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Background: In order for low and middle income countries (LMIC) to transition to Human Papilloma Virus (HPV) test based cervical cancer screening, a greater understanding of how to implement these evidence based interventions (EBI) among vulnerable populations is needed. This paper documents outcomes of an implementation research on HPV screening among women from tribal, rural, urban slum settings in India. Methods: A mixed-method, pragmatic, quasi-experimental trial design was used. HPV screening on self-collected cervical samples was offered to women aged 30–60 years. Implementation strategies were 1) Assessment of contextual factors using both qualitative and quantitative methods like key informant interviews (KII), focus group discussions (FGDs), pre-post population sample surveys, capacity assessment of participating departments 2) enhancing provider capacity through training workshops, access to HPV testing facility, colposcopy, thermal ablation/cryotherapy at the primary health care centers 3) community engagement, counselling for self-sampling and triage process by frontline health care workers (HCWs). Outcomes were assessed using the RE-AIM (Reach, Effectiveness, adoption, implementation, maintenance) framework. Results: Screening rate in 8 months' of study was 31.0%, 26.7%, 32.9%, prevalence of oncogenic HPV was 12.1%, 3.1%, 5.5%, compliance to triage was 53.6%, 45.5%, 84.6% in tribal, urban slum, rural sites respectively. Pre-cancer among triage compliant HPV positive women was 13.6% in tribal, 4% in rural and 0% among urban slum women. Unique challenges faced in the tribal setting led to programme adaptations like increasing honoraria of community health workers for late-evening work and recalling HPV positive women for colposcopy by nurses, thermal ablation by gynaecologist at the outreach camp site. Conclusions: Self-collection of samples combined with HCW led community engagement activities, flexible triage processes and strengthening of health system showed an acceptable screening rate and better compliance to triage, highlighting the importance of identifying the barriers and developing strategies suitable for the setting. Trial registration: CTRI/2021/09/036130. [ABSTRACT FROM AUTHOR]

Data mining and machine learning algorithms' performance is degraded by data of high-dimensional nature due to an issue called "curse of dimensionality". Feature selection is a hot research topic where a subset of features are selected to reduce the dimensionality and thereby increasing the accuracy of learning algorithms. Redundant and irrelevant features are eliminated. Cervical cancer is most commonly occurring disease and driving reasons for untimely mortality among ladies worldwide especially in emerging low income nations like India. However, literature shows that the early identification and exact conclusion of cervical malignant growth can increase the survival chances. The disease does not show signs of its presence in the early stages of its growth. Automated classification and diagnosis of cervical cancer using machine learning and deep learning techniques is in high demand as it allows timely, accurate and regular study of the patient's health progress. Meta-heuristics algorithms provide a global problem independent optimal solution and applied on feature selection problem since decades. In spite of having a good number of literature, there is no survey on feature selection techniques applied to cervical cancer dataset. This paper presents a brief survey on meta-heuristic, its variants, hybrid meta-heuristic and hyper-heuristic techniques. This survey summarizes the feature selection techniques applied to the cervical cancer data to identify the research gap thereby guiding the researchers in the future research direction. The summary of categorization of the techniques such as nature-inspired or non-nature inspired and trajectory or population based is also highlighted. The survey provides a comparative literature review involving classical feature selection techniques and feature selection using metaheuristic algorithms for cervical cancer classification application. [ABSTRACT FROM AUTHOR]

Good health and well being is one of the most essential targets of the Sustainable Development Goals (SDGs). This paper primarily focuses on Preventive and Diagnostic care of Women Health because even today, women are disadvantaged by discrimination in many societies especially in rural sectors. Two main health issues, fetal abnormality in pregnant women and cervical cancer in women are analyzed so that the doctors and patients can be given early signals to take proactive measures. As per National Health Portal of India, around 1.7 million birth defects occur in India every year. So Antenatal Care(ANC) should be given utmost importance during Pregnancy in a woman's life. Cervical cancer is another issue prevalent amongst women, especialy over the age of 30. It's critical to catch it early and eliminate any risks that come with it. Here arises the need to develop a system that can analyze and predict the aforementioned anomalies at an early stage. This work proposes approximate query processing using different dynamic machine learning algorithms to analyze and predict the abnormalities. Further, a web application is built to facilitate the stakeholders, especially doctors, to interact with the system and iteratively query the system to understand the relationships amongst the various data variables and get appropriate predictions about fetal anomaly from CTG scans as well as presence of cervical cancer from various demographic information, habits, and historic medical records. Approximate Query Processing is accomplished using Correlation analysis, linear, and logistic regression algorithms in a dynamic, interactive, and iterative manner. [ABSTRACT FROM AUTHOR]

Background: India has the highest number of estimated deaths from cervical cancer globally, with most cases attributed to Human papillomavirus (HPV). The World Health Organization recommends primary HPV vaccination for girls ages 9–14, with catch-up vaccination for young women ≥ 15 if feasible. India authorized a new, inexpensive HPV vaccine in 2022; given anticipated vaccine expansion, we conducted a mixed-methods study exploring acceptability of HPV catch-up vaccination for young emerging adult women in rural Mysore, India. Methods: Between September 2022-April 2023, participants were recruited with assistance from community health workers. In the qualitative phase, gender-stratified, audio-recorded focus group discussions (FGDs) were conducted in Kannada with emerging adults ages 18–26. FGDs were transcribed, translated, and analyzed using rapid approach to identify key HPV vaccination attributes. In the quantitative phase, a conjoint analysis was conducted to assess the impact of seven vaccination attributes on likelihood to vaccinate (LTV). Women ages 18–26 ranked LTV in eight hypothetical vaccination scenarios, and the relative impact of each attribute on LTV was calculated. All participants received education about cervical cancer, HPV, and HPV vaccination. Results: Fifty-two young adults (female = 31, male = 21) participated in seven FGDs, and 101 women participated in the conjoint analysis. Average age of the 153 participants was 22.5 years, 66.7% had married, and all had completed high school. Only 17.9% had heard of cervical cancer, and 2.7% knew of the HPV vaccine. FGDs identified seven HPV vaccination attributes: cost, vaccination location, family support, peer influence, dose number, side effects, and risk of acquiring HPV. In the conjoint analysis, all attributes except dose number significantly impacted LTV. Family support (impact score = 19.37, p < 0.0001) and peer influence (impact score = 18.01, p < 0.0001) had the greatest influence, followed by cost (impact score = 16.64, p < 0.0001) and HPV risk (impact score = 12.31, p < 0.0001). Vaccination location (government centers preferred) and side effects were also significant. Conclusion: Participants had poor knowledge of cervical cancer and HPV. Social attributes (family support, peer influence) had greatest impacts on LTV, and future studies should explore family-based interventions and peer education. Providing free vaccines at government centers through India's national immunization program would maximize catch-up HPV vaccination for rural young women. [ABSTRACT FROM AUTHOR]

Background: India accounts for a quarter of the world cervical cancer burden. Cervical cancer is highly preventable. However, low level of participating women in screening is one of the major issues. The aim of this work was to study the factors that influence women to participate in cervical cancer screening by providing menstrual pads for human papillomavirus (HPV) testing. Methods: Menstrual clothes were collected from two different populations from the rural areas of Maharashtra state for HPV testing to screen for cervical cancer. For this study, out of 945 participated women, 557 (58.9%) provided their menstrual pads. Multivariate logistic regression was applied to calculate the odds ratio (OR) and 95% confidence interval (95% CI). Results: The probability of providing the menstrual pads was high among the women who were highly educated compared to those with less education (OR: 1.4; 95% CI: 1.0–1.9), having mobile phone facilities as compared to those with no mobile phones (OR: 1.4; 95% CI: 1.0–2.0), who were using new cloths as menstrual pads compared to those who did not use the same (OR: 8.5; 95% CI: 5.0–14.3), who did not have tobacco habit as compared to those who had tobacco habit (OR: 1.4; 95% CI: 1.1–1.9) and in the village where health worker was stationed as compared to the village where health worker was not stationed (OR: 1.8; 95% CI: 1.4–2.5). Conclusion: Factors including health worker availability, using mobile phones for communication and high education level facilitate women’s participation. To improve the participation, there is need to apply special strategies for older age group, less educated women and women having tobacco habit. [ABSTRACT FROM AUTHOR]

Cervical cancer is on the declining trend in India according to the population-based registries; yet it continues to be a major public health problem for women in India. Multifactorial causation, potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. This paper attempts to review the available knowledge regarding the epidemiology and pattern of cervical cancer; types of HPV (human papilloma virus) prevalent among cervical cancer patients and among women in general, high-risk groups such as commercial sex workers, and HIV (human immunodeficiency virus)-positive women; and the role of the national program on cancer in control efforts. The peak age of incidence of cervical cancer is 55-59 years, and a considerable proportion of women report in the late stages of disease. Specific types of oncogenic HPV-16, 18 have been identified in patients with cervical cancer. Other epidemiological risk factors are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness. A multipronged approach is necessary which can target areas of high prevalence identified by registries with a combination of behavior change communication exercises and routine early screening with VIA. Sensitizing the people of the area, including menfolk, is necessary to increase uptake levels. Vaccination against types 16 and 18 can also be undertaken after taking into confidence all stakeholders, including the parents of adolescent girls. Preventing and treating cervical cancer and reducing the burden are possible by targeting resources to the areas with high prevalence. [ABSTRACT FROM AUTHOR]

