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Quality Control (QC) and Quality Assurance (QA) principles are essential for effective cervical cancer prevention. Being a crucial diagnostic step, colposcopy’s sensitivity and specificity improvements are strongly advocated worldwide since inter- and intra-observer differences are the main limiting factors. The objective of the present study was the evaluation of colposcopy accuracy through the results of a QC/QA assessment from a survey in Italian tertiary-level academic and teaching hospitals. A web-based, user-friendly platform based on 100 colposcopic digital images was forwarded to colposcopists with different levels of experience. Seventy-three participants were asked to identify colposcopic patterns, provide personal impressions, and indicate the correct clinical practice. The data were correlated with a panel of experts’ evaluation and with the clinical/pathological data of the cases. Overall sensitivity and specificity with the threshold of CIN2+ accounted for 73.7% and 87.7%, respectively, with minor differences between senior and junior candidates. Identification and interpretation of colposcopic patterns showed full agreement with the experts’ panel, ranging from 50% to 82%, in some instances with better results from junior colposcopists. Colposcopic impressions correlated with a 20% underestimation of CIN2+ lesions, with no differences linked to level of experience. Our results demonstrate the good diagnostic performance of colposcopy and the need for improving accuracy through QC assessments and adhesion to standard requirements and recommendations.

BACKGROUND: This study aims to understand how criminal-legal involved women from three U.S. cities navigate different health resource environments to obtain cervical cancer screening and follow-up care. METHODS: We conducted a cross-sectional study of women with criminal-legal histories from Kansas City KS/MO; Oakland, CA; and Birmingham, AL. Participants completed a survey that explored influences on cervical cancer prevention. Responses from all women with/without up-to-date cervical cancer screening and women with abnormal Pap testing who did/did not obtain follow-up care were compared. Proportions and associations were tested with chi-square or analysis of variance tests. Multivariable regression was performed to identify variables independently associated with up-to-date cervical cancer screening and reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: There were n = 510 participants, including n = 164 Birmingham, n = 108 Kansas City, and n = 238 Oakland women. Criminal-legal involved women in Birmingham (71.3%) and Kansas City (68.9%) were less likely to have up-to-date cervical cancer screening than women in Oakland (84.5%, p = 0.01). More women in Birmingham (14.6%) and Kansas City (16.7%) needed follow-up for abnormal Pap than women in Oakland (6.7%, p = 0.003), but there were no differences in follow-up rates. Predictors for up-to-date cervical cancer screening included access to a primary care provider (OR: 3.3, 95% CI: 1.4–7.7), health literacy (OR: 0.3, 95% CI: 0.2–0.7), and health behaviors, including avoiding tobacco (OR: 0.4, 95% CI: 0.1–0.9) and HPV vaccination (OR: 3.4, 95% CI: 1.0–10.9). CONCLUSIONS: Cervical cancer screening and follow-up varied by study site. The results suggest that patient level factors coupled with the complexity of accessing care in different health resource environments impact criminal-legal involved women's cervical cancer prevention behaviors.

While the benefits of human papillomavirus (HPV) vaccination relating to cervical cancer prevention have been widely documented, recent published evidence is suggestive of an impact on adverse pregnancy outcomes (APOs) in vaccinated mothers and their infants, including a reduction in rates of preterm births and small for gestational age infants. In this review, we examine this evidence and the possible mechanisms by which HPV vaccination may prevent these APOs. Large-scale studies linking HPV vaccination status with birth registries are needed to confirm these results. Potential confounding factors to consider in future analyses include other risk factors for APOs, and historical changes in both the management of cervical precancerous lesions and prevention of APOs. If confirmed, these additional benefits of HPV vaccination in reducing APO rates will be of global significance, due to the substantial health, social and economic costs associated with APOs, strengthening the case for worldwide HPV immunization.

Despite being highly preventable, cervical cancer is the fourth most common cancer and cause of cancer death in women globally. In low-income countries, cervical cancer is often the leading cause of cancer-related morbidity and mortality. Women living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome are at a particularly high risk of cervical cancer because of an impaired immune response to human papillomavirus, the obligate cause of virtually all cervical cancers. Globally, approximately 1 in 20 cervical cancers is attributable to HIV; in sub-Saharan Africa, approximately 1 in 5 cervical cancers is due to HIV. Here, the authors provide a critical appraisal of the evidence to date on the impact of HIV disease on cervical cancer risk, describe key methodologic issues, and frame the key outstanding research questions, especially as they apply to ongoing global efforts for prevention and control of cervical cancer. Expanded efforts to integrate HIV care with cervical cancer prevention and control, and vice versa, could assist the global effort to eliminate cervical cancer as a public health problem.

Cervical cancer screening practices in the United States have been inefficient, with variable screening rates. Some women are screened too frequently, overmanaged, lost to follow-up, or are at risk and should be screened but are not. Timely screening, identification, and management of abnormal cervical cells is vital in order to prevent progression to cervical cancer. Educating, counseling, screening, and offering the human papillomavirus vaccine continue to be the primary methods of cervical cancer prevention practices. Guidelines and primary screening methods have been updated because of supporting evidence, and clinicians must stay up-to-date in order to provide effective patient care.

Objective Thermal ablation (TA) was implemented in public sector cervical cancer prevention services in Zambia in 2012. Initially introduced as a treatment modality in primary healthcare clinics, it was later included in mobile outreach campaigns and clinical research trials. We report the feasibility, acceptability, safety, and provider uptake of TA in diverse clinical contexts. Methods Screening services based on visual inspection with acetic acid were offered by trained nurses to non-pregnant women aged 25-59 years. Women with a type 1 transformation zone (TZ) were treated with same-visit TA. Those with a type 2 or 3 TZ, or suspicious for cancer, were managed with same-visit electrosurgical excision or punch biopsy, respectively. A provider survey was conducted. Results Between 2012 and 2020, 2123 women were treated with TA: primary healthcare clinics, n = 746; mobile outreach clinics, n = 1127; research clinics, n = 250. Of the 996 women treated in primary healthcare and research clinics, 359 (48%) were HIV positive. Mild cramping during treatment was the most common adverse effect. No treatment interruptions occurred. No major complications were reported in the early (6 weeks) follow-up period. Providers expressed an overwhelming preference for TA over cryotherapy. Conclusion TA was feasible, safe, and acceptable in diverse clinical contexts. It was the preferred ablation method of providers when compared with cryotherapy.

Background: Reproductive health problems faced by women today are increasing infections in the reproductive organs, which in turn lead to cancer, one of that is cervical cancer. Lack of awareness to prevent cervical cancer is one of the problems that often occur in the health of Fertile Age Women. The effort that needs to be done to prevent cervical cancer is by providing health education through online media, to increase the knowledge and behavior of Fertile Age Women in preventing cervical cancer. The purpose of this research is to determine the effect of health education on early detection of cervical cancer through online media on the knowledge and behavior of Fertile Age Women in cervical cancer prevention in Nanga Public Health Center of Sikka Regency. Method of this research used a pre-experimental design with one group pre-test post-test design method, using a consecutive sampling technique, with as many as 199 respondents. The data collection tool used a questionnaire. Data were analyzed through the Wilcoxon Signed Rank Test with SPSS for windows version 20. Results of this research indicated that there was a very significant effect on the provision of health education through online media on early detection of cervical cancer on knowledge and behavior of cervical cancer prevention of Fertile Age Women in Nanga Public Health Center of Sikka Regency with a p-value of 0.000 (p < 0.05). Providing health education on early detection of cervical cancer with online media can increase knowledge and behavior of cervical cancer prevention of Fertile Age Women. It is hoped that the public health center will provide health education with online media, to support the prevention of covid-19 transmission and to increase the knowledge and behavior of Fertile Age Women in cervical cancer prevention.

