta a los médicos graduados en la Facultad de Ciencias Médicas de la Universidad de Cuenca.Se utilizó una base de datos del programa de Monitoreo de los graduados de la carrera de Medicina de la Universidad de Cuenca, 2003- 2012. Azuay. Resultados: Se realizaron 208 encuestas, 116 varones (56%) y 92 mujeres (44%), cuyas edades oscilan entre los 23 y 42 años, todos graduados de la Escuela de Medicina de la Universidad de Cuenca entre los años 2003 a 2012. El 98% de ellos residentes en el Ecuador. Respecto a la percepción sobre su formación en relación médico paciente y comunicación: para comunicación escrita, comunicación oral, entrega de noticias negativas, relación afectiva con los pacientes y participación comunitaria: la percepción es que su formación fue adecuada, en tanto aprecian como poco adecuado en manejo de situaciones de conflicto, al igual que en la aplicación del consentimiento informado

Objective. To identify the perception of the graduated doctors from Medical Faculty, regarding to their formation in the Relationship and Communication with patients.Design: It is a cross-sectional study.Methodology: A survey to graduated doctors from Medical Faculty in the University of Cuenca was conducted.A database of the monitoring program for graduated people from Medicine School in the University of Cuenca, Azuay 2003-2012 was used. Results: A total of 208 surveys, 116 males with a 56% and 92 women with a 44%, aged between 23 and 42, all graduated people from Medicine School in the University of Cuenca from 2003 to 2013. The 98% are living in Ecuador.Regarding the perception of training in communication and doctor-patient relationship: to written communication, oral communication, delivering bad news, emotional relationship with patients and community participation: the perception is that their training was adequate, while it is appreciated as little suitable for handling conflict situations, as well as in the application of the informed consent.