Eric Lucas

Analysis of time trends of prevalence of high-risk HPV infections, high grade cervical precancer and cervical cancer disease in women from Eastern India over 20 years − Pooled analysis from three studies

Cervical cancer remains a leading cause of cancer related morbidity and mortality among women worldwide, particularly in low-and middle- income countries (LMICs). The incidence of cervical cancer has declined in India over the last two decades despite the lack of any organised population-based screening programme or HPV vaccination. This study analyses the trends in high-risk human papilloma virus (hrHPV) prevalence and CIN 2 + detection and examines the influence of sociodemographic factors in West Bengal, India from over a span of two decades. Data from three cervical cancer screening studies conducted in rural West Bengal were analysed between 2001 and 2021. A total of 80,988 women aged 30-60 years were screened using Hybrid Capture II© (HC II) test. Detection rates of CIN 2 + were stratified by age, education and marriage. Logistic regression models were used to identify factors influencing high risk HPV positivity and CIN 2 + prevalence. The overall high risk HPV positivity rate remained relatively stable (5 %) across the study periods with no significant difference between self-collected and provider collected samples. However, CIN 2 + detection rates declined significantly from 5.7/1000 in 2001-2003 to 2/1000 in 2018-2021 (adjusted odds ratio [OR]:0.27; 95 % confidence interval [CI]:0.12-0.46). Higher education (OR: 0.64; 95 % CI: 0.45-0.88) and delayed age at marriage (OR: 0.62; 95 %CI: 0.31-1 for age>21) were associated with lower CIN 2 + risk. The findings of the study indicate that the observed decline in CIN 2 + prevalence in West Bengal can be attributed to improved education, delayed age at marriage, reduced fertility rate and women's empowerment, which can explain the gradual reduction in cervical cancer incidence in India. However, the cervical cancer incidence in India remains above WHO elimination targets. Expedited implementation of HPV vaccination and strengthening screening programmes are necessary to sustain and accelerate progress towards elimination of cervical cancer.

A portable thermal ablation device for cervical cancer prevention in a screen-and-treat setting: a randomized, noninferiority trial

AbstractImplementing standard-of-care cryotherapy or electrosurgical excision to treat cervical precancers is challenging in resource-limited settings. An affordable technological alternative that is as effective as standard-of-care techniques would greatly improve access to treatment. This randomized controlled trial aims to demonstrate the noninferiority efficacy of a portable, battery-driven thermal ablation (TA) device compared to cryotherapy and electrosurgical excision (large loop excision of transformation zone (LLETZ)) to treat cervical precancer in a screen-and-treat program in Zambia. A total of 3,124 women positive on visual inspection with acetic acid and eligible for ablative therapy were randomized to one of the treatment arms. Human papillomavirus (HPV) testing was performed at baseline and at the follow-up. The primary outcome was treatment success, defined as either type-specific HPV clearance at the follow-up in participants positive for HPV at baseline, or a negative visual inspection with acetic acid test for those who had a negative HPV test at baseline. After a median follow-up of 12 months, treatment success rates were 74.0%, 71.1% and 71.4% for the TA, cryotherapy and LLETZ arms, respectively, thus demonstrating noninferiority (P = 0.83). TA was a safe and well-accepted procedure. Only 3.6% of those randomized to TA reported moderate-to-severe pain, compared to 6.5% and 1.9% for the cryotherapy and LLETZ arms, respectively. Thus, our randomized controlled trial demonstrates the safety and efficacy of TA, which is not inferior to cryotherapy or surgical excision.ClinicalTrials.gov registration: NCT02956239.

Cancer Screening in the Coronavirus Pandemic Era: Adjusting to a New Situation

PURPOSE The coronavirus-induced pandemic has put great pressure on health systems worldwide. Nonemergency health services, such as cancer screening, have been scaled down or withheld as a result of travel restrictions and resources being redirected to manage the pandemic. The present article discusses the challenges to cancer screening implementation in the pandemic environment, suggesting ways to optimize services for breast, cervical, and colorectal cancer screening. METHODS The manuscript was drafted by a team of public health specialists with expertise in implementation and monitoring of cancer screening. A scoping review of literature revealed the lack of comprehensive guidance on continuation of cancer screening in the midst of waxing and waning of infection. The recommendations in the present article were based on the advisories issued by different health agencies and professional bodies and the authors' understanding of the best practices to maintain quality-assured cancer screening. RESULTS A well-coordinated approach is required to ensure that essential health services such as cancer management are maintained and elective services are not threatened, especially because of resource constraints. In the context of cancer screening, a few changes in invitation strategies, screening and management protocols and program governance need to be considered to fit into the new normal situation. Restoring public trust in providing efficient and safe services should be one of the key mandates for screening program reorganization. This may be a good opportunity to introduce innovations (eg, telehealth) and consider de-implementing non–evidence-based practices. It is necessary to consider increased spending on primary health care and incorporating screening services in basic health package. CONCLUSION The article provides guidance on reorganization of screening policies, governance, implementation, and program monitoring.

