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1.
JNMA J Nepal Med Assoc ; 59(239): 630-634, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508504

RESUMO

INTRODUCTION: Cervical cancer is the leading gynaecological cancer in Nepal. Most of the time, it is diagnosed in the late stage with its associated morbidity and mortality. This study aimed to find out the prevalence of late-stage presentation of cervical cancer among confirmed cases of cervical cancer in a tertiary care centre. METHODS: A descriptive cross-sectional study was conducted at a tertiary care centre of Nepal from March 2021 to May 2021 after obtaining ethical clearance from the Institutional Review Board (Reference no.805). A convenient sampling method was used. A descriptive analysis was done of all cases of cervical cancer who were diagnosed within the last 36 months and attended hospital during the study period. The information was collected by interview and hospital record was checked. Analysis was done using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Among the 142 confirmed cervical cancer cases, the prevalence of late-stage presentation of cervical cancer was 93 (65.5%) (57.7-73.3 at 95% Confidence Interval). The mean age at diagnosis was 50.6±10.9 years. More than two-thirds of the women were from outside Kathmandu valley 102 (71.8%) and came from >50km distance. The majority of the women 83 (58.5%) were illiterate. CONCLUSIONS: The study showed that two-thirds of the women presented in advanced stage and the factors leading to the late stage. This highlights the fact, that the focus should be on the provision of organized screening programs and early diagnosis and treatment of cervical cancer.


Assuntos
Neoplasias do Colo do Útero , Estudos Transversais , Feminino , Humanos , Nepal/epidemiologia , Prevalência , Centros de Atenção Terciária , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia
2.
Artigo em Russo | MEDLINE | ID: mdl-34486854

RESUMO

All around the world, about 570 000 of new cases of cervical cancer are diagnosed annually and more than 300 000 of women die of this pathology. In the Russian Federation, in 2018, more than 17 500 of new cases of cervical cancer were diagnosed and more than 6 000 of women died of this pathology. The purpose of the study was to analyze incidence and mortality of cervical cancer in 2007-2018. The analysis of incidence rates of cervical cancer in the Russian Federation in 2007-2018 established steady trend of increasing of incidence rate from 12.8 (2007) to 15.8 (2018). The incidence rate increased up to 26.6%. The increasing is most pronounced in the age groups of 35-39, 40-44 and 45-49 years. The analysis of dynamics of mortality rates established relative stability indices in 2007-2018 (5.11 and 5.07 in standardized rates per 100 000). The decrease of 2018 as compared to 2007 made up to 0.78%. In most age groups mortality rates are decreasing. However, significant increase of mortality rate in age group of 40-44 years was established amounted up to 25%.


Assuntos
Neoplasias do Colo do Útero , Adulto , Feminino , Humanos , Incidência , Morbidade , Mortalidade , Federação Russa/epidemiologia , Neoplasias do Colo do Útero/epidemiologia
3.
Medicine (Baltimore) ; 100(35): e27030, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477133

RESUMO

ABSTRACT: The Human Immunodeficiency Virus (HIV) seropositive prevalence among women with cervical cancer varies in different parts of the world and even within a country. This study aimed to document the prevalence of HIV infection in women with newly diagnosed cervical cancer at a secondary hospital in South Africa.This study is a retrospective review of records of 89 women who were newly diagnosed with cervical cancer between 01 June 2010 and 31 May 2013 at Pelonomi Hospital, Mangaung, South Africa. Data such as age, parity, gravidity, marital status, occupation, HIV status, CD4 count, on anti-retroviral treatment, clinical stage of disease were retrieved from the case files, the Meditech-patient record and Disa laboratory system. Data analysis was done using the SAS statistical package.HIV-seropositive prevalence was 52.4%, with the highest prevalence (91.3%) in the age group 40 years and younger. In HIV-positive women, the mean CD4 cell count was 280 cell/mm3 and 43% of them were not on anti-retroviral treatment. The majority (86%) of all patients presented with late stage disease (International Federation of Gynecology and Obstetrics Stage III and IV) when newly diagnosed with cervical cancer.This study highlights high HIV-seropositive prevalence; severe immunosuppression and late presentation of the disease in women newly diagnosed with cervical cancer. Cervical cancer screening programs need to be fully reinforced into existing HIV health care services to allow for ideal prevention and early detection of the disease. Anti-retroviral treatment needs to be prioritized for HIV-positive women.


