Indian Journal of Public Health

Genetic Variations Affect Chemotherapy Outcomes: A Role of the Spindle-assembly Checkpoint

Cancer patients suffer from complicated chemotoxicity. Pharmacogenomics can help stratify patients by predicting their response to treatment and susceptibility toward severe side effects. The spindle-assembly checkpoint (SAC) is an important pathway that is activated by platinum and taxane compounds and plays a crucial role in their cytotoxic activity. This study investigated a SAC component, Budding Uninhibited by Benzimidazoles 3 (BUB3), its expression, and genetic variants in advanced ovarian cancer patients treated with paclitaxel–carboplatin chemotherapy. Among 80 patients, BUB3 expression correlated with chemosensitivity, suggesting its potential as a predictive marker for chemotherapy response. However, high BUB3 expression was associated with a higher risk of poor survival. In addition, genetic polymorphisms in BUB3 (rs11248416 and rs11248419) were significantly linked to chemotherapy-related toxicities, with rs11248416 showing a negative impact on the patient’s physical quality of life.

A Systematic Framework for Evaluating Cervical Cancer Screening Programs: Innovative Approaches and Best Practices

Summary Cervical cancer is a major public health issue, particularly in low- and middle-income countries where 90% of cases and deaths occur. This study proposes a comprehensive framework for evaluating cervical cancer screening programs, addressing gaps in existing models that overlook critical components, such as follow-up and treatment. Using a forward logic approach, the framework outlines inputs, processes, outputs, and outcomes across four components: behavior change communication, screening, confirmation and diagnosis, and treatment. The methodology includes reviewing national guidelines, defining key inputs, activities, and developing indicators to assess each screening stage. Key challenges identified include low screening coverage, inconsistent referrals, and high attrition rates. The logic model provides a structured approach for evaluating program performance, facilitating data collection, analysis, and timely interventions. The results highlight the need for comprehensive evaluation frameworks to enhance cervical cancer control efforts and achieve the WHO’s elimination targets by 2030. Further validation in diverse settings is recommended.

Cervical Cancer Screening Methods among Women Living with Human Immunodeficiency Virus: A Systematic Review and Meta-analysis

Summary Background: The efficacy of antiretroviral therapy diminishes without addressing comorbidities, particularly the heightened incidence and mortality of cervical cancer among women with human immunodeficiency virus (HIV). Objectives: This systematic review and meta-analysis aimed to evaluate different cervical cancer screening methods for women living with HIV, given the scarcity of evidence. Materials and Methods: Systematic searches of electronic databases yielded relevant original research published before August 2019, with additional studies identified through cross-referencing. Results: In a pooled analysis, visual inspection with Lugol’s iodine (VILI) demonstrated superior sensitivity, specificity, and accuracy (0.89, 0.88, and 0.88, respectively) compared to cytology testing (0.67, 0.79, and 0.77). VILI outperformed visual inspection with acetic acid (VIA) by 22% in sensitivity and 11% in specificity. Cytology lagged behind VILI by 22% in sensitivity and 9% in specificity. Human papillomavirus (HPV) DNA testing showed a 3% lower sensitivity and 2% lower specificity than VILI. Sequential VIA and cytology testing exhibited lower sensitivity for cervical intraepithelial neoplasia (CIN) 2 + detection than VILI and HPV testing, resulting in more missed cases. HPV testing, in combination with other modalities (VIA, VILI, and cytology), maximized the possibility of CIN2 + detection. Conclusion: VILI as a standalone test meets criteria for good sensitivity, specificity, and accuracy. The choice of screening modality should consider factors such as cost, geographical location, population type, professional training, and laboratory capacity.

Integrating Cervical Cancer Screening and Human Immunodeficiency Virus Care among Women Living with Human Immunodeficiency Virus: A Call for Action

Summary Cervical cancer is a leading cause of cancer-related morbidity and mortality in women living with human immunodeficiency virus (WLHIV) worldwide. However, there is no nationwide public health policy in India that aims to prevent cervical cancer among WLHIV. Thus, the integration of cervical cancer preventive services within existing HIV care programs is essential. This study proposes a framework for healthcare providers and policymakers to enhance the integration of cervical cancer screening services within existing HIV care programs in India. This aims to improve access to early detection and treatment of cervical cancer among WLHIV, ultimately reducing morbidity and mortality.