In 2020, the WHO launched its first global strategy to accelerate the elimination of cervical cancer, outlining an ambitious set of targets for countries to achieve over the next decade. At the same time, new tools, technologies, and strategies are in the pipeline that may improve screening performance, expand the reach of prophylactic vaccines, and prevent the acquisition, persistence and progression of oncogenic HPV. Detailed mechanistic modelling can help identify the combinations of current and future strategies to combat cervical cancer. Open-source modelling tools are needed to shift the capacity for such evaluations in-country. Here, we introduce the Human papillomavirus simulator (HPVsim), a new open-source software package for creating flexible agent-based models parameterised with country-specific vital dynamics, structured sexual networks, and co-transmitting HPV genotypes. HPVsim includes a novel methodology for modelling cervical disease progression, designed to be readily adaptable to new forms of screening. The software itself is implemented in Python, has built-in tools for simulating commonly-used interventions, includes a comprehensive set of tests and documentation, and runs quickly (seconds to minutes) on a laptop. Performance is greatly enhanced by HPVsim's multi-scale modelling functionality. HPVsim is open source under the MIT License and available via both the Python Package Index (via pip install) and GitHub (hpvsim.org). Author summary: Mathematical models have been integral in setting ambitious goals for cervical cancer elimination, along with determining intermediate targets for vaccination, screening, and treatment. However, given that elimination strategies encompass decade-long timelines, these targets will inevitably need updating over time as the landscape of available technologies for combating cervical cancer evolves. In this work, we introduce a new model, HPVsim, which can rapidly evaluate pathways toward elimination under complex combinations of new and existing interventions. We demonstrate several of the model's key features, including a novel multiscale modelling feature for reducing variability, and outputs from fitting the model to data from India. HPVsim is a community-driven software project which continues to evolve as collaborators strengthen the software for ongoing work. We present some illustrative workflows for conducting an analysis with the HPVsim software, to highlight how the model can be adapted to specific user needs. [ABSTRACT FROM AUTHOR]

Objectives: We aim to describe the history of iodine testing of the cervix and identify areas where further work is required.Study Design: We conducted a search of PubMed and Google Scholar. Full article texts were reviewed. Reference lists were screened for additional articles and books. 37 basic articles in journals including ones written in German and three basic articles in books were identified.Results: Glycogen staining of the ectocervical squamous epithelium with iodine goes back to Paul Ehrlich (1854-1915). Walter Schiller (1887-1960) examined nearly 200 different dyes and found that vital staining of the cervical squamous epithelium was best achieved with Lugol's iodine solution, which was indicated by Jean Guillaume Lugol (1786-1851) for disinfection of the vagina. In 1928 W. Lahm observed that the glycogen content of a squamous epithelium cell decreases as anaplasia increases. From the outset, H. Hinselmann included the iodine test in the minimum requirements for colposcopy. In 1946 H. J. Wespi first mentioned the finding of an "uncharacteristic iodine negative area." The first international colposcopic terminology from Graz in 1975 lists the "iodine light area" among the different colposcopy findings. The IFCPC nomenclatures from Rome 1990, Barcelona 2002, and Rio de Janeiro 2011 have evaluated the iodine test and classified their findings differently. A breakthrough to effective cervical cancer screening in resource-limited settings in Africa, India, and Latin America was achieved with R. Sankaranarayanan's publication on naked-eye visual inspection of the cervix after application of Lugol's iodine.Conclusions: This paper is a step toward a better understanding of what we think and do today with iodine testing and what problems and upcoming tasks will arise in future. [ABSTRACT FROM AUTHOR]

Background: The cancer registry provides reliable data from the population. In this article, we provide cancer burden and its patterns from the Varanasi district. Methods: The method adopted by the Varanasi cancer registry is community interaction along with regular visits to more than 60 sources to collect data on cancer patients. The cancer registry was established by the Tata Memorial Centre, Mumbai, in 2017 covering 4 million population (57% rural and 43% urban population). Results: The registry has recorded 1,907 incidence cases (1,058 male and 849 female). The age-adjusted incidence rate per 100,000 population in male and female of Varanasi district is 59.2 and 52.1, respectively. One in 15 male and one in 17 female are at risk of developing the disease. Mouth and tongue cancers are the predominant cancers in male, whereas breast, cervix uteri, and gallbladder are the leading cancer sites among the female. In female, cervix uteri cancer is significantly higher (double) in rural areas when compared with urban areas(rate ratio [RR] 0.5, 95% confidence interval [CI; 0.36, 0.72]), whereas in male, mouth cancer is higher in urban areas when compared with rural areas (RR 1.4, 95% CI [1.11, 1.72]). More than 50% of cancer cases in male are due to tobacco consumption. There may be underreporting of the cases. Conclusion: The results of the registry warrant policies and activities related to early detection services for the mouth, cervix uteri, and breast cancers. The Varanasi cancer registry is the foundation for cancer control and will play an important role in the evaluation of the interventions. [ABSTRACT FROM AUTHOR]

Background: In July 2022, self‐collection became universally available as part of Australia's National Cervical Screening Program. This change aims to address screening inequities experienced among underscreened populations, including women of Indian descent. This study explored experiences of cervical screening, alongside the acceptability of self‐collection, among women of Indian descent living in Victoria, Australia. We also aimed to articulate the informational needs to promote self‐collection among this population. Methods: Five focus group discussions with 39 women living in Victoria were conducted in English (n = 3) and Punjabi (n = 2). Transcripts were thematically analysed, as informed by the Theoretical Framework of Acceptability. Results: Women were motivated by the choice to self‐collect, perceiving the ability to maintain modesty and greater autonomy as key enablers. Healthcare practitioners were seen as central in supporting patient‐centred models of care. Perceived barriers to self‐collection included concerns around its accuracy and women's confidence in collecting their own sample. Widespread dissemination of culturally tailored promotion strategies communicating concepts such as 'privacy' and 'accuracy' were suggested by women to promote self‐collection. Conclusion: Self‐collection was highly acceptable among women of Indian descent, particularly when assured of its accuracy, and sociocultural norms and previous screening experiences are considered. This study highlights the huge potential that self‐collection can play in increasing equity in Australia's cervical screening programme. Patient or Public Contribution: Members of the public were involved in focus group discussions. Findings were summarised and disseminated via a poster. A bicultural worker was involved in all stages of the research. [ABSTRACT FROM AUTHOR]

Worldwide, cervical cancer is considered to be the second commonest cancer as far as mortality and incidence is concerned and India contributes to about 20-30% of the global burden. This paper is based on analysis of records of persons suffering from various cancers over 25 years. Cervical cancer constituted 14.4% of all cancers of men and women put together, 28.8% of the cancers in women and 73.3% of all gynaecological cancer. The cases studied were divided into five Blocks: Block A 1983-1987; Block B 1988-1992; Block C 1993-1997; Block D 1998-2002 and Block E 2003-2007. A 2.34 times increase in cancer cases from Block A to Block E was seen; in women, overall cancer increased by 3.21 times; gynaecological cancer by 3.08 times; cervical cancer 2.91 and ovarian cancer 7.1 times. Cervical cancer in outpatients increased from 0.55% among all gynaecological cases in 1983, to 3.5% in 2007. Cervical cancer comprised of 1.05% of the newly registered outpatients and 70.09% of gynaecological cancer cases. Inpatient gynaecological cancer increased from 2.81% in 1983 to 9.81% in 2007. Out of all cervical cancer in women, cervical cancer was 34.7% in Block A (1983-1987) and 28.6 % in Block E (2003-2007). Of the cervical cancer cases, 43.8% belonged to the age group 30-49 years and 37.6% at 50-64 years. Cervical cancer in women with less than three births increased from 13.1% in Block A to 33.1% in Block E. The proportion of illiterate women or those with primary education was seven times more compared with those with secondary education. Our study revealed that cervical cancer still continues to rank first. Also the overall number of cancer cases has been increasing. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the second leading cause of deaths due to cancer among women in India. This study assesses the prevalence of cervical cancer screening among women in the 30 to 49 years age-group and its relation to demographic, social and economic factors. The equity in the prevalence of screening is studied with respect to the women's household wealth. Methods: Data from the fifth National Family Health Survey are analyzed. The adjusted odds ratio is used to assess the prevalence of screening. The Concentration Index (CIX) and the Slope Index of Inequality (SII) are analyzed to assess the inequality. Results: The average national prevalence of cervical cancer screening is found to be 1.97% (95% C.I, 1.8–2.1), ranging from 0.2% in West Bengal and Assam to 10.1% in Tamil Nadu. Screening is significantly more prevalent among the following demographics: educated, higher age group, Christian, scheduled caste, Government health insurance coverage, and high household wealth. Significantly lower prevalence is found among Muslim women, women from scheduled tribes, general category castes, non-Government health insurance coverage, high parity, and those who use oral contraceptive pills and tobacco. Marital status, place of residence, age at first sexual activity, and IUD usage are not significant influencers. At the national level, CIX (0.22 (95% C.I, 0.20–0.24)) and SII (0.018 (95% C.I, 0.015–0.020)) indicate significantly higher prevalence of screening among women from the wealthier quintiles. Significantly higher screening prevalence among wealthier quintiles in the North-East (0.1), West (0.21) and Southern (0.05) regions and among the poor quintiles in the Central (-0.05) region. Equiplot analysis shows a "top inequality pattern" in the North, North-East and Eastern regions, with overall low performance where the rich alone manage to avail screening. The Southern region exhibits an overall progress in screening prevalence with the exception of the poorest quintile, which is left behind. Pro-poor inequality exists in the Central region, with significantly higher prevalence of screening among poor. Conclusion: The prevalence of cervical cancer screening is very low (2%) in India. Cervical cancer screening is substantially higher among women with education and Government Health insurance coverage. Wealth-based inequality exists in the prevalence of cervical cancer screening and the prevalence is concentrated among the women from wealthier quintiles. [ABSTRACT FROM AUTHOR]