Assuntos
Infecções por HIV/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Estudos de Coortes , Correlação de Dados , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Hospitais/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , África do Sul/epidemiologia , Neoplasias do Colo do Útero/epidemiologia
4.
Pan Afr Med J ; 39: 44, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422167

RESUMO

Introduction: cervical intraepithelial neoplasia the precursor of cervical cancer occurs with increased frequency in women infected with human immunodeficiency virus (HIV). This study aimed at determining the prevalence and correlates of abnormal cervical cytology among HIV-infected women and compare to the uninfected women. Methods: a cross-sectional study conducted among HIV-infected and uninfected women enrolled in a HIV study in Central Kenya. All women had baseline Pap smear examination assessed using Bethesda system. Bivariate and multivariate logistic regression methods were employed to assess the correlates of cervical squamous epithelial lesions (CSIL). Results: a total 480 women had an acceptable baseline smear, 373 (78%) were HIV-infected. Median age was 30.2 years [IQR 25.4-35.5]. Overall prevalence of CSIL was 37% (176/480) with the prevalence of low grade squamous intraepithelial lesion (LSIL), atypical squamous cells undetermined significance (ASCUS), high grade squamous intraepithelial lesions (HSIL) and atypical glandular cells (AGC) were 17%, 14%, 4% and 2% respectively. HIV-infected women had a higher prevalence of CSIL at 42% as compared to HIV-uninfected women at 19%. HIV infection was the predictor associated with development of CSIL at multivariate analysis and specifically, HIV-infected women were 3 times (AOR 3.1, 95% CI: 1.8 - 5.4, p<0.005) more likely to have CSIL than HIV-uninfected women. The age 35 - 44 years was protective to developing CSIL (AOR 0.45, 95% CI: 0.24 - 0.87, p=0.018). Conclusion: cervical squamous epithelial lesions is a major problem among Kenyan women. HIV infection confers a higher risk to development of CSIL. Cervical cancer screening should be an established practice in HIV programs.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Infecções por HIV/complicações , Lesões Intraepiteliais Escamosas/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Neoplasia Intraepitelial Cervical/diagnóstico , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Infecções por HIV/epidemiologia , Humanos , Quênia/epidemiologia , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Teste de Papanicolaou , Prevalência , Lesões Intraepiteliais Escamosas/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal , Adulto Jovem
5.
BMC Health Serv Res ; 21(1): 841, 2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34412641

RESUMO

BACKGROUND: Cervical cancer is the second most common female malignant tumor in the world. According to a study in 2018, the incidence of cervical cancer in Yunnan Province of China was 11.42 per 100,000, the mortality rate was 3.77 per 100,000, and higher than the national average. Health-related quality of life (HRQoL) can be used not only in the selection and effect evaluation of clinical treatment plans of cervical cancer, but also in the evaluation of prognosis and long-term survival status. In this study, 288 cervical cancer patients admitted to the Yunnan Cancer Hospital in Southwest China from 2018 to 2020 were used as the survey objects to understand the HRQoL of cervical cancer patients and explore the related factors that affect HRQoL. METHODS: The Chinese version of the functional assessment of cancer therapy-cervix (functional assessment of cancer therapy-cervix v4.0, FACT-Cx V4) was used to investigate 288 patients with cervical cancer in Yunnan Province. Statistical analysis was performed using t-test, analysis of variance, multiple linear regression and other methods. RESULTS: The total FACT-Cx score of cervical cancer patients was (130.16 ± 14.20), the physical well-being (PWB) score was (22.02 ± 4.47), the social/family well-being (SWB) score was (25.66 ± 3.59), the emotional well-being (EWB) score was (19.75 ± 3.54), the functional well-being (FWB) score was (16.91 ± 5.01) and the additional focus area (cervical cancer subscale, CxS) score was (45.78 ± 4.61). From the multi-factor analysis results, the scores of PWB, FWB, Cxs and the total FACT-Cx were related to the choice of different treatment methods, the PWB scores of patients with concurrent chemoradiotherapy was low(ß = - 1.67, P = 0.003), the FWB scores of patients with concurrent chemoradiotherapy was low(ß = - 2.02, P = 0.001), the CxS scores of patients with concurrent chemoradiotherapy was low(ß = - 1.61, P = 0.006), the total score of FACT-Cx of patients with concurrent chemoradiotherapy was low(ß = - 5.91, P = 0.001). SWB score was affected by marital status, married patients had high PWB scores(ß = 5.44, P = 0.006). The patients with heavy disease expenditures as aproportion of family disposable income(ß = - 3.82, P = 0.002) and aged 60 and above(ß = - 3.29, P = 0.003) had lower FWB scores. The total score FACT-Cx of patients participating in cervical cancer screening was higher(ß = 7.61, P = 0.001). CONCLUSION: The choice of treatment method is the common influencing factor of PWB, FWB, Cxs and the total FACT-Cx. Disease expenditures as a proportion of family disposable income, the treatment method, the marital status and whether to participate in cervical cancer screening affect the patient's evaluation of their own HRQoL. Medical staff should pay special attention to the choice of different treatment methods, popularize vaccination knowledge and cervical cancer screening, give more humanistic care and health education to cervical cancer patients who have low education level, poor economic conditions, divorced or separated, and encourage patients to participate in active treatment to improve the health-related quality of life.


