F1000Research

Lifestyle and reproductive health: the aetiology of ovarian cancer in Pakistan

Ovarian cancer is a fatal gynaecological cancer and eighth most common cancer in women globally. Lifestyle, reproductive and sociodemographic factors are among the influential parameters that may significantly affect the risk of ovarian cancer and its mortality rate. However, the epidemiological investigations have shown that the risk of ovarian cancers associated with these factors is different in varied geographical distributions. Lifestyle and reproductive factors have not been investigated thoroughly across a wide cultural diversity. The objective of this study is to investigate the association of these factors with ovarian cancer in Pakistan. This investigation will focus on the lifestyle effects of fat intake, intake of tea, habitual exercise, use of talc, personal hygiene, habit of holding urine for long time, obesity on ovarian cancer among Pakistani women.  Reproductive variables will include age at menarche, natural menopausal age, parity, nulliparity (miscarriages, abortion, stillbirths), infertility, fertility treatment, tubal ligation, oral contraceptive use, and family history of breast or ovarian cancer. Sociodemographic variables will include effect of age, income, education, and geographical location. A case-control study will be conducted in the major cancer hospitals of Pakistan and the patients will also be interviewed. The controls will be recruited outside the hospital. For controls the same age limit and residency requirements will be applied. The information gained from this research will be an important contribution to develop programs for health promotion, with a focus on ovarian cancer prevention and women’s health. The findings could be used for health policies and planning to prevent ovarian cancer. The research will pave the way for a public policy and interventions to reduce the burden of ovarian cancer in Pakistan.

Experiences of women living with HIV who underwent long loop excision of the transformation zone (LLETZ) in selected hospitals of Vhembe district, Limpopo province, South Africa

Background Cervical cancer poses a significant health threat, especially for women living with HIV, who are at increased risk of developing premalignant cervical lesions. Large Loop Excision of the Transformation Zone (LLETZ) is a standard treatment for cervical intraepithelial neoplasia (CIN) to prevent progression to malignancy. This study explores the experiences of HIV-positive women who underwent LLETZ in Vhembe District, South Africa, where access to such specialized treatments remains limited. Methods Using a qualitative, phenomenological approach, this study engaged seven HIV-positive women who underwent LLETZ, capturing their lived experiences through in-depth, unstructured interviews. Thematic analysis identified key themes and subthemes to elucidate their psychological, physical, and social encounters related to the procedure. Results Analysis revealed eight central themes: psychological and physical experiences, psychosocial and financial support, misconceptions, education, recommendations, and time-related factors. Participants reported anxiety, fear, and initial stress about the procedure, coupled with resilience and acceptance over time. Physical effects such as pain and bleeding were common, though recovery experiences varied. Social support from family and community played a critical role in coping, while financial constraints impacted access to and continuity of care. Misunderstandings about the LLETZ procedure underscored the need for enhanced patient education. Participants emphasized timely screening and support systems to improve treatment outcomes and reduce psychological distress. Conclusions The study highlights the multifaceted impact of LLETZ on HIV-positive women, including the psychological and financial burdens and the importance of clear communication and patient education. Improved support structures, timely result communication, and access to follow-up care are essential to enhance patient outcomes. Recommendations advocate for health system improvements, partner involvement, and proactive counselling to address the specific needs of HIV-positive women undergoing cervical cancer prevention treatments.

Demand-side barriers and economic burden in accessing Human Papillomavirus screening for cervical cancer prevention in rural India: Evidence from a cross-sectional study

Introduction Cervical cancer is a significant global health concern, especially in low- and middle-income countries with limited access to preventive healthcare. India’s vast rural population amplifies the challenge, demanding immediate action. Despite advancements, cervical cancer remains prevalent among underserved rural communities, hindered by barriers to Human Papillomavirus (HPV) screening uptake, including socioeconomic and financial constraints. This study aims to evaluate the economic challenges encountered by rural women when accessing HPV screening. Methods A cross-sectional survey was conducted among 1502 women aged 30 to 45 in Pondicherry, India, utilizing the Andersen Model as a conceptual framework. Household questionnaires gathered data on HPV screening expenses, including patient travel costs, productivity loss, and companion costs. The analysis utilized regression models, to identify the factors impacting the economic challenges associated with accessing HPV screening. Results The study found that employment status significantly influenced healthcare costs, with employed women incurring ₹65.78 more than unemployed women (p < 0.001). Education level was also a significant predictor, with each additional year of education leading to a ₹108.45 increase in costs (p < 0.001). Travel time had a positive association with healthcare costs, with every additional minute spent traveling increasing costs by ₹5.98 (p < 0.001). Income and companion accompaniment were also significant predictors, while distance to the PHC and age did not show significant associations with total healthcare. Conclusions The study highlights the multifaceted economic challenges faced by rural populations accessing HPV screening for cervical cancer prevention in India. Notwithstanding diverse demographics and varying proximity to healthcare facilities, individuals encounter significant barriers such as travel time and associated costs. Addressing these challenges necessitates targeted interventions to reduce socioeconomic disparities and improve healthcare accessibility for vulnerable populations, thereby advancing cervical cancer prevention efforts and promoting health equity in rural communities.