Background: The HPV vaccine is used as one of the main prevention tools for HPV-related cancers globally, yet it is not part of the Indian National Immunization program. In light of the introduction of the indigenous vaccine, we examine the effectiveness of health education about uptake, acceptance, and awareness. Methods: Research was performed in the following databases: PubMed, CINAHL, Scopus, and Embase to identify studies between 2008 and 2022. Studies were included if: they were conducted in India including primary data research and health education intervention, and participants were between 9 and 29 years old. Results: Out of the 10.952 results, 7 studies were included. Four studies focused on adolescent girls, aged from 9 to 20 years old, and 3 on university students aged from 17 to 26 years. Five studies were implemented in urban areas and 2 in rural areas. Health education interventions proved to be effective in increasing uptake, awareness, and acceptance of the HPV vaccine. The barriers included among others: cost, lack of awareness, and cultural barriers. Conclusion: Observations from this study outline immediate action for policymakers to educate and encourage the young population toward HPV vaccination. Future programs should be aimed at different population groups and be adjusted according to their special characteristics and needs. Attention should be given to the male population and marginalized groups. The involvement of various stakeholders proved to be beneficial, and it is highly recommended. [ABSTRACT FROM AUTHOR]

Background: While cervical cancer deaths have declined steeply in high-income countries due to the widespread use of the Papanicolaou test (Pap test), the same trend has not emerged in low or middle-income countries (LMICs). Access to screening in LMICs like India is limited due to barriers such as limited healthcare infrastructures, lack of sexual health education, and stigma demarcating sexually transmitted infections (STIs). HPV self-sampling (HPV-SS), a woman–centered and at-home method for screening, can be utilized as a unique screening tool to overcome some of these barriers. Our study examined the effectiveness of HPV-SS, supported by family-centred arts-based sexual health literacy on the uptake of cervical cancer screening among hard-to-reach women in rural and remote areas in India. Methods: Our community-based mixed methods pilot study recruited 240 participants (120 women and 120 male partners or family members) through female Accredited Social Health Activists (ASHA) across 3 Indian villages of Shirgoan, Khodala, and Jamsar in Palghar district. Inclusion criteria included women ages 30–69 who were under or never screened (UNS) and their male partners/family members aged 18 or over. Knowledge and attitudes about cervical cancer and screening and their perceived stigma surrounding STI were assessed using validated scales prior to and after attending a 2-hour arts-based sexual health education (SHE). In addition, participants' uptake of cervical cancer screening was assessed after attendance in SHE. Findings: Results revealed significant improvement in knowledge and attitudes about cervical cancer and screening, and a reduction in the STI stigma after participation in SHE sessions (overall mean difference in Knowledge: z = 6.1 ± 2.4, P < 0.001; attitudes about Pap-test and VIA: z = 2.2 ± 8.4, P < 0.001 and z = 2.9 ± 8.2, P < 0.001; STI stigma: z = 2.8 ± 12.4, P < 0.001). 118 out of 120 female participants chose to be screened and 115 opted for HPV-SS. Conclusions: The implementation of HPV-SS coupled with family-centered arts-based and culturally appropriate SHE is highly promising in promoting cervical cancer screening among hard-to-reach women. Evidence from our study can be used to advance public health policies and inform the scale-up of similar initiatives in other villages and states across rural India and other LMICs. [ABSTRACT FROM AUTHOR]

Cervical cancer is one of the leading causes of women's mortality in developing countries. The prevalence of cervical cancer is higher in developing countries like India and continents like Africa. Hyper-methylation of tumor suppressor genes through human papillomavirus (HPV) infection is known to be one of the major causes of cervical cancer. The promoter hypermethylation of the cell adhesion molecule 1 (CADM1) and suppressor of cytokine signalling (SOCS1) genes due to DNMT1 overexpression leads to their epigenetic silencing followed by gene repression causing cervical cancer. In silico study on the inhibition effect of capsaicin on DNMT1 was simulated by different servers. The binding energy was observed to be −7.8 kcal/mol. In vitro studies on the effect of capsaicin on aberrant methylation of CADM1 and SOCS1 were performed on the adenocarcinoma cervical cancer cell line, HeLa. The IC50 of capsaicin was observed to be 160 μM through crystal violet assay. DNA methylation of the CADM1 and SOCS1 was analyzed by methylation-specific PCR along with their reversal using capsaicin (20 μM) by treating the cells for 72 h and 6 days. In silico results suggested that capsaicin has an inhibitory effect on DNMT1, which regulates DNA methylation leading to the hypermethylation of CADM1 and SOCS1 genes. The in vitro studies suggested that hypermethylation leads to the inhibition of CADM1 and SOCS1 expression, which could be reversed using capsaicin with visible changes in methylation-specific and unmethylation-specific bands in MS-PCR, respectively. The present study shows the reversal of methylation of CADM1 and SOCS1 after 72 h which showed a further increase in case of 6 days of treatment using 20 μM capsaicin, which makes capsaicin a potent candidate for causing demethylation of CADM1 and SOCS1 genes that may lead to the reactivation of the downregulated gene. [ABSTRACT FROM AUTHOR]

We are reporting (a) updated incidence of cervical intraepithelial neoplasia (CIN) among women who did not have colposcopic or histopathological disease at baseline and (b) disease outcomes among women treated for CIN and their follow‐up HPV status; in a cohort of women living with HIV (WHIV). The median overall follow‐up was 3.5 years (IQR 2.8‐4.3). The incidence of any CIN and that of CIN 2 or worse disease was 16.7 and 7.0 per 1000 person‐years of observation (PYO), respectively. Compared with women who were HPV negative at baseline, women who cleared HPV infection had 23.95 times increased risk of incident CIN 2 or worse lesions (95% CI 2.40‐661.07). Women with persistent HPV infection had 138.18 times increased risk of CIN 2 or worse lesions (95% CI 20.30‐3300.22). Complete disease regression was observed in 65.6% of the HPV positive women with high‐grade CIN and were treated with thermal ablation but HPV persistence was seen in 44.8% of those with high‐grade disease. Among those who did not have any disease at baseline and were also HPV negative, about 87% (95% CI 83.79‐89.48) women remained HPV negative during consecutive HPV test/s with the median interval of 3.5 years. Long‐term surveillance of WHIV treated for any CIN is necessary for the prevention of cervical cancer among them. Our study provides an early indication that the currently recommended screening interval of 3 to 5 years among WHIV may be extended to at least 5 years among HPV negative women. Increasing the screening interval can be cost saving and improve scalability among WHIV to support WHO's cervical cancer elimination initiative. [ABSTRACT FROM AUTHOR]

Cervical cancer ranks as the second most cause of female cancer deaths in India and is the second leading cause of cancer deaths in women aged 15 to 44 years in India. About 87% cervical cancer deaths occur in less developed regions. The estimation of new cancer cases, by major states of India, reveals that burden is very high, in those states which are highly populous. Nearly 41.3% of cancers seen in Indian females are accounted by cancer of cervix. Cervical cancer is a huge trouble in most agricultural nations, where it is a significant reason for mortality and morbidity among females. Several factors are attributed to the widespread incidence of cancer, the precise etiology of which remains unclear. Awareness of cancer should be encouraged in its prevention, detection, and treatment. Indian women face a 2.5% cumulative life me risk and 1.4% cumulative death risk from cervical cancer, at any given time. Nearly 6.6% of women in the general popular on are estimated to harbor cervical HPV infection. Early detection and treatment via screening can prevent up to 80% of cervical cancers in developed countries, where efficient screening programs are in place. This article review the current status of cervical cancer in India and the key barriers affecting women's participation in the cervical screening programme. India has pressing need to foster cervical cancer screening project and local area level endeavors to further develop information about cervical disease and screening programs. This work would assist with saving a huge number of young females and their families from an incredible disaster. [ABSTRACT FROM AUTHOR]