Assuntos
Qualidade de Vida , Neoplasias do Colo do Útero , China/epidemiologia , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Humanos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/terapia
6.
BMJ Open ; 11(8): e048055, 2021 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-34417214

RESUMO

OBJECTIVES: This study aimed to conduct a meta-analysis of estimates of the natural history of high-grade cervical intraepithelial neoplasia (CIN) during pregnancy. SETTING: Studies examining the clinical courses of histologically confirmed high-grade CIN during pregnancy. PARTICIPANTS: We searched PubMed, Web of Science and Embase for eligible studies. Studies were included if they reported the data regarding the natural history of histologically confirmed high-grade CIN during pregnancy. Final estimates were from the meta-analysis of 10 eligible studies. PRIMARY OUTCOME MEASURES: The regression rate, persistence rate and progression rate of histologically proven untreated high-grade CIN during pregnancy. RESULTS: A total of 10 original studies were included in this meta-analysis. During pregnancy, the regression rate, persistence rate and progression rate of high-grade CIN were 40% (95% CI 35% to 45%), 59% (95% CI 54% to 64%) and 1% (95% CI 0% to 2%), respectively. There was moderate heterogeneity among the studies. The results of the subgroup meta-analysis show that the pooled rates of regression and persistence during pregnancy were 59% (95% CI 54% to 65%) and 40% (95% CI 35% to 45%) for CIN2, and 29% (95% CI 25% to 33%) and 70% (95% CI 65% to 73%) for CIN3. CONCLUSIONS: During pregnancy, the majority of histologically confirmed high-grade CIN would be persistent or regressed to lower grade CIN or normal. However, it is still worth noting that a small percentage of high-grade CIN would progress to cervical cancer during pregnancy.


Assuntos
Neoplasia Intraepitelial Cervical , Neoplasias do Colo do Útero , Neoplasia Intraepitelial Cervical/epidemiologia , Feminino , Humanos , Gravidez , Neoplasias do Colo do Útero/epidemiologia
7.
BMC Health Serv Res ; 21(1): 794, 2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380470

RESUMO

BACKGROUND: Cervical cancer is the leading cancer among Ugandan women, contributing to 40 % of all cancer cases recorded in the cancer registry. Having identified the substantial impact of cervical cancer among Ugandan women, the Ministry of Health in 2010 launched a Strategic Plan for Cervical Cancer prevention and control. This study was conducted to determine if health workers working in rural health centres (HCs) III and IV in Northern Uganda provide cervical cancer screening services as recommended in the Strategic Plan. METHODS: A cross-sectional survey using a structured questionnaire was conducted among nurses, midwives and clinical officers working in rural HC III and IV in Northern Uganda. Data were entered in Epidata 3.1 and analysed using Stata 16 statistical software. Univariate, bivariate, and multivariate analyses were performed. Any factor with p-value ≤ 0.05 was considered a significant predictor of outcome. RESULTS: We surveyed 286 health workers. Fifty-one (18 %) health workers were screening women for cervical cancer. Fifty-eight (21 %) health workers have guideline for cervical cancer screening in their HCs, 93 (33 %) participants were trained to screen women for cervical cancer. Two hundred sixty-two (92 %) participants provided HPV vaccination. Two hundred forty-six (87 %) participants were conducting health education about cervical cancer in their HCs. Factors associated with screening women for cervical cancer include: being a staff member from HCs III (AOR = 0.30, 95 % CI 0.13-0.68, p = 0.00), being staff of HCs that have organization to support cervical cancer screening services (AOR = 4.38, 95 % CI 1.99-9.63, p-=0.00), being a health worker who had been trained to screen for cervical cancer (AOR = 2.21, 95 % CI 1.00-4.90, p = 0.05) and staff from HCs that has guideline for cervical cancer screening (AOR = 2.89, 95 % CI 1.22-6.86, p = 0.02). CONCLUSIONS: This study shows an overall structural problem related to the delivery of cervical cancer screening services in HC III and IV in Northern Uganda which the Strategic Plan has not addressed. These structural problems need urgent attention if the Uganda government and other sub-Saharan African (SSA) countries are to achieve the World Health Organization (WHO) 90-70-90 targets by 2030 to be on track for cervical cancer elimination.


