Annals of Global Health

Mortality of Three Major Gynecological Cancers in the European Region: An Age–Period–Cohort Analysis from 1992 to 2021 and Predictions in a 25-Year Period

Background: The European region is marked by pronounced disparities in healthcare access, socioeconomic conditions, and cancer control policies, which influence the mortality trends of gynecological cancers across countries and may persist or intensify in the coming decades. Objective: This study analyses mortality trends of three main gynecological cancers, including ovarian, uterine, and cervical cancers in the European region from 1992 to 2021 and projects rates for the next 25 years to support targeted public health interventions. Methods: Data from the Global Burden of Disease 2021 were used. An age‑period‑cohort (APC) model estimated overall annual percentage changes in mortality (net drifts), local drifts, and age/period/cohort effects for gynecological cancers in the European region. A log‑linear APC model projected mortality and age‑standardized mortality rates (ASMRs) from 2022 to 2046. Findings: Over the past three decades, the European region has had some of the highest mortality rates globally for ovarian and uterine cancers, while trends for cervical cancer have been more favorable. Overall, gynecological cancer mortality declined, though rates increased with age, but period and cohort effects weakened. Ovarian cancer mortality decreased in 17 of the 44 countries studied, while remaining stable in the others. Uterine cancer mortality rose in three countries, with the most pronounced increase observed in Italy. Cervical cancer mortality declined in 32 countries, with Italy being the only country to show an upward trend. Forecasts indicate a steady increase in uterine cancer deaths over the next 25 years, with slight decreases in ASMR, while ovarian cancer and cervical cancer deaths and ASMRs are projected to decline. Conclusion: Despite overall progress in reducing gynecological cancer mortality, significant disparities remain, particularly among older populations and in certain countries such as Italy. Projections indicate a rise in uterine cancer mortality, highlighting the urgent need to strengthen early screening, preventive measures, and equitable healthcare strategies to reduce future disease burden.

Maternal Cancer Mortality and Orphanhood: A Neglected Global Health and Equity Challenge

Parental Knowledge and Acceptance of HPV Vaccine in Rabigh’s School, Saudi Arabia

Cervical Cancer Prevention in Rural Areas

Objective: Globally, cervical cancer (CC) incidence is higher in rural areas than in urban areas that could be explained by the influence of many factors, including inequity in accessibility of the CC prevention measures. This review aimed to identify and analyze factors associated with a lack of cervical cancer screening and HPV vaccination programs in people living in rural areas and to outline strategies to mitigate these factors. Methods: The literature search encompassed two focal domains: cervical cancer screening and HPV vaccination among populations residing in rural areas, covering publications between January 1, 2004 to December 31, 2021 in the PubMed, Google Scholar, Scopus, and Cyberleninka databases, available in both English and Russian languages. Result: A literature review identified 22 sources on cervical cancer screening and HPV vaccination in rural and remote areas. These sources revealed similar obstacles to screening and vaccination in both high and low-income countries, such as low awareness and knowledge about CC, screening, and HPV vaccination among rural residents; limited accessibility due to remoteness and dearth of medical facilities and practitioners, associated with a decrease in recommendations from them, and financial constraints, necessitating out-of-pocket expenses. The reviewed sources analyzed strategies to mitigate the outlined challenges. Possible solutions include the introduction of tailored screening and vaccination campaigns designed for residents of rural and remote locations. New screening and vaccination sites have been proposed to overcome geographic barriers. Integrating HPV testing-based CC screening is suggested to counter the lack of healthcare personnel. HPV vaccination is essential for primary cervical cancer prevention, especially in rural and remote areas, as it requires less medical infrastructure. Conclusion: Certain measures can be proposed to improve the uptake of CC screening and HPV vaccination programs among rural residents, which are needed to address the higher prevalence of CC in rural areas. Further investigation into cervical cancer prevention in rural and remote contexts is necessary to ascertain the optimal strategies that promote health equity.

Identifying Perceived Barriers to Human Papillomavirus Vaccination as a Preventative Strategy for Cervical Cancer in Nigeria