Quantification of impact of COVID-19 pandemic on cancer screening programmes – a case study from Argentina, Bangladesh, Colombia, Morocco, Sri Lanka, and Thailand

It is quite well documented that the COVID-19 pandemic disrupted cancer screening services in all countries, irrespective of their resources and healthcare settings. While quantitative estimates on reduction in volume of screening tests or diagnostic evaluation are readily available from the high-income countries, very little data are available from the low- and middle-income countries (LMICs). From the CanScreen5 global cancer screening data repository we identified six LMICs through purposive sampling based on the availability of cancer screening data at least for the years 2019 and 2020. These countries represented those in high human development index (HDI) categories (Argentina, Colombia, Sri Lanka, and Thailand) and medium HDI categories (Bangladesh and Morocco). No data were available from low HDI countries to perform similar analysis. The reduction in the volume of tests in 2020 compared to the previous year ranged from 14.1% in Bangladesh to 72.9% in Argentina (regional programme) for cervical screening, from 14.2% in Bangladesh to 49.4% in Morocco for breast cancer screening and 30.7% in Thailand for colorectal cancer screening. Number of colposcopies was reduced in 2020 compared to previous year by 88.9% in Argentina, 38.2% in Colombia, 27.4% in Bangladesh, and 52.2% in Morocco. The reduction in detection rates of CIN 2 or worse lesions ranged from 20.7% in Morocco to 45.4% in Argentina. Reduction of breast cancer detection by 19.1% was reported from Morocco. No association of the impact of pandemic could be seen with HDI categories. Quantifying the impact of service disruptions in screening and diagnostic tests will allow the programmes to strategize how to ramp up services to clear the backlogs in screening and more crucially in further evaluation of screen positives. The data can be used to estimate the impact on stage distribution and avoidable mortality from these common cancers.

Design and Validation of a Chatbot-Based Cervical Cancer Screening Decision Aid for Women Experiencing Socioeconomic Disadvantage: User-Centered Approach Study

Background Cervical cancer (CC) screening participation remains suboptimal among vulnerable populations in France. This study aimed to develop and evaluate AppDate-You, a chatbot-based decision aid, to support women from socioeconomically disadvantaged areas in the French Occitanie region to make informed decisions about CC screening, particularly human papillomavirus self-sampling (HPVss). Objective This study aimed to explore the needs, preferences, and barriers related to CC screening and to design and validate a user-centered, empathetic, and effective chatbot-based decision aid to empower women experiencing socioeconomic challenges in France to make informed choices about HPVss. Methods The chatbot was developed following a validated framework for developing decision aids. The process included qualitative research involving online and in-person interviews and focus groups with women and health care professionals, followed by alpha testing with both groups and beta testing with women only. Participants included women (both French and non-French speaking) aged between 30 and 65 years from socioeconomically disadvantaged areas of the Occitanie region and health care professionals (general practitioners, gynecologists, and midwives) working with these populations. AppDate-You was made accessible through WhatsApp and Facebook Messenger, offering text-based and voice-based interactions and multimedia content. Results The exploratory phase identified key barriers to screening and digital tool preferences. Prototype testing revealed great satisfaction with the chatbot’s performance, educational value, and content quality. Contrary to the expectations of health care professionals, women from diverse backgrounds, including women who were older and socioeconomically disadvantaged, were willing and able to use the tool. Users—even those with limited digital literacy—found AppDate-You innovative, user-friendly, and informative. In the beta testing phase, 80% (12/15) of the participants expressed interest in HPVss. Some limitations were identified, such as the chatbot’s occasional repetitive responses and the need for clearer medical terminology. Conclusions This study demonstrates the potential for artificial intelligence chatbots to improve access to health education and increase cervical screening intention among underserved populations. The user-centered approach resulted in a tool that effectively meets the needs of the target population. International Registered Report Identifier (IRRID) RR2-10.2196/39288

Development, Field Testing and Evaluation of the Efficacy of a Hand-held, Portable and Affordable Thermo-coagulator to Prevent Cervical Cancer in Low- and Middle-income Countries

This project develops, tests and produces a lightweight, cordless, battery driven and rechargeable hand-held device for treating cervical precancer (Liger Thermal Coagulator). The study evaluates its effectiveness compared to the current standard treatment (cryocautery) when used as part of a screen and treat programme using Visual Inspection with Acetic acid (VIA) in Sub Saharan Africa.