Assuntos
Serviços de Saúde Rural , Neoplasias do Colo do Útero , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Humanos , Inquéritos e Questionários , Uganda/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle
8.
Cancer Sci ; 112(9): 3691-3698, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34252250

RESUMO

In Japan, the age-adjusted incidence of cervical cancer has been increasing constantly and rapidly among younger women. We set out to accurately confirm the effectiveness of the HPV vaccine in Japan. Data were collected for women born in the fiscal year (FY) 1990 to 1997, who became eligible for their 20-y-old cervical cancer screening between the FY 2010 to 2017. The adjusted incidence of cervical intraepithelial neoplasia (CIN)1+ in women born in FY 1990 to 1993, that is those who reached the national vaccination target age prior to the introduction of publicly subsidized HPV vaccinations, referred here after as "the pre-introduction generation", was 1.42% (242/17 040). The incidence in the "vaccination generation" (women born in FY 1994 to 1997, that is those who were heavily vaccinated as a group when they were of the nationally targeted age of 13-16) was 1.66% (135/8020). There was no significant difference between these incidence rates. However, our FY birth year-by-year analysis revealed that the incidence of CIN1+ was obviously lower than that predicted based on just the trend for CIN1+ seen in the pre-introduction generation. Our analysis revealed that the incidence of CIN3+ was obviously lower in the vaccination generation than in the pre-introduction generation (P = .0008). The incidence of CIN was already tending to increase in both the pre-introduction and vaccination generations. The changes in CIN incidence by individual birth FY must be examined to accurately determine the actual effects of the HPV vaccine for reducing mild cervical lesions.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/prevenção & controle , Papillomaviridae/imunologia , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/métodos , Adolescente , Neoplasia Intraepitelial Cervical/patologia , Feminino , Humanos , Incidência , Japão/epidemiologia , Infecções por Papillomavirus/virologia , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia , Adulto Jovem
10.
Front Public Health ; 9: 670032, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34277540

RESUMO

The World Health Organization announced an ambitious call for cervical cancer elimination worldwide. With existing prevention and treatment modalities, cervical cancer elimination is now within reach for high-income countries. Despite limited financing and capacity constraints in low-and-middle-income countries (LMICs), prevention and control efforts can be supported through integrated services and new technologies. We conducted this scoping review to outline a roadmap toward cervical cancer elimination in LMICs and highlight evidence-based interventions and research priorities to accelerate cervical cancer elimination. We reviewed and synthesized literature from 2010 to 2020 on primary and secondary cervical cancer prevention strategies. In addition, we conducted expert interviews with gynecologic and infectious disease providers, researchers, and LMIC health officials. Using these data, we developed a logic model to summarize the current state of science and identified evidence gaps and priority research questions for each prevention strategy. The logic model for cervical cancer elimination maps the needs for improved collaboration between policy makers, production and supply, healthcare systems, providers, health workers, and communities. The model articulates responsibilities for stakeholders and visualizes processes to increase access to and coverage of prevention methods. We discuss the challenges of contextual factors and highlight innovation needs. Effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing, and thermocoagulation. However, vaccine coverage remains low in LMICs. New strategies, including single-dose vaccination could enhance impact. Loss to follow-up and treatment delays could be addressed by improved same-day screen-and-treat technologies. We provide a practical framework to guide cervical cancer elimination in LMICs. The scoping review highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.