Pre-treatment blood parameters as an economical predictive marker for predicting treatment response in locally advanced cervical cancer

Background Cervical cancer poses a significant public health challenge, particularly in low and middle-income countries. Despite advancements in treatment, the disease remains a leading cause of cancer-related deaths among women globally. Chemoradiation utilizing cisplatin has been the cornerstone therapy for locally advanced cervical cancer. Prognostic biomarkers, including hematological parameters, have emerged as valuable tools in guiding treatment decisions and predicting outcomes. Methodology Data from patients treated between January 2021 and June 2022 were analyzed. Demographic information, histopathology, pre-treatment blood parameters, treatment details, and response assessments were collected. The parameters assessed included hemoglobin levels, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), and eosinophil albumin ratio (EAR). Receiver operating characteristic (ROC) curve analysis was conducted to determine optimal cut-off values for these biomarkers. Results Of the 140 patients included, the majority had squamous cell carcinoma (92%) and were at stage II or III. Complete response to treatment was observed in 86.4% of patients. Non-responders demonstrated significantly higher levels of hemoglobin, NLR, and EAR, along with lower PNI levels compared to responders. ROC analysis revealed cut-off values for hemoglobin (< 9.5), NLR (< 2.98), PLR (> 289.26), PNI (< 37.67), and EAR (< 49.63) associated with treatment response. Conclusion The study highlights the potential utility of pre-treatment blood parameters as predictive markers for treatment response in locally advanced cervical cancer. Lower hemoglobin, higher NLR, and EAR, along with reduced PNI, were associated with poorer treatment outcomes. Integration of these biomarkers into clinical practice could aid in treatment planning and improve patient outcomes. Further validation and prospective studies are warranted to establish the role of these biomarkers in guiding personalized treatment strategies for cervical cancer patients.

Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess

We report an uncommon clinical presentation of a placental site trophoblastic tumor. The patient presented initially with abdominal pain with, fever, bleeding and pelvic mass on ultrasonography leading to the wrong diagnosis of a pelvic abscess. Dilation and curettage were performed and pathological examination confirmed the diagnosis of placental site trophoblastic tumor. Therefore, she underwent abdominal hysterectomy. Four years after surgery, the patient is still disease free. Gestational trophoblastic diseases should be considered in every patient presenting abnormal uterine bleeding after delivery or pregnancy loss despite the associated symptoms being very unusual.

Case Report: Incidental discovery of primary peritoneal psammocarcinoma

Psammocarcinoma is an uncommon subtype of low-grade serous carcinoma. It is characterized by the presence of extensive psammoma bodies and can have either an ovarian or peritoneal origin. To our knowledge fewer than 30 cases of primary peritoneal psammocarcinoma (PPP) have been reported in the English literature. We report a rare case of  PPP in a 74-year-old female, discovered fortuitously within a laparotomy for gallbladder lithiasis. At laparotomy, multiple nodular implants involving the omentum, the peritoneum and a magma of intestinal loops in the right iliac fossa were noted. A biopsy from nodules was performed. Gross examination showed multiple nodules of different sizes in the fat tissue. Pathologic examination showed massive psammoma bodies representing more than 75% of the tumor. The final diagnosis was psammocarcinoma. Our patient was referred to the gynecologic department for further investigation and to ascertain whether the tumor arose from the ovaries or peritoneum. Hysterectomy, bilateral adnexectomy and omentectomy were performed. Macroscopic examination showed that both ovaries were intact having a normal size. No invasion of ovarian stroma was shown in microscopic examination. The patient died of SARS-CoV-2 (COVID-19) six days after the surgery. PPP is a rare type of  low-grade serous carcinoma. The behavior of this tumor is unclear, and the treatment is not standardized because of its rarity and lack of long-term follow-up. More cases need to be studied for better understanding and improvement of the management protocols.

CINNAMON-GUI: Revolutionizing Pap Smear Analysis with CNN-Based Digital Pathology Image Classification

Background Medical imaging has seen significant advancements through machine learning, particularly convolutional neural networks (CNNs). These technologies have transformed the analysis of pathological images, enhancing the accuracy of diagnosing and classifying cellular anomalies. Digital pathology methodologies, including image analysis, have improved cervical cancer diagnostics. However, existing commercial platforms are often costly and restrictive, limiting customization and scalability. Methods CINNAMON-GUI is an open-source digital pathology tool based on CNNs for classifying Pap smear images. Transitioning to a Shiny app in Python, it offers enhanced user interface and interactivity. The application supports dynamic web interactions, advanced features for image analysis, and state-of-the-art CNN models tailored for digital pathology. Key features include intuitive UI components, real-time image and plot generation, memory-efficient data handling, and robust training capabilities with customizable CNN architectures. The tool also integrates with Labelme for defining regions of interest and allows testing on external biospecimens. Results Model A (seed 42, 100 epochs) and Model B (same architecture with adjusted augmentation parameters) were compared. Model A stabilized with training accuracy around 0.88 and validation accuracy around 0.913. Model B showed improved performance with training accuracy around 0.91 and validation accuracy around 0.95. Feature mapping highlighted critical morphological aspects, improving classification accuracy. Model B reduced misclassification errors significantly compared to Model A. Conclusions CINNAMON-GUI demonstrates the potential of an open-source platform in digital pathology, providing transparency and collaborative opportunities. The tool enhances diagnostic accuracy through feature map analysis and optimized CNN training. Future development aims to extend its application to other cancer types, leveraging its dynamic and user-friendly interface for broader use in diagnostics.