Background: Low participation in screening and poor follow-up are major challenges in implementing population based screening in developing countries. Determinants of participation in a community-based organized cervical cancer screening program are discussed here. Objectives: The objectives were to study factors determining compliance of women for cervical cancer screening in an urban low socioeconomic setting. Methodology: Community-based service program was conducted for screening uterine cervix cancers with a visual inspection of the cervix on the application of 5% acetic acid by trained primary health workers. The process involved the selection of clusters, household surveys, health education, and screening of eligible women for uterine cervix cancer. Logistic regression analysis was conducted to identify determinants of participation in cervical cancer screening. Results: A total of 138,383 population were surveyed, of which 21,422 eligible women were contacted and 16,424 (82.50%) complied for screening. According to the results of univariate and multivariate analysis, women belonging to the age group of 30–39 (80.69%), literate women with school level or education up to Senior College (78.97% and 80.86%) (odds ratio [OR], 1.323; P ≤ 0.001) and (OR, 1.402; P ≤ 0.001), belonging to Hindu religion (77.20%), speaking Marathi (77.07%), and with a family history of cancer (81.93%) had higher participation for screening, while women belonging to the Muslim community (73.95%) (OR, 0.743; P ≤ 0.001), speaking other than Marathi and Hindi language (73%) (OR, 0.872; P = 0.017), illiterate women (70.71%), and graduate women (70.78%) had lower participation. Conclusion: High compliance can be achieved by providing good-quality health education and setting up of screening clinics in vicinity of participating women. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention.Methods: A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models.Results: CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers.Conclusion: Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women's screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening. [ABSTRACT FROM AUTHOR]

Context: India has the highest number of cervical cancer cases in the world and also the second most leading cause of cancer among females. Early diagnosis along with appropriate treatment at an earlier stage is needed to combat the high burden of cervical cancer in our setting. Aim: The aim of the study is to study the awareness and practices about cervical cancer among women of self-help groups (SHGs) in rural Puducherry. Subjects and Methods: Community-based cross-sectional study was conducted among women in SHGs in the four villages under field practice area of Rural Health Training Center, Department of Community Medicine of our teaching hospital. Details on sociodemographic characteristics, awareness regarding cervical cancer, and source of information regarding cervical cancer were collected using a pretested questionnaire. Chi-square test was used to assess the significance of study findings. P < 0.05 was considered to be statistically significant. Results: Majority (57.6%) of the SHG women were homemakers and about one-third (31.2%) of them were involved in farming and daily wage labor activities. Around 37.6% have awareness on cervical cancer and almost all (99.2%) of SHG women have never undergone PAP smear examination nor heard about PAP smear/HPV vaccine. The study revealed that women's education and socioeconomic status were associated with the knowledge of the cervical cancer and the difference was statistically significant. Conclusion: The present study found that awareness about cervical cancer among the respondents was very less. It is found to be associated with maternal education, occupation, and socioeconomic status of the women. [ABSTRACT FROM AUTHOR]

Introduction:Cervical carcinoma is the second most common malignancy in women worldwide. It is estimated that over a million women worldwide currently have cervical cancer. Worldwide, cervical cancer is both the fourth-most common cancer and the fourth-most common cause of death from cancer in women. In 2012, 528, 000 new cases of cervical cancer were diagnosed, and 266, 000 women died of the disease (GLOBOCAN 2012), nearly 90% of them in lowto middle-income class countries. Multifactorial causation, potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper by studying the hypoxic marker. Recently, there has been increasing interest in the identification of biomarkers able to predict both response to treatment and survival. Aim: The aim of this study was to evaluate the association of hypoxic marker Carbonic anhydrase (CAIX) markers to predict the clinical outcome of patients with cervical carcinoma. Materials and methods:This study was conducted on biopsy proven previously untreated cases of cancer cervix who presented to the Department of Radiotherapy at King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India. The study was a single institution, non-randomised, prospective study to evaluate carbonic anhydrase IX as a biomarker in cancer cervix patients undergoing radiotherapy. Sample size: Total 75 samples • 25 healthy control subjects (Age and sex matched) • 25 cancer cervix patients (duplicate samples i.e. baseline and follow up). Approximately 2 ml of blood was withdrawn before initiation of treatment and at the time of first follow up. Standard treatment was given as external beam radiotherapy (EBRT) with concurrent chemotherapy followed by intracavitary radiotherapy (ICRT). Blood samples was analysed for the level of CAIX..Statistical analyses was performed with the SPSS software package v13.0. Results: Pre-treatment high level of carbonic anhydrase IX correlated with poor treatment outcome. [ABSTRACT FROM AUTHOR]

Introduction: Cervix cancer is most prevalent cancer in females. Early detection and regular screening methods are helpful for the prevention of cervix cancer related morbidity and mortality. Early stages of development, dermatoglyphic features are generated under genetic influences, but they can be influenced by environmental variables during the first three months of pregnancy. These trends may reflect an individual's genetic make-up and, as a result, his or her proclivity for particular diseases. Therefore, the dermatoglyphic prints may serves as a non invasive anatomic marker of cervix cancer risk, allowing for early detection and treatment. Aim: To characterise dermatoglyphics in cervix cancer patient and correlate them to principal clinical features. Materials and Methods: This cross-sectional study included 300 cervix cancer patients, analysed the clinical presentations and dermatoglyphics prospectively after obtaining ethics approval from a tertiary care hospital, Kanpur, Uttar Pradesh, India, during December 2016-January 2020. The palmar dermatoglyphics (loops, arches, whorls and palmar angle) were obtained and evaluated for correlation with principal clinical features like vaginal discharge, postmenopausal bleeding, and intermenstrual bleeding using Spearman's correlation test. Results: In this study, the frequencies of arches, loops and whorls were 81, 2051, 868 respectively. A strong positive correlation (r>0.92) existed between whorls of palmar digits and clinical features of cervix cancer. Conclusion: Dermatoglyphic patterns could be used to investigate the genetic cause of cervix cancer and could potentially be used as a non invasive anatomical screening method in high-risk patients. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the fourth most common cancer that occurs to women worldwide. This study aims to assess trends in incidence and mortality of cervical cancer in India and its states over past three decades for tracking the progress of strategies for the prevention and control of cervical cancer.Methods: Data on cervical cancer incidence and mortality from 1990 to 2019 for India and its states were extracted from Global Burden of Disease study and were utilized for the analysis. Spatial and rank map has been used to see the changes in incidence and mortality of cervical cancer in different Indian states. Further, joinpoint regression analysis is applied to determine the magnitude of the time trends in the age standardized incidence and mortality rates of cervical cancer. We obtained the average annual percent change (AAPC) and corresponding 95% confidence intervals (CI) for each state.Results: Overall, from 1990 to 2019 Jharkhand (Incidence: -50.22%; Mortality: -56.16%) recorded the highest percentage decrement in cervical cancer incidence and mortality followed by the Himachal Pradesh (Incidence: -48.34%; Mortality: -53.37%). Tamilnadu (1st rank), Jammu & Kashmir and Ladakh (32nd rank) maintained the same rank over the period of three decade for age standardized cervical cancer incidence and mortality. The regression model showed a significant declining trend in India between 1990 and 2019 for age standardized incidence rate (AAPC: -0.82; 95%CI: -1.39 to -0.25; p < 0.05) with highest decline in the period 1998-2005 (AAPC: -3.22; 95%CI: -3.83 to -2.59; p < 0.05). Similarly, a significant declining trend was observed in the age standardized mortality rate of India between 1990 and 2019(AAPC: -1.35; 95%CI: -1.96 to -0.75; p < 0.05) with highest decline in the period 1998-2005 (AAPC: -3.52; 95%CI: -4.17 to -2.86; p < 0.05).Conclusion: Though the incidence and mortality of cervical cancer declined over past three decades but it is still a major public health problem in India. Information, education and communication activities for girls, boys, parents and community for the prevention and control of cervical cancer should be provided throughout the country. [ABSTRACT FROM AUTHOR]