Assuntos
Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Países em Desenvolvimento , Feminino , Humanos , Pesquisa , Neoplasias do Colo do Útero/epidemiologia , Vacinação
11.
J Coll Physicians Surg Pak ; 30(7): 786-791, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34271777

RESUMO

OBJECTIVE: To determine the high risk-human papillomavirus (HR-HPV) prevalence, genotype distribution, and associated risk factors in women with general gynaecological problems. STUDY DESIGN: Descriptive, cross-sectional study. PLACE AND DURATION OF STUDY: Lady Wallingdon Hospital, Lahore from August 2018 to May 2019. METHODOLOGY: One hundred females with general gynaecological problems constituted the sample. Real-time polymerase chain reaction and liquid base cytology were performed for HR-HPV detection, genotyping, and cytological changes in cervical samples. RESULTS: The overall prevalence of HR-HPV was found to be 57%, with the most frequent HR-HPV genotypes HPV 16 (18%), HPV 18 (6%), and HPV 45 (1%). The total prevalence of single HR-HPV infection was 25%; whereas, multiple co-infection of HR-HPV was seen in 32% of cases. In total, 81% of these women had normal cytology and 19% had cytologic abnormalities. A significant association was observed between HR-HPV infection and general gynaecological complaints and between HR-HPV infection and cytological abnormalities (p < 0.001). CONCLUSION: The HR-HPV prevalence was 57% with the most prevalent genotypes were HPV 16 and HPV 18. The results will also aid the identification of HR-HPV 51 and 31 genotypes, which should be added in the multi-type HPV vaccines. Key Words: Cancer of cervix, Human papillomavirus, Papanicolaou test, Pakistan.


Assuntos
Alphapapillomavirus , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Colo do Útero , Estudos Transversais , DNA Viral/genética , Feminino , Genótipo , Humanos , Paquistão/epidemiologia , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Prevalência , Neoplasias do Colo do Útero/epidemiologia
12.
Prev Med ; 151: 106596, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34217415

RESUMO

The COVID-19 pandemic has a major impact on a wide range of health outcomes. Disruptions of elective health services related to cervical screening, management of abnormal screening test results, and treatment of precancers, may lead to increases in cervical cancer incidence and exacerbate existing health disparities. Modeling studies suggest that a short delay of cervical screening in subjects with previously negative HPV results has minor effects on cancer outcomes, while delay of management and treatment can lead to larger increases in cervical cancer. Several approaches can mitigate the effects of disruption of cervical screening and management. HPV-based screening has higher accuracy compared to cytology, and a negative HPV result provides longer reassurance against cervical cancer; further, HPV testing can be conducted from self-collected specimens. Self-collection expands the reach of screening to underserved populations who currently do not participate in screening. Self-collection and can also provide alternative screening approaches during the pandemic because testing can be supported by telehealth and specimens collected in the home, substantially reducing patient-provider contact and risk of COVID-19 exposure, and also expanding the reach of catch-up services to address backlogs of screening tests that accumulated during the pandemic. Risk-based management allows prioritizing management of patients at highest risk of cervical cancer while extending screening intervals for those at lowest risk. The pandemic provides important lessons for how to make cervical screening more resilient to disruptions and how to reduce cervical cancer disparities that may be exacerbated due to disruptions of health services.


Assuntos
COVID-19 , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Detecção Precoce de Câncer , Feminino , Humanos , Programas de Rastreamento , Pandemias , Papillomaviridae , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , SARS-CoV-2 , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia
13.
BMC Womens Health ; 21(1): 267, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229672

RESUMO

BACKGROUND: Cervical cancer is the leading cause of female cancer mortality in Botswana with the majority of cervical cancer patients presenting with late-stage disease. The identification of factors associated with late-stage disease could reduce the cervical cancer burden. This study aims to identify potential patient level clinical and sociodemographic factors associated with a late-stage diagnosis of cervical cancer in Botswana in order to help inform future interventions at the community and individual levels to decrease cervical cancer morbidity and mortality. RESULTS: There were 984 women diagnosed with cervical cancer from January 2015 to March 2020 at two tertiary hospitals in Gaborone, Botswana. Four hundred forty women (44.7%) presented with late-stage cervical cancer, and 674 women (69.7%) were living with HIV. The mean age at diagnosis was 50.5 years. The association between late-stage (III/IV) cervical cancer at diagnosis and patient clinical and sociodemographic factors was evaluated using multivariable logistic regression with multiple imputation. Women who reported undergoing cervical cancer screening had lower odds of late-stage disease at diagnosis (OR: 0.63, 95% CI 0.47-0.84) compared to those who did not report screening. Women who had never been married had increased odds of late-stage disease at diagnosis (OR: 1.35, 95% CI 1.02-1.86) compared to women who had been married. Women with abnormal vaginal bleeding had higher odds of late-stage disease at diagnosis (OR: 2.32, 95% CI 1.70-3.16) compared to those without abnormal vaginal bleeding. HIV was not associated with a diagnosis of late-stage cervical cancer. Rural women who consulted a traditional healer had increased odds of late-stage disease at diagnosis compared to rural women who had never consulted a traditional healer (OR: 1.61, 95% CI 1.02-2.55). CONCLUSION: Increasing education and awareness among women, regardless of their HIV status, and among providers, including traditional healers, about the benefits of cervical cancer screening and about the importance of seeking prompt medical care for abnormal vaginal bleeding, while also developing support systems for unmarried women, may help reduce cervical cancer morbidity and mortality in Botswana.


