Cervical Cancer- Care Delayed-Care Denied and Death Invited

With about 78 billion global population, in 2020, 19 million new cancers and nearly 1 million deaths due to all types estimated to occur. Cervical cancer does not figure in top 5 most common cancers in both sexes globally, but with 6.5% incidence it forms the fourth top among women worldwide. The cancer registry data across the country in India with simple average of the most recent local rates applied to 2020 population estimates a figure of 1324413 cases and 851678 in 2020 and cumulative prevalence around 2.7 million cases in last 5 years of all categories of cancers in India. Cervical cancers in India account for 10% of all cancers in both sexes and about 18% of cancers among women in India as per the international agency for Cancer Research. Nearly one-third of the global cervical cancer deaths occur in India. It is a preventable condition as it has a long precancerous stage amenable for screening and treating. Cervical cancer Cervix uteri is no 3 with about 123 907 cases (9.45) next only to Breast and Oral cancers with a 2.01 cumulative risk. Cervical cancer death risk as 60000 women die annually. While the incidence and mortality rates of cervical cancer in the world are 13.1/ and 6.9/ per lakh population, in India, it is estimated to be 14.7/and 9.2/ per lakh population. Resulting in about 96,922 new cervical cancer cases and 60,078 deaths ranking second among women cancers. The incidence varies within Indian population basically due to ggeographical and socio-economic disparities in screening practices and care seeking practices across the districts of India. Epidemiologically the symptoms are mild and mimic a venereal disease of low infectiousness and therefore delay in seeking care and reporting at a time when the prognosis is poor. The 5-year survival rate is around 76.0% for those aged ≤50 years with much poorer survival among cases with involvement lymph nodes. We present one such case of a 45 year’s old rural women reporting on 4th May 2021 with symptoms vaginal bleeding, back pain, urine leakage & pelvic pain since 2 months to a gynecologic oncology service at a cancer hospital & research center, Bangalore. She had the history of taking treatment for another 2 months earlier from a traditional healer with no progress. She had consulted a family doctor first who referred her to the Cancer hospital. After an evaluation for abnormal vagina bleeding, cervical biopsies that demonstrated invasive adenocarcinoma of the cervix (Stage IV B CA Cervix) the diagnosis was confirmed. Since it was in an advanced stage, a palliative management including radiation therapy for control of bleeding & pain, and systemic chemotherapy for disseminated disease was opted. After 22 days of treatment she got discharged along with medications prescribed Inj. Amikacin 100mg IV OD, Inj. Pantoprazole 40mg IV OD, DNS which was given by the local doctor. But there was no progress and finally she died on 17th June 2021 after 23 days of discharge. This case emphasizes the need for early care seeking behavior, regular screening for all women over 35-45 years and HPV vaccination for adolescent girls in India.

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Barriers to cervical cancer screening among rural women in eastern China: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2018-026413 ◽

2019 ◽

Vol 9 (3) ◽

pp. e026413 ◽

Cited By ~ 2

Author(s):

Huan Yang ◽

Shun-Ping Li ◽

Qing Chen ◽

Christopher Morgan

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Qualitative Study ◽

Cervical Cancer Screening ◽

Rural Women ◽

Eastern China ◽

Healthcare Providers ◽

Knowledge Gaps ◽

Policy And Practice ◽

Incidence And Mortality

ObjectivesTo explore barriers to free cervical cancer screening among rural women in China from the perspective of women, healthcare providers and women’s husbands to inform intervention planning.DesignA qualitative study framed around potential policy and practice options, drawing on the concepts of descriptive phenomenology and implementation research.SettingThis study was carried out at township level within two counties in Jining Prefecture of eastern China.Participants and data collectionSemi-structured in-depth interviews with 21 women and five healthcare providers, focus group discussions with nine healthcare providers and key informant interviews with four husbands of women eligible for screening.ResultsThematic analysis generated five major themes: (1) gaps in knowledge of cervical cancer and health awareness, (2) fear of cancer and screening outcomes, (3) cultural barriers including reticence for intimate examinations, (4) influence of close contacts on screening decisions and (5) inconvenience. These demonstrate key knowledge gaps challenging current community health education. Important barriers, including fear of treatment cost and the time needed for screening, were also raised.ConclusionOur study details important barriers to cervical cancer screening relating to knowledge gaps, attitudes of fear or embarrassment and the role of contacts and service models. These provide data for policy and planning to improve the screening that will decrease the incidence and mortality rates of cervical cancer in China.