Objectives: The study aims to investigate the efficacy of screening by low-cost technology in down-staging and reduction of mortality due to breast and cervix cancer. Methods: The present trial is a community-based, cluster randomised controlled cohort study on screening for breast and cervix cancers (clinical breast examination and visual inspection of the cervix after application of 4% acetic acid). Univariate and multivariate logistic regression analyses are conducted to identify the predictors of compliance to referral among screen-positive women and to treatment among cancer cases. Results: The compliance to diagnostic investigations is 73% among screen-positive women referred for breast cancer and 79% among women referred for cervix cancer. Younger women, women working in service or being self-employed, school level-educated women, mother tongue Marathi, participation in screening in all 3 rounds and women referred as screen positive for cervix cancer had higher compliance to diagnostic investigations. The compliance to treatment completion is higher in women diagnosed with breast cancer, at 95%, compared to 86% for cervix cancers and 81% for cervix pre-cancers. Conclusions: Good compliance rates along with a proper system of referral, further investigations, confirmation of diagnosis and treatment as demonstrated in this trial are crucial for successful screening programmes. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aims: To assess the knowledge, attitude and practices regarding HPV vaccination among medical and para medical students in North India. Results: A total of 391 respondents were enrolled in the study with mean age of 24.39±4.27 years. The overall knowledge level of respondents in the study was satisfactory around 69%. Majority of respondents favours need for more awareness programmes regarding HPV vaccination, implementation of education on HPV infection at schools and colleges, inclusion of HPV vaccination in National Immunisation Schedule and provision to provide vaccination at schools and colleges. In regard to practice, 78.5% respondents either underwent or were willing to undergo vaccination. Reason for non-vaccination were mainly fear of side effect (23.2%), cost (18.8%), doubts about efficacy (10.4%) and others. Methods: This study is Cross sectional study conducted among 391 medical and nursing students after obtaining ethical approval from the Institute's Ethics committee. Data was analyzed using Statistical Package for Social Sciences 21.0. Independent samples t-test and ANOVA were used to compare the data. Correlation between knowledge, attitude and practice scores was assessed using Pearson correlation coefficient. Conclusions: The study concludes, not only the students but a health care professional lacks appropriate knowledge regarding HPV and cervical cancer. [ABSTRACT FROM AUTHOR]

It is planned to be provided at a much lower cost of INR 200-400.[[14]] The vaccination program will be gender neutral and includes boys as it is an important step to reduce the transmission of HPV and protect men from other HPV consequences. One of the targets is full vaccination of 90% of girls with human papillomavirus (HPV) vaccine by the age of 15 years by the year 2030. Human papillomavirus (HPV) vaccine introduction in Sikkim State: Best practices from the first Statewide multiple-age cohort HPV vaccine introduction in India-2018-2019. [Extracted from the article]

Introduction and background: Cervical cancer is one of the leading responsible condition for causing high death rate among women after breast cancer. It is preventable and curable disorder, but the prevalence of cervical cancer remaining too high in India. Majority of women do not aware of cervical screening procedures. Maharashtra is standing in second position in possessing more number of cervical cancer cases. Methodology: A quasi-experimental pretest and post research design was used to execute the study. This study was conducted in selected hospitals of PCMC. The samples were the women age group between 30-60 years attending Gynec OPD. The systemic random sampling techniques was used to select the samples. Total sample size was 501. A self-administered tool was administered to find the reasons for participation and nonparticipation in cervical screening. Tool and content validity was done. The reliability of the tool was done r value is = 0.88. The study proposal has been approved by the Ethical Committee, MGM Institute of Health Sciences, Kamothe, Navi Mumbai. Permission has been taken from the concerned authority of the selected urban health care centers for data collection. The content was prepared on prevention and early detection of cervical screening in the form of video and modules in their regional languages. Results: Majority of participants among three experimental groups, about 38.32 % in verbal group, 41.91% in written group and 40.71 % in video group have responded that they could not take part in the cervical screening programme as they are very embarrassed with cervical screening procedure. While others had responded that, I am healthy I do not have to go for this test, some women said, I have only one sexual partner so I don't require this test. A few women have assumed that the test is very expensive, thinking that not required the Pap test as no symptoms of cancer observed and other have stated that don't know the frequency of test. Conclusion: A key strategy to improve the attendance of the women for cervical screening is to spread the awareness on prevention and early detection of cervical cancer by using various educational methods. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) vaccination offers an excellent prospect for the primary prevention of cervical cancer. The bivalent and quadrivalent vaccines are both available in India. The nonavalent vaccine is licensed but not yet available. However, there still remain controversies regarding the vaccination of older women, immunocompromised females and other special groups. To provide recommendations for HPV vaccination in India. The Federation of Obstetric and Gynecological Societies of India (FOGSI) convened an expert group on cervical cancer prevention to formulate good clinical practice recommendations (GCPR) with respect to vaccine efficacy and safety, target groups, optimal timing and dosing schedules. HPV vaccines are licensed for females aged 9–45 years in India and have been seen to be safe and effective. FOGSI recommends HPV vaccination of all girls <15 years of age as the best target group, in whom two‐doses at an interval of 6 months, extendable to 18 months, are recommended. Three‐doses are recommended in girls >15 years of age, immunocompromised persons and sexual assault survivors. Older women and women with abnormal screening results may be vaccinated with an understanding that vaccination does not protect against already acquired infections and screening has to continue. Single‐dose vaccination results are promising. Increased awareness is required to reduce vaccine hesitancy. HPV vaccination should be the priority to achieve the elimination of cervical cancer. The introduction of affordable HPV vaccines and reduced dose schedules will improve coverage. [ABSTRACT FROM AUTHOR]

The establishment of link between high-risk human papillomavirus (HPV) infection and occurrence of cervical cancer has resulted in development of various HPV related control strategies for the prevention of cervical cancer. The objective of the present study was to assess the cost effectiveness of various screening strategies for cervical cancer and human papilloma virus (HPV) vaccination in India. A Markov model based on societal perspective was designed to estimate the lifetime costs and consequences of screening (with either visual inspect with acetic acid (VIA), Papanicolaou test or HPV DNA test at various time intervals) in a hypothetical cohort of 30–65 years age women or vaccination among adolescent girls. Diagnostic accuracy of the screening strategies, efficacy of HPV vaccination and data on transition probabilities was based on the results of the existing meta-analyses. Primary data was collected for assessing per person cost of screening, cost of treating cervical cancer and quality of life. We found that introduction of different screening strategies leads to reduction in lifetime occurrence of cervical cancer cases caused by HPV 16/18 from 20% to 61%, and cervical cancer deaths from 28% to 70%, as compared to no screening. Among various screening strategies, screening with both VIA 5 yearly and VIA 10 yearly came out to be cost effective at 1-time per capita GDP, with VIA every 5 years providing greater health benefits as compared to VIA 10 years. Hence, screening with VIA 5 years at an incremental cost of US$ 829 (INR 54,881) per QALY gained is the recommended strategy for India. Further, with regards to HPV vaccination, it leads to 60% reduction in cancer cases and mortality caused by HPV 16/18 as compared to no vaccination. Moreover, when this vaccinated cohort of adolescent girls is also screened later in their life (with VIA every 10 years and VIA 5 years), it leads to 69%-76% reduction in cancer cases and 71%-81% reduction in cancer deaths. As compared to no vaccination and no screening, both HPV vaccination alone and vaccination plus screening (with VIA every 5 yearly and VIA 10 yearly) appears to be cost effective with ICERs in the range of US$ 86 (INR 5,693) to US$ 476 (INR 31,511) per QALY gained. In the long run, when the cohort of adolescent girls, who were immunized for HPV, reach the age of 30 years, the screening frequency using VIA should be determined based on the coverage of HPV vaccination in that cohort. [ABSTRACT FROM AUTHOR]

In India, cervical cancer screening is conducted at various levels; however, after screening, the adherence to the cancer care continuum is barely understood. This study evaluated a community-based cancer screening program conducted in a rural setting (Tirunelveli and Tuticorin districts) in South India and reviewed the completion of care continuum. In this longitudinal descriptive study involving secondary data collection, data from the case records of 2192 women who were consecutively screened between March 2015 and May 2016 were included. All women underwent conventional cytology-based screening (Pap smear) and Visual Inspection with Acetic Acid (VIA). Those for whom either test was positive were referred for histopathological confirmation. Patients with confirmed precancerous conditions and unsatisfactory Pap smears were referred for further management. In total, 2192 women were screened [age range, 17–69 years; mean (standard deviation), 39.2 (8.5)]. Common symptom and sign were white discharge per vaginum (34.9%) and cervical erosion (34.4%), respectively. The VIA was positive for 24% (523/2178; 14 women did not cooperate for VIA) and 113 (5.1%) had epithelial cell abnormality in the Pap smear test. Per histopathology findings, one woman had non-keratinizing squamous cell carcinoma. Seven, three, and four had cervical intraepithelial neoplasia I, II and III, respectively. Of 2192, 807 were eligible for referral (597 had positive results on either Pap or VIA). Among the 807 women referred, only 74 (9.2%) women visited the referral center. The follow-up rate was very poor accounting to fragmentation of care continuum. The success of the screening program depends on the completion of the care continuum. [ABSTRACT FROM AUTHOR]

