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Copyright of ESPOCH Congresses: The Ecuadorian Journal of S.T.E.A.M. is the property of Knowledge E DMCC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cervical cancer remains a significant health concern worldwide, where precise segmentation of cervical lesions is integral for effective diagnosis and treatment planning. This systematic review critically evaluates the application of graph-based methodologies for cervical cancer segmentation, identifying their potential, drawbacks, and avenues for future development. An exhaustive literature search across Scopus and PubMed databases resulted in 20 pertinent studies. These studies were assessed focusing on their implementation of graph-based techniques for cervical cancer segmentation, the utilized datasets, evaluation metrics, and reported precision levels. The review highlights the progressive strides made in the field, especially regarding the segmentation of intricate, nonconvex regions and facilitating the detection and grading of cervical cancer using graph-based methodologies. Nonetheless, several constraints were evident, including a dearth of comparative performance analysis, reliance on high-resolution images, difficulties in specific boundary delineation, and the imperative for additional validation and diversified datasets. The review suggests future work to integrate advanced deep learning strategies for heightened accuracy, formulate hybrid methodologies to counteract existing limitations, and explore multimodal fusion to boost segmentation precision. Emphasizing the explainability and interpretability of outcomes also stands paramount. Lastly, addressing critical challenges such as scarcity of annotated data, the need for realtime and interactive segmentation, and the segmentation of multiple objects or regions of interest remains a crucial frontier for future endeavors. [ABSTRACT FROM AUTHOR]

Background: Women with intellectual and developmental disabilities (IDD) do not undergo breast and cervical cancer screening at the same rate as women without IDD. IDDs are diagnosed in childhood, are lifelong, and involve difficulties in adaptive behaviors and intellectual functioning. Native American women also experience disparities in breast and cervical cancer screenings. Despite known disparities, women with IDD are often not included in health promotion programs, and there is a need for evidence-based programming for those with intersectional identities, such as Native American women with IDD. Objective: This study aims to assess the feasibility and acceptability of My Health My Choice (MHMC), an adaptation of the Women Be Healthy 2 program. There are 2 parts to the study: adaptation of the Women Be Healthy 2 program and feasibility and acceptability testing of MHMC. Methods: Individuals aged over 18 years who identify as Native American females with IDD and their caregivers (N=30 women-caregiver dyads) are eligible for the study. Participants, who are affiliated with 2 partnering sites in Arizona (1 rural and 1 urban), complete pre- and postsurveys assessing knowledge, self-efficacy, and screening expectations before and immediately after completing the program. In addition, all participants complete brief satisfaction surveys after each of the 6 educational sessions. A subsample of Native American women with an IDD (n=12), caregivers (n=12), and community health educators (n=2) who participate in the MHMC program will provide semistructured qualitative input regarding the content, delivery, and cultural relevance of the program. Results: The adaptation of the culturally responsive MHMC program was completed in August 2021. In November 2021, the project team began recruitment for feasibility and acceptability studies. Feasibility will be examined using participation metrics, and acceptability will be measured using satisfaction measures. Pre- and postmeasures in cancer screening knowledge, self-efficacy, and screening expectations will examine improvements among participants. Conclusions: The results of feasibility and acceptability testing of MHMC will guide future implementation studies of the program. [ABSTRACT FROM AUTHOR]

Background: Despite the national cervical cancer (CC) screening program established in 2006, the CC incidence in Estonia in 2020 was still one of the highest in Europe. To better understand the possible barriers among women, the aim of this study was to describe the inequalities in the Pap smear uptake trend in 2004–2020 and to analyse the associations between different factors in Estonia. Methods: Weighted data of 25–64-year-old women (N = 6685) from population-based cross-sectional studies of Health Behaviour among Estonian Adult Population in 2004–2020 was used. Linear trends in uptake of Pap smear over time were tested using the Cochrane-Armitage test. Binary logistic regression with interactions was performed to analyse associations between the uptake of Pap smear and sociodemographic, socioeconomic, health-related and lifestyle factors. Crude and adjusted odds ratios with 95% confidence intervals were calculated. Results: Prevalence of lifetime uptake of Pap smear increased in 2004–2020 from 50.6 to 86.7% (P < 0.001). From 2004 to 2020, uptake of Pap smear increased significantly among women aged 25–34, 35–44, 45–54 and 55–64, in both ethnicity groups and among women with basic, secondary and higher education (P < 0.001). The gap in Pap smear uptake increased between Estonians and non-Estonians but decreased between education levels over time. Lower lifetime uptake of Pap smear was associated from sociodemographic factors with younger age, being non-Estonian and single, from socioeconomic factors with lower educational level and unemployment, from health indicators with higher body mass index indicating overweight and obesity, presence of chronic disease and depressiveness, and from lifestyle factors with non-smoking. Conclusions: Although Pap smear uptake among 25–64 year old women increased significantly in Estonia in 2004–2020, inequalities were found indicating an opportunity for development of targeted CC prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Research infrastructures such as biorepositories are essential to facilitate genomics and its growing applications in health research and translational medicine in Africa. Using a cervical cancer cohort, this study describes the establishment of a biorepository consisting of biospecimens and matched phenotype data for use in genomic association analysis and pharmacogenomics research. Method: Women aged > 18 years with a recent histologically confirmed cervical cancer diagnosis were recruited. A workflow pipeline was developed to collect, store, and analyse biospecimens comprising donor recruitment and informed consent, followed by data and biospecimen collection, nucleic acid extraction, storage of genomic DNA, genetic characterization, data integration, data analysis and data interpretation. The biospecimen and data storage infrastructure included shared -20 °C to -80 °C freezers, lockable cupboards, secured access-controlled laptop, password protected online data storage on OneDrive software. The biospecimen or data storage, transfer and sharing were compliant with the local and international biospecimen and data protection laws and policies, to ensure donor privacy, trust, and benefits for the wider community. Results: This initial establishment of the biorepository recruited 410 women with cervical cancer. The mean (± SD) age of the donors was 52 (± 12) years, comprising stage I (15%), stage II (44%), stage III (47%) and stage IV (6%) disease. The biorepository includes whole blood and corresponding genomic DNA from 311 (75.9%) donors, and tumour biospecimens and corresponding tumour DNA from 258 (62.9%) donors. Datasets included information on sociodemographic characteristics, lifestyle, family history, clinical information, and HPV genotype. Treatment response was followed up for 12 months, namely, treatment-induced toxicities, survival vs. mortality, and disease status, that is disease-free survival, progression or relapse, 12 months after therapy commencement. Conclusion: The current work highlights a framework for developing a cancer genomics cohort-based biorepository on a limited budget. Such a resource plays a central role in advancing genomics research towards the implementation of personalised management of cancer. [ABSTRACT FROM AUTHOR]

In the US, incidence and mortality from cervical cancer disproportionately affects racial/ethnic minorities and low-income women. Despite affordable access to primary and secondary prevention measures at Federally Qualified Health Centers (FQHCs), Human Papillomavirus (HPV) vaccination and screening rates are low, suggesting the presence of non-financial barriers to uptake in this population. This explanatory sequential mixed-methods study sought to explore factors that influence the acceptability of cervical cancer prevention services among parents and legal guardians of vaccine-eligible girls attending an urban FQHC and to assess social influences related to cervical cancer prevention. Participants included eight mothers, one father, and two grandparents/legal guardians. Nine participants self-identified as Black/Afro-Caribbean, or African American, two as Latinx, and one as Native American. The quantitative data suggested discordance between participants' cervical cancer prevention knowledge and their practices. Most indicated that their daughters had received the HPV vaccine but were unsure about HPV transmission modes. Qualitative data revealed that participants were comfortable disclosing information on HPV infection and vaccination status, and most women were likely to share information related to cervical cancer testing and diagnosis. Few comments indicated personal stigma on the part of participants, but there was frequent expression of perceived public stigma (shaming and blaming women), gender differences (men are indifferent to risk), and distrust of the healthcare system. Findings highlight several concepts including the disharmony between knowledge and practice, prevalent perceived public stigma, cumbersome attitudes on the part of men regarding HPV and cervical cancer, and distrust of the healthcare system. [ABSTRACT FROM AUTHOR]

Accurate prognosis of cervical cancer in the clinical setting is challenging because of the complexity of the causative factors. Considering the drawbacks of the widely used Cox proportional hazards model, such as the inability to fully use the information and the possible failure to achieve the best fit, several new attempts based on machine learning have been developed to find better prognostic prediction models. However, the application of these attempts is often limited, because they often rely on public databases. Therefore, for cervical cancer, there is a need to explore the value of machine learning in terms of its practical application in prognostic prediction. In this study, we introduced several machine learning methods including k-nearest neighbors (KNN), decision tree (DT), logistic regression (LR), support vector machine (SVM), random forest (RF), extreme gradient boosting (XGBoost) and light gradient boosting machine (LightGBM) to predict the survival of patients by using the real-world pathological data of 216 patients collected from the Fifth People's Hospital of Chengdu. The experimental results showed that these methods have a promising application value in the prediction of overall survival (OS) of patients with cervical cancer (KNN: F1-score = 0.95, Accuracy = 0.93, DT: F1-score = 0.94, Accuracy = 0.92, LR: F1-score = 0.92, Accuracy = 0.90, SVM: F1-score = 0.94, Accuracy = 0.92, RF: F1-score = 0.96, Accuracy = 0.95, XGBoost: F1-score = 0.96, Accuracy = 0.95, LightGBM: F1-score = 0.96, Accuracy = 0.95). Moreover, XGBoost and LightGBM gave the importance of the clinical indicators associated with cervical cancer, whose correlation with OS and progression-free survival (PFS) can be further obtained. Thus, the predictors of OS and PFS were successfully identified. Finally, the results were confirmed by the Cox proportional hazards model. These results indicated that machine learning methods can accurately predict the OS of patients with cervical cancer. Moreover, the methods can be used to analyze the correlation between clinical indicators and OS or PFS to help doctors make more accurate decisions in a clinical setting. [ABSTRACT FROM AUTHOR]