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Molecular-guided therapy for disseminated cervical cancer: present and future

Medical Council ◽

10.21518/2079-701x-2020-9-121-126 ◽

2020 ◽

pp. 121-126

Author(s):

A. А. Rumyantsev

Keyword(s):

Cervical Cancer ◽

Metastatic Cancer ◽

Antiangiogenic Therapy ◽

Phase Iii ◽

Cervix Uteri ◽

Term Survival ◽

Recurrent Cervical Cancer ◽

Number Of Patients ◽

Incidence And Mortality ◽

High Level

Сervical cancer is recognized as one of the leaders in mortality from gynecological oncological diseases. The incidence and mortality from cervical cancer over the past 10 years remained at a consistently high level. For a long time, the only treatment option for metastatic and/or recurrent cervical cancer was cytotoxic chemotherapy, but its results remained extremely unsatisfactory: the 5-year overall survival rate was about 12%. This article is devoted to a review of the current possibilities of targeted and immunotherapy of metastatic and/or recurrent cervical cancer. We reviewed the most recent studies in the field of the effectiveness of antiangiogenic therapy including a critical and detailed analysis of the results of the GOG-240 phase III study. The data of modern literature in the field of immunotherapy using PD-1 / PD-L1 signaling pathway inhibitors in metastatic cervical cancer has been studied. It was found that a significant number of patients (34-95%) showed increased expression of PD-L1 in the tumor tissue, and 3-6% of patients showed a high level of microsatellite instability (MSI) in the tumor, which reveals the possibility of immunotherapy for this disease. We also conducted a review of ongoing clinical studies on the use of targeted and immunotherapy of advanced cervical cancer and the prospects for changing the “landscape” of treatment for this disease were assessed. On the example of a clinical case of treatment of a real patient, the possibilities of modern targeted and immunotherapy of metastatic cancer of the cervix uteri were analyzed, which gave a possibility to ensure long-term survival for the patient with an initially poor prognosis.

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Women’s experiences in a community-based screen-and-treat cervical cancer prevention program in rural Malawi: a qualitative study

BMC Cancer ◽

10.1186/s12885-021-08109-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fan Lee ◽

Agatha Bula ◽

John Chapola ◽

Clement Mapanje ◽

Billy Phiri ◽

...

Keyword(s):

Cervical Cancer ◽

Qualitative Study ◽

Rural Women ◽

Screening Method ◽

High Rate ◽

Pilot Program ◽

Hpv Testing ◽

Community Based ◽

Incidence And Mortality

Abstract Background Malawi has the world’s highest cervical cancer incidence and mortality due to high rate of HIV coupled with inadequate screening and treatment services. The country’s cervical cancer control program uses visual inspection with acetic acid (VIA) and cryotherapy, but screening is largely limited by poor access to facilities, high cost of cryotherapy gas, and high loss-to-follow-up. To overcome these limitations, we implemented a community-based screen-and-treat pilot program with VIA and thermocoagulation. Through a qualitative study, we explore the experiences of women who underwent this community-based pilot screening program. Methods We implemented our pilot program in rural Malawi and conducted an exploratory qualitative sub-study. We conducted in-depth interviews with women who were treated with thermocoagulation during the program. We used semi-structured interviews to explore screen-and-treat experience, acceptability of the program and attitudes towards self-sampling for HPV testing as an alternative screening method. Content analysis was conducted using NVIVO v12. Results Between July – August 2017, 408 participants eligible for screening underwent VIA screening. Thirty participants had VIA positive results, of whom 28 underwent same day thermocoagulation. We interviewed 17 of the 28 women who received thermocoagulation. Thematic saturation was reached at 17 interviews. All participants reported an overall positive experience with the community-based screen-and-treat program. Common themes were appreciation for bringing screening directly to their villages, surprise at the lack of discomfort, and the benefits of access to same day treatment immediately following abnormal screening. Negative experiences were rare and included discomfort during speculum exam, long duration of screening and challenges with complying with postprocedural abstinence. Most participants felt that utilizing self-collected HPV testing could be acceptable for screening in their community. Conclusions Our exploratory qualitative sub-study demonstrated that the community-based screen-and-treat with VIA and thermocoagulation was widely accepted. Participants valued the accessible, timely, and painless thermocoagulation treatment and reported minimal side effects. Future considerations for reaching rural women can include community-based follow-up, cervical cancer education for male partners and self-sampling for HPV testing.