Purpose: Cervical cancer is the most common gynecological cancer in India. Uniform protocol-based treatment is important for achieving optimal outcomes. We undertook a survey to investigate patterns of care with special regard to patterns of care in cervical cancer brachytherapy in India. Material and methods: A 17-question online survey was sent to radiation oncologists across India. Respondents were required to have a minimum of 1-year experience. One response per center was accepted and deemed as representative. Results: Out of 116 centers, 59 responses were generated. Two-thirds (66.1%) were from academic centers and the majority (96.6%) used high-dose-rate (HDR) brachytherapy. The centers treated an average of 255 patients per year (median 161 patients, IQR 76-355). The majority were locally advanced cancers (FIGO 2009 stage II-IV 87.5%). External beam radiotherapy (EBRT) schedules were fairly consistent, administering doses of 45-50 Gy over 5 weeks. Brachytherapy was performed towards EBRT completion by 37/59 (62%) and 43/59 (74.3%) centers used a schedule of 7 Gy × 4 fractions (HDR). Brachytherapy was commonly performed under anesthesia (spinal/general: 44% each) with ultrasound (USG) guidance (29%). Computed tomography (CT) imaging (65%) and orthogonal X-rays (35%) represented the most common imaging for planning, while point A prescription (66%) or GEC-ESTRO based parameters (35%) with manual/geometric methods represented the most common methodology for dose volume prescription and optimization. Overall treatment time (OTT) reported was within 49-56 days in 50%. Complex implants (IC + IS) were performed for more than 30% of cases by 3 centers. Conclusions: Our survey suggested a fairly uniform treatment paradigm for cervical cancer brachytherapy, with a progressive shift from 2D to 3D image-based parameters for planning, with persistence of point A based prescription. Further efforts are needed to augment and ease this transition. [ABSTRACT FROM AUTHOR]

Brachytherapy (BT) for locally advanced cervical cancer is vital for optimal outcomes. There is heterogeneity in brachytherapy treatment practice for cervical cancer across India. In an attempt to standardize various processes involved in cervical cancer brachytherapy, the expert members of the Indian Brachytherapy Society (IBS) developed a document related to radiation therapy treatment of cervical cancer with special emphasis on brachytherapy. The guidelines are based on high quality clinical evidence, expert opinion and consensus wherever evidence was lacking. The document provides a guide for external beam radiation and details of all the processes involved in high-dose-rate (HDR) brachytherapy including patient selection, preparation, principles and technique of BT applications, target and normal tissue definition, dose prescriptions, BT planning, reporting parameters, common complications of BT and their management, scope for research, etc. In summary, we present here practical tips and tricks, recording and reporting of cervical cancer brachytherapy, which can be implemented in various clinical environments and forms the basis of this report. [ABSTRACT FROM AUTHOR]

Introduction: Women in developing countries continue to face barriers to accessing sexual and reproductive health (SRH) services, with marginalized women facing increased challenges to accessing care. The Diagonal Interventions to Fast-Forward Enhanced Reproductive Health (DIFFER) project implemented a package of interventions for female sex workers and women from the general population which integrated horizontal health services for the general population with existing vertical targeted interventions aimed at sex workers with an aim to improve SRH and HIV services. We present an outcome evaluation of the DIFFER project in terms of uptake rates for SRH services among sex workers in Mysore, India. Methods: Ashodaya Samithi, a sex worker-led organization, implemented the DIFFER strategy through their community-based clinic and a Well Women Clinic (WWC), established at a partner private hospital that provided SRH services for women living with HIV. Mixed methods were used to evaluate the intervention that included a baseline (2012–13) and end of project (2015–16) cross sectional surveys (CSS), focus group discussions (FGDs), key informant interviews, and analysis of service statistics from 2013–2016. Results: The CSS found that condom use, STI testing, and treatment were high before, and throughout the intervention; cervical cancer screening and treatment increased significantly, from 11.5% to 56% (aOR 9.85, p<0.001) and HIV testing in the last 3 months increased from 26.3% to 73.3% (aOR 7.25, p<0.001). The proportion of sex workers using any SRH service in the past year doubled from 25.7% to 51.4% (aOR 2.91, p<0.001). Service statistics showed similar trends. The FGDs and key informant interviews showed that women and stakeholders held high levels of satisfaction with the strategy, and affirmed potential for scale up. Conclusion: The DIFFER strategy demonstrated that SRH service uptake can occur in conjuction with HIV services offered to sex workers. This model of integrated service delivery has been accepted by policy makers and needs further analysis for scaling up. [ABSTRACT FROM AUTHOR]

Aim: This study examined the determinants of attitudes and beliefs about human papillomavirus (HPV) infection, cervical cancer and HPV vaccine among parents of adolescent girls in Mysore, India. Methods: A random sample of 800 parents who had at least one adolescent‐aged daughter attending school were recruited for a survey. Results: Most parents (n = 778; 97.3%) completed the survey. Compared to Hindus, Muslims were more likely to perceive that their daughters are susceptible to HPV infection (adjusted odds ratio [aOR]: 4.94; 95% confidence interval [CI]: 2.87, 8.49) or cervical cancer (aOR: 2.73; 95% CI: 1.55, 4.80). However, the likelihood of perceiving that daughters are susceptible to HPV infection (aOR: 0.94; 95% CI: 0.90, 0.98) or cervical cancer (aOR: 0.95; 95% CI: 0.92, 0.99) decreased with an increase in the age of the parents. Perceived severity of HPV infection (aOR: 0.36; 95% CI: 0.14, 0.97) and cervical cancer (aOR: 0.33; 95% CI: 0.15, 0.74) was lower among Muslims than Hindus. Muslims had lower odds of believing that HPV vaccine is safe (aOR: 0.47; 95% CI: 0.25, 0.89) or could protect against cervical cancer (aOR: 0.27; 95% CI: 0.16, 0.48), but were more likely to feel that HPV vaccination may cause girls to become more sexually active (aOR: 1.92; 95% CI: 1.09, 3.39). The odds of believing that HPV vaccine is effective increased with an increase in the age of the parents (aOR: 1.03; 95% CI: 1.003, 1.06). Conclusion: Among Indian parents, age and religion of parents are associated with parental attitudes and beliefs about the threat of HPV and cervical cancer as well as the risks and benefits of HPV vaccine. [ABSTRACT FROM AUTHOR]

Cumulatively, breast, cervical, ovarian, and uterine cancer account for more than 70% of cancers in women in India. Distinct differences in the clinical presentation of women with cancer suggest underlying differences in cancer biology and genetics. The peak age of onset of breast and ovarian cancer appears to be a decade earlier in India (age 45-50 years) than in high-income countries (age >60 years). Understanding these differences through research to develop diagnosis, screening, prevention, and treatment frameworks that ar e specific to the Indian population are critical and essential to improving women's health in India. Since the sequencing of the human genome in 2001, applications of advanced technologies, such as massively parallel sequencing, have transformed the understanding of the genetic and environmental drivers of cancer. How can advanced technologies be harnessed to provide health-care solutions at a scale and to a budget suitable for a country of 1·2 billion people? What research programmes are necessary to answer questions specific to India, and to build capacity for innovative solutions using these technologies? In order to answer these questions, we convened a workshop with key stakeholders to address these issues. In this Series paper, we highlight challenges in tackling the growing cancer burden in India, discuss ongoing genomics research and developments in infrastructure, and suggest key priorities for future research in cancer in India. [ABSTRACT FROM AUTHOR]

Purpose: In India, cervical cancer is the second leading cause of cancer-related death in women. We piloted a cervical cancer prevention intervention in a rural town in southeastern Punjab, India to test the feasibility of a peer-driven intervention (PDI) model. Methods: Sixty-eight women (18-50 years) attended workshops with pre-post evaluation. Women learned skills of community health workers (CHWs), including strategies to engage women from the community for subsequent workshops. Results: Workshop 1 attendees (n=35) referred 33 women for Workshop 2, confirming the feasibility of PDI. Mean age was 29.48 (SD=8.2). Paired T-tests showed increased knowledge (19.41 vs 29.25, p<.001), and confidence (2.67 vs 3.70, p<.001) in imparting information to others. Conclusions: This PDI is a feasible, culturally specific approach in which community women took on the role of CHWs to reach others. They successfully acquired knowledge and confidence in discussing cervical cancer prevention at low cost and minimal resources. [ABSTRACT FROM AUTHOR]

Bhutanese-Nepali refugees are one of the largest refugee groups to be resettled in the U.S. in the past decade. Cervical cancer is a leading cause of cancer disparity in this population, yet screening rates are suboptimal. Nepali-speaking interviewers administered a community health needs questionnaire to a convenience sample of Bhutanese-Nepali refugees in a Midwestern city between July to October of 2015. Descriptive statistics were used to describe socio-demographic characteristics, Pap smear beliefs, post-migration living difficulties, and screening status. Differences in Pap test uptake between groups were tested using t test and Chi square statistics. Of the 97 female participants, 44.3% reported ever having had a Pap smear. Screening rates were lowest among women who did not know English at all. Most women had positive perceptions of Pap smears (80%) and 44.4% had received a Pap test recommendation from their healthcare provider, family, or friends. Pap testing was significantly higher among those who had positive perceptions (58.3 vs. 11.1% for women of negative perception, p = 0.01) and those who had received a recommendation (87.5 vs. 18.6% for women who had no recommendations, p < 0.001). Significant predictors of having a Pap smear were having a healthcare provider/family/friends recommendation (OR 65.3, 95% CI 11.4-373.3) and greater number of post-migration living difficulties (OR 1.18, 95% CI 1.02-1.37). The results of this study have important implications for the development of cervical cancer prevention programs targeting Bhutanese-Nepali refugees. Providing cancer prevention interventions early in the resettlement process could impact Pap test uptake in this population. [ABSTRACT FROM AUTHOR]

