Effectiveness of Co-Testing in Cervical Cancer Screening Program in Macao SAR

Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.

Cervical Cancer Prediction Empowered with Federated Machine Learning

Cervical cancer is an intrusive cancer that imitates various women around the world. Cervical cancer ranks in thefourth position because of the leading death cause in its premature stages. The cervix which is the lower end of thevagina that connects the uterus and vagina forms a cancerous tumor very slowly. This pre-mature cancerous tumorin the cervix is deadly if it cannot be detected in the early stages. So, in this delineated study, the proposed approachuses federated machine learning with numerous machine learning solvers for the prediction of cervical cancer totrain the weights with varying neurons empowered fuzzed techniques to align the neurons, Internet of MedicalThings (IoMT) to fetch data and blockchain technology for data privacy and models protection from hazardousattacks. The proposed approach achieves the highest cervical cancer prediction accuracy of 99.26% and a 0.74%misprediction rate. So, the proposed approach shows the best prediction results of cervical cancer in its early stageswith the help of patient clinical records, and all medical professionals will get beneficial diagnosing approachesfrom this study and detect cervical cancer in its early stages which reduce the overall death ratio of women due tocervical cancer.

LncRNA PCGEM1 facilitates cervical cancer progression via miR-642a-5p/KIF5B axis

At present,the role of many long non-coding RNAs(lncRNAs)as tumor suppressors in the formation and development of cervical cancer(CC)has been studied.However,lncRNA prostate cancer gene expression marker 1(PCGEM1),whose high expression not only aggravates ovarian cancer but also can induce tumorigenesis and endometrial cancer progression,has not been studied in CC.The objective of this study was to investigate the expression and the underlying role of PCGEM1 in CC.The relative expression of PCGEM1 in CC cells was detected by real-time PCR.After the suppression of PCGEM1 expression by shRNA,the changes in the proliferation,migration,and invasion capacities were detected via CCK-8 assay,EdU assay,and colony formation assay wound healing assay.Transwell assay and the changes in expressions of epithelial-to-mesenchymal transition(EMT)markers were determined by western blot and immunofluorescence.The interplay among PCGEM1,miR-642a-5p,and kinesin family member 5B(KIF5B)was confirmed by bioinformatics analyses and luciferase reporter assay.Results showed that PCGEM1 expressions were up-regulated within CC cells.Cell viabilities,migration,and invasion were remarkably reduced after the suppression of PCGEM1 expression by shRNA in Hela and SiHa cells.N-cadherin was silenced,but E-cadherin expression was elevated by sh-PCGEM1.Moreover,by sponging miR-642a-5p in CC,PCGEM1 was verified as a competitive endogenous RNA(ceRNA)that modulates KIF5B levels.MiR-642a-5p down-regulation partially rescued sh-PCGEM1’s inhibitory effects on cell proliferation,migration,invasion,and EMT process.In conclusion,the PCGEM1/miR-642a-5p/KIF5B signaling axis might be a novel therapeutic target in CC.This study provides a research basis and new direction for targeted therapy of CC.

Can we triumph over locally advanced cervical cancer with colossal para-aortic lymph nodes? A case report

BACKGROUND Para-aortic lymph nodes(PALNs)are common sites for the regional spread of cervical squamous cell carcinoma(SCC).CASE SUMMARY We report the case of a 36-year-old woman who presented with cervical SCC with multiple bulky PALNs,largest measured 4.5 cm×5 cm×10 cm.The patient was treated with radical intent with definitive chemoradiation using sequential doseescalated adaptive radiotherapy,followed by maintenance chemotherapy.The patient achieved a complete response;she has been doing well since the completion of treatment with no evidence of the disease for 2 years.CONCLUSION Regardless of the size of PALN metastases of cervical carcinoma origin,it is still treatable(with radical intent)via concurrent chemoradiation.Adaptive radiotherapy allows dose escalation with minimal toxicity.