The quality of the contrast enhancement, which is deemed to be vague in contrast between one region and another, is a problem that many doctors face once identifying their patients with CT scan images. Image correction was used in this study to help doctors gain good CT scan images. In addition to reducing errors in the administering of radiation doses during treatment, accurate images are used to locate and assess the extent of cancer in patients. In this study, a computer application program to improve image contrast was created using the linear regression equation method. In this investigation, the cancer area is still being manually marked by doctors. Additionally, the proportion of the cancer area in the image that the doctor marked from the corrected image is calculated by comparing the ratio of cancer pixels to body pixels. The severity of the cancer is estimated using the proportion of the affected area. The error percentage for the average improvement in application performance is 0.15689%. [ABSTRACT FROM AUTHOR]

Objectives and importance of study: Changing cancer screening programs is notoriously difficult and may be influenced by clinicians' willingness to adhere to new guidelines. Our objective was to investigate clinicians' adherence to revised cervical screening guidelines and to identify any reasons for testing outside the revised guidelines. Methods: Australian clinicians involved in cervical screening and treating women with cervical abnormalities were invited to complete a cross-sectional online survey between September 2019 and February 2020. We measured self-reported adherence to cervical screening guidelines for three common scenarios and analysed free-text reasons for offering tests contrary to guidelines using content analysis. Results: A total of 607 clinicians (283 general practitioners [GPs], and 324 obstetricians and gynaecologists [O&Gs]) were eligible and participated. Of these, 37.8% of GPs and 43.8% of O&Gs would provide testing more frequently than indicated by guidelines, but recognised the need for patients to be aware of the additional cost and for guidelines to be explained; 13.9% of GPs and 10.2% of O&Gs would screen women at a younger age than indicated due to patient request, patient/family history and the need for patient reassurance; and 11.4% of GPs and 23.6% of O&Gs would perform a HPV and cytology co-test when not indicated, mainly as a result of a mistake or lack of familiarity with guidelines, patient/family history and patient reassurance. Patient request for testing was a reason for testing outside the guidelines with regard to frequency of testing, age of testing and co-testing. Conclusions: These data suggest that it is likely cervical screening outside guidelines is occurring in Australia. As patients often request these tests, strategies to reduce screening outside the guidelines should include ensuring that women are aware of the financial implications and the reasons for the updated guidelines. [ABSTRACT FROM AUTHOR]

Cervical cancer is the fourth most common cancer worldwide. Furthermore, it is the 9thmost common cancer in all ages and the 4thmost common in the 25-49 age group of women in Turkey. Given these significantly high figures, it is a significant public health problem. Therefore, this study aimed to evaluate the epidemiological characteristics of patients screened for Human papillomavirus (HPV) in a tertiary-care setting in Turkey. This is a retrospective chart review of patients admitted for clinical examinations and who underwent cervical cancer screening between 1 January 2017 and 1 March 2022. The data analyses included HPV positivity, genotype distribution, cytology analyses, colposcopy results, pathological diagnoses, and follow-up methods. A total of 529 cases were included, of whom 41.6% were HPV positive. The most frequent HPV types were HPV-16 (16.6%) and HPV-high risk (HR) (12.1%). Cytology analyses revealed atypical squamous cells of undetermined significance (ASC-US) in 17.8% and low-grade squamous intraepithelial lesions (LSIL) in 12.7%. The most common pathological finding was cervicitis in 23.1% (n=122), cervical intraepithelial neoplasia (CIN)-1 in 9.3% (n=49), CIN-3 in 4% (n=21), and CIN-2 in 3.8% (n=20) of patients. HPV-59 (p=0.027) and HPV-HR (p=0.003) genotypes were determined in higher proportions in patients with ≥ASC-US cytology, and HPV-16 was significantly higher among patients with ≥CIN-1 lesions. The HPV positivity rate was 41.6% among women admitted to our tertiary-care university hospital for gynecological assessments. Distribution differences in HPV genotypes, cytology assessments, and pathological diagnoses might reflect the population characteristics in different geographical regions from previous studies. Our results provide current data for HPV surveillance in the Turkish population. [ABSTRACT FROM AUTHOR]

Introduction: Imaging is integral part of cervical cancer management. Currently, MRI is used for staging, follow up and image guided adaptive brachytherapy. The ongoing IQ-EMBRACE sub-study is evaluating the use of MRI for functional imaging to aid in the assessment of hypoxia, metabolism, hemodynamics and tissue structure. This study reviews the current and potential future utilization of functional MRI imaging in diagnosis and management of cervical cancer. Methods: We searched PubMed for articles characterizing the uses of functional MRI (fMRI) for cervical cancer. The current literature regarding these techniques in diagnosis and outcomes for cervical cancer were then reviewed. Results: The most used fMRI techniques identified for use in cervical cancer include diffusion weighted imaging (DWI) and dynamic contrast enhancement (DCE). DCE-MRI indirectly reflects tumor perfusion and hypoxia. This has been utilized to either characterize a functional risk volume of tumor with low perfusion or to characterize at-risk tumor voxels by analyzing signal intensity both pre-treatment and during treatment. DCE imaging in these situations has been associated with local control and disease-free survival and may have predictive/prognostic significance, however this has not yet been clinically validated. DWI allows for creation of ADC maps, that assists with diagnosis of local malignancy or nodal disease with high sensitivity and specificity. DWI findings have also been correlated with local control and overall survival in patients with an incomplete response after definitive chemoradiotherapy and thus may assist with post-treatment follow up. Other imaging techniques used in some instances are MRspectroscopy and perfusion weighted imaging. T2-weighted imaging remains the standard technique used for diagnosis and radiation treatment planning. In many instances, it is unclear what additional information functional-MRI techniques provide compared to standard MRI imaging. Conclusions: Functional MRI provides potential for improved diagnosis, prediction of treatment response and prognostication in cervical cancer. Specific sequences such as DCE, DWI and ADC need to be validated in a large prospective setting prior to widespread use. The ongoing IQ-EMBRACE study will provide important clinical information regarding these imaging modalities. [ABSTRACT FROM AUTHOR]

Detecting and categorizing Pap smear images automatically has been a difficult task over the past five decades. There is a significant need for the design and implementation of low‐cost, high‐efficiency screening systems. To address these issues, we have proposed a novel approach for cervical cancer classification. At first, each image is pre‐processed and cropped into 2043*1362 pixels. These images are separated into 681*681 pixels with six square patches. Image augmentation techniques such as image enhancement, image flipping, and image rotation are used to reduce the number of parameters necessary for subsequent processes. The cancer‐affected regions are correctly segmented with the help of kernel weighted fuzzy local information c‐means clustering (KWFLICM) model. The KWFLICM model mainly extracts the cytoplasm and nucleus present in the cell from the background region. The features of the cervical image are extracted using a convolution neural network (CNN), and these retrieved features, such as shape, color, and texture, are crucial for classification. Finally, the Sooty Tern Optimization (STO) algorithm with CNN‐based long short‐term memory classifier (CNN‐LSTM) identifies the four types of CC: normal, light dysplastic, severe dysplastic, and carcinoma. The images for the experiment were obtained from Herlev University Hospital in Denmark, and the software used for the implementation was MATLAB. According to the comparative analysis, the proposed CNN‐LSTM with STO algorithm demonstrates better results using various measures such as accuracy, specificity, sensitivity, and F‐score. Depending upon the experimental results, the proposed CNN‐LSTM with STO algorithm provides 99.80% accuracy, 99% specificity, 98.83% sensitivity, and 97.8 F‐score. The proposed methodology offers an improvement of 28.5% and 19.46% when compared with the random forest and ensemble classifier. [ABSTRACT FROM AUTHOR]

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cervical cancer is an important malignant tumor threatening the physical and mental health of women in the world. As a new calcium activated chloride channel protein, calcium activated chloride channel (CLCA2) plays an important role in tumorigenesis and development. But its role and exact regulatory mechanism in cervical cancer are still unclear. In our study, we found CLCA2 was significantly decreased in cervical cancer cells, and overexpression of CLCA2 inhibited the proliferation, migration and invasion, and promotes apoptosis of cervical cancer cells, and CLCA2 inhibited EMT (Epithelial-mesenchymal transition) through an p38 / JNK / ERK pathway. The results in vivo were consistent with those in vitro. In conclusion, overexpression of CLCA2 inhibited the progression of cervical cancer in vivo and in vitro. This may provide a theoretical basis for CLCA2 as a new indicator of clinical diagnosis and prognosis of cervical cancer or as a potential target of drug therapy. [ABSTRACT FROM AUTHOR]

Introduction: Availability and access to cervical cancer screening (CCS) in less developed countries are limited as compared to developed countries. Moreover, the rise in cervical cancer fatalities and mortalities is attributed to the low patronage in CCS among women. The aim of this study was therefore to explore the cues to cervical cancer screening and perceptions of the reaction to cervical cancer diagnosis among women in Shai Osudoku District. Methods: A qualitative approach and an exploratory descriptive design were considered by the researcher for this study. Seventeen participants in all were recruited to partake in face-to-face in-depth interviews guided by semi-structured interviews. The sampling technique employed is purposive and content analysis was used in the data analysis. Findings: Two main themes, i.e., cues to cervical cancer screening and perception about women’s reaction to cervical cancer diagnosis, emerged. Health workers, peer influence, spousal influence, creation of awareness and reducing cervical cancer screening cost emerged as major determinants (cues) that influence women’s decision to (not to) screen. Conclusion: The participants of this study acknowledged that their decision to (not to) screen was greatly influenced by some external factors. Hence, it is recommended that more attention be directed towards motivating and encouraging women to partake in cervical cancer screening services to help reduce fatalities. [ABSTRACT FROM AUTHOR]

