Cervical Precancer Treatment Planning Tool

Background and context: Cervical cancer is a largely preventable disease, yet kills about 260,000 women each year, mostly in low- and middle-income countries (LMIC). Cervical screening is a proven technique for reducing the incidence of cervical cancer, but only if screen-positive women receive timely, effective precancer treatment. As planning efforts to scale up cervical precancer treatment programs to reach more women are occurring in many high-burden countries, tools to determine what and how much equipment to procure and how to deploy it could help decision-makers make better use of scarce resources. Aim: To assist decision-makers, PATH developed the Cervical Precancer Treatment Planning Tool, with the aim of increasing access to lifesaving treatment while optimizing the use of scarce resources. This tool contains a scenario-based Excel model and Tableau data visualization mapping tool, which enable users to examine various strategies for deployment of ablative cervical precancer treatment equipment. The tool evaluates the number of women treated, the number of treatment devices needed, associated start-up costs, and cost of gas across five different scenarios. Strategy/Tactics: The model contains baseline data, gathered from a literature review and PATH fieldwork, for nine countries in sub-Saharan Africa, but it can be adapted to generate data for any LMIC. Users can also adjust baseline values to reflect the most current local data. The Tableau data visualization, which uses Uganda as an illustrative example, provides results at a district level. The tool's parameters, baseline inputs, and outputs were vetted with cervical precancer experts from eight African countries in 2017. Program/Policy process: The tool is available to country decision-makers who want to weigh the tradeoffs when trying to balance patient convenience and access with efficient utilization of equipment, skilled personnel, and financial resources. Results from the tool can inform national precancer treatment program strategies and decisions about device procurement and deployment. Outcomes: The country-level tool is publicly available ( https://sites.path.org/marketdynamics/ ) for decision-makers to make informed strategic decisions about their country's cervical precancer treatment programs. What was learned: The single-visit approach (SVA) for screening and treatment leads to treatment of the most women, but the financial costs for this scenario are on average more than 7 times greater than the next most costly scenario. In addition, treatment devices are underutilized in the SVA. While reducing the number of devices in each country reduces costs and improves equipment utilization, many women would require a second visit for treatment. Depending on the equipment deployment scenario (e.g., one treatment device per hospital), some women may need to travel long distances for this follow-up visit, potentially reducing treatment completion rates for those in need.

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Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis

10.1101/2020.12.26.20248864 ◽

2021 ◽

Author(s):

Nigus Bililign Yimer ◽

Mohammed Akibu Mohammed ◽

Kalkidan Solomon ◽

Mesfin Tadese ◽

Stephanie Grutzmacher ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Meta Analysis ◽

Cervical Screening ◽

Sub Saharan Africa ◽

African Countries ◽

Screening Uptake ◽

Analytic Review ◽

Sub Saharan

AbstractBackgroundCervical cancer screening and prevention programs have been given considerable attention in high-income countries, while only receiving minimal effort in many African countries. This meta-analytic review aimed to estimate the pooled uptake of cervical cancer screening uptake and identify its predictors in Sub-Saharan Africa.MethodsPubMed, EMBASE, CINAHL, African Journals Online, Web of Science and SCOPUS electronic databases were searched. All observational studies conducted in Sub-Saharan Africa and published in English language from January 2000 to 2019 were included. The Newcastle-Ottawa Scale was applied to examine methodological quality of the studies. Inverse variance-weighted random-effects model meta-analysis was done to estimate the pooled uptake and odds ratio of predictors with 95% confidence interval. I2 test statistic was used to check between-study heterogeneity, and funnel plot and Egger’s regression statistical test were used to check publication bias. To examine the source of heterogeneity, subgroup analysis based on sample size, publication year and geographic distribution of the studies was carried out.ResultsOf 3,537 studies identified, 29 studies were included with 36,374 women. The uptake of cervical cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I2= 98.5%). Meta-analysis of seven studies showed that knowledge about cervical cancer increased screening uptake by nearly 5-folds (OR: 4.81; 95% CI: 3.06, 7.54). Other predictors include educational status, age, HIV status, contraceptive use, perceived susceptibility, and awareness about screening locations.ConclusionCervical screening uptake is low in Sub-Saharan Africa and influenced by several factors. Health outreach and promotion targeting identified predictors are needed to increase uptake of screening service in the region.sProtocol registrationCRD42017079375

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Awareness and Attitude of Women towards Cervical Cancer Screening in Abakaliki, South East Nigeria

Global Journal of Health Science ◽

10.5539/gjhs.v13n4p115 ◽

2021 ◽

Vol 13 (4) ◽

pp. 115

Author(s):

