Journal of Cancer Policy

Incorporation of HPV-DNA molecular test into the Brazilian healthcare system

Cervical cancer is a major public health problem and is among the leading causes of female mortality in Brazil, especially in regions with less access to health services. In this context, in 2025 the country began the gradual implementation of the HPV-DNA molecular test in the Unified Health System, considered by the World Health Organization to be a more sensitive and effective primary screening method than conventional cytopathological examination. The objective of this study was to analyze the main political, logistical, and structural challenges involved in the national adoption of this technology, considering aspects of laboratory infrastructure, logistics, financing, professional training, and equity of access. The methodology adopted was based on the documentary analysis of ministerial decrees, technical guides, and official reports. The implementation of this technological innovation began in 15 municipalities in 12 Brazilian states, potentially benefiting approximately seven million women between 25 and 64 years of age annually. The interval between tests, when negative, increases from three to five years, optimizing resources and expanding coverage. However, challenges remain related to expanding laboratory capacity, transporting samples, maintaining diagnostic quality, and women's adherence to the new protocol. In conclusion, the incorporation of the HPV-DNA oncogenic molecular test represents a milestone for cervical cancer screening in Brazil, with the potential to reduce female mortality, provided it is accompanied by sustainable investments in infrastructure, health education, and territorial equity strategies.

Process evaluation of quality of precancerous cervical lesion screening program in selected public health centers in Addis Ababa, Ethiopia

Cervical cancer is the second most prevalent disease among Ethiopian women of reproductive age and a serious gynecological malignancy affecting women regionally. About, 3235 deaths and 4648 new cases are reported nationwide each year. Precancerous cervical screening programs face many difficulties in settings with limited resources, despite their severity, such as a lack of medical supplies and equipment, poorly trained healthcare workers, a heavy workload for current staff, low professional compliance, and insufficient support from medical facilities. Furthermore, the quality of screening services is not well-supported by data in many places, which makes efforts to enhance these programs even more difficult. Improving service quality and customer satisfaction requires an understanding of the accessibility of critical screening tools and the skill of healthcare providers. Hence, this study aims to evaluate the process quality of the pre-cancerous cervical lesion screening program at selected public health centers in Gulele sub-city, Addis Ababa, Ethiopia. A case study design involving both quantitative and qualitative methods was conducted from April 09 to May 10, 2022. The study was conducted based on clinical guidelines and previously published evidence in peer-reviewed journals. A total of nine (n = 9) public health centers were involved in the study. A total of 223 study participants for service program evaluation. For the qualitative study, 12 key informants were interviewed at exit consecutively. Additionally, resource inventory and record review were conducted. Data were analyzed using SPSS for Windows version 25. Multi-variate logistic regression was used to check the association between the outcome and independent variables. Multivariate logistic regression was analyzed when the p-value was less than or equal to 0.25 in bivariate binary logistic regression, considering the statistical significance at p-value < 0.05. Qualitative data were analyzed manually by summarizing into a key thematic area. The evaluation findings were interpreted based on a predetermined judgment matrix with stakeholders during the evaluability assessment. From quality perspectives, study found that, pre-cancerous cervical lesion screening service concerning program resource availability was measured to be 80 %, which was good. In terms of satisfaction, the study found that 88 % of clients were satisfied with the precancerous cervical lesion screening service provided by health centers. Occupational status of a government employee (AOR: 0.04; 95 % CI: 0.003,0.63), educational status with no formal education (AOR: 0.04; 95 %CI: 0.006, 0.23), long-term use of contraceptives (AOR: 3.70; 95 %CI: 1.34, 10.21), and having multiple children up to three (AOR: 3.27; 95 %CI: 1.3, 9.44) were significantly associated factors with client satisfaction on screening services for precancerous cervical. However, while the overall program implementation scored 78.67 %, categorized as good, certain areas require improvement. Compliance with national guidelines among healthcare professionals were rated at 74 %, indicating a need for enhanced adherence to established standards. Qualitative findings revealed that trained providers often handle multiple responsibilities, leading to service quality challenges due to overburdening. Additionally, financial constraints hinder the availability of essential equipment and medications, posing significant barriers to effective service delivery. In conclusion, although the level of satisfaction with service provision was good and the overall quality of service was acceptable. However, the availability of necessary resources and compliance of health care providers to national guidelines need improvement. We recommend more efforts be exerted on improving providers' compliance and availing of necessary resources to enhance the status of pre-cancerous cervical cancer screening services.

