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Introduction: This article elicits our experiences and strategic approaches to ensure the sustainability of the online capacity-building programmes for healthcare providers (HCPs) in comprehensive cancer screening through the 'Hub and Spoke' model during the coronavirus disease (COVID-19) pandemic. Methods: During the first wave of COVID-19, training for three cohorts of medical officers (MO) (Batch-A) was ongoing (May-December 2020). The Indian health system abruptly shifted focus towards containing the COVID-19 spread, leading to new challenges in conducting training courses. A new five-step strategic approach for cohort MO-14 (Batch-B) was adopted to spread awareness about the importance of cancer screening and the roles and responsibilities of HCPs in the implementation and conduct of practical sessions in their states in collaboration with their respective state governments. We also adopted social media - WhatsApp for official communication. Results: Enrolling Batch-B following the new strategic approach reduced refusals by 25% and dropouts by 36% compared to Batch-A. Course compliance and completion was a significant 96% in Batch-B. Conclusion: The COVID-19 pandemic opened a window of opportunity to understand the need for vital changes to improve the quality of our hybrid cancer screening training. Inclusion of the state government in planning and implementing the changes, awareness among HCPs about the importance of training and responsible acceptance of cancer screening, district-wise approach, use of social media in sharing course materials and conducting in-person training in the respective state have demonstrated significant impact on the quality of the training and in scaling-up of cancer screening. Prolonged mentorship, robust Internet connectivity for providers and training on handling gadgets and online video communication would profoundly benefit remote training programmes.A well-devised backup system is essential for training programmes during unforeseen eventualities such as the COVID pandemic. [ABSTRACT FROM AUTHOR]

Background & objectives: Lack of awareness is one of the major reasons for the high morbidity and mortality associated with cancers. The present study was aimed to evaluate the awareness of prevalent cancers among the rural population in a district of north India and its association specifically with mobile phone usage. Methods: Using a stratified random sampling technique, households in three villages of Gautam Buddh Nagar district of India were selected. A house-to-house survey on cancer awareness was conducted among adults in selected households and data were analyzed to check for the association of such an awareness with sociodemographic factors and internet usage. Results: The study included 59 males and 145 females, with majority (115) being in the age group of 18-30 yr. Although most (96.5%) of the participants were aware of cancer, the common risk factors and warning signs of cancer were known to only a few. Specific risk factors for cervical and breast cancers were, however, not known to a majority (79.9% and 72.2%). A significant association between the awareness of general risk factors and warning signs as well as specific aspects including risk factors for breast, cervical and oral cancer, HPV vaccine and the education level of the participants (P<0.05 for all). Knowledge of risk factors, warning signs and cancer prevention modalities was higher among mobile phone users who accessed internet for health information. There was no significant association between age group and cancer risk factor awareness, though females were more aware of the risk factors for breast cancer (P=0.002). Interpretation & conclusions: The findings of this study highlight the existing low level of awareness of cervical and breast cancers among the rural population. The association of cancer awareness with education level and mobile phone-based internet usage suggests the potential utility of internet-based platforms such as m-health programmes for cancer prevention activities. [ABSTRACT FROM AUTHOR]

Cytology identifies the women who are at higher risk of harboring high-grade cervical premalignant lesions or invasive cancer. However, a diagnostic test such as colposcopy is crucial for women with abnormal cytology for localization of the abnormality, confirmation of diagnosis, and appropriate management. To standardize this subjective technique and to minimize the interobserver variations, Swede scoring system was introduced. The revised colposcopic nomenclature of the International Federation of Cervical Pathology and Colposcopy in 2011 included various normal and abnormal colposcopic findings and gives a description of colposcopic features which improves its accuracy over the colposcopic indices. There is consensus agreement that cytology indicative of high-grade lesions (ASC-H and HSIL in the Bethesda system) should engender immediate referral for colposcopy and biopsy. The management of women who have equivocal or borderline cytology of low-grade abnormalities (ASCUS/LSIL) is still under deliberation. It is generally agreed to have an HPV triage for women with equivocal cytology. Based on the latest recommendations, the current chapter provides an extensive overview of the role of colposcopy in the management of women with various abnormalities reported on Pap smear. [ABSTRACT FROM AUTHOR]