Introduction: In Denmark, women with a future childbearing desire diagnosed with cervical intraepithelial neoplasia grade 2 (CIN2) are recommended active surveillance instead of excisional treatment. However, we have limited and contradictory knowledge about how active surveillance of CIN2 may affect women emotionally. The aim of this study was to explore thoughts and emotional responses in women undergoing active surveillance of CIN2 and to explore how active surveillance may affect women’s future childbearing desire. Material and methods: This qualitative study was conducted in the gynecological outpatient clinic, the Department of Obstetrics and Gynecology, Gødstrup Hospital, Denmark. Women of childbearing age undergoing active surveillance with colposcopy, biopsy and smear every 6 months due to CIN2 were eligible for enrollment. In-depth semi-structured interviews were conducted. The interviews were audiotaped and transcribed verbatim. A thematic analysis was performed using a phenomenological approach. Results: A total of 20 women were included. All women experienced nervousness and anxiety when they were diagnosed with CIN2 initially. Their main concern was whether they had cancer. Most women carried on with their everyday lives with only minor occasional worries about CIN2, often prompted just before check-up. However, some women were particularly nervous and found the period between check-ups frustrating and challenging. Women did not want to postpone their plans for pregnancy because of CIN2, but experienced the worries and check-ups associated with active surveillance as disruptive elements in their family planning. Women preparing for fertility treatment had their startup unnecessarily delayed due to active surveillance of CIN2, as clinical guidelines were inconsistent across subspecialties. Various factors influenced women’s emotional well-being: life circumstances, information needs, and mental and physical discomfort during colposcopic examination. Conclusions: Women felt that worries and check-ups due to active surveillance of CIN2 were disrupting elements in their family planning, although they did not affect their every-day life. Some women, however, were particularly anxious, demonstrating the importance of including women’s experiences and preferences in clinical counseling. The fact that fertility treatment was delayed due inconsistent guidelines across subspecialties, suggests a need for a revision of current guidelines.

The study aimed to evaluate the effectiveness of a cervical cancer prevention education program for rural Korean immigrant women. A total of 46 Korean immigrant women who had not been screened in the past three years participated. The experimental group participated in the intervention program once a week for four weeks and completed a post-program survey in week 12. Compared to the control group, significant increases were detected in level of knowledge of cervical cancer prevention ( p = .001), behavioral attitude toward cervical cancer prevention ( p = .029) and behavioral intention regarding cervical cancer prevention ( p = .005) in the experimental group. Pap screening rate of the experimental group was significantly increased ( p = .029), but the rate of change in the selection of primary care providers was not significant. The results suggest the need for a multilevel approach to address cultural and systemic barriers to Korean immigrant women in promotion of cervical cancer prevention behavior.

Cervical cancer is the second most common cancer in Solomon Islands; no national cervical screening programme currently exists. In 2015 the Solomon Islands Government invited Family Planning Austra...

Cervical cancer imposes a huge global burden. Cervical carcinoma is one of the most common and feared diseases of women, and in India, it accounts for 16 per cent of total cervical cancer cases occurring globally. The situation is more alarming in the rural areas where the majority of women are illiterate and ignorant about the hazards of cervical cancer. To date, various studies have been conducted on the risk factors associated with cervical cancer. Accumulated evidence has demonstrated the reasons by which HPV infection causes carcinogenesis. Two viral oncoproteins E6 and E7could play a key role in the HPV-infected cervical cancers. It has been documented that not all integrations necessarily depend on the E6 and E7 oncogenes expression. Currently, clinical treatment managements for cervical cancer typically include surgery, radiotherapy, and platinum-based chemotherapy. Treatment for early stage disease often is surgical therapy such as cervical conisation, total simple hysterectomy, or radical hysterectomy based on extent of spread of cervical cancer. In the recent years, a series of systemic treatments, for instance, the platinum-based chemotherapy and the recent FDA approved pembrolizumab, have applied for recurrent and advanced cervical cancer. Although screening and advanced therapeutic strategies have improved the survival rate of cervical cancer, some patients still die due to metastasis and drug resistance. Without a doubt, HPV vaccination could pre-vent the development of cervical cancer; however, many patients’ in underdeveloped countries cannot get HPV vaccination due to economic condition. The aim of this study was to investigate the incidence, mortality, and geographical distribution of cervical cancer and its risk factors in the world and study the molecular mechanisms of cervical cancer development and progression, to discover the novel molecular diagnostic methods and systemic management for cervical cancer. The findings of this study demonstrated that several factors including sexually transmitted infections, reproductive factors, hormonal influences, genetics and host factors are responsible for the incidence of cervical cancer. The results of this review study suggested that combination of biological, economic and health factors contributes to the incidence of cervical cancer. A large proportion cervical cancer can be prevented by prevention programs, lifestyle enhancement, smoking cessation, and timely and effective treatment of pre-cancerous lesions.

HPV infection is estimated to be responsible for about 5% of human cancers worldwide. Among all HPV-associated malignancies, cervical cancer is the most important cause of morbidity and mortality worldwide. Cervical cancer is the fourth most common cancer in women worldwide and leading cause of cancer death among females in less developed countries. Persistent HPV infection is a necessary cause of invasive cervical cancer with a prevalence of 99.7% in cervical cancer worldwide.At least 70% of cervical cancers are caused by HPV 16 and HPV 18. HPV vaccination in combination with regular screening offers the most effective way for women to be protected against cervical cancer.The global burden of cervical cancer falls heaviest on the developing countries which haven’t introduced the HPV vaccine as part of their national public health strategy to prevent and control cervical cancer. Different studies showed a drop in the prevalence of HPV associated diseases in vaccinated populations. Sustained efficacy, immunogenicity, and safety of the bHPV vaccine were observed in the final analysis of a follow-up study up to 9.4 years postvaccination. Cervical cancer is a major public health problem in Bangladesh. There has been little success with screening program against cervical cancer in Bangladesh. Therefore, a National HPV Vaccination Program seems to be the window of opportunity to reduce the mortality and morbidity of cervical cancer in Bangladesh. J Bangladesh Coll Phys Surg 2021; 39(2): 123-131

Cervical cancer remains a leading cause of cancer death for women in low- and middle-income countries. The goal of our study was to evaluate screening and triage strategies, including high-resolution microendoscopy (HRME), to detect cervical abnormalities concerning for precancer at the point of care. Women (n = 1824) were enrolled at the Instituto de Cancer de El Salvador. All underwent screening by both human papillomavirus (HPV) testing using careHPV and visual inspection with acetic acid (VIA). Screen-positives, along with 10% of screen-negatives, were invited to return for a follow-up examination that included triage with VIA, colposcopy and HRME imaging. Biopsies were taken of any abnormalities identified. If no abnormalities were identified, then the worst scoring site by HRME was biopsied. The sensitivities of HPV testing and VIA to screen for cervical intraepithelial neoplasia Grade 2 or more severe diagnoses (CIN2+) were 82.1% and 75% (P = .77), while the specificities were 90.4% and 80.9% (P < .001), respectively. The sensitivities of VIA, colposcopy and HRME as triage tests for CIN2+ were 82.1%, 82.1% and 71.4%, respectively (P ≥ .38). HRME had a significantly higher specificity (66.7%) than VIA (51.9%) (P < .001) and colposcopy (53.3%) (P < .001). When evaluating different theoretical screening and triage strategies, screening with HPV testing followed by triage with HRME would result in more women receiving appropriate care (97%) compared to screening with VIA (75%) or HPV alone (90%). Our findings demonstrate that screening with HPV is superior to VIA, and that triage with HRME imaging increases the specificity of detecting CIN2+ at the point of care in a low-resource setting.