Doctors and pathologists have long been concerned about determining the malignancy from cell images. This task is laborious, time-consuming and needs expertise. Due to this reason, automated systems assist pathologists in providing a second opinion to arrive at accurate decision based on cytology images. The classification of cytology images has always been a difficult challenge among the various image analysis approaches due to its extreme intricacy. The thrust for early diagnosis of cervical cancer has always fuelled the research in medical image analysis for cancer detection. In this paper, an investigative study for the classification of cytology images is proposed. The proposed study uses the discrete coefficient transform (DCT) coefficient and Haar transform coefficients as features. These features are given as a input to seven different machine learning algorithms for normal and abnormal pap smear images classification. In order to optimize the feature size, fractional coefficients are used to form the five different sizes of feature vectors. In the proposed work, DCT transform has given the highest classification accuracy of 81.11%. Comparing the different machine learning algorithms the overall best performance is given by the random forest classifier. [ABSTRACT FROM AUTHOR]

Cervical cancer is one of the most common and deadliest cancers among women and poses a serious health risk. Automated screening and diagnosis of cervical cancer will help improve the accuracy of cervical cell screening. In recent years, there have been many studies conducted using deep learning methods for automatic cervical cancer screening and diagnosis. Deep-learning-based Convolutional Neural Network (CNN) models require large amounts of data for training, but large cervical cell datasets with annotations are difficult to obtain. Some studies have used transfer learning approaches to handle this problem. However, such studies used the same transfer learning method that is the backbone network initialization by the ImageNet pre-trained model in two different types of tasks, the detection and classification of cervical cell/clumps. Considering the differences between detection and classification tasks, this study proposes the use of COCO pre-trained models when using deep learning methods for cervical cell/clumps detection tasks to better handle limited data set problem at training time. To further improve the model detection performance, based on transfer learning, we conducted multi-scale training according to the actual situation of the dataset. Considering the effect of bounding box loss on the precision of cervical cell/clumps detection, we analyzed the effects of different bounding box losses on the detection performance of the model and demonstrated that using a loss function consistent with the type of pre-trained model can help improve the model performance. We analyzed the effect of mean and std of different datasets on the performance of the model. It was demonstrated that the detection performance was optimal when using the mean and std of the cervical cell dataset used in the current study. Ultimately, based on backbone Resnet50, the mean Average Precision (mAP) of the network model is 61.6% and Average Recall (AR) is 87.7%. Compared to the current values of 48.8% and 64.0% in the used dataset, the model detection performance is significantly improved by 12.8% and 23.7%, respectively. [ABSTRACT FROM AUTHOR]

Background: The wide availability of mobile phones has made it easy to disseminate health-related information and make it accessible. With gamification, mobile apps can nudge people to make informed health choices, including attending cervical cancer screening. Objective: This matched retrospective cohort study examined the association between exposure to the FightHPV mobile app gamified educational content and having a cervical exam in the following year. Methods: Women aged 20 to 69 years who signed an electronic consent form after downloading the FightHPV app in 2017 (intervention group) were matched 1:6 with women of the same age and with the same screening history (reference group) in 2015. To estimate the impact of exposure to the FightHPV app, we estimated cumulative incidence and hazard ratios (HRs) with 95% CIs. We used data from the Norwegian Cervical Cancer Screening Program database and Statistics Norway to determine screening participation and outcomes, respectively. Results: We matched 3860 women in the control group to 658 women in the intervention group; 6 months after enrollment, 29.6% (195/658) of the women in the intervention group and 15.21% (587/3860) of those in the reference group underwent a cervical exam (P<.01). Women exposed to the FightHPV app were 2 times more likely to attend screening (adjusted HR 2.3, 95% CI 2.0-2.7), during which they were 13 times more likely to be diagnosed with high-grade abnormality (adjusted HR 12.7, 95% CI 5.0-32.5) than the women in the reference group. Conclusions: Exposure to the FightHPV app significantly increased cervical cancer screening attendance across the various analyses and improved detection of women with high risk for cervical cancer. For the first time, we demonstrated the effectiveness of gamification combined with mobile technology in cancer prevention by empowering women to make active health-related decisions. Gamification can significantly improve the understanding of complicated scientific concepts behind interventions and increase the acceptance of proposed cancer control measures. [ABSTRACT FROM AUTHOR]

Multi-center cervical cytology images have various image styles due to the differences in staining and imaging techniques, which pose a significant challenge to the performance of automated cervical cancer diagnosis tools. We propose a dual-head network architecture that explicitly disentangles image features into content and style features, and applies contrastive self-supervised learning to a large number of unlabeled images, achieving enhanced generalization across various styles. We pretrain our model on 1,024,855 images cropped from 3,561 whole slide images (WSIs), and visualize the features using t-distributed stochastic neighbor embedding (t-SNE) method, demonstrating the effectiveness of our method in distinguishing between content and style features. In the downstream task, we evaluate our model on 192,123 binary-classified images with 10 styles, and achieve the best accuracy among all methods for every style. Across the 10 different data sources, our method attained an average accuracy of 80.4%, outperforming all other comparative methods by 3% to 17%, demonstrating our method's potential to enhance the performance and robustness of automated cytology image analysis in multi-center settings. • We propose a method for the disentanglement of content and style features via self-supervised contrastive learning. • It decouples features by simultaneous contrastive learning for content and style representations. • Feature visualization shows it can obtain compact content representations for images with identical content but varying styles. • Linear probing evaluation on multi-center cytology image datasets demonstrates its superior performance. [Display omitted] [ABSTRACT FROM AUTHOR]

Digital Twin (DT) will transform digital healthcare and push it far beyond expectations. DT creates a virtual representation of a physical object reflecting its current state using real-time converted data. Nowadays, Women's health is more frequently impacted by cervical cancer, but early detection and rapid treatment are critical factors in the cure of cervical cancer. This paper proposes and implements an automated cervical cancer detection DT framework in healthcare. This framework is a valuable approach to enhance digital healthcare operations. In this proposed work, the SIPaKMeD dataset was used for multi-cell classification. There were 1013 images (Input size 224 × 224 × 3) in the collection, from which 4103 cells could be extracted. As a result, the CervixNet classifier model is developed using machine learning to detect cervical problems and diagnose cervical disease. Using pre-trained recurrent neural networks (RNNs), CervixNet extracted 1172 features, and after that, 792 features were selected using an independent principal component analysis (PCA) algorithm. The implemented models achieved the highest accuracy for predicting cervical cancer using different algorithms. The collected information has shown that integrating DT with the healthcare industry will enhance healthcare procedures by integrating patients and medical staff in a scalable, intelligent, and comprehensive health ecosystem. Finally, the suggested method produces an impressive 98.91 % classification accuracy in all classes, especially for support vector machines (SVM). [ABSTRACT FROM AUTHOR]