LncRNA AFAP1-AS1 exhibits oncogenic characteristics and promotes gemcitabine-resistance of cervical cancer cells through miR-7-5p/EGFR axis

Background:Drug resistance is the main factor contributing to cancer recurrence and poor prognosis.Exploration of drug resistance-related mechanisms and effective therapeutic targets are the aim of molecular targeted therapy.In our study,the role of long non-coding RNA(lncRNA)AFAP1-AS1 in gemcitabine resistance and related mechanisms were explored in cervical cancer cells.Methods:Gemcitabine-resistant cervical cancer cell lines HT-3-Gem and SW756-Gem were constructed using the gemcitabine concentration gradient method.The overall survival rates and recurrence-free survival rates were evaluated by Kaplan-Meier analysis.The interaction was verified through a Dual-luciferase reporter gene assay and a Biotinylated RNA pull-down assay.Cell proliferation ability was assessed through methyl-thiazolyl-tetrazolium(MTT),soft agar,and colony formation experiments.Cell cycle and apoptosis were detected byflow cytometry.Results:Up-regulation of AFAP1-AS1 in cervical cancer predicted a poor prognosis.Besides,patients in the gemcitabine-resistance group had higher levels of AFAP1-AS1 than the gemcitabine-sensitive group.AFAP1-AS1 promoted tumor growth and induced gemcitabine tolerance of cervical cancer cells.In addition,AFAP1-AS1 mediated epidermal growth factor receptor(EGFR)expression by serving as a molecular sponge for microRNA-7a-5p(miR-7-5p).This present study also proved that the knockdown of EGFR or overexpression of miR-7a-5p abolished the accelerative role of AFAP1-AS1 overexpression in cancer progression and gemcitabine tolerance.Conclusions:In general,the AFAP1-AS1/miR-7-5p/EGFR axis was tightly related to the progression and gemcitabine tolerance of cervical cancer,providing potential targets for the management of cervical cancer.

Potential of non-Western medicines in chemoradiotherapy for cervical cancer

This editorial explores the potential integration of non-Western medicine into radiotherapy for cervical cancer.While radiotherapy remains a radical treatment for cervical cancer,its associated toxicity and decline in quality of life can significantly impact patients’lives.Currently,most treatments are supportive,with no specific treatment options available in Western medicine.Non-Western medicine,often less toxic and easier to administer,has shown promising results when used alongside radiotherapy for cervical cancer.Despite these potential benefits,challenges such as limited evidence and restricted application areas persist.While non-Western medicines may offer potential improvements in chemoradiotherapy outcomes for cervical cancer,further research is necessary to substantiate these benefits.

New cheaper human papilloma virus mass screening strategy reduces cervical cancer incidence in Changsha city:A clinical trial

BACKGROUND Cervical cancer is the second leading cause of death in women worldwide,second only to breast cancer.Around 80%of women have been infected with human papillomavirus(HPV)in their lifetime.Early screening and treatment are effective means of preventing cervical cancer,but due to economic reasons,many parts of the world do not have free screening programs to protect women’s health.AIM To increase HPV cervical cancer screening in Changsha and reduce the incidence of cervical cancer.METHODS Cervical cancer screening included gynecological examination,vaginal secretion examination and HPV high-risk typing testing.Cervical cytology examination(ThinPrep cytology test)was performed for individuals who test positive for HPV types other than 16 and 18.Vaginal colposcopy examination was performed for HPV16 and 18 positive individuals,as well as for those who were positive for ThinPrep cytology test.If the results of vaginal colposcopy examination were abnormal,histopathological examination was performed.We conducted a cost-benefit analysis after 4 years.RESULTS From 2019 to 2022,523437 women aged 35-64 years in Changsha city were screened and 73313 were positive,with a 14%positive rate.The detection rate of precancerous lesions of cervical cancer was 0.6%and the detection rate of cervical cancer was 0.037%.Among 311212 patients who underwent two cancers examinations,the incidence rate was reduced by more than half in the second examination.The average screening cost per woman was 120 RMB.The average cost of detecting early cases was 10619 RMB,with an early detection cost coefficient of 0.083.CONCLUSION Our screening strategy was effective and cost-effective,making it valuable for early diagnosis and treatment of cervical cancer.It is worth promoting in economically limited areas.

Status Quo of Acceptance of Illness among Reproductive Age Cervical Cancer Patients and Its Influencing Factors

Objective: To explore the status quo of acceptance of illness among reproductive-age cervical cancer patients and its influencing factors, to provide a theoretical basis for the implementation of targeted interventions. Methods: The convenience sampling method was used to investigate 256 reproductive-age cervical cancer patients using the general information questionnaire, Acceptance of Illness Scale, Reproductive Concerns After Cancer Scale, and Medical Coping Style Scale. Results: The total score of the acceptance of illness was (18.03 ± 3.24), and reproductive concerns were (57.02 ± 6.30), among reproductive-age cervical cancer patients. Multivariate analysis showed that age, number of children, income level, treatment method, level of reproductive concerns, and the yield and avoidance dimensions of medical coping style were the main influencing factors on patients’ level of illness acceptance (all P Conclusion: The acceptance of illness levels in reproductive-age cervical cancer patients was low to intermediate, and medical staff should timely identify high-risk groups and take preventive management measures based on influencing factors.