Determination of Human Papillomavirus Serotypes in Endocervical Samples from Patients with Normal Cytology from a Mexican Population by Polymerase Chain Reaction-restriction Fragment Length Polymorphism

Abstract Human papillomavirus (HPV) is associated with cervical cancer (CC). Genotypes 16 and 18 are high-risk (HR) factors for CC. The Papanicolaou (Pap) identifies the morphological changes for CC. However, HPV is presented in normal Pap smears. This study aimed to estimate the prevalence of HPV in patients with normal cytology and a cross-sectional study was conducted among 141 women with normal cytology. DNA was extracted from a cervical swab. The viral genome was screened by polymerase chain reaction-restriction fragment length polymorphism, using MY09/11 and L1C1/L1C2 oligonucleotides. A bivariate analysis of the main risk factors was performed. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from multiple logistic regression models. HPV prevalence increased to 16.3% (95% CI) when L1C1/L1C2 were used. Genotypes 11, 13, 33, and 59 were detected; 33 and 59 are HR factors for CC. The number of sexual partners is associated with HPV, OR 5.2 (P < 0.05). The regional HR variations should be considered in CC prevention.

Gay and Bisexual Men too should not be Left Out/Deprived of Human Papilloma Virus Vaccination in “Cervical Cancer Elimination Programme” in Countries with a High Prevalence of HIV

Awareness on cancer cervix, willingness, and barriers for screening of cancer cervix among women: A community-based cross-sectional study from urban Pondicherry

Early detection of cervical cancer can significantly reduce the associated morbidities and mortality. However, uptake of screening for cervical cancer in India is not encouraging. To assess the awareness about cervical cancer, willingness, and barriers for undergoing screening of cervical cancer among women in urban Pondicherry. This cross-sectional study was conducted among women of 30-65 years in urban Pondicherry during January - July 2019. A total of 219 women, selected using two-stage random sampling, were interviewed using a pretested semi-structured questionnaire. Multistep multivariable logistic regression was done to identify the independent correlates of willingness to undergo screening for cervical cancers. About one-third women were aware of cervical cancer. Awareness was more among women who were young, had higher education, had family history of cancer, and currently working. Awareness of risk factors, signs and symptoms of cancer cervix was low. Although 60% of the women, who have been aware of cervical cancer, were aware of possibility of early detection, <15% were aware of the various methods. 32% of the women were willing to undergo screening for cervical cancer, and occupation, family history of cancer, and knowledge about risk factors were found to be independent correlates. Fear and "not having signs and symptoms" were the major reasons for unwillingness. Level of awareness and willingness for undergoing screening of cervical cancer was low in study area. Targeted interventions for awareness and health system efforts for addressing the reasons behind unwillingness are required.

Human Papillomavirus Vaccination – A Moment of Prevention, a Lifetime of Protection

Summary Human papillomavirus (HPV) vaccination is the primary preventive strategy to reduce the burden of cervical cancer as well as other HPV-related malignancies. Today, at least 144 countries provide the HPV vaccine as part of the national immunization schedule for girls. The original WHO recommendation of three doses of the HPV vaccine has been recently updated to a one to two-dose schedule. This has been proven to be cost-effective and will be able to protect more girls and women with the limited resources in low- and middle-income countries.

Role of education and income on disparities of time-to-treatment initiation and its impact on cervical cancer survival

In India, cervical cancer is the second-leading cause of cancer incidence among women. Socioeconomic factors play a vital role in cervical cancer survival. This study assessed the role of education and income on disparities in time-to-treatment initiation (TTI) and its impact on cervical cancer survival. This was a retrospective facility-based record study conducted among newly treated cervical cancer patients registered in a tertiary medical care center in Mumbai between 2014 and 2016. Adjusted hazard ratio with a 95% confidence interval was reported. In total, 1947 cervical cancer patients with a mean age of 52.89 (±10.55) years were included. The average number of days for TTI among highly educated patients was 27 versus 35 days for patients with no formal education. An increasing trend in survival was observed as education levels shift from no formal to higher education category (75.54%, 77.30%, and 85.10%, P = 0.01). All cause mortality was lower in cervical cancer patients with secondary education and above than illiterates (hazard ratio [HR] = 0.63, P < 0.01), among those with higher income (HR = 0.78, P = 0.04) than lower income and among who started on treatment within 30 days (HR = 0.90, P = 0.29) than patients who started treated after 30 days. Inferior survival is found for cervical cancer patients with lower education and income and who initiated treatment after 30 days. Hence, it is important to improve awareness and screening activities, especially among the lower socioeconomic groups, for early diagnosis and better treatment outcomes.