A cross-sector approach to explore socio-ecological associations with treatment engagement behaviours in Northern Ghana

Real-world outcomes associated with use of front-line bevacizumab in ovarian cancer

In the pivotal ICON7 study, addition of bevacizumab to front-line treatment of ovarian cancer (OC) significantly improved overall survival (OS) (p = 0.03) in a high-risk subgroup of patients with suboptimally debulked/unresectable stage III or IV disease, leading to approval in Ontario, Canada in March 2016. Here we describe utilization of bevacizumab for front-line, high-risk OC and determine outcomes in routine clinical practice. Provincial administrative databases were utilized to identify all patients treated with front-line bevacizumab following its approval. Median OS (mOS) was determined using the Kaplan-Meier method. Factors associated with OS were identified using a Cox proportional hazard model. A comparative effectiveness analysis was performed to determine mOS pre- (2006-2016) and post- (2016-2019) approval. From March 2016 to October 2019, 282 patients received bevacizumab. Mean age was 64 years old, and 58% had stage IV disease. Median survival was 29 months and was longer in stage III (37 months) compared to stage IV disease (28 months). In a comparative effectiveness analysis of patients with stage IV serous OC, post-approval uptake of bevacizumab was low (23%). Median OS was similar pre (26 months) and post (27 months) approval (HR 0.92, 0.75-1.12, p = 0.383). Survival in real-world patients treated with front-line bevacizumab is shorter than in pivotal clinical trials. Survival in stage IV serous patients has not significantly improved post public reimbursement of bevacizumab. This analysis was limited by poor uptake, however mOS was similar in patients who did and did not receive bevacizumab.

Epidemiological profile of cancer at the laboratory of anatomy and pathological cytology of mungbere in the Democratic Republic of Congo

Cancer is the second leading cause of death worldwide, causing about 10 million deaths per year, 70 % of which occur in low- and middle-income countries. In the DRC, the absence of a national cancer registry is a handicap to the definition of a strategy to combat this disease. The purpose of this study is to establish an epidemiological profile of cancer in this laboratory in order to overcome this deficit in this part of the country. We conducted a descriptive study of 1636 histopathological analysis reports from 2015 to 2021 at the Anatomy and Pathological Cytology Laboratory of Anualite Hospital in Mungbere. A total of 502 cases of cancer have been identified; female accounted for 51.4 % of cases; all age groups are affected; The most common cancers in both sexes are Kaposi's sarcoma (17.9 %), breast cancer (15.3 %), lymphoma (13.7 %), cervical cancer (9.6 %) and squamous cell carcinoma of the skin (9 %). In women, breast cancer (27.1 %), cervical cancer (18.6 %), Kaposi's sarcoma (10.1 %), lymphoma (7.4 %) and squamous cell carcinoma of the skin (5.8 %) and in men Kaposi's sarcoma (26.2 %), lymphoma (20.5 %), liver cancer (13.1 %)) and squamous cell carcinoma of the skin (12.3 %). Cancer affects all age groups with a slight female predominance. The most common in both sexes are Kaposi's sarcoma, breast cancer, lymphoma, cervical cancer and squamous cell carcinoma of the skin. For an effective fight against cancer, the creation of a national cancer registry is an emergency in our country.

Cancer survival in Thailand from 1997 to 2012: Assessing the impact of universal health coverage

In recent decades, many countries worldwide have implemented some form of Universal Health Coverage (UHC). We sought to evaluate incidence and survival trends of breast, cervical, and colorectal cancer before and after the implementation of UHC in Thailand. The age-standardized incidence rate and 1- and 5-year net survival (NS) were calculated for five Thai provinces, namely Bangkok, Chiang Mai, Khon Kaen, Lampang, and Songkhla for breast, cervix, and colorectal cancer in three study periods (1997-2012): before, during, and after the implementation of UHC. The incidence of breast and colorectal cancer has increased over time, while the incidence of cervical cancer has decreased (17.9-29.9, 9.0-13.6, and 19.6-12.3 per 100,000, respectively). Larger proportion of breast cancer were diagnosed with localized stage after UHC implementation compared to the period prior to UHC (31.5 % vs 19.0 %). Overall, The improvement in survival by cancer site varied in magnitude with a 5-year NS increase from 61.3 % to 75.1 % for breast, 55.4-59.5 % for cervical, and 39.9-47.6 % for colorectal cancer. The amount of increase slightly differed across provinces. Rising incidence for breast and colorectal, and declining cervical cancer may partly be attributable to improved awareness and early detection programs. Additionally, improvement in survival may partly be attributable to increased access to healthcare, availability of treatment, and increased access to cancer screening after UHC was implemented. Thus, continued expansion of UHC package on cancer could potentially contribute to further improvement of cancer control in Thailand. This study provides important evidence on the impact of UHC in cancer burden and survival for breast, cervical, and colorectal cancer in Thailand. This study serves as an example for other countries where UHC has been recently implemented and guide policymakers in allocating resources towards UHC and cancer control programs.