Assuntos
Neoplasias do Colo do Útero , Botsuana/epidemiologia , Diagnóstico Tardio , Detecção Precoce de Câncer , Feminino , Humanos , Programas de Rastreamento , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia
14.
Chin Med J (Engl) ; 134(15): 1838-1844, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34267066

RESUMO

BACKGROUND: Cervical cancer remains a major public health issue for the Uyghur women and other women living mainly in rural areas of Xinjiang. This study aims to investigate the distribution of human papillomavirus (HPV) infection and cervical cancer in rural areas of Xinjiang, China. METHODS: Cervical cancer screening was performed on rural women aged 35 to 64 years from Xinjiang, China in 2017 through gynecological examination, vaginal discharge smear microscopy, cytology, and HPV testing. If necessary, colposcopy and biopsy were performed on women with suspicious or abnormal screening results. RESULTS: Of the 216,754 women screened, 15,518 received HPV testing. The HPV-positive rate was 6.75% (1047/15,518). Compared with the age 35-44 years group, the odds ratios (ORs) of HPV positivity in the age 45-54 years and 55-64 years groups were 1.18 (95% confidence interval [CI]: 1.02-1.37) and 1.84 (95% CI: 1.53-2.21), respectively. Compared with women with primary or lower education level, the ORs for HPV infection rates of women with high school and college education or above were 1.37 (95% CI: 1.09-1.72) and 1.62 (95% CI: 1.23-2.12), respectively. Uyghur women were less likely to have HPV infection than Han women, with an OR (95% CI) of 0.78 (0.61-0.99). The most prevalent HPV types among Xinjiang women were HPV 16 (24.00%), HPV 33 (12.70%), and HPV 52 (11.80%). The detection rate of cervical intraepithelial neoplasia (CIN)2+ was 0.14% and the early diagnosis rate of cervical cancer was 85.91%. The detection rates of vaginitis and cervicitis were 19.28% and 21.32%, respectively. CONCLUSIONS: The HPV infection rate in Xinjiang is low, but the detection rate of cervical cancer and precancerous lesions is higher than the national average level. Cervical cancer is a prominent public health problem in Xinjiang, especially in southern Xinjiang.


Assuntos
Alphapapillomavirus , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Adulto , China/epidemiologia , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/epidemiologia , População Rural , Neoplasias do Colo do Útero/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-34207093

RESUMO

Criminal-legal involved women experience significant barriers to preventive cervical care, and consequently there is a higher incidence of cervical cancer in this population. The purpose of this study is to identify variables that may facilitate abnormal Pap follow-up among criminal-legal involved women living in community settings. The study included n = 510 women with criminal-legal histories, from three U.S. cities-Birmingham, AL; Kansas City, KS/MO; Oakland, CA. Participants completed a 288-item survey, with questions related to demographics, social advantages, provider communication, and reasons for missing follow-up care. There were n = 58 women who reported abnormal Pap testing, and n = 40 (69%) received follow-up care. Most women received either repeat Pap/HPV testing (n = 15, 38%), or colposcopy and/or biopsy (n = 14, 35%). Women who did not follow-up (n = 15, 26%) cited that they forgot (n = 8, 53%), were uninsured (n = 3, 20%), or were reincarcerated (n = 3, 20%). In a multivariate analysis, both having a primary care provider (OR 4.6, 95% CI 1.3-16.0) and receiving specific provider communication about follow-up (OR 3.8, 95% CI 1.1-13.2) were independent predictors for abnormal Pap follow-up. Interventions that offer linkages to providers in the community or ensure abnormal Pap care plans are communicated effectively may mitigate the disparate incidence of cervical cancer among criminal-legal involved women.


