Accelerating action on cervical screening in lower- and middle-income countries (LMICs) post COVID-19 era

In many middle-income countries with a high incidence of cervical cancer, organized screening programmes with the Pap test are being planned. We assessed the knowledge of, and attitudes towards, cervical screening among 63 doctors and 102 randomly selected community members in Trinidad where screening is still opportunistic. Doctors were well informed about cervical cancer, but not all knew the approximate specificity of the Pap test. Many did not routinely discuss the benefits and disadvantages of screening with their clients. Most women had heard of the Pap test, but only 56% knew its purpose; 25% would not participate in screening, stating reasons such as being in menopause or not having symptoms. More information about the aim of screening and the purpose of the Pap test must be communicated. Doctors need to keep their knowledge on screening up-to-date, and offer counselling that helps women to make an informed decision whether or not to participate in screening.

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Systematic Review and Meta-Analysis of Individual Patient Data to Assess the Sensitivity of Cervical Cytology for Diagnosis of Cervical Cancer in Low- and Middle-Income Countries

Journal of Global Oncology ◽

10.1200/jgo.2016.008011 ◽

2017 ◽

Vol 3 (5) ◽

pp. 524-538 ◽

Cited By ~ 1

Author(s):

Alejandra Castanon ◽

Rebecca Landy ◽

Dimitrios Michalopoulos ◽

Roshni Bhudia ◽

Hannah Leaver ◽

...

Keyword(s):

Cervical Cancer ◽

Meta Analysis ◽

Cervical Screening ◽

Relative Sensitivity ◽

Cervical Cytology ◽

Abnormal Cytology ◽

Middle Income ◽

Middle Income Countries ◽

Intraepithelial Lesion ◽

Low And Middle Income

Purpose To assess the sensitivity of cervical cytology to cancer by pooling individual patient cytology results from cancers diagnosed in studies that assessed cervical screening in low- and middle-income countries. Methods Two authors reviewed studies identified through PubMed and Embase databases. We included studies that reported cervical cytology in which at least one woman was diagnosed with cervical cancer and in which abnormal cytology results were investigated at colposcopy and through a histologic sample (if appropriate). When cytology results were not reported in the manuscript, authors were contacted. Stratified analyses and meta-regression were performed to assess sources of heterogeneity between studies. Results We included 717 cancers from 23 studies. The pooled sensitivity of cytology to cancer at a cutoff of a high-grade squamous intraepithelial lesion (HSIL) or worse was 79.4% (95% CI, 67.7% to 86.0%). Results from stratified analyses did not differ significantly, except among studies that recruited symptomatic women or women referred because of abnormal cytology, when the sensitivity of cytology was much higher (95.9%; 95% CI, 86.5% to 99.9%). The cutoff of an HSIL or worse detected 85% of the cancers that would have been detected at a cutoff of atypical squamous cells of undetermined significance or worse (relative sensitivity, 85.2%; 95% CI, 80.7% to 89.7%). Conclusion Cytology at a high cutoff could be an excellent tool for targeted screening of populations at high risk of cervical cancer with a view to diagnose cancer at an earlier stage.

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Evaluation of a Worksite Cervical Screening Initiative to Increase Pap Smear Uptake in Malaysia: A Cluster Randomized Controlled Trial

BioMed Research International ◽

10.1155/2013/572126 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7

Author(s):

Fauziah Abdullah ◽

Michael O’Rorke ◽

Liam Murray ◽

Tin Tin Su

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Cervical Screening ◽

Pap Test ◽

Control Group ◽

Care Providers ◽

Middle Income ◽

Middle Income Countries ◽

Cluster Randomized ◽

The Impact

Background. Despite the significant burden of cervical cancer, Malaysia like many middle-income countries relies on opportunistic cervical screening as opposed to a more organized population-based program. The aim of this study was to ascertain the effectiveness of a worksite screening initiative upon Papanicolaou smear test (Pap test) uptake among educated working women in Malaysia.Methods. 403 female teachers who never or infrequently attended for a Pap test from 40 public secondary schools in Kuala Lumpur were recruited into a cluster randomized trial conducted between January and November 2010. The intervention group participated in a worksite cervical screening initiative whilst the control group received usual care from the existing cervical screening program. Multivariate logistic regression was performed to determine the impact of the intervention program on Pap smear uptake after 24 weeks of followup.Results. The proportion of women attending for a Pap test was significantly higher in the intervention than in the control group (18.1% versus 10.1%,Pvalue < 0.05) with the worksite screening initiative doubling the Pap smear uptake, adjusted odds ratio 2.44 (95% CI: 1.29–4.62).Conclusion. Worksite health promotion interventions can effectively increase cervical smear uptake rates among eligible workers in middle-income countries. Policy makers and health care providers in these countries should include such interventions in strategies for reducing cervical cancer burden. This trial is registered withIRCT201103186088N1.

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Evaluation of research on interventions aligned to WHO ‘Best Buys’ for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015

BMJ Global Health ◽

10.1136/bmjgh-2017-000535 ◽

2018 ◽

Vol 3 (1) ◽

pp. e000535 ◽

Cited By ~ 24

Author(s):

Luke N Allen ◽

Jessica Pullar ◽

Kremlin Khamarj Wickramasinghe ◽

Julianne Williams ◽

Nia Roberts ◽

...