Radical Hysterectomy in Cervical Cancer: Patients’ Epidemiological and Clinical Profiles and Perioperative Outcome in Two Referral Hospitals in Cameroon

Background: Cervical cancer (CC) is one of the most frequent cancers and the leading cause of death from gynecological cancer in Low and middle income countries, Cameroon inclusive. Surgery is the primary treatment modality when the disease is diagnosed at early stage. Radical hysterectomy in cervical cancer has not been evaluated in recent years in Cameroon. The purpose of this study is thus to evaluate the epidemiological and clinical features and short term outcomes of patients who underwent surgery. Patients and methods: This retrospective study was conducted at the Douala Gynaeco-obstetric and Pediatric Hospital and the Douala General Hospital. Cervical cancer patients who underwent Radical hysterectomy between January 2015 and December 2020 were included. A pre-established data collection tool was used to record socio-demographic, clinical and outcomes information from patients’ files;additional outcome information was obtained from phone calls. Descriptive analysis was done using the SPSS version 26. Bivariate analysis was used to determine associations between disease and patients characteristics and occurrence of adverse postoperative outcome. P value of 0.05 was considered. Results: Sixty one patients were enrolled. Their ages ranged from 33 to 74 years with a mean age of 51.95 ± 10.29 years. Over 85% of women were married, 65.57% were unemployed and 86.88% were multiparous. Only 28% had never done cervical cancer screening. Most patients had stage IB1 to IB2 stage disease (57.1%). Less than 9% underwent radical hysterectomy and 8 of those (13.11%) suffered intraoperative complications. Twenty-five patients (40.98%) presented immediate and short term complications. There was no significant association between the disease or patients’ characteristics and adverse outcomes. Conclusion: Cervical cancer patients are relatively young in our settings and only 9% of them reach the hospital at early stage. Postoperative adverse outcomes rate is higher than that reported in the literature. Sensitization on screening and awareness of early symptoms can reverse the situation.

Economic Burden of Illness of the Cervical Cancer Treatment Protocol in Bangladesh

Background: Cervical cancer is a significant health concern in Bangladesh, with high mortality rates due to limited awareness and costly treatments. The disease stages influence treatment protocols, ranging from surgery and radiotherapy for early stages to chemotherapy and radiation for advanced stages, but survival rates decrease as the cancer progresses. Objective: The objective of this study is to determine the economic impact of the disease and recommend cost-efficient strategies for prevention and treatment. Methods: A population-based, cross-sectional study was conducted with a stratified sample of cervical cancer patients from selected healthcare facilities across Bangladesh. Data collection involved structured interviews and validated questionnaires. The study measured the economic impact, treatment costs, and other related expenses. Quantitative data analysis was performed using SPSS v22, MS-Excel, and R Programming, with Multivariate regression analysis and Post Hoc tests, including the chi-square test, applied to selected indicators. Results: All respondents in the study were female, aged 34 - 75, with 72.3% aged 40 - 50. Most were illiterate (38.6%) and housewives (95.0%). Additionally, 98% were married, 85.10% married before age 18, and 46.50% experienced their first menstruation before age 12. Families typically had a monthly income of 10,000 - 30,000 Taka, spending similar amounts on treatment. Significant relationships were found between educational qualifications, occupation, personal hygiene practices, history of oral contraceptive use, and age of marriage (p Conclusion: The article emphasizes the impact of monthly family income on cervical cancer treatment costs, stressing the need for comprehensive support services to address the financial and emotional burdens faced by patients. Improving access to quality care and implementing measures can enhance outcomes for cervical cancer patients in Bangladesh.