Assuntos
Criminosos , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Cidades , Feminino , Seguimentos , Humanos , Kansas , Teste de Papanicolaou , Neoplasias do Colo do Útero/epidemiologia , Esfregaço Vaginal
16.
Medicine (Baltimore) ; 100(28): e26335, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34260524

RESUMO

ABSTRACT: Cervical intraepithelial neoplasia (CIN) is the abnormal growth of cells on the surface of the cervix that could potentially lead to cervical cancer. In the present study, we investigated whether measuring the neutrophil-lymphocyte ratio (NLR) can be useful for predicting the risks of developing cervical lesions.This is a retrospective analysis of 212 women who were enrolled in this study. Among them, 106 patients with histologically confirmed CIN1-3 who were treated with loop electrosurgical excision procedure or cold knife cone in the Department of Gynecology, The Affiliated Hospital of Inner Mongolia Medical University between July 30th 2016 and January 30th 2019.Among the 106 patients in the CIN group, cytology showed minor abnormality which included atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion in 42, high-grade squamous intraepithelial lesion in 62, and squamous cell carcinoma in 2 patients. We found that the NLR has no significant difference between the control group and the CIN1 group, while there were significant differences between CIN1 and CIN2, and CIN2 and CIN3 group. The median of the NLR was higher in the HPV16-persistent groups than in the HPV-negative group.In conclusion, a high NLR value independently predicts CIN and the stage of CIN. The NLR may help doctors evaluate outcomes of patients received conization and choose alternative therapies for patients with high NLR value.


Assuntos
Neoplasia Intraepitelial Cervical/sangue , Linfócitos/metabolismo , Neutrófilos/metabolismo , Neoplasias do Colo do Útero/sangue , Adulto , Idoso , Biomarcadores Tumorais , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/virologia , Feminino , Humanos , Pessoa de Meia-Idade , Papillomaviridae , Infecções por Papillomavirus/epidemiologia , Estudos Retrospectivos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Adulto Jovem
17.
JCO Glob Oncol ; 7: 1116-1128, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34264750

RESUMO

PURPOSE: In East Africa, cervical cancer is a leading cause of morbidity and mortality among women diagnosed with cancer. In this study, we describe the burden of risk factors for cervical cancer among women of reproductive age in five East African countries. METHODS: For each country, using STATA13 software and sampling weights, we analyzed the latest Demographic and Health Survey data sets conducted between 2014 and 2017 in Burundi, Kenya, Rwanda, Tanzania, and Uganda. We included women age 15-49 years and considered six risk factors (tobacco use, body mass index, age at first sexual intercourse, age at first birth, number of children, and hormonal contraceptive use). RESULTS: Of the 93,616 women from the five countries, each country had more than half of the women younger than 30 years and lived in rural areas. Pooled proportion of women with at least one risk factor was 89% (95% CI, 87 to 91). Living in a rural area in Burundi (adjusted incidence rate ration 0.94; 95% CI, 0.9 to 0.99; P = .019) and Rwanda (adjusted incidence rate Ration 0.92; 95% CI, 0.88 to 0.96; P < .001) was associated with a lower number of risk factors compared with living in an urban area. In all the countries, women with complete secondary education were associated with a lower number of risk factors compared with those with no education. CONCLUSION: This study reveals a high burden of risk factors for cervical cancer in East Africa, with a high proportion of women exposed to at least one risk factor. There is a need for interventions to reduce the exposure of women to these risk factors.


Assuntos
Neoplasias do Colo do Útero , Adolescente , Adulto , Burundi , Criança , Demografia , Feminino , Inquéritos Epidemiológicos , Humanos , Quênia , Pessoa de Meia-Idade , Fatores de Risco , Ruanda/epidemiologia , Fatores Socioeconômicos , Tanzânia , Uganda , Neoplasias do Colo do Útero/epidemiologia , Adulto Jovem
18.
BMC Infect Dis ; 21(1): 691, 2021 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-34273957