OBJECTIVE This study compared cervical cancer knowledge, screening practices, and barriers to screening among undocumented and documented Hispanic women. MATERIALS AND METHODS An anonymous cross-sectional survey was administered to self-identifying Hispanic women older than 21 years at community-based clinics and health care-focused community sites in Rhode Island. The survey included demographics, immigration status, questions related to cervical cancer knowledge, screening practices, and barriers to screening. Participants were stratified based on their immigration status. Categorical variables were compared by χ2 or Fisher exact test. Knowledge scores and the number of barriers were compared by t test and Wilcoxon rank sum test, respectively. p values of less than .05 were considered statistically significant. RESULTS Seventy-three undocumented women and 70 documented women were enrolled. Undocumented women had a significantly lower mean cervical cancer knowledge score (3.53, SD =1.97) compared with documented women (4.43, SD = 2.04; p = .0085) and also experienced more barriers to having cervical cytology or a human papillomavirus test (p = .001). Eighty-eight percent of the undocumented women and 47% of the documented women did not have health insurance (p < .0001). Sixty-two percent of the undocumented women felt that their lack of documentation was a barrier to cervical cancer screening. Fifty percent of the undocumented and 47% of the documented women had never heard of the human papillomavirus vaccine. CONCLUSIONS Undocumented women have significantly lower mean cervical cancer knowledge scores compared with documented women. A lack of legal documentation is a significant barrier to cervical cancer screening among Hispanic women. Challenges inherent to being undocumented may contribute to women's lower knowledge scores and more pronounced barriers.

Objectives: We are reporting the evaluation of an opportunistic point of care cervical cancer screening initiative in Pune, India using a mobile screening unit (MSU). Methods: We conducted 290 cervical cancer screening outreach clinics in the MSU. Screening was performed by trained nurses/ health care providers using visual inspection with 5% acetic acid (VIA). Screen positive women when eligible were treated by thermal ablation during the same sitting. Women with large lesions not eligible for treatment with thermal ablation were referred for colposcopy and treatment. Results: A total of 10, 925 women were screened between Nov 2016 and June 2019 in 290 outreach clinics in the MSU. The overall screen positivity was 6.6% (95% CI 6.1, 7.0) with a declining trend over time. A total of 304/717 (42.4%, 95% CI 38.7, 46.1) women received treatment with thermal ablation. About 3.6% (11/304) reported minor side effects and 1.6% (5/304) reported lower abdominal pain and all of them subsided after treatment. Among the 413 women who were advised colposcopy, only 84 (20.33%) women underwent the procedure. Of these 84 women, 64 (76.19%) had normal colposcopy/ histopathology, 7 (8.33%) had CIN1, 2 (2.38%) had CIN 2, 9 (10.71%) had CIN 3 disease and 2 (2.38%) women were diagnosed with invasive cancer. Conclusion: MSUs are useful for providing cervical cancer screening services, using the ‘screen and treat’ strategy. Thermal ablation is safe in the field clinics. Additional efforts are needed to improve the compliance for referral of those with large lesions requiring additional visits.

Objective: Intern nurses will play an important role in the use of vaccination to prevent cervical cancer. This study assesses the knowledge about human papillomavirus (HPV) infection and cervical cancer prevention among intern nurses. Methods: We developed a questionnaire to investigate intern nurses' knowledge about HPV infection and cervical cancer prevention. Participants included 323 intern nurses from eight schools. Results: The effective response rate was 79.8%. Some (7.0%) knew that early-stage cervical cancer is commonly asymptomatic. Only 9.7% knew that infection is generally asymptomatic and 20.5% knew that vaccination has no major side effects. There were differences in gender, age, school type, and place of residence for several questions. Conclusions: This study indicates a low level of knowledge about HPV infection and cervical cancer prevention among intern nurses. Our findings highlight the need for more education in this topic to increase the knowledge of intern nurses.

Objective: Cervical cancer is common disease worldwide and ranks fourth among all malignancies for women. It has been reported to have been responsible for almost quarter of a million deaths annually, of which about 85% occurred in developing nations. Hence, the present study was conducted to assess the knowledge and attitude on cervical cancer prevention and its associated factors among female students in Batu Preparatory School, Ziway town, Oromia Regional State, Ethiopia in 2018. Methods: Institution based quantitative cross sectional study was conducted using anonymous self- administered questionnaire among female students in Batu Preparatory School in 2018. Results: Our results showed, the overall (62.1%) female preparatory students had heard of cervical cancer for most the source of information was mass media (50.7%). Though most has information on CC, only 33.3% were knowledgeable. Of the participants, 7.8% of had information about risk factor and 16% were aware of at least one of the symptom of CC. Results indicated that 72.5% of the participants believes that CC is preventable disease but only 21% had good knowledge on prevention. The overall positive attitude of the participants was 58.8%. Conclusion: Most participant believe that CC is preventable disease, and their knowledge on prevention is either poor or not satisfactory. In addition, most of the participants showed positive attitude towards CC prevention.

O objetivo deste estudo foi analisar o perfil das mulheres que realizaram o exame de Papanicolaou. Trata-se de um estudo transversal, retrospectivo e quantitativo. A população estudada foram mulheres atendidas em uma Unidade Básica de Saúde entre os anos de 2014 a 2016, totalizando 215 mulheres. A coleta de dados ocorreu por meio de fichas arquivadas na Unidade Básica de Saúde. A análise descritiva foi realizada com frequências absolutas e relativas. Evidenciou que a maior parte das mulheres apresentou idade entre 25-64 anos (80,9%), com companheiro (61,6%), com trabalho remunerado (48%), não fumantes (71,2%), com índice de massa corpórea elevada (50,4%), sem queixas ginecológicas (66,8%), ativas sexualmente (69,6%), sedentárias (51,2%) e que não utilizavam métodos contraceptivos (35,2%). Ressalta-se que o estudo possibilitou conhecer o perfil da população estudada, auxiliando no direcionamento das atividades em consonância com as recomendações da Política de Prevenção do câncer de colo de útero.

Background: Carcinoma of cervix is common yet preventable. Sri Lankan young population is at risk. This study was conducted among the students attached to three non-conventional higher education institutions with ref­erence to assessing the awareness, screening methods, Human Papilloma Virus (HPV) as causative factor and attitude towards HPV vaccination.Methods: A validated questionnaire was used. Data were analyzed using SPSS 25 software.Results: 120 females participated, age ranging 19 to 25 years. Seventy (57.5%) participants were aware of the cervical cancer. Seventy percent of them were also aware HPV as causative factor. About half of the participants (50.8%) were not aware of availability of cervical screening. Among those aware of the screening, about half re­ported the availability of both Pap smear and HPV testing. Totally about 87% were aware of the Pap smear. Sixty nine students [57.5%] were ‘not sure’ of the availability of HPV vaccine and 58 of them stated ‘unsure of vaccine received’. About 16% did not want to receive the vaccine. One third mentioned that the HPV Vaccine is available in Sri Lanka.Conclusions: The awareness noted under 60% of the participants indicates the need for structured awareness programs to young population. Majority of participants were confused about the availability and whether they had received of HPV vaccine.