Sarcopenia and Anemia Are Predictors of Poor Prognostic in Cervical Cancer Patients

Objective: Evaluate pretreatment sarcopenia and anemia as prognostic factors in women undergoing treatment for cervical cancer (CC) with concurrent chemoradiotherapy (CCRT). Methods: 151 women with CC were analysed in this cohort study. Pretreatment computed tomography (CT) images were analysed to assess skeletal muscle index (SMI). Hazard ratios (HR) and multivariate Cox proportional HR were used to analyse association between low SMI, age, body mass index (BMI), haemoglobin levels, histological type, and International Federation of Gynaecology and Obstetrics (FIGO) stage with PFS and OS. Results: A total of 151 patients were included, 53 (35.1%) presented pretreatment sarcopenia;51 (34%) stage I/II and 100 (66%) stage III/IV. Among those patients in advanced stage (III/IV) 37 (70%) (p = 0.28) were sarcopenic at the beginning of treatment. Sarcopenia was associated with worse progression-free survival (PFS) and overall survival (OS) in our cohort [HR 0.97 (p = 0.01)] [HR 0.73 (p = 0.001)], as well as anemia [HR 0.73 (p = 0.001)] [HR 0.78 (p = 0.001)]. Linear regression models indicated that despite showing no association with age, neutrophil or platelet counts, sarcopenia was associated with pretreatment anemia levels (p = 0.01). After a multivariate analysis, only haemoglobin (anemia) and complete CCRT remained associated with PFS and OS. Sarcopenia and anemia were associated with worse PFS and OS in FIGO stage I/II. Conclusion: Pretreatment sarcopenia was significantly associated with low haemoglobin levels. Anemia and incomplete CCRT were independently associated with poor prognosis in women with CC. Pretreatment sarcopenia, as low SMI, was a predictor of poor prognostic in early stages of CC.

Relationship between Stigma and Marital Satisfaction in Cervical Cancer Patients

Objective: To investigate the status quo of stigma and marital satisfaction of patients with cervical cancer, and analyze the correlation between them, to provide a reference for making intervention plans for patients with cervical cancer. Methods: 216 patients in a third-class first-class hospital in Zhengzhou were investigated by convenient sampling method, using a general information questionnaire, social impact scale, and Olson marriage quality questionnaire. Results: The total stigma score of cervical cancer patients was 73.00 (62.00, 76.00), which was high. The total marital satisfaction score is 36.00 (26.00, 38.00), in the middle level. There was a negative correlation between marital satisfaction and stigma (P Conclusion: The stigma of patients with cervical cancer is at a high level, and their marital satisfaction is at a medium level. Medical staff should give them health education through various channels, pay attention to low-income patients, improve marital satisfaction, and reduce stigma.

Health promotion and education proposal among Chinese female college students:eliminating cervical cancer is no longer a dream

Cervical cancer is a serious threat to women’s health.Persistent high-risk human papillomavirus(HPV)infection is a necessary factor for cervical cancer development and has become a serious public health threat to women.At present,young women have become a high-risk group for potential HPV infection.HPV vaccination is an effective method to prevent HPV infection and related diseases and is a primary preventive measure for HPV infection-related diseases.This study explores the influencing factors of female college students’willingness to receive HPV vaccination,their ability to understand college students’HPV awareness,their motivation for HPV vaccination,their behavioral skills related to HPV vaccination,their willingness to receive HPV vaccination and their vaccination rate.The aim of this study was to increase the HPV vaccination rate of Chinese female college students through health education programs and thus reduce the incidence of cervical cancer.

Study on the Knowledge of Mothers or Guardians of Girls Aged 9 - 14 from the Langue de Barbarie in Saint-Louis, Senegal about Cervical Cancer and Its Relationship to HPV Vaccination in 2024

Introduction: The relationship between knowledge of HPV and vaccination has been established. The aim of this study was to investigate the knowledge of mothers or guardians of girls aged 9 - 14 about cervical cancer and their attitudes to HPV vaccination. Methodology: This was a descriptive cross-sectional survey. The sample size was calculated using the Schwartz formula and distributed proportionally to the size of the neighbourhood population. Data was collected between 2nd to 19th January 2024 using anonymous questionnaires configured on tablets with Survey 123 software and analysed using R software. Results: A total of 799 people were interviewed. The average age of the respondents was 35.67 years, with a standard deviation of 7.08 and a range of 17 and 49 years. The information channels for cervical cancer were the media (82.8%), health facilities (47.7%) and community intermediaries (23.3%). Only 53.7% had information about the vaccine and 25.5% about the vaccination strategy. The main reason for accepting the vaccine was awareness of the seriousness of cervical cancer (55.1%). Conclusion: It is essential to take stock of knowledge about cervical cancer and attitudes to vaccination to assess the impact of interventions and redirect strategies to improve vaccination coverage. .