RESUMO

BACKGROUND: Female genital schistosomiasis (FGS) is a neglected tropical gynaecological disease that affects millions of women in sub-Saharan Africa (SSA). FGS is caused by Schistosoma haematobium, a parasitic carcinogen involved in the pathogenesis of squamous cell carcinoma of the bladder. Cervical cancer incidence and mortality are highest in SSA, where pre-cancerous cervical dysplasia is often detected on screening with visual inspection with acetic acid (VIA). There are no studies evaluating the association between VIA positivity and FGS diagnosed by genital PCR. METHODS: Women were recruited from the Bilharzia and HIV (BILHIV) study in Zambia a community-based study comparing genital self-sampling to provider obtained cervicovaginal-lavage for the diagnosis of FGS in women aged 18-31. FGS was defined as positive Schistosoma DNA from any genital PCR. Urogenital schistosomiasis diagnostics included urine circulating anodic antigen, urine microscopy and portable colposcopy. Participants were offered cervical cancer screening using VIA at Livingstone Central Hospital. Associations of PCR confirmed FGS and other diagnostics with VIA positivity were assessed using multivariable logistic regression. RESULTS: VIA results were available from 237 BILHIV participants. A positive Schistosoma PCR in any genital specimen was detected in 14 women (5.9%), 28.6% (4/14) of these women had positive VIA compared to 9.0% without PCR evidence of schistosome infection (20/223). Schistosoma PCR positivity in any genital specimen was strongly associated with VIA positivity (OR: 6.08, 95% CI: 1.58-23.37, P = 0.02). CONCLUSIONS: This is the first study to find an association between FGS and positive VIA, a relationship that may be causal. Further longitudinal studies are needed.


Assuntos
Esquistossomose Urinária/epidemiologia , Displasia do Colo do Útero/epidemiologia , Adolescente , Adulto , Animais , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/parasitologia , Colposcopia/métodos , Testes Diagnósticos de Rotina/métodos , Detecção Precoce de Câncer/métodos , Feminino , Genitália Feminina/parasitologia , Genitália Feminina/patologia , Humanos , Incidência , Microscopia/métodos , Reação em Cadeia da Polimerase , Schistosoma haematobium/genética , Schistosoma haematobium/isolamento & purificação , Esquistossomose Urinária/diagnóstico , Esquistossomose Urinária/parasitologia , Manejo de Espécimes , Urinálise/métodos , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/parasitologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/parasitologia , Adulto Jovem , Zâmbia/epidemiologia
19.
Int J Cancer ; 149(8): 1564-1575, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34164807

RESUMO

In 2020, the World Health Organisation (WHO) published a strategy to eliminate cervical cancer as a public health concern. In South Africa, despite having a national screening policy in place since 2000, diagnosed cervical cancer incidence has shown no signs of decline. We extend a previously developed individual-based model for human immunodeficiency virus (HIV) and human papillomavirus (HPV) infection to include progression to cervical cancer. The model accounts for future reductions in HIV incidence and prevalence and includes a detailed cervical cancer screening algorithm, based on individual-level data from the public health sector. We estimate the impact of the current prevention programme and alternative screening scenarios on cervical cancer incidence. The South African screening programme prevented 8600 (95%CI 4700-12 300) cervical cancer cases between 2000 and 2019. At current levels of prevention (status quo vaccination, screening, and treatment), age-standardised cervical cancer incidence will reduce from 49.4 per 100 000 women (95%CI 36.6-67.2) in 2020, to 12.0 per 100 000 women (95%CI 8.0-17.2) in 2120. Reaching WHO's prevention targets by 2030 could help South Africa reach elimination (at the 10/100 000 threshold) by 2077 (94% probability of elimination by 2120). Using new screening technologies could reduce incidence to 4.7 per 100 000 women (95%CI 2.8-6.7) in 2120 (44% probability of elimination at the 4/100 000 threshold). HPV vaccination and decreasing HIV prevalence will substantially reduce cervical cancer incidence in the long term, but improvements to South Africa's current screening strategy will be required to prevent cases in the short term. Switching to new screening technologies will have the greatest impact.


Assuntos
Alphapapillomavirus/efeitos dos fármacos , Infecções por HIV/prevenção & controle , HIV/efeitos dos fármacos , Modelos Estatísticos , Infecções por Papillomavirus/prevenção & controle , Neoplasias do Colo do Útero/epidemiologia , Vacinas contra a AIDS/administração & dosagem , Adulto , Idoso , Alphapapillomavirus/isolamento & purificação , Detecção Precoce de Câncer/métodos , Feminino , Seguimentos , HIV/isolamento & purificação , Infecções por HIV/complicações , Infecções por HIV/virologia , Humanos , Incidência , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/administração & dosagem , Prognóstico , África do Sul/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Adulto Jovem
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