Cervical cancer screening through cytopathological images poses a significant challenge due to the intricate nature of cancer cells, often resulting in high misdiagnosis rates. This study presents the Integrated Attention-Transformer System (IATS), a pioneering framework designed to enhance the precision and efficiency of cervical cancer cell image analysis, surpassing the capabilities of existing deep learning models. Instead of relying solely on convolutional neural networks (CNNs), IATS leverages the power of transformers, a recently emerged architecture, to holistically capture both global and local features within the images. It employs a multi-pronged approach: Vision Transformer (ViT) module captures the overall spatial context and interactions between cells, providing a crucial understanding of potential cancer patterns. Token-to-token module zooms in on individual cells, meticulously examining subtle malignant features that might be missed by CNNs. SeNet integration with ResNet101 and DenseNet169 refines feature extraction by dynamically analyzing the importance of different features captured by these popular deep learning architectures. SeNet acts like a skilled analyst, prioritizing the most informative features for accurate cancer cell identification. Weighted voting combines the insights from each module, leading to robust and accurate identification, minimizing misdiagnosis risk. The proposed framework achieves an impressive accuracy of 98.44% on Mendeley dataset and 95.88% on SIPaKMeD dataset, outperforming 25 deep learning models, which included Convolutional Neural Network (CNN) and Vision Transformer (VT) models. These results reveal a 2.5% accuracy improvement compared to the best-performing CNN model on the Mendeley dataset. This significant advancement holds the potential to revolutionize cervical cancer screening by substantially reducing misdiagnosis rates and improving patient outcomes. While this study focuses on model performance, future work will explore its computational efficiency and real-world clinical integration to ensure its broader impact on patient care. • IATS, a novel architecture, aims to revolutionize cervical cancer diagnosis through image analysis. • IATS surpasses 25 models with 98.44% & 95.88% accuracy on Mendeley & SIPaKMeD datasets. • IATS: A game-changer for cervical cancer screening, paving the way for broader cancer detection advancements. • Emphasizing how the framework might reduce the probability of misdiagnosis and provide better patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Pain is the most common complaint among cancer patients, significantly impairing their health-related quality of life (HRQOL). There is limited evidence on the characteristics of pain among cancer patients in Nepal with low-resource settings.The primary objective of this study was to evaluate the clinical characteristics of pain, factors influencing pain intensity, and the association of pain severity with quality of life (QoL) among cancer patients. Secondary objectives included investigating perceived barriers to pain management and medication adherence among these patients.This multi-center, cross-sectional study enrolled adult patients (over 18 years old) with reported cancer diagnoses experiencing pain. Socio-demographic characteristics (e.g., age, gender, educational status), clinical characteristics (e.g. cancer diagnosis, staging), and pain characteristics (e.g., duration, type, location, medicines used for pain management, etc.) were recorded. Outcomes were assessed using the Numeric rating scale (NRS), Pain management Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire, Barriers Questionnaire II, Medication Adherence Rating Scale, and Hospital Anxiety and Depression Scale.Four hundred and eight patients participated in the study. The mean ± SD age was 54.87 ± 15.65, with 226 patients (55.4%) being female. The most common cancer diagnoses were cervical (17.6%), lung (11.8%), and colon/rectum (12.0%) cancers. The most common pain locations were the head and neck (27.0%); a majority (55.6%) reported pain duration of more than 3 months. Nociceptive pain was reported by 42.4% of patients; the mean ± SD of NRS was 4.31 ± 2.69, with 32.4% of patients experiencing moderate pain. Patients with mixed pain type (B = 1.458, p < 0.001) or pain in multiple sites (B = 1.175, p < 0.001), lower Karnofsky Performance Status (KPS) (B = -1.308, p < 0.001), and specific cancer diagnoses such as prostate (B = -2.045, p = 0.002), pancreatic (B = 1.852, p = 0.004), oesophageal (B = 1.674, p = 0.012), and ovarian cancer (B = 1.967, p = 0.047), experienced varying degrees of increased NRS score. The combined chemotherapy and radiotherapy treatment modality was associated with a lower NRS score (B = -0.583, p = 0.017). A significant inverse relationship was observed between pain severity and global health status/QoL (B = -37.36, p < 0.001. Key barriers to pain management included moderate perceptions of physiological effects, communication issues between doctors and patients, and concerns about the harmful effects of pain medicine. The prevalence of non-adherence to pain medications was 13.97%.In conclusion, this study highlights the multi-faceted nature of pain management and QoL for cancer patients in Nepal with low-resource settings. These findings underscore the multifactorial nature of pain perception in cancer patients, with mixed pain types, pain in multiple sites, lower KPS, and specific cancer diagnoses, all contributing significantly to pain severity. Additionally, pain severity was associated with declining QoL. These findings contribute valuable insights into the complex aspects of cancer pain and its broader implications for the well-being of patients, offering a foundation for targeted interventions and improved pain management strategies in the context of cancer care in low-resource settings.Objectives: Pain is the most common complaint among cancer patients, significantly impairing their health-related quality of life (HRQOL). There is limited evidence on the characteristics of pain among cancer patients in Nepal with low-resource settings.The primary objective of this study was to evaluate the clinical characteristics of pain, factors influencing pain intensity, and the association of pain severity with quality of life (QoL) among cancer patients. Secondary objectives included investigating perceived barriers to pain management and medication adherence among these patients.This multi-center, cross-sectional study enrolled adult patients (over 18 years old) with reported cancer diagnoses experiencing pain. Socio-demographic characteristics (e.g., age, gender, educational status), clinical characteristics (e.g. cancer diagnosis, staging), and pain characteristics (e.g., duration, type, location, medicines used for pain management, etc.) were recorded. Outcomes were assessed using the Numeric rating scale (NRS), Pain management Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire, Barriers Questionnaire II, Medication Adherence Rating Scale, and Hospital Anxiety and Depression Scale.Four hundred and eight patients participated in the study. The mean ± SD age was 54.87 ± 15.65, with 226 patients (55.4%) being female. The most common cancer diagnoses were cervical (17.6%), lung (11.8%), and colon/rectum (12.0%) cancers. The most common pain locations were the head and neck (27.0%); a majority (55.6%) reported pain duration of more than 3 months. Nociceptive pain was reported by 42.4% of patients; the mean ± SD of NRS was 4.31 ± 2.69, with 32.4% of patients experiencing moderate pain. Patients with mixed pain type (B = 1.458, p < 0.001) or pain in multiple sites (B = 1.175, p < 0.001), lower Karnofsky Performance Status (KPS) (B = -1.308, p < 0.001), and specific cancer diagnoses such as prostate (B = -2.045, p = 0.002), pancreatic (B = 1.852, p = 0.004), oesophageal (B = 1.674, p = 0.012), and ovarian cancer (B = 1.967, p = 0.047), experienced varying degrees of increased NRS score. The combined chemotherapy and radiotherapy treatment modality was associated with a lower NRS score (B = -0.583, p = 0.017). A significant inverse relationship was observed between pain severity and global health status/QoL (B = -37.36, p < 0.001. Key barriers to pain management included moderate perceptions of physiological effects, communication issues between doctors and patients, and concerns about the harmful effects of pain medicine. The prevalence of non-adherence to pain medications was 13.97%.In conclusion, this study highlights the multi-faceted nature of pain management and QoL for cancer patients in Nepal with low-resource settings. These findings underscore the multifactorial nature of pain perception in cancer patients, with mixed pain types, pain in multiple sites, lower KPS, and specific cancer diagnoses, all contributing significantly to pain severity. Additionally, pain severity was associated with declining QoL. These findings contribute valuable insights into the complex aspects of cancer pain and its broader implications for the well-being of patients, offering a foundation for targeted interventions and improved pain management strategies in the context of cancer care in low-resource settings.Methods: Pain is the most common complaint among cancer patients, significantly impairing their health-related quality of life (HRQOL). There is limited evidence on the characteristics of pain among cancer patients in Nepal with low-resource settings.The primary objective of this study was to evaluate the clinical characteristics of pain, factors influencing pain intensity, and the association of pain severity with quality of life (QoL) among cancer patients. Secondary objectives included investigating perceived barriers to pain management and medication adherence among these patients.This multi-center, cross-sectional study enrolled adult patients (over 18 years old) with reported cancer diagnoses experiencing pain. Socio-demographic characteristics (e.g., age, gender, educational status), clinical characteristics (e.g. cancer diagnosis, staging), and pain characteristics (e.g., duration, type, location, medicines used for pain management, etc.) were recorded. Outcomes were assessed using the Numeric rating scale (NRS), Pain management Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire, Barriers Questionnaire II, Medication Adherence Rating Scale, and Hospital Anxiety and Depression Scale.Four hundred and eight patients participated in the study. The mean ± SD age was 54.87 ± 15.65, with 226 patients (55.4%) being female. The most common cancer diagnoses were cervical (17.6%), lung (11.8%), and colon/rectum (12.0%) cancers. The most common pain locations were the head and neck (27.0%); a majority (55.6%) reported pain duration of more than 3 months. Nociceptive pain was reported by 42.4% of patients; the mean ± SD of NRS was 4.31 ± 2.69, with 32.4% of patients experiencing moderate pain. Patients with mixed pain type (B = 1.458, p < 0.001) or pain in multiple sites (B = 1.175, p < 0.001), lower Karnofsky Performance Status (KPS) (B = -1.308, p < 0.001), and specific cancer diagnoses such as prostate (B = -2.045, p = 0.002), pancreatic (B = 1.852, p = 0.004), oesophageal (B = 1.674, p = 0.012), and ovarian cancer (B = 1.967, p = 0.047), experienced varying degrees of increased NRS score. The combined chemotherapy and radiotherapy treatment modality was associated with a lower NRS score (B = -0.583, p = 0.017). A significant inverse relationship was observed between pain severity and global health status/QoL (B = -37.36, p < 0.001. Key barriers to pain management included moderate perceptions of physiological effects, communication issues between doctors and patients, and concerns about the harmful effects of pain medicine. The prevalence of non-adherence to pain medications was 13.97%.In conclusion, this study highlights the multi-faceted nature of pain management and QoL for cancer patients in Nepal with low-resource settings. These findings underscore the multifactorial nature of pain perception in cancer patients, with mixed pain types, pain in multiple sites, lower KPS, and specific cancer diagnoses, all contributing significantly to pain severity. Additionally, pain severity was associated with declining QoL. These findings contribute valuable insights into the complex aspects of cancer pain and its broader implications for the well-being of patients, offering a foundation for targeted interventions and improved pain management strategies in the context of cancer care in low-resource settings.Results: Pain is the most common complaint among cancer patients, significantly impairing their health-related quality of life (HRQOL). There is limited evidence on the characteristics of pain among cancer patients in Nepal with low-resource settings.The primary objective of this study was to evaluate the clinical characteristics of pain, factors influencing pain intensity, and the association of pain severity with quality of life (QoL) among cancer patients. Secondary objectives included investigating perceived barriers to pain management and medication adherence among these patients.This multi-center, cross-sectional study enrolled adult patients (over 18 years old) with reported cancer diagnoses experiencing pain. Socio-demographic characteristics (e.g., age, gender, educational status), clinical characteristics (e.g. cancer diagnosis, staging), and pain characteristics (e.g., duration, type, location, medicines used for pain management, etc.) were recorded. Outcomes were assessed using the Numeric rating scale (NRS), Pain management Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire, Barriers Questionnaire II, Medication Adherence Rating Scale, and Hospital Anxiety and Depression Scale.Four hundred and eight patients participated in the study. The mean ± SD age was 54.87 ± 15.65, with 226 patients (55.4%) being female. The most common cancer diagnoses were cervical (17.6%), lung (11.8%), and colon/rectum (12.0%) cancers. The most common pain locations were the head and neck (27.0%); a majority (55.6%) reported pain duration of more than 3 months. Nociceptive pain was reported by 42.4% of patients; the mean ± SD of NRS was 4.31 ± 2.69, with 32.4% of patients experiencing moderate pain. Patients with mixed pain type (B = 1.458, p < 0.001) or pain in multiple sites (B = 1.175, p < 0.001), lower Karnofsky Performance Status (KPS) (B = -1.308, p < 0.001), and specific cancer diagnoses such as prostate (B = -2.045, p = 0.002), pancreatic (B = 1.852, p = 0.004), oesophageal (B = 1.674, p = 0.012), and ovarian cancer (B = 1.967, p = 0.047), experienced varying degrees of increased NRS score. The combined chemotherapy and radiotherapy treatment modality was associated with a lower NRS score (B = -0.583, p = 0.017). A significant inverse relationship was observed between pain severity and global health status/QoL (B = -37.36, p < 0.001. Key barriers to pain management included moderate perceptions of physiological effects, communication issues between doctors and patients, and concerns about the harmful effects of pain medicine. The prevalence of non-adherence to pain medications was 13.97%.In conclusion, this study highlights the multi-faceted nature of pain management and QoL for cancer patients in Nepal with low-resource settings. These findings underscore the multifactorial nature of pain perception in cancer patients, with mixed pain types, pain in multiple sites, lower KPS, and specific cancer diagnoses, all contributing significantly to pain severity. Additionally, pain severity was associated with declining QoL. These findings contribute valuable insights into the complex aspects of cancer pain and its broader implications for the well-being of patients, offering a foundation for targeted interventions and improved pain management strategies in the context of cancer care in low-resource settings.Conclusion: Pain is the most common complaint among cancer patients, significantly impairing their health-related quality of life (HRQOL). There is limited evidence on the characteristics of pain among cancer patients in Nepal with low-resource settings.The primary objective of this study was to evaluate the clinical characteristics of pain, factors influencing pain intensity, and the association of pain severity with quality of life (QoL) among cancer patients. Secondary objectives included investigating perceived barriers to pain management and medication adherence among these patients.This multi-center, cross-sectional study enrolled adult patients (over 18 years old) with reported cancer diagnoses experiencing pain. Socio-demographic characteristics (e.g., age, gender, educational status), clinical characteristics (e.g. cancer diagnosis, staging), and pain characteristics (e.g., duration, type, location, medicines used for pain management, etc.) were recorded. Outcomes were assessed using the Numeric rating scale (NRS), Pain management Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire, Barriers Questionnaire II, Medication Adherence Rating Scale, and Hospital Anxiety and Depression Scale.Four hundred and eight patients participated in the study. The mean ± SD age was 54.87 ± 15.65, with 226 patients (55.4%) being female. The most common cancer diagnoses were cervical (17.6%), lung (11.8%), and colon/rectum (12.0%) cancers. The most common pain locations were the head and neck (27.0%); a majority (55.6%) reported pain duration of more than 3 months. Nociceptive pain was reported by 42.4% of patients; the mean ± SD of NRS was 4.31 ± 2.69, with 32.4% of patients experiencing moderate pain. Patients with mixed pain type (B = 1.458, p < 0.001) or pain in multiple sites (B = 1.175, p < 0.001), lower Karnofsky Performance Status (KPS) (B = -1.308, p < 0.001), and specific cancer diagnoses such as prostate (B = -2.045, p = 0.002), pancreatic (B = 1.852, p = 0.004), oesophageal (B = 1.674, p = 0.012), and ovarian cancer (B = 1.967, p = 0.047), experienced varying degrees of increased NRS score. The combined chemotherapy and radiotherapy treatment modality was associated with a lower NRS score (B = -0.583, p = 0.017). A significant inverse relationship was observed between pain severity and global health status/QoL (B = -37.36, p < 0.001. Key barriers to pain management included moderate perceptions of physiological effects, communication issues between doctors and patients, and concerns about the harmful effects of pain medicine. The prevalence of non-adherence to pain medications was 13.97%.In conclusion, this study highlights the multi-faceted nature of pain management and QoL for cancer patients in Nepal with low-resource settings. These findings underscore the multifactorial nature of pain perception in cancer patients, with mixed pain types, pain in multiple sites, lower KPS, and specific cancer diagnoses, all contributing significantly to pain severity. Additionally, pain severity was associated with declining QoL. These findings contribute valuable insights into the complex aspects of cancer pain and its broader implications for the well-being of patients, offering a foundation for targeted interventions and improved pain management strategies in the context of cancer care in low-resource settings. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) negative cancers are associated with symptomatic detection, late-stage diagnosis, and worse prognosis. It is thus essential to investigate all possible infectious agents and biomarkers that could early identify these HPV negative cancers. We aimed to analyze and compare the metatranscriptome present in HPV positive and HPV negative cervical cancers. We analyzed the whole RNA sequencing files from 223 HPV negative cervical cancers (negativity established after confirming cervical cancer diagnosis, sample adequacy and subjecting specimens to PCR and unbiased RNA sequencing), 223 HPV positive tumors and 11 blank paraffin block pools (used as controls) using Kraken2 software. Overall, 84 bacterial genera were detected, with 6/84 genera showing a positive median number of reads/sample and being present in both cervical tumor groups (HPV positive and negative). Viral reads belonged to 63 different viral genera, with 6/63 genera showing a positive median annotated read/sample value. No significant difference among genera was detected except for the presence of alpha-papillomaviruses. Metatranscriptome of bacteria and viruses present in HPV positive and HPV negative cervical cancers show no significant difference, except for HPV. Further studies are needed to early identify this biologically distinct group of cervical cancers. [ABSTRACT FROM AUTHOR]