Background: The three most commonly occurring cancers in India are those of the breast, uterine cervix, and lip or oral cavity, together accounting for approximately 34% of all cancers. All the three cancers are amenable to prevention, early detection, and treatment through which the morbidity and mortality due to these cancers can be reduced. This pilot study was conducted to assess the operational feasibility of the national cancer screening guidelines. Method: This study was conducted in the Dibrugarh district of Assam in seven tea garden hospitals which serve as the primary health centers for the tea estate population in the Northeast region of India. The study intervention was a three-day training package designed to train primary care physicians in population-based screening for oral, breast, and cervical cancers. Knowledge evaluation and skill assessment were performed with a validated questionnaire and checklist, respectively. Results: Pre and posttraining knowledge assessment showed significant gain in the knowledge levels of the participants in all topics. The greatest knowledge increase was seen in breast cancer (96.3%), followed by cervical cancer (57.5%), oral cancer (35.5%) and general cancer-related information (16.7%). The skill assessment done for each participant individually at the end of the training indicated a need for retraining all participants in breast cancer screening. Conclusion: The learnings from this study will be of great help in scaling up the capacity building programme for cancer screening when the nation-wide population-based cancer screening programme will be rolled out in the country. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of recently published American Society of Cytopathology (ASC) guidelines (2017) on the conduct of cervical cytology‐histology correlation (CHC). Methods: A retrospective review was conducted for cervical biopsies with their corresponding conventional cervical smears over a 7.5‐year period (January 2011‐June 2018). As per the ASC guidelines, a discrepancy assessment grid was prepared. Major cytology‐histology discordance was defined as a diagnosis of high‐grade squamous intraepithelial lesion (HSIL) or CIN2+ in one of the tests with negative result in the other. Smears and biopsies of all discordant cases were reviewed for reasons of overcall and undercall. Results: Of the 341 cervical biopsies with corresponding Papanicolaou smear, cytology‐histology agreement was noted in 249 (73%) cases. Major discordance was observed in 22 cases (6.4%)—16 undercalls and six overcalls on cytology—while minor discrepancies were noted in 70 cases. Atypical metaplasia and repair changes were the main reasons for overcall while small HSIL cells in atrophic smear and scant HSIL cells were important causes of undercall on cytology review. Using the ASC guidelines, we could improvise upon the existing CHC methodology for categorisation of cyto‐histological pairs of cases with a cytological diagnosis of atypical glandular cells. Conclusion: The present study demonstrates, for the first time, that the recent ASC guidelines facilitate cervical CHC, especially for categorisation of cases with atypical glandular cells on cytology. Uniform application of these guidelines would standardise the conduct of cervical CHC internationally and provide scope for inter‐laboratory comparison of data as well as enhance self‐learning and peer learning. The current American Society of Cytoapthology's guidelines could facilitate the uniform conduct of cyto‐histologic correlation in laboratories engaged in cervical pathology and provide scope for inter‐laboratory data comparisons. [ABSTRACT FROM AUTHOR]

Objective To find an association between metabolic non-communicable disease (NCD) risk factors (high blood pressure (BP), high random blood sugar (RBS) and overweight/obesity) and oral, breast, cervical cancers/precancerous or potentially malignant conditions. Design This is an observational study using convenience sampling. The participants were screened through opportunistic or population-based screening. Setting The study was conducted at a health promotion clinic (HPC) located in Northern India under the Indian Council of Medical Research. HPC is a screening clinic where screening is done for hypertension (HT), diabetes mellitus (DM), obesity, and oral, breast and cervical cancers. The study was conducted between December 2016 and January 2019. Participant The number of participants screened was 8352 (6712 women and 1640 men). All consenting men and women above 18 years were included. All participants were screened for oral cancer, DM, HT and obesity. All women were also screened for breast and cervical cancers. Cervical screening was done for non-pregnant women 21 years and above with history of sexual activity. Result Oral potentially malignant disease (OPMD) was the most prevalent, followed by breast cancer, oral cancer, cervical cancer and cervical precancer. High RBS had a strong association with oral cancer (OR=2.29, 95% CI 1.09 to 4.82, p=0.03) and breast cancer (OR=1.95, 95% CI 1.01 to 3.76, p=0.05). High BP had a strong association with breast cancer (OR=2.50, 95% CI 1.43 to 4.35, p<0.0001). An inverse association was noted between oral cancer and overweight/obesity (OR=0.20, 95% CI 0.08 to 0.48, p<0.0001). Current tobacco use was strongly associated with oral cancer (OR=6.51, 95% CI 3.63 to 11.67, p<0.0001) and OPMD (OR=9.82, 95% CI 8.13 to 11.86, p<0.0001). No association was elicited between the metabolic NCD risk factors and cervical cancer/precancer. Conclusions The study reaffirms that NCD metabolic risk factors determine oral and breast cancers. Besides NCD risk factors, current tobacco use was a strong determinant of OPMD and oral cancer. Hence, primary and primordial prevention measures to control NCD metabolic risk factors and tobacco use should move along with secondary prevention of breast and oral cancers. [ABSTRACT FROM AUTHOR]

Purpose: Every year > 450,000 individuals are diagnosed with cancer and approximately 350,000 die of it in India. The Ministry of Health and Family Welfare has released an Operational Framework for the Management of Common Cancers that highlights population-based cancer screening programs in primary health care facilities by health care providers (HCPs) and capacity building of HCPs. The purpose of this study is to present a low-cost training model that is highly suitable for resource-deficient settings, such as those found in India, through Extension for Community Health Outcome (ECHO), a knowledge-sharing tool, to enable high-quality training of HCPs. Materials and Methods: An in-person, 3-day training program was conducted for 27 HCPs in the tribal primary health care center of Gumballi in Karnataka, India, to teach the basics of cancer screening in oral, breast, and cervical cancer. The training of HCPs was done using the ECHO platform while they implemented the cancer screening, thus enabling them to build the much needed knowledge and skill set to conduct cancer screening in their respective communities. Results: The knowledge level of the HCPs was tracked before the intervention, immediately after the 3-day training program, and 6 months after the ECHO intervention, which clearly showed progressive acquisition and retention of knowledge. A marked improvement in knowledge level score from an average of 6.3 to 13.7 on a 15-point scale was noticed after the initial in-person training. The average knowledge further increased to a score of 14.4 after 6 months as a result of training using the ECHO platform. Conclusion: ECHO is an affordable and effective model to train HCPs in cancer screening in a resource-constrained setting. [ABSTRACT FROM AUTHOR]