Cervical cancer with transferrin receptor has a poor prognosis and is associated with immune infiltration, according to a comprehensive bioinformatics study

Background:The molecular mechanism underlying the involvement of the Transferrin receptor(TFRC)in cervical cancer remains poorly understood.This study aims to elucidate the role of TFRC in cervical cancer by analyzing data from The Cancer Genome Atlas(TCGA)and Genotype-Tissue Expression(GTEx)databases.Methods:TFRC protein expression was obtained from Human Protein Altas(HPA).All datas were collected from TCGA and GTEx.In this study,we analyzed the expression of TFRC in cervical cancer and its clinical significance.Through Kyoto Encyclopedia of Genes and Genomes(KEGG)and Gene set enrichment analyses(GSEA),investigated the related molecular pathways of TFRC.The relationship between TFRC and immune infiltration was then examined.The prognosis of different immune cell subsets was then analyzed after dividing cervical cancer patients into high and low expression of TFRC groups.Results:TFRC is highly expressed in various tumor tissues compared to control normal tissues,including cervical cancer.An increased expression of TFRC was associated with higher Tumor(T)and Node(N)stage,as well as a higher clinical stage.Kaplan–Meier(KM)survival analysis investigated that higher TFRC expression patients have a poor overall survival(OS),disease specific survival(DSS)and progress free interval(PFI).Both KEGG and GSEA enriched signaling pathway by high TFRC and low TFRC groups.There was a significant negative linear correlation between TFRC expression and immune infiltration.TFRC affects the prognosis of cervical cancer patients through immune pathway.Conclusions:Cervical cancer patients with TFRC expression may have a worse prognosis.

Cervical Cancer Prevention Challenges and Barriers to Cervical Cancer Screening and HPV Vaccinations in Ukraine and Eastern Europe

Objectives: To identify the obstacles and issues that hinder effective cancer prevention efforts in Ukraine. The study aims to provide a comprehensive assessment of the barriers to cancer prevention, including both infrastructure and behavioral factors, and identify potential solutions to address these challenges. Study Design: Comprehensive literature review. Methods: The following databases were searched: National Center for Biotechnology Information (NCBI) and PubMed (U.S. National Library of Medicine at the National Institutes of Health). The keywords used in the search included “Cervical Cancer”, “Human Papillomavirus Vaccination (HPV)”, “Ukraine”, “Eastern Europe”, “Healthcare Infrastructure in Disasters”, “Cervical Cancer Prevention”, “Pap Smear”, and “HPV Testing”. Results: A total of 3500 articles were screened. A total of 65 articles met the inclusion criteria. Limited public awareness and limited access to vaccination and screening, combined with inadequate treatment facilities lead to higher rates of cervical cancer. The COVID pandemic, war with Russia, and the Chernobyl disaster are significant factors for the low level of vaccination in Ukraine. Conclusion: The prevention and treatment of cervical cancer in Ukraine face significant challenges due to the inadequate HPV vaccination rates and screening by cytology. Efforts to improve funding and increase education of both the population and health care providers are necessary to increase interventions such as HPV vaccination, cervical cytology, and HPV testing to reduce cervical cancer rates in Ukraine.

The role of nurses in the prevention of cervical cancer: Cervical screening, an unkept promise by the majority of women in Nigeria

Cervical cancer remains a major public health problem accounting for continuous female death in developing countries.Cervical cancer is the second most common cancer in women globally with an estimated number of 500,000 new cases of cervical cancer and 273,000 mortalities annually.Cervical screening is the best cancer screening test in the history of medicine and most cost-effective of all medical screening tests.The study review aimed to highlight methods of cervical cancer prevention,identify the uptake of cervical screening among women,and explain the role of nurses in uptake of cervical screening.Cervical cancer is preventable and easily treatable if it is detected at early stages,but poor information on prevention and access to screening and treatment contributes to 90%of deaths.In the developing countries such as Nigeria,a large proportion of cervical cancers are diagnosed in advanced stages,with poor rates of survival.The three main methods for preventing cervical cancer are through primary prevention(human papillomavirus vaccination and health education),secondary prevention(cervical screening,early detection of precancerous lesions,and treatment),and tertiary prevention(measures to slow the progression or recurrence,surgical removal,radiotherapy,and chemotherapy).Nurses can help improve the acceptability of this neglected promise by focusing on health education on cervical screening and vaccination in prenatal clinics and infant welfare clinics where there are more women.Inclusion of cyberspace could also serve as a successful and popular platform for this health teaching.All nurses/midwives must preach and fervently work toward the WHO 90–70–90 plan for eradicating cervical cancer.