Background: Breast and cervical cancer are two of the most common cancers among women worldwide and were the two leading causes of cancer related death for women in India in 2013. While it is recognized that psychosocial and cultural factors influence access to education, prevention, screening and treatment, the role of stigma related to these two cancers has received limited attention.Methods: Two qualitative exploratory studies. One focusing on cervical cancer, the other on breast cancer, were conducted in Karnataka, India using in-depth interviews and focus group discussions. In the breast cancer study, 59 in-depth interviews were conducted with patients, primary caregivers and healthcare providers. In the cervical cancer study, 147 respondents were interviewed including older and younger women, husbands, healthcare providers and community leaders. While stigma was not the focus of either study, themes relating to stigma emerged and are the focus of this analysis.Results: Cancer stigma emerged as a general theme across both data sets. It appeared throughout the transcripts as descriptions of how women with breast or cervical cancer would be treated and talked about by husbands, family and the community (manifestations of stigma) and the reasons for this behavior. Stigma as a theme also arose through discussions around managing disclosure of a cancer diagnosis. Stigma was juxtaposed with a narrative of support for women with cancer. Three major themes emerged as driving the manifestations of cancer stigma: fear of casual transmission of cancer; personal responsibility for having caused cancer, and; belief in and fear of the inevitability of disability and death with a cancer diagnosis. Manifestations of cancer stigma were described in terms of experienced (enacted) stigma, including isolation or verbal stigma, and anticipated (fear of) stigma, should a cancer diagnosis be disclosed.Conclusions: The presence in these communities of cancer stigma and its many forms emerged across both the cervical and breast cancer data sets. Stigma was a feared outcome of a cancer diagnosis and described as a barrier to screening, early diagnosis and treatment seeking for women with symptoms. While further research on cancer stigma is needed, this exploration of some of the driving factors provides insight for future programmatic efforts to reduce cancer stigma and improve access to information, screening and treatment. [ABSTRACT FROM AUTHOR]

This study examines the prevalence of suspected cervical cancer (established through the use of visual inspection with Lugol's Iodine - VILI) among outpatients attending Surat Municipal Institute of Medical Education & Research Hospital, India. A cross-sectional study was conducted on 356 patients; 178 with an established sexually transmitted disease ( STD) and 178 patients without. Patients with positive results were investigated with cervical biopsy; out of 356 patients, 21.91% patients with STD and 12.35% patients without STD tested positive for VILI respectively ( p = .017). The factors found to be significantly associated with a positive VILI test were STD, marital status, oral contraceptive pill use, a complaint of PV bleeding, white discharge on speculum examination ( PS) and cervical erosion on PS. On applying multiple logistic regression, STD, age of patient in years, parity, OC pill use, a complaint of PV bleeding and cervical erosion on PS were found to be significant predictors of VILI positivity among the patients. STD patients are 2.5 times more likely to test positive for VILI than patients without STD. In Indian populations comparable to ours, opportunistic screening should be considered in gynaecology outpatient clinics for women presenting with complaints related to STDs. [ABSTRACT FROM AUTHOR]

We studied the relationship between human leukocyte antigen (HLA) class I alleles and cervical cancer among Indian women. Seventy-five cervical cancer cases were compared with 175 noncancer controls. Cervical biopsy tissue specimen from cancer cases and cervical swab specimen from controls were collected for HPV detection and typing. Blood was taken for HLA typing by PCR-SSOP method. The impact of HLA class I alleles on cervical cancer risk was evaluated using StatCalc program (Epi Info version 6.0.4. CDC Atlanta, GA, USA), and confirmed with Bonferroni correction. Results revealed HLA-B*37, HLA-B*58 were associated significantly with increased risk while HLA-B*40 with decreased risk for cervical cancer. At high-resolution analysis after Bonferroni correction, HLA-B*37:01 allele was associated with increased risk, whereas HLA-B*40:06 was with decreased risk for cervical cancer. HLA-B*37:01 and HLA-B*40:06 belong to the same superfamily of HLA-B44. In silico analysis revealed different binding affinities of HLA-B*37:01 and HLA-B*40:06 for the epitopes predicted for E6 and L1 proteins of HPV16. The higher binding affinity of epitopes to B*40:06, as revealed by docking studies, supports the hypothesis that this allele is able to present the antigenic peptides more efficiently than B*37:01 and thereby can protect the carriers from the risk of cervical cancer. Thus, there is a clear indication that HLA plays an important role in the development of cervical cancer in HPV-infected women. Identification of these factors in high-risk HPV-infected women may help in reducing the cervical cancer burden in India. [ABSTRACT FROM AUTHOR]

Cervical cancer is the leading cause of cancer mortality in India, accounting for 17% of all cancer deaths among women aged 30 to 69 years. At current incidence rates, the annual burden of new cases in India is projected to increase to 225,000 by 2025, but there are few large-scale, organized cervical cancer prevention programs in the country. We conducted a review of the cervical cancer prevention research literature and programmatic experiences in India to summarize the current state of knowledge and practices and recommend research priorities to address the gap in services. We found that research and programs in India have demonstrated the feasibility and acceptability of cervical cancer prevention efforts and that screening strategies requiring minimal additional human resources and laboratory infrastructure can reduce morbidity and mortality. However, additional evidence generated through implementation science research is needed to ensure that cervical cancer prevention efforts have the desired impact and are cost-effective. Specifically, implementation science research is needed to understand individual- and community-level barriers to screening and diagnostic and treatment services; to improve health care worker performance; to strengthen links among screening, diagnosis, and treatment; and to determine optimal program design, outcomes, and costs. With a quarter of the global burden of cervical cancer in India, there is no better time than now to translate research findings to practice. Implementation science can help ensure that investments in cervical cancer prevention and control result in the greatest impact. [ABSTRACT FROM AUTHOR]

Human Papillomavirus (HPV)-mediated cervical cancer is a leading cause of morbidity and mortality in women worldwide, including Indian women. Cervical cancer control and prevention strategies are being adopted in developing nations to reduce the increasing burden of HPV infection in the vaccine era. The present study, therefore, aimed to evaluate cervical cancer awareness and knowledge of Gardasil vaccination in North Indian women. A pilot survey was conducted among 103 women of North Indian ethnicity residing in Lucknow/adjoining areas in state of Uttar Pradesh, during routine screening/clinic visits from June 2012 to December 2012. The study subjects were interviewed in either Hindi or English; subsequently the awareness of HPV-mediated cervical cancer and knowledge of Gardasil vaccination was assessed in terms of 'yes', 'no' and 'no response'. The study was approved by the Institutional Review Board. Written informed consent was taken from the participants. Overall, the response of participants (n = 103) in our single-centre survey-based pilot study was well-defined. The response regarding HPV-mediated cervical cancer awareness in terms of 'yes', 'no' and 'no response' among the study subjects was 43.7, 44.7 and 11.6 %, respectively. Furthermore, in response to knowledge of HPV vaccine Gardasil, out of 103 subjects, 28.1 % answered 'yes' while 37.9 and 34.0 % stated 'no' and 'no response', respectively. Our pilot survey may help in assessing knowledge of HPV-mediated cervical cancer and Gardasil vaccination awareness in women, and accordingly develop cost-effective cervical cancer control and prevention/public health counseling sessions in a clinical setting. [ABSTRACT FROM AUTHOR]

The human papillomavirus (HPV) vaccine research and marketing in India exemplifies the privatization of public sectors and global assemblages of novel actors and public-private partnerships in service delivery and pharmaceutical marketing. Drawing on ethnographic research, in this article I examine how the molecularized conception of cervical cancer and the simultaneous global rise of the HPV vaccine is redefining the meaning of prevention, the role of the state, and blurring the relationship between health care and health research in India. In 2009, two Indian states began “demonstration projects” to vaccinate 30,000 girls. The subsequent deaths of a number of girls exposed inherent problems with the projects. For many health activists, the vaccine has potentially grave consequences for India's public health system. This case demonstrates how biopolitical actors, and the drive for biocapital, can create a public health campaign that might in the end place women's health and the public health system at a greater risk. [ABSTRACT FROM PUBLISHER]