Purpose: Every year > 450,000 individuals are diagnosed with cancer and approximately 350,000 die of it in India. The Ministry of Health and Family Welfare has released an Operational Framework for the Management of Common Cancers that highlights population-based cancer screening programs in primary health care facilities by health care providers (HCPs) and capacity building of HCPs. The purpose of this study is to present a low-cost training model that is highly suitable for resource-deficient settings, such as those found in India, through Extension for Community Health Outcome (ECHO), a knowledge-sharing tool, to enable high-quality training of HCPs. Materials and Methods: An in-person, 3-day training program was conducted for 27 HCPs in the tribal primary health care center of Gumballi in Karnataka, India, to teach the basics of cancer screening in oral, breast, and cervical cancer. The training of HCPs was done using the ECHO platform while they implemented the cancer screening, thus enabling them to build the much needed knowledge and skill set to conduct cancer screening in their respective communities. Results: The knowledge level of the HCPs was tracked before the intervention, immediately after the 3-day training program, and 6 months after the ECHO intervention, which clearly showed progressive acquisition and retention of knowledge. A marked improvement in knowledge level score from an average of 6.3 to 13.7 on a 15-point scale was noticed after the initial in-person training. The average knowledge further increased to a score of 14.4 after 6 months as a result of training using the ECHO platform. Conclusion: ECHO is an affordable and effective model to train HCPs in cancer screening in a resource-constrained setting. [ABSTRACT FROM AUTHOR]

The article focuses on an awareness campaign organized by National Institute of Cancer Prevention and Research (NICPR) in 2014 at India International Trade Fair, Pragati Maidan, New Delhi, India. It mentions aim of awareness campaign was educating public about risk factors and symptoms of non-communicable diseases (NCDs) and performing of cervical cancer screening of women at fair. It also mentions woman diagnosed with atypical squamous cells-undetermined significance underwent colposcopy.

Context: Primary ovarian cancer and ovarian metastasis from non-ovarian cancers in advanced stage are closely mimicking conditions whose therapeutics and prognosis are different. Objective: To identify biomarkers that can differentiate the two variants of advanced ovarian cancers. Methods: Gel-based proteomics and antibody-based assays were used to study the differentially expressed proteins in the ascitic fluid of fourteen patients with advanced ovarian cancers. Results: Programmed Cell Death 1-Ligand 2, apolipoprotein A1, apolipoprotein A4 and anti-human fas antibody are differentially expressed proteins. Conclusions: Apolipoprotein A1 with a 61.8ng/ml cut-off is a potential biomarker with the best differentiating statistical parameters. [ABSTRACT FROM AUTHOR]

Background: To evaluate the prevalence and correlates of concurrent uterine cervical and anal HR-HPV infections in women living with HIV (WLHIV). Setting: A cross-sectional study was undertaken at a tertiary care hospital and linked ART center. Methods: One hundred and forty-one WLHIV and 161 HIV-negative women were enrolled for cervical and anal cytology as well as HR-HPV testing using the HC2 method. Screen-positive women were followed-up with colposcopy/anoscopy and/or repeat cytology. Appropriate statistical tests were applied to assess the association of concurrent HR-HPV with various parameters. Results: Concurrent cervical and anal HR-HPV infection was detected in 22 WLHIV (16.3%) and 5 HIV-negative women (3.1%), the difference being statistically significant (P < 0.001). Among WLHIV, concurrent HR-HPV was associated with tobacco use (P < 0.001), receptive anal intercourse (P = 0.02), low CD4 counts (P = 0.001), and negatively with ART intake (P = 0.004) on bivariate analysis. Multivariate logistic regression analysis showed a positive association of concurrent HR-HPV positivity with tobacco use (P = 0.02) and low nadir CD4 counts (P = 0.03). Conclusions: WLHIV, especially those with CD4 counts less than 200/µL, should be offered HR-HPV screening and follow-up to detect cervical and anal lesions. [ABSTRACT FROM AUTHOR]

To study the prevalence of bacterial vaginosis (BV) in pregnant women and to evaluate the accuracy of clinical criteria for the diagnosis of BV. In this observational study 502 asymptomatic pregnant women were screened for bacterial vaginosis in a rural health care facility by Gram stain. Accuracy of clinical diagnosis using individual and two of Amsel’s criteria was evaluated. The frequency of BV was 8.6% by Nugent’s method. For Amsel’s criteria, sensitivity and specificity was 51.2 and 98%, with 71% PPV and 95.5% NPV. The most sensitive individual criterion was vaginal pH, but with lowest specificity. The criterion with highest specificity was clue cells. The combination of the two criteria, vaginal pH and positive amine test, had best positive and negative predictive values 60.5 and 97.8%, respectively. The diagnosis of BV according to Amsel’s criteria may be simplified using a combination of the two criteria, vaginal pH and amine test, in settings where microscopy or Gram staining is not available. [ABSTRACT FROM AUTHOR]