Objectives: The study aims to investigate whether there is any difference between human papillomavirus (HPV) types, smear results, and colposcopic biopsy results in terms of iliac, uterine, and cervical artery pulsatility and resistive index values in high-risk HPV positive patients. Methods: Iliac, uterine, and cervical artery pulsatility and resistive index values were determined by pelvic Doppler ultrasonography in patients who applied for high-risk HPV positivity and underwent colposcopyguided cervical biopsy. Results: There was no difference between HPV types and Pap-smear results and the pulsatility and resistive indices of the iliac artery, uterine artery, and cervical artery. It was observed that the mean cervical artery pulsatility index of the patients whose colposcopic cervical biopsy result was cervical intraepithelial neoplasia (CIN) 1 was 1.61 ± 0.43 and the cervical artery pulsatility index of the patients with CIN 2-3 was 1.15 ± 0.28, and a statistically significant difference was found between them (p = 0.038). There was no difference between other Doppler indices and colposcopic cervical biopsy results. Conclusions: Doppler indices such as cervical artery pulsatility index may be helpful in the evaluation of cervical cancer precursor lesions. [ABSTRACT FROM AUTHOR]

(1) Background: HPV infection can progress over the years to become cervical cancer. In this study, genotype and a normalized viral load were evaluated as surrogate markers of progression to cancer. (2) Methods: A total of 558 endocervical swabs were collected from 120 women (mean, 40.1 ± 11.8 years old). Seventy-eight of the women underwent clinical intervention (CI) to clear the infection during the course of the study, while forty-two did not (NCI). Normalized viral load (NVL) was calculated using a COBAS 4800 system. The INNOLIPA genotyping system was used to classify HPV which was neither type 16 or 18. (3) Results: The mean age of CI women was 41.1 ± 11.4 (22–68) years old and that of the NCI group was 37.7 ± 12.13 (23–65) (p: 0.104). HPV16 was present in 11 (25%) NCI and 30 (35.2%) CI patients, HPVα9non16 in 20 (45%) NCI and 34 (40%) CI, and HPVnonα9 in 13 (29.5%) NCI and 21 (24.7%) CI (p = 0.48). In NCI women there was an average NVL decrease of 0.95 log after two years and a further decrease of 2.35 log at the end of the third year. At the end of the study, 34 (80%) of the NCI patients were clear of HPV. However, NVL of CI women remained at around 5 log until intervention (p < 0.001). (4) Conclusions: Viral load decreased in NCI women at follow-up in the second year. In contrast, in CI women, their viral load did not fall over the follow-up period. This work thus demonstrates that a reduction in normalized viral load was associated with good evolution. [ABSTRACT FROM AUTHOR]

Background and aims: Cervical cancer is one of the most common cancers of the female reproductive system. Despite the importance of cervical cancer screening in early detection, the uptake of screening is poor. The present study aimed to predict the factors that influence the cervical cancer screening behavior of Iranian women visiting health centers. Methods: This cross-sectional study was performed on 661 women of reproductive age referred to health centers in Karaj, Iran, in 2021, who were selected by convenience sampling. Data collection was performed with a multi-sectional questionnaire designed to collect information about demographic characteristics and constructs of Protection Motivation Theory (PMT) and emotional support. Data analysis was performed using SPSS version 24.0, and AMOS version 24. Results: The mean age of the participants was 38.2±13.77. Most of the participants had a high school diploma and a moderate socioeconomic status. The results showed the direct effect of intention on behavior (β=0.54) and the direct effect of fear on intention (β=-0.66). Perceived self-efficacy had the greatest indirect effect on behavior through intention (β=0.34). All protection motivation constructs except response cost (β=0.06) showed a significant effect on cervical cancer screening behavior. Model fit indices showed the good capability of the extended protection motivation model to predict cervical cancer screening behavior. Conclusion: Perceived self-efficacy is the strongest predictor of cervical cancer screening behavior, and emotional support affects this behavior through self-efficacy and intention. Therefore, it is recommended to pay attention to these factors when designing and planning educational interventions for improving cervical cancer screening behavior. [ABSTRACT FROM AUTHOR]

Background/Aim: Cervical cancer remains a major public health concern. The ratio of CD4+:CD8+ Tcells is used to evaluate the immune system function. This study aimed to explore the CD4+:CD8+ T-cell ratio in relation to the glycemic status, inflammatory markers, vitamin D, and vitamin B12 in patients with early diagnosed cervical cancer. Patients and Methods: This is a crosssectional study. Blood samples were collected for flow cytometry analysis. Information regarding Papanicolaou (Pap) smears and colposcopy investigations were collected from 152 women with type 2 diabetes admitted to East Jeddah Hospital, Jeddah, Saudi Arabia, between January 2018 and January 2021. Results: Patients with early cervical carcinoma and a higher CD4+:CD8+ ratio (>1.2) had a higher C-reactive protein (CRP) level than those with a lower CD4+:CD8+ ratio (Mean±SD=13.75±13.3 vs. 10.85±8.1; p-value=0.034). Patients with early cervical carcinoma, diabetes, and higher CD4+:CD8+ ratio (>1.2) had a higher blood HbA1c percent than those with a lower CD4+:CD8+ ratio. Conclusion: A high CD4+:CD8+ T-cells ratio was associated with an increased HbA1c% and CRP levels in women with diabetes diagnosed with early cervical carcinoma, which can induce inflammation in early diagnosed patients with cervical cancer. [ABSTRACT FROM AUTHOR]

Background and Objectives: Cervical cancer is a leading cause of mortality among women. Chemo-radiation followed by interventional radiotherapy (IRT) is the standard of care for stage IB–IVA FIGO. Several studies have shown that image-guided adaptive IRT resulted in excellent local and pelvic control, but it is associated with vaginal toxicity and intercourse problems. The purpose of this review is to evaluate the dysfunctions of the sexual sphere in patients with cervical cancer undergoing different cervix cancer treatments. Materials and Methods: We performed a comprehensive literature search using Pub med, Scopus and Cochrane to identify all the full articles evaluating the dysfunctions of the sexual sphere. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Results: One thousand three hundred fifty-six women included in five studies published from 2016 to 2022 were analyzed. The median age was 50 years (range 46–56 years). The median follow-up was 12 months (range 0–60). Cervical cancer diagnosis and treatment (radiotherapy, chemotherapy and surgery) negatively affected sexual intercourse. Sexual symptoms such as fibrosis, strictures, decreased elasticity and depth and mucosal atrophy promote sexual dysfunction by causing frigidity, lack of lubrication, arousal, orgasm and libido and dyspareunia. Conclusions: Physical, physiological and social factors all contribute to the modification of the sexual sphere. Cervical cancer survivors who were irradiated have lower sexual and vaginal function than the normal population. Although there are cures for reducing discomfort, effective communication about sexual dysfunctions following treatment is essential. [ABSTRACT FROM AUTHOR]