Laura M Torrado-García, Ruth A Martínez-Vega, Bladimiro Rincon-Orozco Microbiology School, Universidad Industrial De Santander, Bucaramanga, Santander, ColombiaCorrespondence: Bladimiro Rincon-Orozco Email blrincon@uis.edu.coIntroduction: Human papillomavirus molecular detection prevents cervical cancer (CC). To widen its use, cervical-vaginal self-collection devices are proposed. Our aim was to determine the acceptability of self-sampled cervical-vaginal protocol and the reproducibility of results using HPV detection brushes in a low-income Colombian population between 35 and 65 years old.Methods: Cross-sectional study including women classified as medium to high-risk for developing CC by using a short-standardized survey. After receiving instructions, women self-collected a cervical-vaginal sample. Subsequently, a perception survey was conducted.Results: Four hundred and twenty-three women performed self-collected sampling. The median age was 46.5 years (IQR 40– 52), 56.5% were housewives, and 55.1% had finished elementary school. About 99% of the population (n=419) considered that they understood the instructions, 19.4% (n=82) reported having concerns about the self-collected sample, 9.2% (n=39) distrusted the results because of the self-collection, 7.3% (n=31) felt uncomfortable with the procedure, and 9.7% (n=41) reported some pain. The majority would recommend the procedure to others (99%), 88.5% of the sampled population preferred the self-collected method, 4% preferred conventional cytology, and 7.3% were not sure. The reasons behind favoring the self-collected procedure included privacy (n= 149, 40.1%), comfort (n=110, 29.7%), easiness (n=52, 14%), reliability (n=46, 12.4%), and less painful (n=110, 29.7%). The percentage of HPV detection agreement between the self-collected and the healthcare professional-collected procedures was 98.99% (Cohen’s Kappa=0.9774).Conclusion: Women living in low-income households in Bucaramanga, Colombia preferred the self-sampling procedure because it was easy to use, convenient, and private, resulting in 98% acceptability, and positioning it as an excellent tool for CC prevention.Keywords: cervical smear, uterine cervical neoplasms, female, self-collected HPV

From normal epithelial cells to invasive cervical cancer take a long time. It needs a step-by-step process. Normal cervical cells may be infected with the high-risk human papillomavirus (HPV). The infection may persist or be cleared. The HPV persistence may change normal cells to invasive cancer. Recent findings showed that the intrauterine device (IUD) might have a protective effect on cervical cancer. Inflammation in the cervix induces the immune response that may alter normal cells' progression to cervical cancer. This article will explain the change from normal cells to invasive cervical cancer, the role of the IUD in cervical cancer prevention.

Summary: Background: Cost data of human papillomavirus (HPV) self-sampling programs from low-and-middle-income countries is limited. We estimated the total and unit costs associated with the Hope Project, a community-based HPV self-sampling social entrepreneurship in Peru. Methods: We conducted a micro-costing analysis from the program perspective to determine the unit costs of (1) recruitment/training of community women (Hope Ladies); (2) Hope Ladies distributing HPV self-sampling kits in their communities and the laboratory testing; and (3) Hope Ladies linking screened women with follow-up care. A procedural manual was used to identify the program's activities. A structured questionnaire and in-depth interviews were conducted with administrators to estimate the resource/time associated with activities. We obtained unit costs for each input previously identified from budgets and expenditure reports. Findings: From November 2018 to March 2020, the program recruited and trained 62 Hope Ladies who distributed 4,882 HPV self-sampling kits in their communities. Of the screened women, 586 (12%) tested HPV positive. The annual cost per Hope Lady recruited/trained was $147·51 (2018 USD). The cost per HPV self-sampling kit distributed/tested was $45·39, the cost per woman followed up with results was $55·64, and the cost per HPV-positive woman identified was $378·14. Personnel and laboratory costs represented 56·1% and 24·7% of the total programmatic cost, respectively. Interpretation: Our findings indicate that implementation of a community-based HPV self-sampling has competitive prices, which increases its likelihood to be feasible in Peru. Further economic evaluation is needed to quantify the incremental benefits of HPV self-sampling compared to more established options such as Pap tests. Funding: Thomas Francis Jr. Fellowship provided funding for data collection. The Hope Project was funded by grants from Grand Challenges Canada (TTS-1812-21131), Uniting for Health Innovation, Global Initiative Against HPV and Cervical Cancer, University of Manitoba, and the John E. Fogarty International Center (5D43TW009375-05).

The implementation of the Human Papillomavirus (HPV) vaccination program is still experiencing obstacles in several developing countries. This setback is related to the lack of knowledge and the high cost of the vaccine so that it affects people's behavior about the HPV vaccine. HPV vaccination in adolescents itself as primary prevention has not been widely conducted by adolescents in Indonesia. The results of previous studies showed that not many teenagers had vaccinated against HPV by using self-financing guarantees such as health savings. The obstacles faced in implementing HPV vaccination are that the vaccine is still expensive and there is lack of knowledge of parents and adolescents about the importance of HPV immunization. This formative research using qualitative methods was conducted to analyze the implementation plan of the HPV vaccination program. Data were collected through focus group discussions (FGD) and in-depth interviews. At the end of each FGD activity or interview, transcription and thematic analysis based on content were done. The FGD participants were ten teachers, while the in-depth interview participants were one school committee. This study found two main themes, namely the scheme of implementing the HPV vaccination program and obstacles to the implementation of HPV vaccination. Schools generally supported the program implementation. However, parents still question the importance of the HPV vaccination for their daughters and consider the vaccine costs expensive. Implementation of the HPV vaccination program must consider the existing program schemes in schools and possible obstacles. The results suggested that for the next HPV vaccination program, the facilitators should provide intense and relevant education to parents about the importance and side effects of HPV immunization, and are expected to build a willingness of parents to vaccinate their daughters and seek vaccination costs, one of which can be through a savings program.

IntroductionIn this review and meta-analysis we aimed to investigate whether human papilloma virus (HPV) vaccination administered after excisional treatment of cervical intraepithelial neoplasia (CIN) is associated with a reduced risk of recurrence of CIN grade 2 or worse (CIN2+).Material and methodsWe performed a systematic literature search in three online databases through June 2021. Observational studies and randomized controlled trials (RCTs) were eligible for inclusion if the prophylactic HPV vaccine was administered after excisional treatment for histologically verified CIN. Only English language literature was included. The primary outcome measure was recurrence of CIN2+ after treatment. A meta-analysis was performed using fixed and random-effects models, and results were reported as pooled odds ratios (OR) with 95% confidence intervals (95% CI). Quality assessment was performed using ROB2-tool for RCTs and ROBINS-I for observational studies. The protocol was registered in PROSPERO (CRD42021238257).ResultsA total of 1561 studies were identified, of which nine, including 19 971 women, were included. Two studies were RCTs and seven were observational studies. Using the fixed-effect model on the two RCTs, the OR for recurrence of CIN2+ was 0.29 (95% CI 0.16–0.53). Due to considerable heterogeneity in observational studies, the random-effects model was used to estimate pooled OR for CIN2+ recurrence in these studies. Thus, using unadjusted data from observational studies, the OR for CIN2+ recurrence was 0.35 (95% CI 0.18–0.67), whereas when using adjusted data, the OR for CIN2+ recurrence was 0.54 (95% CI 0.21–1.35). However, quality assessment revealed a serious risk of bias for the majority of the studies included.ConclusionsHPV vaccination post-treatment was associated with a significantly reduced risk of CIN2+ recurrence when using unadjusted estimates from observational studies and RCTs. We found no significant effect of HPV vaccination on risk of CIN2+ recurrence when using the outcome measure from observational studies with the least risk of bias. Large, well-designed randomized placebo-controlled trials are needed to determine whether post-treatment HPV vaccination should be recommended to all women undergoing excisional treatment for CIN.

Background: Human papillomavirus (HPV)-DNA testing combined with self-sampling could increase cervical cancer screening effectiveness, utilizing a sensitive screening modality and an easy sampling method with minimal pain or discomfort. Self-sampling acceptability, though, is pivotal. Materials and Methods: This study is a nested cross-sectional survey within GRECOSELF, a cross-sectional study on HPV-based screening with self-sampling, aiming at investigating self-sampling acceptability among Greek women residing in rural areas, and the factors affecting it. Women between 25 and 60 years old were recruited by midwives participating in a nationwide midwifery network. Participants, after self-sampling, filled out a questionnaire with three sections, one regarding demographic characteristics, a second with questions pertaining to the participants' cervical cancer screening history, and a third with questions regarding the self-sampling process per se. Results: The sample included 13,111 women. Most participants (67.9%), including those screened or not in the past, would prefer self-sampling if assured that the results are not inferior to standard testing. Discomfort or pain during self-sampling was absent or minimal in 97.1% and 96.5% of the cases, respectively, and 74.4% of the women felt adequately confident that they followed the instructions correctly. Women mostly preferred self-sampling at home compared with health care facilities. Pain and discomfort during the procedure, although rare, were significant factors against acceptance. Most of the women reporting a negative impression had a negative experience with conventional sampling in the past. Conclusion: Self-sampling is highly acceptable. Acceptance can be further improved with proper communication of the process and its noninferiority compared with conventional screening.