Trends in cervical cancer screening research in sub-Saharan Africa: A bibliometric analysis of publications from 2001 to 2020

Sub-Saharan Africa has the highest incidence of cervical cancer globally. However, compared to developed countries, the region has lower uptake of cervical cancer screening. Research contribution and progress in the field of cervical cancer in the region has not been well investigated. This bibliometric review aimed to address this information gap by examining changes in research volume and type over a 20 year time frame. Medline, Embase, PsycINFO, CINAHL, and Cochrane Library were searched to identify peer-reviewed publications about cervical cancer screening in sub-Saharan Africa. Changes (from 2001 to 2020) in the (i) total publications, (ii) number and proportion of data-based publications relative to non-data-based publications, and descriptive relative to intervention publications, and (iii) the number and proportion of publications meeting the EPOC design criteria relative to those not meeting the EPOC design criteria were assessed using a generalised linear Poisson model, a generalised binomial model and the Pearson Chi-squared test respectively. A two-year increase in time was associated with an estimated 32 % increase in the total number of publications. While no measurement studies were recorded, the bulk of data-based publications (89 %) were descriptive studies. Relative to descriptive publications, a 1 % increase in the proportion of intervention publications was observed over time. Only a small proportion (28 %) of intervention studies met the EPOC design criteria. Our findings suggest that researchers and funders in the region should invest more effort and money in measurement and rigorous intervention research to inform outcome measures and cervical cancer screening policy and practice, respectively.

Effect of municipal and state regulation on access and outcomes for cervical cancer patients in Rio de Janeiro, Brazil: An interrupted time series analysis

Cervical cancer (CC) is one of Brazil's most prevalent neoplasms, and organizing health care flows that guarantee adequate and timely referral is a challenge. This paper analyzes the effect of municipal and state regulation on access and outcomes for CC patients treated in Rio de Janeiro. Retrospective, quasi-experimental study, applying interrupted time series, using data from Cancer Registry from January-2012 to December-2017. We analyzed the implementation of the municipal (August-2013) and state (June-2015) regulation systems for the treatment of CC. The primary outcomes were 1. Time from diagnosis to the first Specialist Visit (TSV); 2. Time from a specialist visit to Treatment Initiation (TSV-TTI); 3. Time from diagnosis to treatment initiation (DTTI); 4. Percentage of patients with adequate Time to Treatment Initiation (PATTI); 5. Percentage of patients with a positive outcome (PPO). were included 4119 women. 71.04 % were between 30 and 59 years old, 55.57 % were black or brown, and 50.52 % had completed elementary school. The monthly average TSV was 43 days in 2012. After the first intervention, TSV increased by seven days, with a decreasing trend of 1 day per month until December-2017. Similarly, after June-2015, DTTI increased to 63 days, decreasing by one day per month until December-2017. After both interventions, there was an increase of 11.98 % in PATTI, with an increasing monthly trend of 0.18 %. PPO remained stable throughout the analyzed period. the results suggest that regulation organized access flow for specialized care. However, other relevant issues must be addressed, such as an internal backlog at the institutions, which compromises a timely start of treatment. To improve access to the diagnosis and treatment of CC in its early stages, it is necessary to invest in health policies to adjust the supply to the required demand and thus reduce mortality from this pathology.

Why cervical self-sampling can aid radiotherapy in India in the COVID-19 era

Can financial incentives encourage women to participate in a cervical cancer screening programme? Evidence from a randomized controlled trial analysis

The incidence of cervical cancer can be reduced by introducing effective screening programmes to detect the earliest signs of cancer. However, the literature reveals that, despite the availability of some level of infrastructural facilities for screening in low- and middle-income countries, very few women are screened in these countries due to their low acceptance of and participation in screening. Therefore, increasing the participation of women in cancer screening programmes is one of the major challenges for policy-makers. With this background, we attempted in this study to evaluate the effectiveness of financial incentives as an intervention to encourage women to accept and participate in a cervical cancer screening programme. Within a framework of randomized controlled trial (RCT) analysis, an experiment was conducted to evaluate the effectiveness of a financial intervention. The experiment was conducted in two districts of Assam, India. In total, 412 women participated in the experiment. Participants were divided between control and treatment groups on a random basis. Logistic regression was used to quantify the effectiveness of the financial intervention. The likelihood of participation in a cancer screening programme was 20.5 times greater for those respondents who received financial assistance to attend the cancer screening programme. Financial incentive was found to be an effective intervention to encourage women to participate in a cervical cancer screening programme. The study also generated evidence that, along with financial incentives, there are other factors or determinants that also play a crucial role in a woman's decision-making process. Therefore, these factors should also be considered while formulating any policies for managing and controlling cervical cancer incidence. By introducing a financial incentive as an intervention, the problem of low acceptance and participation of women in cervical cancer screening programmes can be overcome to a significant level.