Growing teratoma syndrome is an increase of tumor size containing only a mature teratoma component, during or after chemotherapy for germ cell tumors. Mature teratomatous elements are chemoresistant and have to be resected surgically. We describe three patients with malignant immature teratoma treated with chemotherapy and surgical resection. All three had an increase in the size of the mass after chemotherapy, surgery was possible, and histology revealed mature teratoma. One of the patients showed fluorodeoxy glucose positron emission tomography (FDG-PET) positivity for growing teratoma syndrome, but the histology revealed only mature teratoma. All three patients are alive, at 55, 72, and 103 months’ follow up after the initial diagnosis. Data collected from the literature are reviewed. Early recognition of this syndrome is essential as it offers hope for curative resection and avoids the use of ineffective chemotherapy. [ABSTRACT FROM AUTHOR]

Aim Background Design Method Result Conclusion To assess the prevalence of non‐communicable disease risk factors among the nursing staff and educate them on prevention.Nursing staff is integral to the Indian community healthcare systems. Recent studies report a high prevalence of non‐communicable diseases in Indian nursing staff. Therefore, data on the prevalence of non‐communicable disease risk factors among nursing staff are crucial for education on prevention.A cross‐sectional digital survey‐based study.We invited 4435 nursing staff to attend our online survey. We used a customized questionnaire for data collection, including a digitized version of the Community‐Based Assessment Checklist form. A score of >4 was considered high risk and warranted screening.Among 682 nursing staff who attended, 70% had never undergone screening for non‐communicable diseases. The prevalence of non‐communicable disease risk factors was significantly higher in male nursing staff. In addition, logistic regression analysis showed that age, tobacco and alcohol use, increased waist circumference, physical inactivity and family history of non‐communicable diseases were significant risk factors among nursing staff.The study findings suggest that the nursing staff have suboptimal self‐health concerns on non‐communicable diseases. This situation warrants continued medical education, awareness campaigns on adopting a healthy lifestyle and health promotion. [ABSTRACT FROM AUTHOR]

Ovarian cancer is the seventh most common gynaecologic malignancy seen in women. Majority of the patients with ovarian cancer are diagnosed at the advanced stage making prognosis poor. The standard management of advanced ovarian cancer includes tumour debulking surgery followed by chemotherapy. Various types of chemotherapeutic regimens have been used to treat advanced ovarian cancer, but the most promising and the currently used standard first-line treatment is carboplatin and paclitaxel. Despite improved clinical response and survival to this combination of chemotherapy, numerous patients either undergo relapse or succumb to the disease as a result of chemotherapy resistance. To understand this phenomenon at a cellular level, various macromolecules such as DNA, messenger RNA and proteins have been developed as biomarkers for chemotherapy response. This review comprehensively summarizes the problem that pertains to chemotherapy resistance in advanced ovarian cancer and provides a good overview of the various biomarkers that have been developed in this field. [ABSTRACT FROM AUTHOR]

Ovarian cancer is the seventh most common gynaecologic malignancy seen in women. Majority of the patients with ovarian cancer are diagnosed at the advanced stage making prognosis poor. The standard management of advanced ovarian cancer includes tumour debulking surgery followed by chemotherapy. Various types of chemotherapeutic regimens have been used to treat advanced ovarian cancer, but the most promising and the currently used standard first-line treatment is carboplatin and paclitaxel. Despite improved clinical response and survival to this combination of chemotherapy, numerous patients either undergo relapse or succumb to the disease as a result of chemotherapy resistance. To understand this phenomenon at a cellular level, various macromolecules such as DNA, messenger RNA and proteins have been developed as biomarkers for chemotherapy response. This review comprehensively summarizes the problem that pertains to chemotherapy resistance in advanced ovarian cancer and provides a good overview of the various biomarkers that have been developed in this field. [ABSTRACT FROM AUTHOR]