Cervical cancer deaths are disproportionately higher in developing countries depicting one of the most profound health disparities existing today and is ranked as the second most frequent cancer among women in Nigeria. The Human Papillomavirus (HPV) vaccine as a primary prevention strategy is not widely used in Nigeria. This study investigated perceived barriers to HPV vaccination in a Nigerian community, targeting health workers' perceptions. This descriptive study captured responses from a cross-sectional, convenience sample of adult health workers within Anambra State, Nigeria. An anonymous 42-item survey with multiple validated scales was developed based on the Theory of Planned Behavior model and previous studies. The self-administered survey was distributed by research assistants at study sites within Anambra State which were identified through local constituents by the regional zones Adazi-Ani, Onitsha, and Awka. Data analyses were performed using Microsoft Excel for descriptive statistics and R software for the logistic regression, with a statistical significance level of 5%. Subgroup analysis was performed for the baseline knowledge questionnaire to determine if there were any differences in correct responses based on demographics such as: Institution type, profession, age, sex, religion and parental status. Responses were collected from 137 Nigerian health workers; 44% nurses, 14% physicians, 6% pharmacists and 31% other health workers. The majority of respondents were female (69%), between 18 and 39 years of age (78%), from urban settings (82%), and identified as having Christian religious beliefs (97%). The most significant barriers identified were lack of awareness (39%), vaccine availability (39%), and cost (13%). When asked baseline knowledge questions regarding HPV, females were more likely to answer incorrectly as compared to males. Significant differences were found for statements: (1) HPV is sexually transmitted (p = 0.008) and (2) HPV is an infection that only affects women (p = 0.004). Perceived barriers to HPV vaccination identified by Nigerian health workers include lack of awareness, vaccine availability/accessibility, cost, and concerns about acceptability. Ongoing efforts to subsidize vaccine costs, campaigns to increase awareness of HPV vaccine, and interventions to improve attainability could advance administration rates in Nigeria, and ultimately improve death rates due to cervical cancer in this population.

Factors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda

Cervical cancer is among the most common cancers affecting women globally. Where treatment is available in low- and middle-income countries, many women become lost to follow-up (LTFU) at various points of care. This study assessed predictors of LTFU among cervical cancer patients in rural Rwanda. We conducted a retrospective study of cervical cancer patients enrolled at Butaro Cancer Center of Excellence (BCCOE) between 2012 and 2017 who were either alive and in care or LTFU at 12 months after enrollment. Patients are considered early LTFU if they did not return to clinic after the first visit and late LTFU if they did not return to clinic after the second visit. We conducted two multivariable logistic regressions to determine predictors of early and late LTFU. Of 652 patients in the program, 312 women met inclusion criteria, of whom 47 (15.1%) were early LTFU, 78 (25.0%) were late LTFU and 187 (59.9%) were alive and in care. In adjusted analyses, patients with no documented disease stage at presentation were more likely to be early LTFU vs. patients with stage 1 and 2 when controlling for other factors (aOR: 14.93, 95% CI 6.12-36.43). Patients who travel long distances (aOR: 2.25, 95% CI 1.11, 4.53), with palliative care as type of treatment received (aOR: 6.65, CI 2.28, 19.40) and patients with missing treatment (aOR: 7.99, CI 3.56, 17.97) were more likely to be late LTFU when controlling for other factors. Patients with ECOG status of 2 and higher were less likely to be late LTFU (aOR: 0.26, 95% CI 0.08, 0.85). Different factors were associated with early and later LTFU. Enhanced patient education, mechanisms to facilitate diagnosis at early stages of disease, and strategies that improve patient tracking and follow-up may reduce LTFU and improve patient retention.

Cancer Risk Studies and Priority Areas for Cancer Risk Appraisal in Uganda

Research into aetiologies and prevention of the commonest cancers and implementation of primary and secondary prevention can reduce cancer risk and improve quality of life. Moreover, monitoring the prevalence of cancer risk factors in a specific population helps guide cancer prevention and early detection efforts and national cancer control programming. This article aims to provide the scope and findings of cancer risk studies conducted in Uganda to guide researchers, health-care professionals, and policymakers. Between November 2019 to January 2020, we searched peer-reviewed published articles in Pubmed, EMBASE and Cochrane Library (Cochrane central register of controlled trials-CENTRAL). We followed the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - the PRISMA. The primary focus was to identify cancer risk and prevention studies conducted in Uganda and published in peer-reviewed journals from January 2000 and January 2020. We used key Boolean search terms with their associated database strings. We identified 416 articles, screened 269 non-duplicate articles and obtained 77 full-text articles for review. Out of the 77 studies, we identified one (1%) randomized trial, two (2.5%) retrospective cohort studies and 14 (18%) case-control studies, 46 (60%) cross-sectional studies, five (6.4%) ecological studies, three panel studies (4%) and six (8%) qualitative studies. Cervical cancer was the most studied type of cancer in Uganda (23.4%, n = 18 studies), followed by lymphomas - both Hodgkin and Non-Hodgkin sub-types (20.7%), n = 16 studies) and breast cancer (15.6%, n = 12 studies). In lymphoma studies, Burkitt lymphoma was the most studied type of lymphoma (76%, n = 13 studies). The studies concentrated on specific cancer risk awareness, risk perceptions, attitudes, uptake of screening, uptake of human papillomavirus vaccination, the prevalence of some of the known cancer risk factors and obstacles to accessing screening services. The unmet need for comprehensive cancer risk and prevention studies is enormous in Uganda. Future studies need to comprehensively investigate the known and putative cancer risk factors and prioritize the application of the higher-hierarchy evidence-generating epidemiological studies to guide planning of the national cancer control program.