Background: The distribution of HPV genotypes, their association with rigorously confirmed cervical precancer endpoints, and factors associated with HPV infection have not been previously documented among HIV-infected women in India. We conducted an observational study to expand this evidence base in this population at high risk of cervical cancer. Methods: HIV-infected women (N = 278) in Pune, India underwent HPV genotyping by Linear Array assay. Cervical intraepithelial neoplasia (CIN) disease ascertainment was maximized by detailed assessment using cytology, colposcopy, and histopathology and a composite endpoint. Results: CIN2+ was detected in 11.2% while CIN3 was present in 4.7% participants. HPV genotypes were present in 52.5% (146/278) and 'carcinogenic' HPV genotypes were present in 35.3% (98/278) HIV-infected women. 'Possibly carcinogenic' and 'non/unknown carcinogenic' HPV genotypes were present in 14.7% and 29.5% participants respectively. Multiple (⩾2) HPV genotypes were present in half (50.7%) of women with HPV, while multiple 'carcinogenic' HPV genotypes were present in just over a quarter (27.8%) of women with 'carcinogenic' HPV. HPV16 was the commonest genotype, present in 12% overall, as well as in 47% and 50% in CIN2+ and CIN3 lesions with a single carcinogenic HPV infection, respectively. The carcinogenic HPV genotypes in declining order of prevalence overall included HPV 16, 56, 18, 39, 35, 51, 31, 59, 33, 58, 68, 45 and 52. Factors independently associated with 'carcinogenic' HPV type detection were reporting ⩾2 lifetime sexual partners and having lower CD4+ count. HPV16 detection was associated with lower CD4+ cell counts and currently receiving combination antiretroviral therapy. Conclusion: HPV16 was the most common HPV genotype, although a wide diversity and high multiplicity of HPV genotypes was observed. Type-specific attribution of carcinogenic HPV genotypes in CIN3 lesions in HIV-infected women, and etiologic significance of concurrently present non/unknown carcinogenic HPV genotypes await larger studies. [ABSTRACT FROM AUTHOR]

The most prevalent types of human papillomavirus in cervical cancer in India are HPV 16 and HPV 18, found in 60.7 per cent and 16 per cent of cases respectively. A comprehensive strategy with a judicious mix of interventions on health promotion, specific protection (vaccination), early diagnosis (screening), and treatment should be instituted to prevent and control cervical cancer in India. Proponents of vaccination and screening argue for enhanced investments on these interventions based on their relative cost-effectiveness. For policymakers, the major concerns about these interventions remain affordability and cost to government. Herein we try to review comprehensively the evidence on prevention and control interventions and to recommend appropriate policies to guide public health decision-making. [ABSTRACT FROM AUTHOR]

Background: Demographic, socioeconomic and cultural changes in India have increased longevity, delayed childbearing, decreased parity and resulted in a more westernised lifestyle, contributing to the increasing burden of cancer, especially among women.Methods: We evaluated secular changes in the incidence of breast, cervical and ovarian cancer in Mumbai women aged 30-64 between 1976 and 2005. Age-standardised incidence rates were calculated and presented by site and calendar period. An age-period-cohort (APC) analysis quantified recent time trends and the significance of birth cohort and calendar period effects. The estimated annual percent change (EAPC) was obtained from the drift parameter, expressing the linear time trend common to both calendar period and birth cohort.Results: Over the 30-year study period, the age-standardised rates significantly increased for breast cancer (EAPC: 1.1% (95% confidence interval (CI): 1.0, 1.3)), significantly decreased for cervical cancer (EAPC: -1.8% (95% CI: -2.0, -1.6)) and there was no statistically significant change for ovarian cancer (EAPC: 0.3% (95% CI: -0.1, 0.6)). For breast and cervical cancer, the best-fitting model was the APC model.Conclusions: The rates of breast, cervical and ovarian cancer remain low in comparison with western countries, and the divergent trends of breast (increasing) and cervical cancer (decreasing) in Mumbai were similar to those observed in several other Asian countries. The changing risk profile in successive generations - improved education, higher socioeconomic status, later age at marriage and at first child, and lower parity - may in combination partially explain the diverging generational changes in breast and cervical cancer in Mumbai in the last decades. [ABSTRACT FROM AUTHOR]

Background: Prevalence of both cervical cancer and Human Immunodeficiency Virus (HIV) infection are very high in India. Natural history of Human Papilloma Virus (HPV) infection is known to be altered in HIV positive women and there is an increased possibility of persistence of HPV infections in this population. Therefore, this study was conducted to understand the epidemiology and circulating genotypes of oncogenic HPV among HIV positive and negative female population in West Bengal, India. Methods: In this hospital-based cross-sectional study, 93 known HIV positive females attending a pre-ART registration clinic and 1106 HIV negative females attending a Reproductive and Child Health Care Clinic were subjected to study. Cervical cell samples collected from the study population were tested for the presence of HPV 16, 18 using specific primers. Roche PCR assay was used to detect other specific HPV genotypes in the cervical cells specimens of HIV positive cases only. Results: Prevalence of HPV 16, 18 among HIV positive females (32.2%; n = 30) was higher than HIV negative females (9.1%; n = 101). About 53% (23/43) of cases with oncogenic HPV were infected with genotypes other than 16, 18 either as single/multiple infections. HPV 18 and HPV 16 were the predominant genotypes among HIV positive and HIV negative subjects respectively. Oncogenic HPV was not found to be associated with age and duration of sexual exposure. But the presence of HIV was found to a statistically significant predictor oncogenic HPV. Conclusion: The currently available HPV vaccines offer protection only against HPV 16 and 18 and some crossprotection to few associated genotypes. These vaccines are therefore less likely to offer protection against cervical cancer in HIV positive women a high percentage of who were infected with non-16 and non-18 oncogenic HPV genotypes. Additionally, there is a lack of sufficient evidence of immunogenicity in HIV infected individuals. Therefore, prevention of cervical cancer in HIV positive women must be focused towards early detection of oncogenic HPV & cervical cytological abnormality followed by an appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: While many studies have compared the efficacy of Pap cytology, visual inspection with acetic acid (VIA) and human papillomavirus (HPV) DNA assays for the detection cervical intraepithelial neoplasia and cancer, few have evaluated the program effectiveness. Methods and Findings: A population-based sample of 5603 women from Medchal Mandal in Andhra Pradesh, India were invited to participate in a study comparing Pap cytology, VIA, and HPV DNA screening for the detection of CIN3+. Participation in primary screening and all subsequent follow-up visits was rigorously tracked. A 20% random sample of all women screened, in addition to all women with a positive screening test result underwent colposcopy with directed biopsy for final diagnosis. Sensitivity, specificity, positive and negative predictive values were adjusted for verification bias. HPV testing had a higher sensitivity (100%) and specificity (90.6%) compared to Pap cytology (sensitivity = 78.2%; specificity = 86.0%) and VIA (sensitivity = 31.6%; specificity = 87.5%). Since 58% of the sample refused involvement and another 28% refused colposcopy or biopsy, we estimated that potentially 87.6% of the total underlying cases of CIN3 and cancer may have been missed due to program failures. Conclusions: We conclude that despite our use of available resources, infrastructure, and guidelines for cervical cancer screening implementation in resource limited areas, community participation and non-compliance remain the major obstacles to successful reduction in cervical cancer mortality in this Indian population. HPV DNA testing was both more sensitive and specific than Pap cytology and VIA. The use of a less invasive and more user-friendly primary screening strategy (such as self-collected swabs for HPV DNA testing) may be required to achieve the coverage necessary for effective reduction in cervical cancer mortality. [ABSTRACT FROM AUTHOR]

Objective Interferon gamma ( IFN-γ) is a pro-inflammatory cytokine playing a pivotal role in both innate and adaptive immune responses. A single nucleotide polymorphism located in the first intron of the human IFN-γ gene can influence the secretion of cytokine. Therefore, we aimed to investigate the association of IFN-γ T/A gene polymorphism with the risk of cervical cancer. Design Case–control study. Setting Uttar Pradesh State in India. Sample Two hundred cases with histologically proven cancer of the cervix and healthy controls ( n = 230), age and ethnicity matched were recruited in this study. Methods Genotyping was performed for bi-allelic +874 (T/A) polymorphism of IFN-γ by amplification refractory mutation system method. Main outcome measures Low producer IFN-γ +874 AA genotype was associated with high risk for cervical cancer, which further modulated the increased risk in tobacco users. Results IFN-γ AA genotype which is low producer of IFN-γ was associated with increased risk of cervical cancer (OR = 2.43, P = 0.003). Allele A was at 1.54-fold increased risk of cervical cancer (OR=1.54, P = 0.002). The AA genotype showed statistically significant risk with high stage (III + IV) of cervical cancer (OR = 4.99, P = 0.001). In tobacco users, AA genotype showed significantly increased susceptibility to cervical cancer (OR = 5.08, P = 0.010). Conclusion Variation in IFN-γ +874 AA genotype because of ethnicity in north-Indian population may represent an important susceptibility biomarker for cervical cancer risk as well as other diseases and should be explored further. [ABSTRACT FROM AUTHOR]