Perceived Barriers to Cervical Cancer Screening Using Pap Smear Test among Women Attending Saad Abu Al Ella Hospital in Khartoum State, 2022

Background: Cervical cancer is the second common cancer among women worldwide. It is a preventable cancer, and early detection of precancerous conditions through the Papanicolaou cytology screening (Pap smear) is a key aspect of prevention;it is accepted worldwide as an efficient tool for secondary prevention. While the PS test is simple, inexpensive, and relatively reliable as a method of diagnosing cervical cancer, most women do not take the test. Therefore, this study is sought to describe the barriers to pap smear uptake among Sudanese women. Materials and Method: This total coverage observational, analytical and cross sectional, hospital-based study was conducted in Saad Abu El Ella Hospital in April 2022. The study was conducted using an anonymous questionnaire to assess the perceived barriers of 93 participants. All data were computerized using Microsoft Excel’17 and the data were described and analyzed using statistical package for social science (SPSS23). Results: The findings revealed that the mean age of the participants was 39.5 years and only 3.2% had ever undergone a pap smear test. Identified barriers were lack of information, not knowing where to go, and fear of pain. The majority, 72% are willing to routinely perform a pap smear test if well informed about it. The study also demonstrates that there is a significant correlation between perceived barriers score and willingness to perform the pap smear test (p value = 0.008), and between the perceived barriers score and the sociodemographic factors: Age (p value = 0.006), educational level (p value = 0.028) and occupation (p value = 0.040), but no association with the economic status was found (p value = 0.378). Conclusion: The detection rate is too low compared to the national target of over 70%. Therefore, more work is needed to reduce perceived barriers to cervical cancer screening by providing education/raising for popular awareness;addressing misconceptions and false beliefs;informing women about the necessity and importance of Pap smear;and health promotion using mass media such as national television, social media, radio, billboards, and newspapers and other print media.

Establishment of a prediction model for severe acute radiation enteritis associated with cervical cancer radiotherapy

BACKGROUND Cervical cancer is one of the most common gynecological malignant tumors.Radiation enteritis(RE)leads to radiotherapy intolerance or termination of radiotherapy,which negatively impacts the therapeutic effect and seriously affects the quality of life of patients.If the incidence of RE in patients can be predicted in advance,and targeted clinical preventive treatment can be carried out,the side effects of radiotherapy in cervical cancer patients can be significantly reduced.Furthermore,accurate prediction of RE is essential for the selection of individualized radiation dose and the optimization of the radiotherapy plan.AIM To analyze the relationships between severe acute RE(SARE)of cervical cancer radiotherapy and clinical factors and dose-volume parameters retrospectively.METHODS We included 50 cervical cancer patients who received volumetric modulated arc therapy(VMAT)from September 2017 to June 2018 in the Department of Radiotherapy at The First Affiliated Hospital Soochow University.Clinical and dose-volume histogram factors of patients were collected.Logistic regression analysis was used to evaluate the predictive value of each factor for SARE.A nomogram to predict SARE was developed(SARE scoring system≥3 points)based on the multiple regression coefficients;validity was verified by an internal verification method.RESULTS Gastrointestinal and hematological toxicity of cervical cancer VMAT gradually increased with radiotherapy and reached the peak at the end of radiotherapy.The main adverse reactions were diarrhea,abdominal pain,colitis,anal swelling,and blood in the stool.There was no significant difference in the incidence of gastrointestinal toxicity between the radical and postoperative adjuvant radiotherapy groups(P>0.05).There were significant differences in the small intestine V_(20),V_(30),V_(40),and rectal V40 between adjuvant radiotherapy and radical radiotherapy after surgery(P<0.05).Univariate and multivariate analyses revealed anal bulge rating(OR:14.779,95%CI:1.281-170.547,P=0.031)and disease activity index(DAI)score(OR:53.928,95%CI:3.822-760.948,P=0.003)as independent predictors of SARE.CONCLUSION Anal bulge rating(>0.500 grade)and DAI score(>2.165 points)can predict SARE.The nomogram shows potential value in clinical practice.

Estimation of economic burden throughout course of cervical squamous intraepithelial lesion and cervical cancer in China:A nationwide multicenter cross-sectional study

Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment.Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated.Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage.Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.