Introduction Cervical cancer is the fourth most common cancer among women. It is related to persistent HPV infection. In order to improve diagnostic methods, a lot of research has been focused on detecting HPV DNA. A test known as a high-risk HPV test or HPV primary screening provides very encouraging results. Objective The aim of this review is to present the actual knowledge about the possibilities of cervical cancer screening methods. Particular attention is paid to the question concerning the effectiveness of detecting viral DNA as a screening programme, compared to pap smear. State of knowledge The HPV primary screening has higher sensitivity than the cervical smear test and it is able to detect lower-stage lesions, which are considered clinically irrelevant. Nonetheless, many HPV infections recede naturally. Therefore, relying only on the results of this test may expose women to unnecessary colposcopies and stress. Due to this fact, women under 30 years should not be screened with the hrHPV test. In view of its limitations, the HPV primary screening strategy is still tested worldwide as a pilot project. In Poland in 2019, a pilot project with the hrHPV test started at the National Institute of Oncology. Conclusions Detecting viral DNA has its advantages and disadvantages. Further research is still required, but the hrHPV test has a great opportunity to become one of the main screening programmes worldwide, or at least, a valuable addition to cervical smear test.

Cervical cancer is a malignant tumor that grows in the cervix or serviks. This cancer occurs because cells in the cervix has multiplied and the abnormalities. Cervical cancer usually occurs in women of child-bearing age who are 30-45 years old because the average woman at that age has been active in sexual intercourse and has been productive, but it can also occur in women aged 18 years due to women's inability to maintain cleanliness and the health of the reproductive organs. This study aims to describe the awareness and behavior of cervical cancer in Women of Child-bearing Age. This study used a quantitative methods type of descriptive survey research with a sample of 150 respondents and Accidental sampling technique. The analysis used is univariate (age, occupation, last education, awareness, and behavior). The average univariate results of respondents were 31 years old (6,0%), the average of the last high school education was 83 people (55.3%), the majority of women who came to the health center 141 people (94.0%), most of them had a good awareness of 91 people (60.7%), and positive behavior 104 people (69.3%) for early prevention of cervical cancer. Researcher hope that respondents who had never done early cervical cancer screaning should checkup immediately and respondents who had already done screaning must to improve and maintain the efforts to prevent cervical cancer. Bibliograph: 59 (2003-2018) Key words: Cervical Cancer, Awareness, Behavior

Background and Purpose: Survey-based research was conducted in Yantalo, Peru, a rural Amazonian community, to assess the knowledge base among women surrounding cervical cancer, human papilloma virus (HPV), and preventative health practices as well as to gain a better understanding of barriers to accessing care. Methods: A total of 217 women were interviewed out of the 1612 female inhabitants of Yantalo utilizing a structured interview-style questionnaire with both closed and open-ended questions. Results: Our average respondent was 41.6 years old with the equivalent of some high school education. Approximately 75% of respondents reported that they had heard of HPV and/or cervical cancer, with 44.4% reporting they had received a test to check for cervical cancer within their lifetime. When given a 10-question knowledge assessment regarding safe sex practices and cervical cancer, women obtained an average score of 57.3%. When asked about receiving the HPV vaccine, 29% reported “Yes”, 59.4% reported “No”, and 11.6% reported “I don't know.” Although 62.6% of women indicated that they have “easy access to cervical cancer screening,” 37.4% of women reported experiencing at least one barrier to accessing care. The highest reported barriers include fear of the test causing them pain and/or lack of knowledge of the necessity cervical cancer testing. Cervical cancer rates in Peru are approximately three times that in developed countries. Conclusions: Gathering data surrounding knowledge and the barriers among the female population in rural communities is essential to developing targeted initiatives that address pertinent obstacles within these and other vulnerable communities.

Background: Cancer, next to cardiovascular disease, obesity, diabetes, accidents, and mental illness, is one of the most common diseases of the 21st century. In the female population, cervical cancer is most often diagnosed at late stages. Aim of the study: The goal of the study is to determine the opinions of women who reside in Bialski poviat about midwife participation in cervical cancer screening and prevention. Material and methods: The study group was recruited from randomly selected patients from two physiotherapy offices in the Bialski poviat, as well as students and employees of the State University Pope John Paul II in Biala Podlaska. The research tool consisted of the author’s questionnaire concerning the role of midwives in cervical cancer prevention and consisted of 25 questions. Results: Almost half of the respondents or 44.2% (76) believe that the role of a midwife in cervical cancer prevention is based on health education given to women about cervical cancer screening and prevention. 27.3% (47) believe that the role of a midwife in prevention is based on the availability of cytological pap smears. Most or 56% (14) respondents from the age group over 55 and 29.2% (7) surveyed in the 18-25 age group knew about the important role of midwives performing cytological pap smear as part of a prevention strategy against cervical cancer. Conclusions: 1. The knowledge base of the women examined, regarding the role of a midwife in the prevention of cervical cancer, is lacking or insufficient. 2. The role of the midwife in the prevention of cervical cancer is unknown to young women in the 18-25 age group.

High-risk human papillomavirus strains are widely known to be the causative agents responsible for cervical cancer development. Aggregated damage caused by papillomaviruses solely is estimated in at least 5% of all malignancies of the human body and 16% in cancers that affect the female genital area. Enhanced understanding of the complex issue on how the high extent of carcinogenicity is eventually formed due to the infection by the Papoviridae family would contribute to enhancing current prevention strategies not only towards cervical cancer, but also other HPV associated cancers. This review article is aimed at presenting the key points in two directions: the current cervical cancer prevention and related aspects of HPV behavior. Virtually all applied technologies related to HPV diagnostics and screening programs, such as HPV tests, colposcopy-based tests (VIA/VILI), conventional and liquid-based cytology, currently available are presented. Issues of availability, advantages, and drawbacks of the screening programs, as well as vaccination strategies, are also reviewed in the article based on the analyzed sources. The current point of view regarding HPV is discussed with emphasis on the most problematic aspect of the HPV family concerning the observed increasing number of highly carcinogenic types. Present trends in HPV infection diagnostics throughout the human fluids and tissues are also reported, including the latest novelties in this field, such as HPV assay/self-sample device combinations. Besides, a brief outline of the related prevention issues in Kazakhstan, the leading country of Central Asia, is presented. Kazakhstan, as one of the post-soviet middle-income countries, may serve as an example of the current situation in those terrains, concerning the implementation of globally accepted cervical cancer prevention strategies. Along with positive achievements, such as the development of a nationwide screening program, a range of drawbacks is also analyzed and discussed.