Among gynecological cancers, cervical cancer is a common malignancy and remains the leading cause of cancer-related death for women. However, the exact molecular pathogenesis of cervical cancer is not known. Hence, understanding the molecular mechanisms underlying cervical cancer pathogenesis will aid in the development of effective treatment modalities. In this research, we attempted to discern candidate biomarkers for cervical cancer by using multiple bioinformatics approaches. First, we performed differential expression analysis based on cervical squamous cell carcinoma and endocervical adenocarcinoma data from The Cancer Genome Atlas database, then used differentially expressed genes for weighted gene co-expression network construction to find the most relevant gene module for cervical cancer. Next, the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed on the module genes, followed by using protein-protein interaction network analysis and Cytoscape to find the key gene. Finally, we validated the key gene by using multiple online sites and experimental methods. Through weighted gene co-expression network analysis, we found the turquoise module was the highest correlated module with cervical cancer diagnosis. The biological process of the module genes focused on cell proliferation, cell adhesion, and protein binding processes, while the Kyoto Encyclopedia of Genes and Genomes pathway of the module significantly enriched pathways related to cancer and cell circle. Among the module genes, SOX9 was identified as the hub gene, and its expression was associated with cervical cancer prognosis. We found the expression of SOX9 correlates with cancer-associated fibroblast immune infiltration in immune cells by Timer2.0. Furthermore, cancer-associated fibroblast infiltration is linked to cervical cancer patients' prognosis. Compared to those in normal adjacent, immunohistochemical and real-time quantitative polymerase chain reaction (qPCR) showed that the protein and mRNA expression of SOX9 in cervical cancer were higher. Therefore, the SOX9 gene acts as an oncogene in cervical cancer, interactive with immune infiltration of cancer-associated fibroblasts, thereby affecting the prognosis of patients with cervical cancer. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare histological outcomes between pre-menopausal and post-menopausal women with cervical cytological abnormalities and to investigate the clinical factors affecting the misinterpretation of cytology and histology. Methods: We conducted a retrospective analysis of 599 patients with abnormal cervical cytology who underwent loop electrosurgical excision procedure (LEEP) between January 2010 and May 2019. Baseline characteristics were collected, including age, height, weight, body mass index, gravity, parity, and menopausal status. In total, 477 pre-menopausal women and 122 post-menopausal women were recruited. Results: Atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions were cytologically observed in 73.4% (135/184) of the pre-menopausal women, which were high-grade lesions confirmed by LEEP. In postmenopausal patients with cytology results that cannot exclude high-grade squamous intraepithelial lesions (ASC-H) or high-grade squamous intraepithelial lesions (HSIL), 27.0% (24/89) were confirmed to have histologically low-grade lesions. High-risk HPV (hrHPV) prevalence in abnormal cervical smears was 92.2%. Moreover, other hrHPVs had a higher risk of unexpected histological outcomes unrelated to cytologic results. Conclusions: Menopausal status and HPV infection are associated with misinterpretation of cervical cytology and histology. Therefore, the menopausal status of patients should be considered for the management of cervical cytology, and primary co-testing is recommended to identify women at risk of cervical abnormalities. [ABSTRACT FROM AUTHOR]

Previous studies suggest that sleeping problems are frequent after cervical cancer. However, the evidence on the use of hypnotics is sparse. We investigated if women diagnosed with cervical cancer have an increased risk of using hypnotics and identified risk factors for prolonged use. In this nationwide register-based cohort study, 4264 women diagnosed with cervical cancer from 1997 to 2013 and 36,632 cancer-free women were followed in registers until 2016. Prolonged use of hypnotics was defined as more than three prescriptions with no more than three months in between. Data were analysed using Cox proportional hazards regression models and multistate Markov models separately for women with localized and advanced cervical cancer. The rate of first use of hypnotics was substantially increased during the first year after cervical cancer diagnosis compared to cancer-free women (HR localized 4.4, 95% CI 3.9–5.1; HR advanced 8.9, 95% CI 7.5–10.6) and remained markedly increased for up to five years after diagnosis. Dependent on stage of disease and age, 1.4 to 4.7 excess women per 100 with cervical cancer were prolonged users of hypnotics compared to cancer-free women one year after diagnosis. Risk factors for prolonged use of hypnotics were higher age, short education, previous use of antidepressants or anxiolytics, and advanced disease. Women diagnosed with cervical cancer are at increased risk of prolonged use of hypnotics. For the majority, treatment with hypnotics is initiated within the first year after cancer diagnosis, but the rate of first use is increased for up to five years. • Women with cervical cancer are more likely to become prolonged users of hypnotics than women without a history of cancer. • Risk factors are higher age, short education, previous antidepressant/anxiolytic use, and advanced disease. • The risk of initiating treatment with hypnotics is increased up to 5 years after cervical cancer diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Studies have shown that cancer screenings dropped dramatically following the onset of the coronavirus diseases 2019 (COVID‐19) pandemic. In this study, we examined differences in rates of cervical and colorectal cancer (CRC) screening and diagnosis indicators before and during the first year of the COVID‐19 pandemic. Methodology: We used retrospective data from a large healthcare system in Washington State. Targeted screening data included completed cancer screenings for both CRC (colonoscopy) and cervical cancer (Papanicolaou test (Pap test)). We analyzed and compared the rate of uptake of colorectal (colonoscopies) and cervical cancer (Pap) screenings done pre‐COVID‐19 (April 1, 2019–March 31, 2020) and during the pandemic (April 1, 2020–March 31, 2021). Results: A total of 26,081 (12.7%) patients underwent colonoscopies in the pre‐COVID‐19 period, compared to only 15,708 (7.4%) patients during the pandemic, showing a 39.8% decrease. A total of 238 patients were referred to medical oncology for CRC compared to only 155 patients during the first year of the pandemic, a reduction of 34%. In the pre‐COVID‐19 period, 22,395 (10.7%) women were administered PAP tests compared to 20,455 (9.6%) women during the pandemic, for a 7.4% reduction. period 1780 women were referred to colposcopy, compared to only 1680 patients during the pandemic, for a 4.3% reduction. Conclusion: Interruption in screening and subsequent delay in diagnosis during the pandemic will likely lead to later‐stage diagnoses for both CRC and cervical cancer, which is known to result in decreased survival. Impact: The results emphasize the need to prioritize cancer screening, particularly for those at higher risk. [ABSTRACT FROM AUTHOR]

We report the case of a 29-year-old patient with low-grade squamous intraepithelial lesion (L-SIL), negative human papilloma virus (HPV), positive p16/Ki-67 dual-staining and colposcopy suggestive for severe dysplastic lesion. The patient underwent a loop electrosurgical excision procedure (LEEP), the pathology report revealing mesonephric hyperplasia and adenocarcinoma. The patient also opted for non-standard fertility-sparing treatment. The trachelectomy pathology report described a zone of hyperplasia at the limit of resection towards the uterine isthmus. Two supplementary interpretations of the slides and immunohistochemistry (IHC) were performed. The results supported the diagnosis of mesonephric adenocarcinoma, although with difficulty in differentiating it from mesonephric hyperplasia. Given the discordant pathology results that were inconclusive in establishing a precise diagnosis of the lesion and the state of the limits of resection, the patient was referred to a specialist abroad. Furthermore, the additional interpretation of the slides and IHC were performed, the results suggesting a clear cell carcinoma. The positive p16/Ki-67 dual-staining prior to LEEP, the non-specific IHC and the difficulties in establishing a diagnosis made the case interesting. Given the limitations of cytology and the fact that these variants are independent of HPV infection, dual staining p16/Ki-67 could potentially become useful in the diagnosis of rare adenocarcinoma variants of the cervix, however further documentation is required. [ABSTRACT FROM AUTHOR]

Background: The French organized population-based cervical cancer screening (CCS) program transitioned from a cytology-based to a human papillomavirus (HPV)-based screening strategy in August 2020. HPV testing is offered every 5 years, starting at the age of 30 years. In the new program, women are invited to undergo an HPV test at a gynecologist's, primary care physician's, or midwife's office, a private clinic or health center, family planning center, or hospital. HPV self-sampling (HPVss) was also made available as an additional approach. However, French studies reported that less than 20% of noncompliant women performed vaginal self-sampling when a kit was sent to their home. Women with lower income and educational levels participate less in CCS. Lack of information about the disease and the benefits of CCS were reported as one of the major barriers among noncompliant women. This barrier could be addressed by overcoming disparities in HPV- and cervical cancer-related knowledge and perceptions about CCS. Objective: This study aimed to assess the effectiveness of a chatbot-based decision aid to improve women's participation in the HPVss detection-based CCS care pathway. Methods: AppDate-You is a 2-arm cluster randomized controlled trial (cRCT) nested within the French organized CCS program. Eligible women are those aged 30-65 years who have not been screened for CC for more than 4 years and live in the disadvantaged clusters in the Occitanie Region, France. In total, 32 clusters will be allocated to the intervention and control arms, 16 in each arm (approximately 4000 women). Eligible women living in randomly selected disadvantaged clusters will be identified using the Regional Cancer Screening Coordinating Centre of Occitanie (CRCDC-OC) database. Women in the experimental group will receive screening reminder letters and HPVss kits, combined with access to a chatbot-based decision aid tailored to women with lower education attainment. Women in the control group will receive the reminder letters and HPVss kits (standard of care). The CRCDC-OC database will be used to check trial progress and assess the intervention's impact. The trial has 2 primary outcomes: (1) the proportion of screening participation within 12 months among women recalled for CCS and (2) the proportion of HPVss-positive women who are "well-managed" as stipulated in the French guidelines. Results: To date, the AppDate-You study group is preparing and developing the chatbot-based decision aid (intervention). The cRCT will be conducted once the decision aid has been completed and validated. Recruitment of women is expected to begin in January 2023. Conclusions: This study is the first to evaluate the impact of a chatbot-based decision aid to promote the CCS program and increase its performance. The study results will inform policy makers and health professionals as well as the research community. Trial Registration: ClinicalTrials.gov NCT05286034; https://clinicaltrials.gov/ct2/show/NCT05286034 International Registered Report Identifier (IRRID): PRR1-10.2196/39288 [ABSTRACT FROM AUTHOR]