Keyword(s):

Low Income ◽

Controlled Trial ◽

Cervical Screening ◽

Cost Effective ◽

Evidence Base ◽

Good Evidence ◽

Media Campaigns ◽

Middle Income ◽

Mortality And Morbidity ◽

Middle Income Countries

BackgroundNon-communicable diseases (NCDs) are the leading cause of death and disability worldwide, with low-income and middle-income countries experiencing a disproportionately high burden. Since 2010 WHO has promoted 24 highly cost-effective interventions for NCDs, dubbed ‘best buys’. It is unclear whether these interventions have been evaluated in low-income and lower-middle-income countries (LLMICs).AimTo systematically review research on interventions aligned to WHO ‘best buys’ for NCDs in LLMICs.MethodsWe searched 13 major databases and included papers conducted in the 83 World Bank-defined LLMICs, published between 1 January 1990 and 5 February 2015. Two reviewers independently screened papers and assessed risk of bias. We adopted a narrative approach to data synthesis. The primary outcomes were NCD-related mortality and morbidity, and risk factor prevalence.ResultsWe identified 2672 records, of which 36 were included (608 940 participants). No studies on ‘best buys’ were found in 89% of LLMICs. Nineteen of the 36 studies reported on the effectiveness of tobacco-related ‘best buys’, presenting good evidence for group interventions in reducing tobacco use but weaker evidence for interventions targeting individuals. There were fewer studies on smoking bans, warning labels and mass media campaigns, and no studies on taxes or marketing restrictions. There was supportive evidence that cervical screening and hepatitis B immunisation prevent cancer in LLMICs. A single randomised controlled trial supported polypharmacy for cardiovascular disease. Fourteen of the ‘best buy’ interventions did not have any good evidence for effectiveness in LLMICs.ConclusionsWe found studies on only 11 of the 24 interventions aligned with the WHO ‘best buys’ from LLMIC settings. Most LLMICs have not conducted research on these interventions in their populations. LLMICs should take action to implement and evaluate ‘best buys’ in their national context, based on national priorities, and starting with interventions with the strongest evidence base.

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Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries

The Lancet ◽

10.1016/s0140-6736(20)30068-4 ◽

2020 ◽

Vol 395 (10224) ◽

pp. 575-590 ◽

Cited By ~ 41

Author(s):

Marc Brisson ◽

Jane J Kim ◽

Karen Canfell ◽

Mélanie Drolet ◽

Guillaume Gingras ◽

...

Keyword(s):

Cervical Cancer ◽

Low Income ◽

Cervical Screening ◽

Hpv Vaccination ◽

Middle Income ◽

Middle Income Countries ◽

Comparative Modelling ◽

Modelling Analysis

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Human Papillomavirus Research: Where Should We Place Our Bets?

Acta Cytologica ◽

10.1159/000493800 ◽

2019 ◽

Vol 63 (2) ◽

pp. 85-96

Author(s):

Kate Cuschieri ◽

Attila T. Lorincz ◽

Belinda Nedjai

Keyword(s):

Human Papillomavirus ◽

Cervical Screening ◽

Basic Research ◽

Hpv Infection ◽

Middle Income ◽

Middle Income Countries ◽

Research Areas ◽

Prophylactic Vaccination ◽

Important Time ◽

Expert Community

Background: Massive strides have been made with respect to primary and secondary prevention of human papillomavirus (HPV)-associated disease as a result of prophylactic vaccination and cervical screening based on molecular HPV testing. However, cervical cancer continues to be an important clinical and societal burden. Additionally, other HPV-associated cancers, for which there are no screening programmes, are rising. Finally, the optimal combination of vaccination and screening strategies will require careful thinking. Considering this unprecedented and important time, we were keen to solicit the views of the expert community to determine what they perceived were the key priorities for HPV research. Our objective was to identify consensus and key priorities for HPV-based research through provision of a questionnaire disseminated to a multidisciplinary group of key opinion leaders (KOLs). Summary: A structured survey composed of 46 HPV research “categories” was sent to 73 KOLs who were invited to “rank” the categories according to priority. The invitees represented clinical and public health disciplines as well as basic scientists. Scores were weighted according to the number of responses. Invitees also had the opportunity to comment on barriers to the research and suggest other research areas that required attention not reflected in the survey. We received 29 responses in total; overall, the 3 highest-ranked categories were “optimal cervical screening in low and middle-income countries (LMICs),” “primary disease prevention in LMICs” and “impact of vaccine on HPV infection and associated disease.” “HPV and the microbiome” and “mechanisms of transformation” were the highest-ranked categories with respect to basic research. Consistent barriers to research were around governance on the use of samples and data and funding, particularly in an era of vaccination. Key Messages: Research to support the management of disease in LMICs is clearly perceived as a priority in the international community in addition to other diverse areas which necessitate an improved basic understanding of viral mechanisms and interactions. International, multidisciplinary efforts which articulate the broader HPV research agenda will be important when seeking funding in addition to international endeavours to support the efficient use of existing samples and cohorts to facilitate such research.

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