Among the emerging economies Brazil, Russia, India, China and South Africa (together known as the BRICS countries) share collectively approximately 40 per cent of the global population and contribute to 25 per cent of the world gross domestic products. All these countries are facing the formidable challenge of rising incidence of breast cancer and significant number of premature deaths from the disease. A multidimensional approach involving prevention, early detection and improved treatment is required to counteract the growing burden of breast cancer. A growing trend in the prevalence of major preventable risk factors of breast cancer such as obesity, western dietary habits, lack of physical activity, consumption of alcohol and smoking is contributing significantly to the rising burden of the disease in BRICS nations. Specific interventions are needed at the individual and population levels to mitigate these risk factors, preferably within the broader framework of non-communicable disease control programme. Population-based quality assured mammography-based screening of the 50-69 yr old women can reduce breast cancer mortality at least by 20 per cent. However, none of the BRICS countries have been able to implement population-based organized screening programme. Large scale opportunistic screening with mammography targeting predominantly the younger women is causing harms to the women and wasting precious healthcare resources. There are recent national recommendations to screen women with mammography in Brazil and Russia and with clinical breast examination in China (along with ultrasound) and India. Given the challenges of implementing systematic screening of the population, the BRICS countries should prioritize the early diagnosis approach and invest in educating the women about the breast cancer symptoms, training the frontline health providers to clinically detect breast cancers and appropriately refer for diagnostic confirmation, and creating improved access to good quality diagnostic and treatment facilities for breast cancer. The early diagnosis approach has been proved to achieve downstaging and improve survival at a fraction of the resources needed for population screening. The countries also need to focus on improving the services and capacity for multidisciplinary treatment of breast cancer, histopathology and immunohistochemistry, safe administration of chemotherapy and palliative care. [ABSTRACT FROM AUTHOR]

Objective: To compare the AV Magnivisualizer with colposcopy to detect cervical intraepithelial neoplasia (CIN) using the Swede scoring system.Methods: Cross-sectional study conducted in a tertiary care hospital from May 2017 to March 2018. One hundred women with positive results at visual inspection with acetic acid underwent cervical inspection using the Magnivisualizer followed by a colposcope. Biopsies were taken if the Swede score was greater than 4. Pregnant women, women with an obvious cervical growth, acute cervicitis, or prior cervical surgery were excluded. Diagnostic accuracy of the Magnivisualizer and colposcope was calculated for high-grade lesions (CIN 2/CIN 2+) and agreement was compared between the two modalities.Results: The sensitivity, specificity, and positive and negative predictive values of the Magnivisualizer were 88.2%, 70.0%, 50.0%, and 94.6%, respectively, to detect high-grade lesions at a Swede score cutoff of 5 or more. The area under the curve for the Magnivisualizer was 0.80 (95% CI, 0.67-0.92), which was comparable with colposcopy (AUC 0.86; 95% CI, 0.76-0.96). There was very good agreement between the Magnivisualizer and colposcopy (κ=0.865, P<0.001) for high-grade lesions.Conclusion: The Magnivisualizer had high diagnostic accuracy to detect high-grade CIN in screen-positive women, which was comparable with colposcopy. [ABSTRACT FROM AUTHOR]

Smokeless tobacco (SLT) is certainly one of the major risk factors associated with oral cancer. Disruption of oral microbiota-host homeostasis contributes to the progression of oral cancer. Here, we profiled SLT users' oral bacterial composition and inferred their functions by sequencing 16S rDNA V3-V4 region and PICRUSt2, respectively. Oral bacteriome of SLT users (with or without oral premalignant lesions), SLT with alcohol co-users, and non-SLT consumers were compared. Oral bacteriome is shaped primarily by SLT use and the incidence of oral premalignant lesions (OPL). A significantly increased bacterial α-diversity was monitored in SLT users with OPL compared to in SLT users without OPL and non-users, whereas β-diversity was significantly explained by OPL status. Overrepresented genera were Prevotella, Fusobacterium, Veillonella, Haemophilus, Capnocytophaga, and Leptotrichia in SLT users having OPL. LEfSe analysis identified 16 genera as a biomarker that were differentially abundant in SLT users having OPL. The functional prediction of genes significantly increased for several metabolic pathways, more importantly, were nitrogen metabolism, nucleotide metabolism, energy metabolism, and biosynthesis/biodegradation of secondary metabolites in SLT users having OPL. Furthermore, HPV-16 and EBV, but not HPV-18, were considerably connected with the SLT users having OPL. Overall, this study provides evidence that SLT utilization and OPL development are associated with oral bacteriome dysbiosis indicating the enrichment of bacterial species known for their contribution to oral carcinogenesis. Therefore, delineating the cancer-inducing bacterial population in SLT users will facilitate the future development of microbiome-targeted therapies. Key points: • SLT consumption significantly elevates oral bacterial diversity. • Prevalent significant genera are Prevotella, Veillonella, and Haemophilus in SLT users with OPL. • SLT promotes the occurrence of the cancer-inducing bacterial population. [ABSTRACT FROM AUTHOR]

Smokeless tobacco (SLT) alters the oral microbiome of smokeless tobacco users. Dysbiosis of oral bacteriome has been determined; however, the mycobiome of SLT users has not been characterized. The oral mycobiome was assayed by amplification and sequencing of the fungal internal transcribed spacer (ITS1) region from oral swab samples of non-SLT users, SLT users (with or without oral lesions), and SLT with alcohol users. We observed that the richness and diversity of oral mycobiome were significantly decreased in SLT with oral lesions users than in non-users. The β-diversity analysis showed significant dissimilarity of oral mycobiome between non-users and SLT with oral lesions users. Linear discriminant analysis effect size and random forest analysis of oral mycobiome affirm that the genus Pichia was typical for SLT with oral lesions users. Prevalence of the fungal genus Pichia correlates positively with Starmerella, Mortierella, Fusarium, Calonectria, and Madurella, but is negatively correlated with Pyrenochaeta, Botryosporium, and Alternaria. Further, the determination of oral mycobiome functionality showed a high abundance of pathotroph-saprotroph-symbiotroph and animal pathogen-endophyte-epiphyte-undefined saprotroph at trophic and guild levels, respectively, indicating possibly major changes in normal growth repression of types of fungi. The oral mycobiome in SLT users was identified and comprehensively analyzed for the first time. SLT intake is associated with oral mycobiome dysbiosis and such alterations of the oral mycobiome may contribute to oral carcinogenesis in SLT users. This study will provide a basis for further large-scale investigations on the potential role of the mycobiome in SLT-induced oral cancer. Key points: • SLT induces dysbiosis of the oral microbiome that can contribute to oral cancer. • Oral mycobiome diversity is noticeably reduced in SLT users having oral lesions. • Occurrence of Pichia can be used as a biomarker for SLT users having oral lesions. [ABSTRACT FROM AUTHOR]