The accurate segmentation of cervical cell images is one of the key steps of the cervical cancer computer-aided diagnosis system. For the problem of overlapping cell and boundary blurring in cervical cell clusters, the researchers propose a segmentation algorithm based on the nuclear radial boundary enhancement for overlapping cell of cervical cytology images. This method not only suppresses the noise of cervical cytology images but also preserves the contrast of overlapping cell boundary. The researchers generate the weight graph by the candidate contour points and contour line segment attributes and utilize the dynamic programming algorithm to find the shortest path in the weight graph. The shortest path corresponds to the coarse segmentation contour in the cell image. The level set model is used to finely segment the obtained coarse cell segmentation boundary, so as to obtain the final cervical cell boundary. Through the quantitative and qualitative evaluation results, such as dice similarity coefficient, true positive rate, and false positive rate, it can be seen that the overlapping cell segmentation algorithm in this paper has achieved better segmentation results. Compared with other current overlap cell segmentation algorithms, the segmentation results obtained in this paper have greater advantages. [ABSTRACT FROM AUTHOR]

Graphene Quantum Dots (GQDs) have attracted significant attention and applications in the field of biosensors, particularly for early detection of cervical cancer, due to their excellent electrochemical, optical, and biocompatibility properties. In this review, recent results on green methods for the synthesis of GQDs as well as their characterization techniques are discussed, with particular emphasis on structural, morphological, elemental, optical, and functional group analysis. In addition, a comprehensive overview of how the electrochemical and biocompatibility properties of GQDs enable their use in the development of sensing elements for biosensing applications is presented. This paper also highlights the most recent developments in the fabrication of GQDs‐based biosensors for cervical cancer detection. Finally, the future prospects are critically discussed to assist researchers in identifying the shortcomings of the existing biosensors and establishing new methods centered on the development of unique, efficient, sensitive and selective GQDs‐based biosensors. [ABSTRACT FROM AUTHOR]

Objectives: To determine the application value of thinprep cytologic test (TCT) combined with serum carbohydrate antigen 153 (CA153) and carbohydrate antigen 50 (CA50) detection in the early diagnosis and screening of cervical cancer and precancerous lesions. Methods: A total of 187 females with cervical lesions admitted to Shanghai 7th People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2017 to December 2018 were selected and divided into two groups: the cervical cancer group and the cervical precancerous lesion group, with 16 cases in the cervical cancer group and 171 cases in the cervical precancerous lesion group (cervical precancerous lesions were divided into 63 cases of the CNI group, 59 cases of the CNII group and 49 cases of the CNIII group). During the same period, 106 healthy females were selected as the healthy group. The serum tumor markers CA153 and CA50 of all subjects were detected by chemiluminescence method; The diagnostic value of TCT combined with serum CA153 and CA50 in cervical cancer and precancerous lesions was analyzed with colposcopy pathological diagnosis results as gold standard; ROC curve was drawn to evaluate the diagnostic value of serum TCT, CA153 and CA50 in cervical cancer and precancerous lesions. Results: The levels of serum CA153 and CA50 in the cervical cancer group were significantly higher than those in the cervical precancerous lesion group and the healthy group (p< 0.05), and the levels of serum CA153 and CA50 in the cervical precancerous lesion group were significantly higher than those in the healthy group (p< 0.05). The sensitivity of TCT, serum CA153 and serum CA50 in the single detection of cervical cancer and precancerous lesions was 95.93%, 97.54% and 96.00%, the specificity was 59.41%, 60.23%, 60.12%, the accuracy was 74.74%, 75.77%, 75.43%, the positive predictive value was 62.03%, 63.64%, 63.10%, and the negative predictive value was 96.22%, 97.17% and 95.28%, respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TCT combined with serum CA153 and CA50 were 96.77%, 73.19%, 85.67%, 80.21% and 95.28%, respectively. ROC curve showed that the area under the curve (AUC) of TCT and serum CA153 and CA50 in the single detection of cervical cancer and precancerous lesions was 0.791, 0.864 and 0.787, respectively, the AUC of combined detection of TCT and serum CA153 and CA50 in patients with cervical cancer and precancerous lesions was 0.877, which was significantly higher than that of single detection (p< 0.05). Conclusions: TCT combined with serum CA153 and CA50 has been reported as a treatment regimen with high accuracy, which has a high diagnostic efficiency for early diagnosis of cervical cancer and precancerous lesions, and can significantly improve the sensitivity. [ABSTRACT FROM AUTHOR]

Romania has a high ocurrence and death rate caused by cervical cancer. Most affected by HPV infection are fertile women (65 %) whilst the percentage of menopausal women is 35%. This study aims the comprehension of all the paths in which HPV affects the pathogeny of the squamous intraepithelial lesions, and the overview of diagnosis. The specific pathogens were Cаndidа ѕp (3 %) and Trichomonаѕ vаginаliѕ (1 %). The cure in precancerous lesions should start immediately after a certain diagnosis. Cervical cancer is curable as long as one is aware of it. [ABSTRACT FROM AUTHOR]

The Pap test serves for diagnosis purposes, recommended by the gynecologist or for the early depict of precancerous lesions. Women are assessed every 3 years by means of the Pap test, revealing the benefits of the screening programs. The main cause that induces this type of cancer is the HPV infection 95%. Cervix cancer, along with melanoma and breast cancer, may be prevented by early diagnosis and treatment. Early diagnosis for this disease is a key factor to achieve therapeutical success, considering the outburst of pacients. [ABSTRACT FROM AUTHOR]

Background: Colposcopy imaging is widely used to diagnose, treat and follow-up on premalignant and malignant lesions in the vulva, vagina, and cervix. Thus, deep learning algorithms are being used widely in cervical cancer diagnosis tools. In this study, we developed and preliminarily validated a model based on the Unet network plus SVM to classify cervical lesions on colposcopy images. Methodology: Two sets of images were used: the Intel & Mobile ODT Cervical Cancer Screening public dataset, and a private dataset from a public hospital in Ecuador during a routine colposcopy, after the application of acetic acid and lugol. For the latter, the corresponding clinical information was collected, specifically cytology on the PAP smear and the screening of human papillomavirus testing, prior to colposcopy. The lesions of the cervix or regions of interest were segmented and classified by the Unet and the SVM model, respectively. Results: The CAD system was evaluated for the ability to predict the risk of cervical cancer. The lesion segmentation metric results indicate a DICE of 50%, a precision of 65%, and an accuracy of 80%. The classification results' sensitivity, specificity, and accuracy were 70%, 48.8%, and 58%, respectively. Randomly, 20 images were selected and sent to 13 expert colposcopists for a statistical comparison between visual evaluation experts and the CAD tool (p-value of 0.597). Conclusion: The CAD system needs to improve but could be acceptable in an environment where women have limited access to clinicians for the diagnosis, follow-up, and treatment of cervical cancer; better performance is possible through the exploration of other deep learning methods with larger datasets. [ABSTRACT FROM AUTHOR]

Objectives: Human papillomavirus infection (HPV) is one of the most common sexually transmitted diseases. Long-term exposure to the HPV leads to development of high-grade squamous intraepithelial lesions that can eventually transform into cervical cancer. The aim of the study was to assess the HPV genotype distribution in patients with abnormal pap smear and provide prospective study. Material and methods: We obtained material from 674 women who registered to Specialist Medical Practice in the years 2008-2020. The sample for the molecular test was collected using combi brush and forwarded to the independent, standardized laboratory. HPV detection was done using PCR followed by DNA enzyme immunoassay and reverse hybridization line probe assay for virus genotyping. Sequence analysis was performed to characterize virus genotypes in HPV -- positive samples. Results: We found that 53% of patients tested positive for HPV. The percentage decreased with age. The following HPV types were the most common: HPV -- 16 (24.5%), HPV -- 53 (13.1%), HPV -- 31 (10.3%), HPV -- 51 (9.7%), HPV -- 56 (9.5%). Conclusions: Our results suggest that type-specific, high-risk HPV DNA -- based screening should focus on HPV types 16, 31, 51, 56. [ABSTRACT FROM AUTHOR]

Prevention of cervical cancer becomes essential and is carried out by the use of Pap smear images. Pap smear test analysis is laborious and tiresome work performed visually using a cytopathologist. Therefore, automated cervical cancer diagnosis using automated methods are necessary. This paper designs an optimal deep learning based Inception model for cervical cancer diagnosis (ODLIM-CCD) using pap smear images. The proposed ODLIM-CCD technique incorporates median filtering (MF) based pre-processing to discard the noise and Otsu model based segmentation process. Besides, deep convolutional neural network (DCNN) based Inception with Residual Network (ResNet) v2 model is utilized for deriving the feature vectors. Moreover, swallow swarm optimization (SSO) based hyperparameter tuning process is carried out for the optimal selection of hyperparameters. Finally, recurrent neural network (RNN) based classification process is done to determine the presence of cervical cancer or not. In order to showcase the improved diagnostic performance of the ODLIM-CCD technique, a series of simulations occur on benchmark test images and the outcomes highlighted the improved performance over the recent approaches with a superior accuracy of 0.9661. [ABSTRACT FROM AUTHOR]