J. O. Egede ◽

L. O. Ajah ◽

U. M. Agwu ◽

M. I. Ajah ◽

F. O. Edegbe ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Willingness To Pay ◽

Cervical Cancer Screening ◽

Cervical Screening ◽

Sub Saharan Africa ◽

University Teaching ◽

High Risk Population ◽

Cross Sectional ◽

Screening Services

INTRODUCTION: Cervical cancer screening has significantly contributed to the detection of premalignant and malignant lesions of the cervix and prevention of the morbidity and mortality associated with the disease. In the developing countries, especially sub-Saharan Africa where the burden of cervical cancer is highest, the high-risk population may not know the screening schedules or be able to pay for the services, and so fail to benefit. OBJECTIVE: To determine the level of awareness of cervical cancer screening schedule and willingness to pay for cervical screening services among women in Abakaliki, southeast Nigeria. METHOD: The study design was a descriptive cross-sectional questionnaire-based and the population comprised 800 participants who came for free cervical cancer screening at well women centre, Alex Ekwueme Federal University Teaching Hospital, Abakaliki between January and December 2017. Data were analyzed using the Statistical Package for Sciences version 20.0. RESULT: Of the 756 (94.5%) questionnaires analyzed, the mean age was 41.4 years, modal parity 4; 83.6% had prior knowledge of cervical cancer while 81.0% knew that cervical cancer screening is a diagnostic tool. Surprisingly, only 32% of those aware of cervical cancer had previously done cervical cancer screening, while 10.8% knew the interval for cervical cancer screening. On screening for cervical cancer in future, 89.2% of the respondents were willing to repeat the test while 54.2% would be willing to pay for the screening services. Being 40 years of age or less, married, educated, of high socio-economic class and having first sexual intercourse at 18 years or less were associated with willingness to pay for screening. CONCLUSION: Although the knowledge of cervical cancer is high, cervical cancer screening uptake is low, many women are aware of the interval for cervical cancer screening, and many will not be willing to pay for cervical cancer screening out of their pockets. 

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Contributions of Liquid-Based (Papanicolaou) Cytology and Human Papillomavirus Testing in Cotesting for Detection of Cervical Cancer and Precancer in the United States

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa074 ◽

2020 ◽

Vol 154 (4) ◽

pp. 510-516 ◽

Cited By ~ 1

Author(s):

Harvey W Kaufman ◽

Damian P Alagia ◽

Zhen Chen ◽

Agnieszka Onisko ◽

R Marshall Austin

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cervical Screening ◽

The United States ◽

Heterogeneous Population ◽

Reference Laboratory ◽

National Reference ◽

Recent Debate ◽

Liquid Based Cytology ◽

Cervical Precancer

Abstract Objectives Given the recent debate challenging the contribution of cytology in cervical screening, we evaluated results of liquid-based cytology (LBC) and human papillomavirus (HPV) testing in cotesting preceding cervical cancer (CxCa) and precancer diagnoses in a national, heterogeneous population. Methods We assessed the results of cotesting, performed by Quest Diagnostics, in 13,633,071 women 30 years and older, tested 2010 to 2018. Cotest results preceding CxCa or precancer diagnoses were analyzed and stratified by histopathology. Results Among all screening results, 1,615 cotests preceded 1,259 CxCa diagnoses, and 11,164 cotests preceded 8,048 cervical precancer diagnoses. More women who were subsequently diagnosed with CxCa within 1 year were identified by the LBC result than by the HPV result (85.1%, 1,015/1,193 vs 77.5%, 925/1,193). Among all women with CxCa, the overall rate of nondetection was 13.1% (212/1,615) for cotesting results (LBC negative/HPV negative) and this rate increased substantially when testing exceeded 12 months compared to within 1 year prediagnosis of either CxCa or precancer. Conclusions Analysis of 9-year cotest results from a national reference laboratory confirms the value of LBC element in cotesting. This supports that LBC/HPV cotesting enhances screening for the identification of CxCa in women 30 years and older, more so than LBC or HPV alone within cotesting.

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Cervical Cancer Awareness and Detection of Precancerous Lesions at Two District Health Centres in the West Region of Cameroon

Asian Pacific Journal of Cancer Care ◽

10.31557/apjcc.2021.6.3.263-269 ◽

2021 ◽

Vol 6 (3) ◽

pp. 263-269

Author(s):

Richard Tagne Simo ◽

Christian Kamnang Tchakounte ◽

Armel Hervé Nwabo Kamdje ◽

Léonie Marthe Ghomsi Sidje ◽

Paul F. Seke Etet ◽

...