Introduction: Nurses are the foundation of the Indian health system. They play a crucial role in primary care and implementation of community-centered government health initiatives such as cancer screening. The purpose of this manuscript is to share the experience of this educational intervention study and emphasize the need for drastic medical education reforms to include curricula to strengthen knowledge about cancer screening among nursing students. Methods: A one-day workshop on "Cervical and breast cancer screening" was conducted for nursing students pursuing BSc Nursing (Group 1) and General Nursing and Midwifery (GNM) (Group 2) in India. A structured, self-administered questionnaire was administered among consented participants before and after the workshop to assess their knowledge and awareness on the subject at the baseline and the improvement they gained after the workshop. Results: Ninety-one students attempted both pre and post-surveys, of which 56 were from Group 1 and 35 from Group 2. Students demonstrated statistically significant improvements in knowledge on cervical and breast cancer screening after participating in the workshop. Conclusion: Undergraduate nursing education curricula must undergo medical education reform to include education and training for nurses in cancer screening and further motivate their increased participation in preventive cancer screening programs. [ABSTRACT FROM AUTHOR]

Population based cancer screening was initiated in India in 2016 owing to an increased burden of cancers. A feasibility health system study was done by utilising community health workers (CHWs) to conduct the cancer screening. The current study is a qualitative study to elicit the barriers and facilitators in implementing population based cancer screening through CHWs. The study was conducted at three subcentres of Dholai block of Cachar district, Assam, India and Cachar Cancer Hospital and Research Center, Silchar. The participants of the study were CHWs, master trainer nurses and women from community. Three focus group discussions (FGDs) and one in-depth interview (IDI) were conducted at the provider level and seven IDIs of women from the community. The FGDs and IDIs were audio recorded after taking verbal consent from the participants. The verbatims were prepared following translation and transcription and data analysis using ATLAS ti ver 8. The major barrier faced by the community was a lack of motivation to get screened which stemmed from various factors such as personal beliefs, attitudes and fear. The major facilitators were accessibility of tests, family support and CHWs as screening service providers. The major barriers for CHWs were difficulty in motivating the community, lack of support from supervisors and lack of motivation to work. The major facilitators were convenience of screening during home visits, empowerment, skill enhancement and teamwork. Population based cancer screening was a new concept for the community under study. Cancer screening by CHWs was well accepted by the community. Awareness generation among the community was a major factor in improving screening coverage. The study highlights that training and motivation of CHWs can improve the uptake of cancer screening services. CHWs felt empowered with the new skills imparted and were able to carry out screening. [ABSTRACT FROM AUTHOR]

The aim of the present study is to investigate the functional role of TNF-α single-nucleotide polymorphisms/haplotypes in an association with reproductive tract infections (RTIs) in symptomatic and asymptomatic women. A total of 850 consecutive subjects consisting of 400 cases and 450 healthy controls, were screened for RTIs, along with their risk factors and associated symptoms. The propensity score matching was performed to reduce the confounding bias arise owing to covariates and to balance the data between two groups. A total of 211 pairs (1:1) have been created. Genotyping of rs1800629 (-308) and rs361525 (-238) SNPs of TNF-α was done by PCR–RFLP followed by sequencing. The functional implication of TNF-α SNPs in an association with RTIs was also checked by using ELISA. The frequency of -238A allele and -308A allele was found to be twofold (P < 0.0001) and threefold (P < 0.0001) higher in the presence of RTIs. AA haplotype emerged as a major player in an association with RTIs and elevated TNF-α expression. The present study revealed the functional role of rs1800629 (-308) and rs361525 (-238) of TNF-α in an association with RTIs. This information may be used to establish biomarkers for an inflammatory response during the persistence of RTIs. [ABSTRACT FROM AUTHOR]