Cervical cancer is the most common gynecological malignancy and screening for risk factors with early detection has been shown to reduce the mortality. In this study, we aimed to analyze the characteristics and risk factors of human papillomavirus (HPV) infection and precancerous lesions in women and provide clinical evidence for developing strategies to prevent cervical precancerous lesions and cancer in women. Furthermore, we evaluated the influencing factors for high-risk HPV infection. From April 2018 to December 2021, 10,628 women were recruited for cervical cancer screening at Liaoning Cancer Hospital, Shenyang Sujiatun District Women's and Infants Hospital, Benxi Manchu Autonomous County People's Hospital, and Shandong Affiliated Hospital of Qingdao University. The study participants were tested to determine if they were HPV-positive (HPV +) or underwent thinprep cytology test (TCT) for atypical squamous cells of undetermined significance (ASCUS) and above. Furthermore, colposcopies and biopsies were performed for the histopathological examination. Finally, 9991 cases were included in the statistical analysis, and the factors influencing HPV infection and those related to cervical cancer and precancerous lesions were analyzed. HPV + infection, high-grade squamous intraepithelial lesion-positive (CINII +) in cervical high-grade intraepithelial neoplasia, and early cervical cancer diagnosis rates were 12.45, 1.09, and 95.41%, respectively. The potential risk factors for HPV were education ≤ high school [odds ratio (OR) = 1.279 (1.129–1.449), P < 0.001], age at initial sexual activity ≤ 19 years [OR = 1.517 (1.080–2.129), P = 0.016], sexual partners > 1 [OR = 1.310 (1.044–1.644), P = 0.020], ASCUS and above [OR = 11.891 (10.105–13.993), P < 0.001], non-condom contraception [OR = 1.255 (1.059–1.487), P = 0.009], and HSIL and above [OR = 1.541 (1.430–1.662), P < 0.001]. Compared with women aged 56–65 and 35–45 years [OR = 0.810 (0.690–0.950), P = 0.010] the HPV infection rate was significantly lower in those aged 46–55 years [OR = 0.79 (0.683–0.915), P = 0.002]. Furthermore, ≤ high school age [OR = 1.577 (1.042–2.387), P = 0.031], not breastfeeding [OR = 1.763 (1.109–2.804), P = 0.017], ASCUS and above [OR = 42.396 (28.042–64.098), P < 0.001] were potential risk factors for cervical cancer and precancerous lesions. In women with HPV infection, ≤ high school education level, initial sexual activity at ≤ 19 years of age, number of sexual partners > 1, ASCUS and above, non-condom contraception, HSIL and above were risk factors for HPV infection. Compared with women aged 56–65 years, those aged 35–45 and 46–55 years had significantly lower HPV infection rates, and high school age and below, non-breastfeeding, and ASCUS and above were all potential risk factors for cervical cancer and precancerous lesions. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study is to explore the expressions and clinical significance of melanoma-associated antigen-A9 (MAGE-A9) in cervical cancer tissues and peripheral blood mononuclear cells (PBMC). Methods. 108 patients who were scheduled to undergo cervical conization or extensive hysterectomy between March 2019 and January 2021 due to cervical lesions were selected by convenient sampling. According to postoperative pathological results, the patients were divided into a cervical cancer group (n = 64) and cervical intraepithelial neoplasia (CIN) group (n = 44). The expression levels of MAGE-A9 mRNA in cervical lesion tissues and PBMC were detected by real-time fluorescence quantitative PCR, and the expression of MAGE-A9 protein in lesion tissues was detected by immunohistochemistry. The correlation between MAGE-A9 mRNA expressions in cancer tissues and PBMC and serum tumor markers in patients with cervical cancer and the relationship between MAGE-A9 protein expression in cancer tissues and clinicopathological characteristics were analyzed, and a receiver operating characteristic curve (ROC curve) was drawn to explore the diagnostic value of MAGE-A9 mRNA expressions in cancer tissues and PBMC on cervical cancer. Results. The expression levels of MAGE-A9 mRNA in cervical lesion tissues and PBMC in the cervical cancer group were significantly higher than those in the CIN group (P < 0.05), and the levels of serum SCC-Ag, CA-125, and CEA were significantly higher than those in the CIN group (P < 0.05). The positive rate of the MAGE-A9 protein expression in cervical lesion tissues in the cervical cancer group was significantly higher than that in the CIN group (P < 0.05). The expression levels of MAGE-A9 mRNA in cancer tissues and PBMC of patients with cervical cancer were positively correlated with serum SCC-Ag, CA-125, and CEA (P < 0.05). The positive rate of the MAGE-A9 protein expression in cervical cancer tissues was related to FIGO stage, tumor diameter, degree of differentiation, lymph node metastasis, and high-risk HPV infection (P < 0.05) and was not correlated with age and pathological type (P > 0.05). The areas under the ROC curves of MAGE-A9 mRNA in lesion tissue and MAGE-A9 mRNA in PBMC were 0.925 and 0.900 in the diagnosis of cervical cancer (P < 0.05). Conclusion. The expressions of MAGE-A9 in cancer tissues and PBMC of patients with cervical cancer are upregulated, which is related to the levels of serum tumor markers and the progression of disease. MAGE-A9 is expected to become an important marker for the diagnosis of early cervical cancer. [ABSTRACT FROM AUTHOR]

Introduction: Cervical cancer is the second most common female cancer in Ghana. The disease and its treatment significantly affect survivors' health-related quality of life (HRQoL). We determined the overall quality of life (QoL) and identified its predictors among cervical cancer survivors after treatment. Materials and methods: A hospital-based cross-sectional analytical study was conducted on 153 disease-free cervical cancer survivors who completed curative treatment between January 2004 and December 2018 at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. We used the European Organization for Research and Treatment of Cancer core-30 item (EORTC QLQ-C30) and cervical cancer module (EORTC QLQ-CX24) to assess the survivors' overall QoL. QoL domain scores were dichotomised as affected or unaffected by disease and its treatment. Significant differences between the affected and unaffected groups within each QoL domain were determined using the student T-test. We used Kruskal-Wallis and Dunn's tests to examine the difference in QoL domains between treatment types, with significance based on Bonferroni corrections. Multivariable logistic regression was performed to identify predictors of overall QoL. A p-value of less than 0.05 was considered statistically significant. Results: One hundred and fifty-three (153) women having a mean age of 58.3 (SD 11.4) years were studied. The overall QoL score was 79.6 (SD 16.0), and 74.5% of survivors reported good QoL score within the median follow up time of 41.8 months (interquartile range [IQR], 25.5–71.1 months) after cervical cancer diagnosis. Although the majority (66.0–84.3%) of the QoL functioning scale were unaffected, about a fifth (22.2%) to a third (34.5%) of the subjects had perceptual impairment in cognitive and role functioning. Financial difficulties, peripheral neuropathy and pain were most common symptoms reported as affected. A third of the survivors were worried that sex would be painful, and 36.6% indicated that their sexual activity as affected. The overall QoL scores for survivors who had surgery, chemoradiation and radiation-alone were 86.1 (SD 9.7), 76.9 (SD 17.7), and 80.7 (SD 14.7), respectively (p = 0.025). The predictors of survivor's overall QoL were loss of appetite [Adjusted Odd Ratio (AOR) = 9.34, 95% Confidence Interval (CI) = 2.13–35.8, p = 0.001], pain (AOR = 3.53, 95% CI = 1.25–9.31, p = 0.017) and body image (AOR = 5.89, 95% CI = 1.80–19.27, p = 0.003). Conclusion: About 75% of the survivors had a good overall quality of life. Primary surgical treatment affords the best prospects for quality of life with the least symptom complaints and financial burden. Loss of appetite, pain or diminution in body image perception predicted the overall quality of life of cervical cancer survivors after treatment. [ABSTRACT FROM AUTHOR]

Background and purpose: The Shanghai Municipal Center for Disease Control and Prevention provides annual updates on cancer occurrence and trends in Shanghai. This study aimed to investigate the cervical cancer incidence and mortality in 2016 and their trends from 2002 to 2016 in Shanghai. Methods: Data of new cervical cancer diagnoses and deaths from 2002 to 2016 were obtained from the population-based cancer registry and Vital Statistics System of Shanghai Municipal Center for Disease Control and Prevention. Cervical cancer incidence and mortality stratified by year of diagnosis or death, and age group were analyzed. Number, proportion, crude rate, age-specific rate, age-standardized rate and others were calculated. The number, proportion and rates of common cancers in different groups were also calculated. Trends in number, age-standardized rates and age-specific rates of incidence and death were estimated. Trends in age-standardized rates of incidence and death were estimated by Joinpoint analysis and characterized by the annual percent change (APC). The cases and proportion of selected diagnostic characteristics in different periods of diagnosis years grouped were also calculated. Segi's 1960 world standard population was used for calculating age-standardized rates of incidence and mortality. Results: The new cervical cancer cases and deaths were 987 and 267 in Shanghai in 2016. The crude rate of incidence was 13.53/105, and the age-standardized rate of incidence was 8.26/105. The crude rate of mortality was 3.66/105, and the age-standardized rate of mortality was 1.87/105. The age-specific number and rate of incidence reached the peak in the age group of 55-59 years and 45-49 years respectively, while those of mortality reached the peak in the age group of 50-54 years and 80-84 years respectively. The standardized incidence rate of cervical cancer increased by an average annual growth of 12.51% from 2002 to 2010 and 3.12% per year from 2010 to 2016 in Shanghai. The standardized mortality rate increased by 4.52% per year from 2002 to 2016. The major histopathological type of cervical cancer was squamous cell carcinoma. The proportions of morphological verification and stage Ⅰwere increasing. Conclusions: In Shanghai, the incidence and mortality of cervical cancer were at a lower level of the world, but they were increasing. The current status and trends reflect Shanghai permanent population changes in risk factors, screening test use, diagnostic practices and treatment advances. Improvement of the surveillance and research on cervical cancer will help to promote more efficient control and prevention strategies and decrease cancer burden. [ABSTRACT FROM AUTHOR]