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Precancerous Lesions ◽

Cervical Screening ◽

Sub Saharan Africa ◽

Health Concern ◽

District Health ◽

Female Population ◽

Screening Programs ◽

Health Centres

Background: Due to the late diagnosis, resulting partly from the absence of national screening programs, Cervical cancer is a public health concern for women in Sub-Saharan Africa, where 34 over 100,000 are diagnosed with cervical cancer and 23 over 100,000 die yearly. We evaluated the knowledge and practices of the female population towards the prevention of cervical cancer in the city of Bafoussam, West Cameroon, considering that poor awareness about the disease and its prevention drives its progression in Africa.Methods: 228 women were recruited during a cross-sectional study with simple random selection of participants in two District Health Centres in Bafoussam from February to August 2017. They were administered a questionnaire aimed at asserting their knowledge about cervical cancer, risk factors and prevention. Subsequently, cervicovaginal smears were screened and gynaecological signs were assessed. Data analysis was done using Epi info version 7.2.2.6. with Chi 2 test application.Statistical significance was set at p < 0.05.Results: The most represented age group was [25-35] (50.88%). Only 89 participants (39.04%) had heard about cervical cancer, 63 (27.63%) had heard about risk factors with only 13 (5.70%) able to name at least one risk factor. Moreover, 72 participants (31.58%) had heard about cervical screening test, 48 (21.05%) were aware about the existence of means of prevention, and only 6 (2.63%) had heard about human papillomavirus (HPV) relationship to cervical cancer or HPV vaccine. An incidence of 07.63% was obtained. The most common reason reported for not attending cervical cancer screening was ignorance (68.92%). Conclusions: Our data suggest that there is a real need for raising the awareness about cervical cancer and its prevention in the western region of Cameroon.

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Epidemiologic Evidence That Excess Body Weight Increases Risk of Cervical Cancer by Decreased Detection of Precancer

Journal of Clinical Oncology ◽

10.1200/jco.2017.75.3442 ◽

2018 ◽

Vol 36 (12) ◽

pp. 1184-1191 ◽

Cited By ~ 18

Author(s):

Megan A. Clarke ◽

Barbara Fetterman ◽

Li C. Cheung ◽

Nicolas Wentzensen ◽

Julia C. Gage ◽

...

Keyword(s):

Body Mass Index ◽

Cervical Cancer ◽

Human Papillomavirus ◽

Body Mass ◽

Cancer Incidence ◽

Cervical Screening ◽

Obese Women ◽

Cervical Cancer Incidence ◽

Cervical Precancer ◽

Risk Of Cancer

Purpose Obesity has been inconsistently linked to increased cervical cancer incidence and mortality; however, the effect of obesity on cervical screening has not been explored. We investigated the hypothesis that increased body mass might decrease detection of cervical precancer and increase risk of cervical cancer even in women undergoing state-of-the-art screening. Methods We conducted a retrospective cohort study of 944,227 women age 30 to 64 years who underwent cytology and human papillomavirus DNA testing (ie, cotesting) at Kaiser Permanente Northern California (January 2003 to December 2015). Body mass index was categorized as normal/underweight (< 25 kg/m2), overweight (25 to < 30 kg/m2), or obese (≥ 30 kg/m2). We estimated 5-year cumulative risks of cervical precancer and cancer by category of body mass index using logistic Weibull survival models. Results We observed lower risk of cervical precancer (n = 4,489) and higher risk of cervical cancer (n = 490) with increasing body mass index. Specifically, obese women had the lowest 5-year risk of precancer (0.51%; 95% CI, 0.48% to 0.54% v 0.73%; 95% CI, 0.70% to 0.76% in normal/underweight women; P trend < .001). In contrast, obese women had the highest 5-year risk of cancer (0.083%; 95% CI, 0.072% to 0.096% v 0.056%; 95% CI, 0.048% to 0.066% in normal/underweight women; P trend < .001). Results were consistent in subgroups defined by age (30 to 49 v 50 to 64 years), human papillomavirus status (positive v negative), and histologic subtype (glandular v squamous). Approximately 20% of cervical cancers could be attributed to overweight or obesity in the women in our study who underwent routine cervical screening. Conclusion In this large, screened population, overweight and obese women had an increased risk of cervical cancer, likely because of underdiagnosis of cervical precancer. Improvements in equipment and/or technique to assure adequate sampling and visualization of women with elevated body mass might reduce cervical cancer incidence.