Objectives: to analyze the access to cervical cancer preventive examination in Pernambuco between 2002 and 2015 by cytopathological exam coverage. Methods: public data from SUS Computer Department were used, then processed by Tabnet and Excel and calculated the slope of the over time coefficient trend by simple regression techniques. Afterwards, they were plotted in thematic maps covering cytopathological exams on Terraview app 4.2.2. Results: Pernambuco State presented an increase of exam coverage trend in all the health regions until 2010. Since that year it started to have stabilization and decreased the tendency. Comparing the coverage of the two first years, in 2002, 42.7% of the cities coverage was below 0.2 and in 2015 the scenario changed, 41.1% of the cities coverage was above 0.6. We emphasize that even in that same year 13.5% of the cities still had a low or too low coverage (less than 0.4). The over time trends in increase and decline were strongly meaningful. Conclusions: this study revealed that all health regions presented a coverage lower than recommended, in some period or in all of them, even with the State growth tendency it demonstrated an unequal and heterogeneous characteristic. Resumo Objetivos: analisar o acesso ao exame preventivo para o câncer de colo do útero em Pernambuco, entre 2002 e 2015, por meio da cobertura do citopatológico. Métodos: foram utilizados dados de domínio público do Departamento de Informática do SUS, processados no Tabnet e Excel® e calculados os coeficientes de inclinação de tendência temporal, por meio de técnicas de regressão simples. Por fim, foram plotados em mapas temáticos de cobertura de exames citopatológicos no aplicativo Terraview 4.2.2. Resultados: Pernambuco apresentou aumento na tendência de cobertura ao exame para todas as regiões de saúde até 2010. A partir deste ano, apresentou uma tendência de estabilização e diminuição. Ao comparar a cobertura no primeiro e no último ano, em 2002 42,7% dos municípios estavam com cobertura abaixo de 0.2 e em 2015 o cenário muda para 41,1% de municípios com cobertura acima 0.6. Destaca-se que neste mesmo ano 13,5% dos municípios ainda apresentavam uma cobertura baixa e muito baixa (

Background Cytology-based screening has been a cornerstone of cervical cancer prevention for decades. Following extensive evidence demonstrating higher sensitivity and accuracy, lower variability and better reproducibility of human papillomavirus (HPV)-based screening compared with conventional or liquid-based cytology, recent European guidelines strongly recommend primary HPV-based screening over standard cytology-based screening. In addition, HPV-based screening offers the possibility of self-sampling and makes possible longer screening intervals in women with negative screening results. Objectives We summarize the current status of implementation of HPV-based screening in Europe, describe the real-life experience and challenges from countries already performing HPV-based screening, and briefly review immediate and long-term plans for screening implementation in selected European countries. Sources Data were obtained from peer-reviewed literature, personal communication with experts and authorities involved in formulating national recommendations and practical guidelines, and relevant national websites. Content As of July 2019, the Netherlands and Turkey are the only European countries with fully implemented national HPV-based cervical cancer screening. Italy, Sweden and Finland have already implemented HPV-based screening in several regions, and several other countries are at various stages of implementation. Some countries are considering transitioning from cytology-based to HPV-based screening, but are struggling with the suboptimal performance of current population-based programmes. Implementation of HPV-based screening has resulted in higher colposcopy referral rates, but also higher detection rates of CIN3+ lesions and cervical cancers requiring immediate treatment. Cytology is mostly used as a triage test, although other strategies are under consideration in some countries. Implications HPV-based screening is best suited in organized population-based screening settings. In 2019, cervical cancer screening policies across Europe vary greatly. Experience in countries with national and regional HPV-based screening already implemented is generally very positive. Urgent action is needed in many European countries, especially those with suboptimal opportunistic cytology-based cervical cancer screening.

El Cancer Cervicouterino es la cuarta causa mas comun de cancer en las mujeres a nivel mundial y es la segunda neoplasia mas comun en mujeres en Mexico. Se sabe que el estado nutricio comprometido esta asociado con resultados adversos en pacientes con cancer. La evidencia cientifica sugiere que el cancer se puede atender desde la prevencion primaria, favoreciendo la ingesta dietetica. Sin embargo, es importante continuar investigado los antioxidantes y vitaminas en la prevencion del CaCu. Objetivos. Correlacionar la prevencion de cancer cervical mediante la ingesta dietetica vitamina C, zinc. Metodologia . Estudio transversal, observacional, correlacional. La muestra se conformo por 202 mujeres participantes a las cuales se les realizo una entrevista nutricional mediante una encuesta de frecuencia de consumo de alimentos y ademas se les realizo una evaluacion antropometrica. En el analisis estadistico se utilizo la prueba T de student. Resultados . Se encontro que la ingesta de zinc y vitamina C es mayor en personas sanas que en mujeres con NIC. Conclusion . Las mujeres deben consumir alimentos que contienen antioxidantes ya que son requeridos en la dieta humana para favorecer la prevencion del cancer. Antioxidant intake and its association with Cervical Cancer in women of a University System Cervical cancer is the fourth most common women’s cancers cause worldwide and the second most common neoplasm in Mexico. It is well known that poor nutritional status is associated with adverse outcomes at oncological patients. Scientific evidence suggests that cancer can be attended, favoring dietary intake, from primary attention. By the way, It’s important to continue researching the antioxidants and vitamins role at cervical cancer prevention. Objectives : To correlate Cervical cancer prevention through dietary intake of vitamin c and zinc. Methodology : Observational, correlational and transversal study. The sample was made up by 202 women who had a nutritional interview with a food consumption survey, also and anthropometric evaluation was carried out. In the statistical analysis the Student´s T test was used. Results : The intake of zinc and vitamin C is higher in healthy people tan in women with NIC. Conclusion . Women should consume foods that contain antioxidants as they are required in the human diet to promote cancer prevention.

The article describes the current issues of the epidemiology of human papillomavirus infection of high carcinogenic risk and genital herpes, affecting reproductive health. The attention is focused on modern principles of diagnosis and treatment, including approaches to immunotherapy and combination therapy.

Cervical cancer is a scary disease for women all over the world. This disease can actually be prevented and identified early. Pap smear is one of the tools of early detection to determine the presence of symptoms of cervical cancer. If women’s knowledge is good about pap smear’s early detection of cervical cancer, it can prevent the disease. The objective of this study was to know the effect of health education in women about pap smear which aids in early detection and prevention of cervical cancer. This was a quasi-experimental one group pretest, conducted without a control group at Murni Teguh Memorial Hospital (MTMH), Medan, North Sumatra from June to July 2018. There were 36 samples selected using purposive sampling. Wilcoxon signed-rank test was used for data analysis. The results of this study showed that there was a difference in the mean value of women's knowledge levels (p = 0. 000) before and after the intervention. The conclusion of this study was that there was a significant effect of health education in terms of an increase in the level of women's knowledge about pap smear’s early detection and prevention of cervical cancer. It is expected that health education about pap smear’s early detection and prevention of cervical cancer will prove to be very important in the future.

Objective: To understand the state of education for the prevention of cervical cancer and trends in research. The subject of cervical cancer prevention will be examined. Method: Articles from the ICHUSHI Web version 5, CiNii, and PubMed databases for the period from 2009-2019 were used. Search terms used were cervical cancer, HPV/human papillomavirus, prevention, public awareness, and education. Results: 17 articles (9 Japanese and 8 English) were analyzed. The majority of students had heard of cervical cancer but did not know of the link between it and HPV. Vaccinated individuals were significantly more likely to have deeper knowledge regarding cervical cancer and HPV. Various factors affect the vaccination rate. These include knowledge of HPV and cervical cancer, age, ethnicity, the organization or location which administers the vaccine, how to breach the subject, finances, and the opinions of friends and family. In particular, consultations with parents lead to mothers recognizing the importance of the vaccine. By way of educational intervention, opinions have grown more positive about advancing awareness, being vaccinated, and having cervical cancer screenings for the future. Conclusion: The prevention of cervical cancer requires support and fostering the judgement based on sufficient awareness and adequate education. What we need is educational intervention rooted firmly in the current societal climate aimed not only at students, but at their parents as well.

Cervical cancer is considered as a common female genital cancer. It is also recognized as the second most frequent cause of cancer-related death among women. It is estimated that in Iran cervical cancer ranks the 4th most frequent cancer in women. Therefore, with regard to the importance of Pap smear in preventing cervical cancer, together with the impact of women's knowledge and attitude towards Pap smear performance, we aimed to assess women's knowledge, performance and attitude towards Pap smear test in Sabzevar, Iran. This descriptive cross-sectional study was conducted on 385 women referred to health care centers and gynecological offices in Sabzevar, Iran. A questionnaire designed and validated by Abedian and Dormohamadi (2013) was used for data collection. Descriptive and analytic statistics were used for analysis. The mean scores of knowledge, attitude and performance were reported to be 2.1 ± 0.10, 66 ± 0.43, and 0.70 ± 0.06, respectively. Participants' age, education and their spouses' education were found as effective variables in their Pap smear knowledge, attitude and performance. The findings indicated that despite the fact that participants' knowledge and performance regarding cervical cancer were not desirable, their attitude was rather acceptable. Therefore, education and training of women in health centers by physicians together with engaging the health staff in improving women's knowledge, performance and attitude towards cervical cancer prevention and treatment are highly recommended.