The Global Burden of Disease Study Estimates of Brazil’s Cervical Cancer Burden

Cervical cancer represents an important preventable cause of morbidity and mortality in developing countries such as Brazil. Investigating temporal evolution of a disease burden in the different realities of the country is essential for improving public policies. To describe the national and subnational burden of cervical cancer, based on the estimates of the 2017 Global Burden of Disease study. Descriptive study of premature mortality (years of life lost [YLL]) and burden of disease (disability-adjusted life years [DALYs]) associated with cervical cancer among Brazilian women aged 25-64 years, between 2000 and 2017. During the study period, age-standardized incidence decreased from 23.53 (22.79-24.26) to 18.39 (17.63-19.17) per 100,000 women, while mortality rates decreased from 11.3 (11.05-11.56) to 7.74 (7.49-8.02) per 100,000 women. These rates were about two to three times greater than equivalent rates in a developed country, such as England: 11.98 (11.45-12.55) to 10.37 (9.85-10.9), and 3.75 (3.68-3.84) to 2.82 (2.75-2.9) per 100,000 women, respectively. Poorer regions of Brazil had greater rates of the disease; for instance, Amapá State in the Northern Region had rates twice as high as the national rates during the same period. Cervical cancer was the leading cause of premature cancer-related mortality (YLL = 100.69, 91.48-110.61 per 100,000 women) among young women (25-29 years) in Brazil and eight federation units of all country regions except the Southeast in 2017. There was a decrease in the burden of cervical cancer in Brazil from 339.59 (330.82-348.83) DALYs per 100,000 women in 2000 to 238.99 (230.45-247.99) DALYs per 100,000 women in 2017. Although there has been a reduction in the burden of cervical cancer in Brazil, the rates remain high, mainly among young women. The persistence of inequalities between regions of Brazil suggests the importance of socioeconomic determinants in the burden for this cancer.

Prevalence of Cervical Cancer Screening and Awareness among Women in an Urban Community in South India—A Cross Sectional Study

Although the incidence of cervical cancer has declined in developed countries, cervical cancer remains a major problem in those that are developing. Past studies suggest that Indian women, who account for at least one-fourth of the global disease burden, are not routinely screened. Among the women living in our low-income urban community in South India, we sought to determine the prevalence of screening and to assess women's knowledge of cervical cancer. We conducted a community-based cross-sectional survey evaluating cancer screening prevalence among women aged 25-65 living in the communities served by our clinic. We also assessed knowledge of cervical cancer, screening and the HPV vaccine in a subset of 175 women in the same age range. Prevalence data was available for 1033 women. Of these,14.3% had at least one lifetime pelvic exam and 7.1% had undergone cervical cancer screening. Women who were married below the age of 18, who belonged to non-Hindu religion, and who were from a higher socioeconomic status were more likely to be screened. Women who were single did not undergo screening. With regard to knowledge of cervical cancer, 84.6% of women had poor knowledge, 10.3% had moderate knowledge, and 5.1% had good knowledge. Women aged 41 years or younger had better knowledge of the disease. Very few women are screened for cervical cancer and few have adequate knowledge of the disease within this South Indian community. These findings suggest opportunities for a community-based education and screening campaign to reduce the prevalence of cervical cancer within this population.

Awareness and Knowledge Among Dental and Medical Undergraduate Students Regarding Human Papilloma Virus and Its Available Preventive Measures

India is a major contributor to the global burden of human papilloma virus (HPV) infection and associated diseases like cervical and oropharyngeal cancers. Hence, it is essential to recognize the existing knowledge pool of current healthcare students about HPV and its preventive measures to translate this into benefits for the society in the future. To determine the awareness and knowledge among dental and medical undergraduate students regarding HPV and its diagnosis and prevention. This cross-sectional study enrolled in 577 dental and undergraduate medical students from a tertiary-care teaching hospital. A questionnaire containing 20 closed-ended multiple-choice questions was used to assess their knowledge regarding HPV and its transmission, cervical cancer and its screening, as well as HPV vaccines and their attitude towards them. Descriptive statistics, Mann Whitney U test, and Chi square test were employed for statistical analysis. p ≤ 0.05 was considered statistically significant. The study consisted of 52.68% dental and 47.31% medical students, with a mean age of 20.95 ± 1.82 years, M:F ratio of 0.7:1, and a mean overall score of 10.75 ± 5.18 (average). The mean scores for knowledge about HPV, its vaccination, and its diagnosis were 7.98 ± 3.26 (good), 1.61 ± 0.95 (average), and 1.15 ± 1.16 (average), respectively. These scores showed no significant difference between the courses as well as the genders (p > 0.05). Overall, the dental and medical undergraduate students presented an average level of knowledge and awareness regarding HPV and its prevention. This reflects a greater need for educating healthcare professionals in order to have a ripple effect on society at large.