Efforts are being made to scale up human papillomavirus (HPV) vaccination for adolescent girls in India. Bivalent and quadrivalent HPV vaccines were licensed in the country in 2008, and a nonavalent vaccine was licensed in 2018. Demonstration projects initiated in Andhra Pradesh and Gujarat in 2009 introduced HPV vaccination in public health services in India. Following a few deaths in these projects, although subsequently deemed unrelated to vaccination, HPV vaccination in research projects was suspended. This suspension by default resulted in some participants in a trial evaluating two versus three doses receiving only one dose. Since 2016, the successful introduction of HPV vaccination in immunisation programmes in Punjab and Sikkim (with high coverage and safety), government-sponsored opportunistic vaccination in Delhi, prospects of a single dose providing protection, and future availability of an affordable Indian vaccine shows promise for future widespread implementation and evaluation of HPV vaccination in India. [ABSTRACT FROM AUTHOR]

Breast cysticercosis is difficult to diagnose as the clinical manifestations are non-specific. We report a case of an isolated cysticercosis of the breast presenting as a breast lump which was diagnosed based on the clinical and ultrasonographic findings. This entity although rare should be kept in the differential diagnosis of breast lumps, especially in endemic areas. [ABSTRACT FROM AUTHOR]

The article focuses on the use of human papillomavirus vaccine for preventing cancer cervix in India. Topics discussed include improving public health in the country; analysis of immunogenicity, adverse effects and cost-effectiveness of the vaccine; and World Health Organization's recommendations on the same.

Management algorithms for screen-positive women in cervical cancer prevention programs have undergone substantial changes in recent years. The WHO strongly recommends human papillomavirus (HPV) testing for primary screening, if affordable, or if not, then visual inspection with acetic acid (VIA), and promotes treatment directly following screening through the screen-and-treat approach (one or two clinic visits). While VIA-positive women can be offered immediate ablative treatment based on certain eligibility criteria, HPV-positive women need to undergo subsequent VIA to determine their eligibility. Simpler ablative methods of treatment such as cryotherapy and thermal coagulation have been demonstrated to be effective and to have excellent safety profiles, and these have become integral parts of new management algorithms. The challenges faced by low-resource countries are many and include, from the management perspective, identifying an affordable point-of-care HPV detection test, minimizing over-treatment, and installing an effective information system to ensure high compliance to treatment and follow-up. [ABSTRACT FROM AUTHOR]

Conventional treatment for advanced ovarian cancer is an initial debulking surgery followed by chemotherapy combination of carboplatin and paclitaxel. Despite initial high response, three-fourths of these women experience disease recurrence with a dismal prognosis. Patients with advancedstage ovarian cancer who underwent cytoreductive surgery were enrolled and tissue samples were collected. Post surgery, these patients were started on chemotherapy and followed up till the end of the cycle. Fluorescence-based differential in-gel expression coupled with mass spectrometric analysis was used for discovery phase of experiments, and real-time polymerase chain reaction, Western blotting, and pathway analysis were performed for expression and functional validation of differentially expressed proteins. While aldehyde reductase, hnRNP, cyclophilin A, heat shock protein-27, and actin are upregulated in responders, prohibitin, enoyl-coA hydratase, peroxiredoxin, and fibrin-β are upregulated in the nonresponders. The expressions of some of these proteins correlated with increased apoptotic activity in responders and decreased apoptotic activity in nonresponders. Therefore, the proteins qualify as potential biomarkers to predict chemotherapy response. [ABSTRACT FROM AUTHOR]

Limited information is available from developing countries about complications, pattern of infections, and long-term outcome of patients following high-dose chemotherapy (HDCT) and autologous blood stem cell transplantation (ASCT). Between April, 1990 and December 2009, 228 patients underwent ASCT. Patients' median age was 48 years, ranging from 11 to 68 years. There were 158 males and 70 females. Indications for transplant included multiple myeloma, n = 143; lymphoma, n = 44 (Hodgkin's, n = 25 and non-Hodgkin's, n = 19); leukemia, n = 22; and solid tumors, n = 18. Patients received HDCT as per standard protocols. Following ASCT, 175 (76.7%) patients responded; complete, 98 (43%); very good partial response, 37 (16.2%); and partial response, 40 (17.5%). Response rate was higher for patients with good Eastern Cooperative Oncology Group (ECOG) performance status (0-2 vs. 3-4, p < 0.001), pretransplant chemo-sensitive disease ( p < 0.001) and those with diagnosis of hematological malignancies ( p < 0.003). Mucositis, gastrointestinal, renal, and liver dysfunctions were major nonhematologic toxicities, 3.1% of patients died of regimen-related toxicities. Infections accounted for 5.3% of deaths seen before day 30. At a median follow-up of 66 months (range, 9-234 months), median overall (OS) and event-free survival (EFS) were 72 months (95% CI 52.4-91.6) and 24 months (95% CI 17.15-30.9), respectively. For myeloma, OS and EFS were 79 months (95% CI 52.3-105.7) and 30 months (95% CI 22.6-37.4), respectively. Pretransplant good performance status and achievement of significant response following transplant were major predictors of survival. Our analysis demonstrates that such procedure can be successfully performed in a developing country with results comparable to developed countries. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our retrospective analysis was to study and report the clinical outcome of patients with uterine sarcoma (US) treated at our center; and to share our experience with literature. Materials and Methods: We retrieved the information regarding the patient's demography, clinico-pathological details, treatment given, survival, and complications of all the US patients treated at our center between the years 2000-2008. The three-year overall survival (OS) was determined with respect to various prognostic factors like age, stage of disease, histopathological type, adjuvant RT etc. Results: A total of 50 case records were retrieved for this retrospective analysis. Age ranged from 24 to 75 years with a median of 50 years. Carcinosarcoma was the commonest histopathological type (23/50 patients). FIGO stage distribution was: stage I, 27; stage II, 7; stage III, 12; stage IV, 2; and unknown stage, two patients. Forty-eight patients underwent surgery; 31 received postoperative radiation therapy (PORT) and 16 received chemotherapy therapy. Median follow-up period was 34 months (range 2-69 months). The three-year OS for the entire group of patients was 42%. Stage of the disease, histopathological type, and use of PORT were found significant prognostic factors for survival. Conclusion: Although limited by small sample size and retrospective nature, ours is the only study on US being reported from India. Our results have demonstrated FIGO stage of the disease, histopathology and use of PORT to be the significant prognostic factor for survival. Use of chemotherapy in future trials is warranted. [ABSTRACT FROM AUTHOR]