Cervical cancer disproportionally affects women in low- and middle-income countries, in part due to the difficulty of implementing existing cervical cancer screening and diagnostic technologies in low-resource settings. Single-board computers offer a low-cost alternative to provide computational support for automated point-of-care technologies. Here we demonstrate two new devices for cervical cancer prevention that use a single-board computer: 1) a low-cost imaging system for real-time detection of cervical precancer and 2) a low-cost reader for real-time interpretation of lateral flow-based molecular tests to detect cervical cancer biomarkers. Using a Raspberry Pi computer to provide real-time image collection and processing, we developed: 1) a low-cost, portable high-resolution microendoscope system (PiHRME); and 2) a low-cost automatic lateral flow test reader (PiReader). The PiHRME acquired high-resolution (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$4.4~\mu \text{m}$ \end{document}) images of the cervix at half the cost of existing high-resolution microendoscope systems; image analysis algorithms based on convolutional neural networks were implemented to provide real-time image interpretation. The PiReader acquired and analyzed images of a point-of-care human papillomavirus (HPV) serology test with the same contrast and accuracy as a standard flatbed high-resolution scanner coupled to a laptop computer, for less than one-fifth of the cost. Raspberry Pi single-board computers provide a low-cost means to implement point-of-care tools with automatic image analysis. This work demonstrates the promise of single-board computers to develop and translate low-cost, point-of-care technologies for use in low-resource settings., Cervical cancer disproportionally affects women in low- and middle-income countries, in part due to the difficulty of implementing existing cervical cancer screening and diagnostic technologies in low-resource settings. Here we demonstrate two new devices for cervical cancer prevention that use a single-board computer: 1) a low-cost imaging system for real-time detection of cervical precancer and 2) a low-cost reader for real-time interpretation of lateral flow-based molecular tests to detect cervical cancer biomarkers.

Background: Recent data have shown that the human papillomavirus (HPV) vaccine could impact on a decrease in high-grade cervical intraepithelial lesions (HSIL) in women who have undergone surgical treatment. This study aimed to evaluate the efficacy of human papilloma virus (HPV) vaccination against persistent/recurrent disease in patients undergoing conization for high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia-grade 2-3 (HSIL/CIN 2-3). Methods: From January 2009 to March 2019, 563 patients with HSIL/CIN 2-3 underwent conization. The population was divided into two groups according to vaccination status: vaccinated-group (V-Group) and non-vaccinated-group (NV-Group). Bivalent or quadrivalent vaccines were administered indiscriminately. A follow-up was scheduled every 6–12 months according to clinical guidelines. The mean follow-up was 29.6 vs. 36.5 months in the V-group and NV-group, respectively. Results: 277 (49.2%) women were vaccinated, while 286 (50.8%) were not. Overall, persistent/recurrent HSIL/CIN 2-3 was presented by 12/277 (4.3%) women in the V-Group and 28/286 (9.8%) in the NV-Group (HR: 0.43, 95% Confidence interval 0.22–0.84, p = 0.014). Vaccination was associated with a 57% reduction in HSIL persistence/recurrence after treatment. When no disease was present in the first 6-month follow-up visit, persistence/recurrence rates were very low in both groups: 1.1% in the V-Group vs. 1.5% in the NV-Group (p > 0.05). The factor associated with a high-risk of HSIL persistence/recurrence was the presentation of a positive co-test in the first control after treatment (p < 0.001). Conclusions: Our results corroborate the benefit of HPV vaccination in woman treated for HSIL/CIN 2-3, showing a reduction of persistent/recurrent HSIL/CIN 2-3.

INTRODUCTION: Creating effective programs for cervical cancer prevention is essential to avoid premature deaths from cervical cancer. The Dominican Republic has persistently high rates of cervical cancer, despite the availability of Pap smear screening. This study explored Dominican provider attitudes towards human papillomavirus (HPV) testing and current challenges to effective cervical cancer prevention. METHODS: In this Consolidated Framework for Implementation Research (CFIR)-driven mixed methods study, we conducted in-depth interviews (N=21) and surveys (N=202) with Dominican providers in Santo Domingo and Monte Plata provinces regarding their perspectives on barriers to cervical cancer prevention and their knowledge and attitudes towards HPV testing as an alternative to Pap smear. RESULTS: Providers believed the main barrier to cervical cancer prevention was lack of cervical cancer awareness and resulting inadequate population screening coverage. Providers felt Pap smear was widely available to women in the Dominican Republic and were unsure how a change to HPV testing for screening would address gaps in current cervical cancer screening programs. A subset of providers felt HPV testing offered important advantages for early detection of cervical cancer and were in favor of more widespread use. Cost of the HPV test and target age for screening with HPV testing were the main barriers to acceptability. DISCUSSION: Providers had limited knowledge of HPV testing as a screening test. The group was divided in terms of the potential impact of a change in screening test in addressing barriers to cervical cancer prevention in the Dominican Republic. Findings may inform interventions to disseminate global evidence-based recommendations for cervical cancer screening.

Childbirth educators play an important role in educating pregnant women regarding their health. They bridge the gap between pregnant women and healthcare providers. A paucity of information exists on the benefits that pregnant women derive from interactions with childbirth educators regarding early cervical cancer detection. The purpose of our cross-sectional study was to investigate the association among education during early pregnancy offered by the childbirth educators, access to childbirth educators, availability of childbirth educators in the United States and survival from cervical cancer. Secondary data from the Surveillance, Epidemiology, and End Results (SEER) on 520,153 women were analyzed using logistic regression. Childbirth education delivered by childbirth educators during early pregnancy was associated with significantly fewer cervical cancer deaths (odds ratio = .917, CI = .896–.939, P = .000). Women with late-stage diagnosis had an increased likelihood of dying when diagnosed with cervical cancer (odds ratio = 1.043, CI = 1.042– 1.044, P = .000). Childbirth educators are effective at increasing awareness of cervical cancer among women in the early stages of pregnancy; this can improve survival and lead to positive social change.

Background Cervical cancer is considered as the third most leading cause of death among female worldwide with most of the deaths were found to occur in the developing countries. Several etiological agents were studied however Human papilloma virus (HPV) is identified as the most common etiological agent that involved in the induction of cervical cancer. The aim of our current study was to assess the Knowledge, attitudes, and practices toward cervical cancer prevention among women in Khartoum state, Sudan. Methods this is a descriptive cross-sectional community-based study. An electronic questionnaire was used for data collection. Descriptive statistics like frequency, mean and percentage were computed using SPSS version 20.0 software program. Results About 716 females in age between 18 and 74 years old with a mean age 27.58 years (STD 8.74 years) have enrolled in this study. 93.7 of them are educated at university level or higher. Although that 580 (81.0%) of our study participants have heard about cervical cancer only 29 (4.1%) were vaccinated against HPV as a preventive measure against the disease. Conclusion We highly recommended conducting health education sessions for both the Obstetrician and females in reproductive age regarding the benefit of the Pap test in the early detection of the cervical intraepithelial lesions and malignancy as well as HPV vaccination should be introduced in the local healthcare facilities

Low- and middle-income countries carry a high burden of preventable cervical cancer cases and deaths. Because human papillomavirus DNA-based testing is increasingly becoming the preferred method of screening for cervical cancer prevention, this commentary discusses next steps and key considerations for its expansion.