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Population Based Study of Cervical Cancer Screening in Bharatpur, Nepal

Journal of Manmohan Memorial Institute of Health Sciences ◽

10.3126/jmmihs.v1i4.11994 ◽

2015 ◽

Vol 1 (4) ◽

pp. 3-8

Author(s):

Ang Tshering Sherpa ◽

Balman Singh Karki ◽

Johanne Sundby ◽

Mari Nygard ◽

Silvia Franceschii ◽

...

Keyword(s):

Cervical Cancer ◽

Developing Countries ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Pap Smear ◽

Significant Proportion ◽

Target Population ◽

Population Based ◽

International Agency ◽

Incidence And Mortality

Cervical cancer is the most common form of cancer among women in developing countries. Hospital based data in Nepal also showed cervical cancer is most commonly occurring cancer among women in Nepal. Pap smear is the very significant screening test for reduction of incidence and mortality from cervical cancer but many developing countries failed to obtain high coverage of target population. Hence failed to achieve major impact of cervical cancer screening. National guidelines for cervical cancer and prevention in Nepal is formulated in 2010 and set target population age range of 30-60 with 50% coverage of target population with in a five years span. This study was aimed to elicit baseline survey of cervical cancer screening in a locale where resource for cervical cancer screening is easily available. Population based cross sectional study was done from October 2006 to March 2007. 1547 ever married women aged 16–59 were selected with cluster randomization procedure from Bharatpur municipalities, where BPKMCH (BP Koirala Memorial Cancer Hospital) is located. Free cervical cancer screening was conducted in collaboration with International Agency for Research on Cancer (IARC) France and BPKMCH. Ethical clearance was obtained from Nepal Health Research council. Interviews were performed using a standard questionnaire to elicit required information. Out of 1033 participants 394 were 16-29 years old. Among them 117 (30%) had at least one Pap test prior coming to the clinic. 16(4%) were age 16-19, 42(11%) were age 20-24 and 59 (15%) were age 25-29. This concludes Present opportunistic cervical cancer screening in Bharatpur is directed towards screening significant proportion of women with less risk.DOI: http://dx.doi.org/10.3126/jmmihs.v1i4.11994Journal of Manmohan Memorial Institute of Health SciencesVol. 1, Issue 4, 2015page : 3-8

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Contributions of the newly revised 2018 international federation of gynecology and obstetrics staging of cervical cancer

Medicinski pregled ◽

10.2298/mpns2006158s ◽

2020 ◽

Vol 73 (5-6) ◽

pp. 158-163

Author(s):

Bojana Scepanovic ◽

Nikola Andjelic ◽

Dejan Nincic ◽

Natasa Prvulovic-Bunovic

Keyword(s):

Cervical Cancer ◽

Invasive Cervical Cancer ◽

Staging System ◽

International Federation ◽

Cervix Uteri ◽

International Agency ◽

Lymph Node Status ◽

Pathological Findings ◽

Gynecology And Obstetrics ◽

Made In

Introduction. According to the latest data from International Agency for Research on Cancer from 2018, global burden of cancer cervical cancer is the fourth most common cancer in women worldwide. The aim of this article was to present the contributions of the new, revised 2018 International Federation of Gynecology and Obstetrics staging of carcinoma of the cervix uteri, allowing much more precise staging with the use of any imaging modalities and/or pathological findings to allocate the stage and provide more effective treatment. International Federation of Gynecology and Obstetrics staging system. The main changes in the new staging system were made in IB stage of the disease, which now includes 3 subgroups i.e. substages for every 2 cm increments in tumor size: stage IB1 (< 2 cm), stage IB2 disease (2 to < 4 cm), and stage IB3 (? 4 cm). This system also incorporates the lymph node status into stage III cervical cancer, allowing imaging and/or pathological findings of lymph nodes to the pelvic and/or para-aortic nodes to assign stage IIIC disease. Conclusion. The main goal of the new staging system revision was to improve the accuracy of staging in order to provide more refined understanding of prognostic groups and facilitate better treatment for women with invasive cervical cancer.