India's cervical cancer screening program was launched in 2016. We evaluated baseline facility readiness using nationally representative data from the 2012-13 District Level Household and Facility Survey on 4 tiers of the public health care system - 18,367 sub-health centres (SHCs), 8540 primary health centres (PHCs), 4810 community health centres and 1540 district/sub-divisional hospitals. To evaluate facility readiness we used the Improving Data for Decision Making in Global Cervical Cancer Programmes toolkit on six domains - potential staffing, infrastructure, equipment and supplies, infection prevention, medicines and laboratory testing, and data management. Composite scores were created by summing responses within domains, standardizing scores across domains at each facility level, and averaging across districts/states. Overall, readiness scores were low for cervical cancer screening. At SHCs, the lowest scores were observed in 'infrastructure' (0.55) and 'infection prevention' (0.44), while PHCs had low 'potential staffing' scores (0.50) due to limited manpower to diagnose and treat (cryotherapy) potential cases. Scores were higher for tiers conducting diagnostic work-up and treatment/referral. The highest scores were in 'potential staffing' except for PHCs, while the lowest scores were in 'infection & prevention' and 'medicines and laboratory'. Goa and Maharashtra were consistently among the top 5 ranking states for readiness. Substantial heterogeneity in facility readiness for cervical cancer screening spans states and tiers of India's public healthcare system. Infrastructure and staffing are large barriers to screening at PHCs, which are crucial for referral of high-risk patients. Our results suggest focus areas in cervical cancer screening at the district level for policy makers. [ABSTRACT FROM AUTHOR]

Squamous metaplasia though is commonly associated with ovarian endometrioid neoplasm, mixed mullerian tumor and Brenner tumors; it has not been described in an ovarian clear cell carcinoma. Unusual presence of squamous islands, either in the form of morules or keratin plaques, may create diagnostic difficulty in a clear cell carcinoma of ovary, and thus the other common associations should be ruled out. Here, we describe a case of clear cell carcinoma of the ovary, with both gross and microscopically identifiable squamous metaplasia. To the best of our knowledge, this is the first report on this rare association and should be documented for wider awareness. [ABSTRACT FROM AUTHOR]

Purpose: To address high breast cancer (BC) mortality globally and especially in low- and middle-income countries (LMICs), resource-stratified screening and treatment guidelines have been provided by global expert groups. How these guidelines are implemented and aligned with facility readiness in low-resource settings is less well understood. We propose to modify, apply, and evaluate a cervical cancer toolkit designed to evaluate facility readiness in LMICs as an implementation science tool for the treatment of BC. Methods: We will draw upon an existing toolkit for cervical cancer, the Improving Data for Decision Making in Global Cervical Cancer Programs (IDCCP) developed by the Centers for Disease Control and Prevention, WHO, and the George W. Bush Institute. The IDCCP includes 13 domains—for example, services, staffing, infrastructure, procurement and supply chain, equipment and supplies, referral pathways, etc—by which to assess facility readiness, and information on six categories is available in India's District Level Household and Facility Level Survey (2012 to 2013). We applied the IDCCP toolkit for cervical cancer screening in India using District Level Household and Facility Level Survey data and propose to extend this work to include BC screening evaluation per Indian government guidelines—clinical breast exam followed by ultrasound, with or without mammography, followed by biopsy as needed across the four tiers of India's public health care system. As a test of construct validation, we will correlate facility readiness for BC screening at the district level with self-reported BC examination data at the district level using the National Family Health Survey-4 (2015 to 2016). Results: Composite scores that summarize the six categories for cervical cancer yield wide variation in facility readiness across 30 states and union territories, with a trend toward higher scores for higher levels of the public health care system. Some consistencies emerge for higher-performing states, such as Maharashtra and Goa. We will conduct similar analyses for BC screening after modifying the tool kit for BC. Conclusion: The modified toolkit for either BC alone or in combination with cervical cancer can be considered an implementation science tool to by which assess facility readiness of health centers in LMICs and for understanding gaps in the implementation of government guidelines. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. No COIs from the authors. [ABSTRACT FROM AUTHOR]

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