Objectives: The aims of this study to assess the practice of preventing cervical cancer of 15 - 49 years old and having gynecological examination women at Lam Dong General Hospital. Research method: A cross-sectional description. Interviewed practice about cervical cancer prevention of 400 women. Results: Over the course of the study, 400 women showed the number of women who had not been vaccinated is still high at 85.5%, the rate who had not been screened for cervical cancer is 62.3%. Based on the results of the study, we recommend that reproductive age women should be communicated more frequently about HPV vaccination and periodic cervical cancer screening to prevent cervical cancer.

Introduction/Background* The Cervical Cancer Prevention Policy Atlas is a comparative map that scores 46 countries across geographical Europe (not only the European Union) on prevention policies of cervical cancer. The Atlas compares the countries on: 1. Primary prevention of cervical cancer through HPV vaccination 2. Secondary prevention of cervical cancer through screening programs, and 3. Online information on HPV, cervical cancer and accessing vaccination It does not reflect the prevalence rate of cervical cancer in the countries or programmatic performance. The Atlas aims is to serve as a baseline to compare policies on HPV in Europe and concretely to: - Establish the need for HPV prevention by highlighting inequity of access. - Educate national stakeholders on the issue - Spark debate with key policy makers at the most appropriate levels (national, regional and international) Methodology We scored 46 European countries based on 3 headings, 9 criteria and 14 sub-criteria using the Analytic Hierarchy Process (AHP). AHP method is about setting a general, overall goal and further breaking it down the headings, criteria and sub-criteria, resembling the ’tree and the branches’. Each final ‘branch’, the smallest sub-criteria has its specific weight and based on the answer will receive a percentage score. Finally the scores for each sub-criteria are added up to the total score of each country. Result(s)* Belgium, Denmark, Ireland and the UK are the policy champions and lead the Atlas with excellent policies on primary secondary prevention and providing evidence based information to citizens. Romania, Bulgaria and Slovakia worst performing countries in the EU (no funding for vaccines, vaccine only available to girls, poorly organised screening programmes, absence of reliable online information). In terms of geographical Europe, Belarus and Azerbaijan score the worse, as there is literally no information about the HPV prevention to be found and policies on primary or secondary prevention are non-existent. Conclusion* The situation in Europe is very unequal. There is a clear divide between northern Europe, Southern Europe and Eastern Europe. While vaccine exists and screenings technologies are available – today the access is very dependent on where you live. This leads to high incidence and mortality which could be avoided should proper policies be put in place. Links ATLAS: EPF

Highlights • Provider recommendations significantly improve HPV vaccination rates. • The emphasis a provider gives with a recommendation is important. • Stressing the importance of same-day vaccination increases uptake., The goal was to evaluate how provider recommendations regarding Human Papillomavirus (HPV) vaccination impact uptake in a rural setting. The study used a cross-sectional, population-based design with cluster sampling to survey parents/guardians of children ages 9 to 18 in 2019 in Alabama. In addition to demographics/knowledge questions, participants were asked about type of healthcare provider recommendation and impressions they had from this interaction. The primary outcome variable was the result of the healthcare provider recommendation with options including: child got vaccinated day of recommendation, HPV vaccination was scheduled, or HPV vaccination was not scheduled. Bivariate analysis and multinomial logistic regression were performed. Of the 358 respondents, approximately 40% indicated receiving a recommendation from a provider to vaccinate their child. Age of the parent, race/ethnicity, educational attainment, and health insurance coverage were similar across groups. Female parents were more likely to report receiving HPV vaccination recommendation than males (44.1% vs. 23.3%; p = 0.009). The type of provider recommendation was not significantly associated with HPV vaccination uptake. The impression from the recommendation of HPV vaccination being “important” was significantly associated with the child being vaccinated that day (OR = 7.31, 95% CI = 2.20–24.3) as well as scheduling HPV vaccination (OR = 3.17, 95% CI 1.01–9.92). Parents who got the impression that “there was no hurry” were less likely to vaccinate their child that day (OR = 0.23, 95% CI = 0.09–0.59). Provider recommedation is well-established as a significant predictor of HPV vaccination, these findings indicate that how the recommendation is perceived may play a more important role in HPV vaccination uptake.

Background and Objectives: In Poland, the rates of morbidity and mortality due to cervical cancer are amongst the highest in Europe. A significant percentage of newly diagnosed cases of cervical cancer are at an advanced stage. Unfortunately, only about 20% of Polish women take part in cervical cancer screening. The aim of the study was to assess students’ knowledge of cervical cancer risk factors and prevention. Materials and Methods: The study was provided to Polish students from various universities and faculties between May 2020 and November 2020. The questionnaire was designed specifically for this study and was validated. The chi-square test was used to compare the responses between subgroups. Results: The study was carried out on a group of 995 students (80.6% women, 19% men, 0.4% no data), (average age 21.9 years). Most students knew that the main risk factor for cervical cancer is human papillomavirus (HPV) infection (82% of all responders, 86% of medical students, 73% of non-medical students, p &lt, 0.001). Only 40% of students knew that in Poland the Population Prevention and Early Diagnosis Program is carried out on women aged 25–59 years every three years. Most students correctly indicated that cervical cancer screening in Poland is performed using cervical cytology and were familiar with the basis of cytology. Only 57% of students knew that there are no specific early symptoms of cervical cancer. A total of 78% of all respondents knew that HPV vaccination reduces the risk of cervical cancer. Medical students and students who are sexually active demonstrated a better knowledge of cervical cancer. Conclusions: The Polish students had some knowledge of cervical cancer risk factors and primary and secondary prevention. Significantly better knowledge was demonstrated by medical students. Some efforts should be made to ensure that young people, who are not associated with medicine are better educated about cervical cancer in order to reduce the overall incidence and improve early detection rates.

Cervical cancer is caused by HPV (human papilloma virus). It is the second most common cancer in women living low developed countries. The components of cervical cancer prevention and control comprises primary prevention, secondary prevention and tertiary prevention. Primary prevention of cervical cancer encompasses prevention of infection with HPV. Giving HPV vaccine for girls aged 9–14 years before they initiate sexual activity is one of the interventions of primary prevention of cervical cancer. Screening and treatment is needed in secondary prevention of cervical cancer. Screening of cervical cancer encompasses testing a target group (women) who are at risk for a cervical pre-cancer. Tertiary prevention of cervical cancer comprises treatment of cervical cancer and palliative care. The components of tertiary care comprise surgery, radiotherapy, chemotherapy and palliative care. Community mobilization, health education and counseling on cervical cancer prevention and control is vital to make ownership on cervical prevention. Monitoring and evaluation of cervical cancer prevention and control on key program indicators should be done regularly.

Numerous national guidelines now include primary human papillomavirus (HPV) testing as a recommended screening option for cervical cancer in the United States yet little is known regarding screening intentions for this specific screening strategy or interventions that may increase uptake. Gain- and loss-framed messaging can positively impact health behaviors; however, there is mixed evidence on which is more effective for cervical cancer screening, with no published evidence examining HPV testing. To help address this gap, this study compared the effects of message framing on screening knowledge and intentions related to primary HPV testing. We randomized females aged 21–65 (n=365) to receive brief messaging about cervical cancer screening with either gain- or loss-framing. In January-February 2020, participants completed pretest and posttest measures evaluating cervical cancer knowledge, beliefs, and intentions to be screened using HPV testing. We used generalized estimating equations to model message and framing effects on screening outcomes, controlling for age, education, race, and baseline measures. In comparison to pretest, messaging significantly increased HPV-related screening intentions [aOR: 2.4 (1., 3.5)] and knowledge [aOR: 1.7 (1.2, 2.4)], perceived effectiveness of HPV testing [aOR: 4.3 (2.8, 6.5)], and preference for primary HPV screening [aOR: 3.2 (1.2, 8.5), regardless of message framing. For all outcomes, no significant interaction by message framing was observed. Brief public health messaging positively impacted HPV-related screening intentions, knowledge, and beliefs, independent of message framing. In conjunction with other strategies, these results suggest that messaging could be an effective tool to increase uptake of primary HPV testing.