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Factors associated with the intention to undergo Pap smear testing in the rural areas of Indonesia: a health belief model

Reproductive Health ◽

10.1186/s12978-021-01188-7 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Sumarmi Sumarmi ◽

Yu-Yun Hsu ◽

Ya-Min Cheng ◽

Shu-Hsin Lee

Keyword(s):

Cervical Cancer ◽

Health Beliefs ◽

Rural Women ◽

Rural Areas ◽

Pap Smear ◽

Statistical Significance ◽

Health Belief ◽

Pap Smear Test ◽

Smear Test ◽

Smear Testing

Abstract Purposes This study aimed to understand the influence of health beliefs, demographic factors, and health characteristics on the intention to undergo Pap smear testing among women in rural areas of Indonesia. Methods A descriptive cross-sectional study was conducted and 687 married women participated in the study. A convenience sampling was applied to recruit the participants from community health centres in a rural region in Indonesia. Self-reported data using the Health Beliefs Model Scale for Cervical Cancer and Pap Smear Test was collected to assess the health beliefs. Independent t-tests, simple logistic regressions, and a hierarchical logistic regression with 3 steps were run. Statistical significance for analysis was set at p < 0.05. Results The mean age of the participants was 42 years (SD = 8.4). Among the participants, 81% of the women had never undergone a Pap smear test, and 61% (n = 422) of the women reported a high intention of receiving a Pap smear test. Income and education Health beliefs regarding Pap smear testing were different between women who had low and high intentions to undergo Pap smear testing. Health beliefs, such as perceived benefits, severity, barriers to Pap smear testing, and health motivation for a Pap smear test were associated with the intention to undergo Pap smear testing among rural Indonesian women. Overall, the hierarchical multiple regression with 3 steps containing demographic, health characteristics, and health belief variables accounted for 31% variance of the intention to undergo Pap smear test among the Indonesian rural women. Conclusions Low screening rates of cervical cancer and high intentions to do the screening exist among rural Indonesian women. Health beliefs significantly affect the rural women’s intention of Pap smear testing in Indonesia.

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Study on cervical cancer screening amongst nurses

10.1055/s-0039-1685284 ◽

2016 ◽

Author(s):

Astha Srivastava ◽

Bindiya Gupta ◽

Vikas Lakha ◽

Shilpa Singh

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Pap Smear ◽

Tertiary Care ◽

Tertiary Care Centre ◽

Attitude And Practice ◽

Validated Questionnaire ◽

Incidence And Mortality ◽

Knowledge Attitude And Practice

Objective: To study the knowledge, attitude and practice of nurses at tertiary centre regarding cervical cancer screening. Material and Methods: Validated questionnaire was circulated amongst staff nurses at tertiary care centre after taking informed consent. Results and Discussion: Cancer of cervix is the most common genital tract malignancy in female and it is ranked second to breast cancer. It has a positive association with HPV infection. Cervical cancer incidence and mortality have declined substantially following introduction of screening programmes. This present study investigated the knowledge, attitude and practice of nurses at GTB Hospital towards cervical cancer risk factors, sign & symptoms and screening as they are important health professionals. In our study, the results showed that 99% of respondents were aware of Pap smear as screening programme and about 60-70% were aware of HPV as positive organism, but most of them never had a Pap smear done before. Majority of them did not know VIA, VILI and colposcopy as screening techniques. Conclusion: It may thus be recommended that institutions should periodically organize seminars and training for health personnel especially the nurses which form a group of professionals that should give health education to women about cervical cancer.

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