Farshad Farzadfar

Iran is falling behind WHO cervical cancer elimination targets: HPV vaccination coverage and cervical cancer screening participation in 2021

Objective This study aimed to assess HPV vaccination coverage and cervical cancer screening participation among Iranian females under 46 years old, comparing Iran’s situation to he Cervical Cancer Elimination Initiative (CCEI) targets. Methods This nationally and sub-nationally representative cross-sectional study analyzed data from the STEPS 2021 survey. Female participants aged 18–45 years without missing data on HPV vaccination or cervical cancer screening were included. Categorical data were presented as weighted percentages with 95% confidence intervals (95% CI). Logistic regression assessed associations between demographic and female cancer screening variables with the outcomes. Results A total of 8,158 females were included. Only 0.85% (95% CI: 0.69–1.02) of women received the HPV vaccine, while cervical cancer screening participation was 39.4% (95% CI: 38.21–40.6). No significant differences in HPV vaccination coverage were observed across age groups. However, screening rates were significantly higher in older women, rising from 27.99% (18–35 years) to 54.07% (36–45 years). HPV vaccination was not significantly associated with demographic variables. In contrast, cervical cancer screening participation was higher among unemployed women (40.58%), married women (49.6%), and those in the highest wealth quintile (42.47% compared to 28.29% in the lowest quintile). Conclusion HPV vaccination coverage in Iran is critically low, falling far short of the CCEI target of 90%. Cervical cancer screening participation is comparatively better but still lags approximately 30% behind the target. Strategic interventions are critical to bridge the gap between Iran’s current status and the CCEI targets.

Global, regional, and national quality of care index of cervical and ovarian cancer: a systematic analysis for the global burden of disease study 1990–2019

Abstract Background and objective Cervical cancer is the most preventable and ovarian cancer is the most lethal gynecological cancer. However, in the world, there are disparities in health care performances resulting in differences in the burden of these cancers. The objective of this study was to compare the health-system quality of care and inequities for these cancers using the Quality of Care Index (QCI). Material and methods The 1990–2019 data of the Global Burden of Disease (GBD) was analyzed to extract rates of incidence, prevalence, mortality, Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLL), and Years of healthy life lost due to disability (YLD) of cervical and ovarian cancer. Four indices were developed as a proxy for the quality of care using the above-mentioned rates. Thereafter, a Principal Components Analysis (PCA) was applied to construct the Quality of Care Index (QCI) as a summary measure of the developed indices. Results The incidence of cervical cancer decreased from 1990 to 2019, whereas the incidence of ovarian cancer increased between these years. However, the mortality rate of both cancers decreased in this interval. The global age-standardized QCI for cervical cancer and ovarian cancer were 43.1 and 48.5 in 1990 and increased to 58.5 and 58.4 in 2019, respectively. QCI for cervical cancer and ovarian cancer generally decreased with aging, and different age groups had inequitable QCIs. Higher-income countries generally had higher QCIs for both cancers, but exceptions were also observed. Conclusions Uncovering disparities in cervical and ovarian cancer care across locations, Socio-Demographic Index levels, and age groups necessitate urgent improvements in healthcare systems for equitable care. These findings underscore the need for targeted interventions and prompt future research to explore root causes and effective strategies for narrowing these gaps.