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Women's attitudes and understanding of cervical cancer and the new National Cervical Screening Program

Health Promotion Journal of Australia ◽

10.1002/hpja.365 ◽

2020 ◽

Author(s):

Archana Nagendiram ◽

Rachel Bidgood ◽

Jennifer Banks ◽

Clare Heal

Keyword(s):

Cervical Cancer ◽

Screening Program ◽

Cervical Screening

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Cervical Cancer in Sub-Saharan Africa – a multinational population-based study on treatment guideline adherence

10.1055/s-0039-1692081 ◽

2019 ◽

Author(s):

M Griesel ◽

DM Parkin ◽

C Thomssen ◽

EJ Kantelhardt

Keyword(s):

Cervical Cancer ◽

Guideline Adherence ◽

Treatment Guideline ◽

Population Based ◽

Sub Saharan Africa ◽

Population Based Study ◽

Sub Saharan

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Systematic review of cervical cancer prevalence and determinants of early detection in Sub-Saharan Africa

KIBOGORA POLYTECHNIC SCIENTIFIC JOURNAL ◽

10.33618/kpscj.2018.01.006 ◽

2018 ◽

Vol 1 (1) ◽

pp. 32-36

Author(s):

Eleazar Ndabarora ◽

Dariya Mukamusoni ◽

Clarte Ndikumasabo ◽

Védaste Ngirinshuti

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Early Detection ◽

Cervical Cancer Screening ◽

Sub Saharan Africa ◽

Extensive Literature ◽

Early Management ◽

Screening Programs ◽

Mesh Terms ◽

Sub Saharan

Cervical cancer is one of the leading causes of morbidity and mortality globally and in Sub-Saharan Africa in particular. There is evidence that early detection and early management of cases are the best strategies to prevent and control this health threat, since treatment of the later stages of the diseases are very expensive. The objectives of the review were: (1) to identify and review studies on the prevalence of cervical cancer and determinants of early detection in Sub-Saharan Africa, and (2) to recommend further studies and interventions based on the findings of this review. Extensive literature search was conducted using the MeSH terms. Articles on cervical cancer and/or determinants of early detection which fulfilled inclusion criteria were reviewed independently by three reviewers. The prevalence of cervical cancer in Sub-Saharan Africa is increasing. Although there are evidences that cervical cancer screening programs are practical and feasible even in resource-limited settings in Sub-Saharan Africa, there is a very low uptake of cervical cancer screening and there are key factors that need to be addressed in order to make these programs established and effective.

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Knowledge and Practice of Cervical Cancer Screening among Women in Orlu Local Government Area, Imo State, Nigeria.

10.33798/ajmas2019/00266 ◽

2019 ◽

Vol 1 (1) ◽

pp. 55-65

Author(s):

Jude Egwurugwu ◽

S.D. Ejikunle ◽

E.I. Dike ◽

M.C. Ohamaeme ◽

Jude Egwurugwu ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Local Government ◽

Cervical Cancer Screening ◽

Cervical Screening ◽

Local Government Area ◽

Care Providers ◽

Imo State ◽

Study Results ◽

Knowledge And Practice

Background: Cervical cancer is the 2nd commonest cancer among women worldwide and the most common cancer among women in developing countries like Nigeria. Though preventable by screening for premalignant and early cervical lesions, this is predicated on the knowledge and practice of a cervical screening. Objective: To assess the knowledge and practice of cervical cancer screening among women in Orlu, Local Government Area(LGA) Imo State, Nigeria. Materials & Methods: A community based cross-sectional study with the use of 502 interviewer – administered questionnaires was conducted among women in Orlu LGA of Imo State. All the women in the communities attending the annual August Meeting who consented were recruited for this study. Results: The study showed that the mean age of the respondents was 42±2.8years. Furthermore, 82.3% of respondents attained postsecondary school educational level, 61.8% & 21.1% were multiparous and grand multiparous respectively. Also, 80.5% of respondents have heard about cervical cancer screening. Majority (67.5%) of these respondents heard it from health care providers. There was a positive statistically significant relationship between educational status and the likelihood of having knowledge of cervical cancer screening, (p< 0.01). The level of practice of cervical cancer screening was very low among the respondents(13.5%).Though majority of the respondents have high level of educational attainment this did not reflect their practice of cervical cancer screening. Conclusion: There was high knowledge of cervical cancer and cervical screening modalities among women in Orlu but their practice of cervical cancer screening was very low. There is an urgent need to educate and encourage women on the benefits of cervical cancer screening. Key words: cervical cancer, knowledge, Practice, Orlu women, Screening.

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