Sexual health in women and sexual-gender-minority patients with cancer: A nationwide survey on healthcare professional awareness and attitude on behalf of MITO and AIRO-gynecology group

Quality improvement initiatives on colposcopy and treatment of cervical pre-cancer services in Bhutan: Experiences, challenges, and way forward

Bhutan has achieved 90-70-90 global targets by 2023, way ahead of the global targets of elimination of cervical cancer by 2030. However, cervical cancer remains the most prevalent cancer, among women in Bhutan. While all healthcare screening, diagnosis and treatment of cervical cancers are provided free of cost, sustainability in terms of financing and human resources and ensuring quality of services are the major challenges. Development of a national standard guideline is a major intervention towards improving the quality of colposcopy services and treatment of precancer in the country. In this article, we discuss the summary of the consensus-based practical guideline on colposcopy and treatment of cervical pre-cancers in Bhutan, challenges faced and potential way forward.

Beyond virtual learning: Leveraging project ECHO to sustain and localize national cancer control plan implementation in LMICs

Project ECHO has emerged as a promising virtual peer-learning model to support National Cancer Control Plan (NCCP) implementation in low- and middle-income countries (LMICs). It aligns with the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020, which underscores national coordination and multisectoral action [2]. In response to the recent evaluation by Eldridge et al., we offer additional insights highlighting the limitations of individual-level training when structural barriers remain unaddressed. Drawing lessons from cervical cancer prevention in Botswana and palliative care capacity-building in India, we argue that ECHO's full potential lies in national-level integration, cross-sector policy coordination, and localized implementation. This correspondence emphasizes a systems-level perspective to sustainably embed ECHO-based knowledge into cancer control programs across LMICs.

Bhutan achieves the 90-70-90 targets on the path to elimination of cervical cancer: Experience, challenges and way forward

Cervical cancer is the most common form of cancers among females in Bhutan. The Royal Government of Bhutan has achieved the 90-70-90 global milestones towards elimination of cervical cancer. However, challenges remain in improving the quality of services, and addressing sustainability issues. With continued political commitment, dedicated efforts of health professionals and public support, Bhutan is committed in our efforts towards elimination of invasive cervical cancer by 2030, in alignment with the World Health Organization's global target. This review article presents the efforts, challenges and way forward towards elimination of cervical cancer in Bhutan.

Challenges and opportunities in ovarian cancer care: A qualitative study of clinician perspectives from 24 low- and middle-income countries

Ovarian cancer poses a significant and growing burden, particularly in low- and middle-income countries (LMICs) where incidence and mortality are projected to increase by over 50 % by 2050. However, there is a critical lack of qualitative data on the challenges and opportunities for improvement in treatment and care for women with ovarian cancer in these regions. The aim of this research is to investigate clinicians' perspectives on the matter in 24 LMICs. As part of the multi-country observational Every Woman Study™ (EWS), semi-structured interviews were conducted with clinicians between June 2022 and June 2023. The interview guide was developed by the EWS LMIC Oversight Committee, including patients, clinicians and data specialists. Relational content and inductive thematic analyses were employed and categories synthesized using the World Health Organization's six building blocks of the Health Systems Framework. 24 clinicians (54 % female; 79 % gynaecologic oncologists, 8 % gynaecologists, 8 % clinical oncologists not specializing in gynaecological cancers, and 4 % clinical oncologists specializing in gynaecological cancers; 42 % from Africa, 29 % from Asia, 29 % from Latin America) participated. Six dominant themes were identified: "Poor Ovarian Cancer Data'', "Inequity in Access to Treatment", "In-Country Inequities in Access to Care", "Role of Cultural Norms on Women's Health", "Increased Engagement of Men in Ovarian Cancer Control", and "Advocacy and Education for Empowering Women". Content analysis revealed system-level challenges such as delayed drug payments, lack of population-based cancer data, and limited imaging facilities. Patient-level challenges included disparities in access to specialists, limited medication affordability, poor symptom recognition, and reliance on alternative treatments. This study reveals the complexity of ovarian cancer treatment and care in LMICs and the need to mitigate disparities in these regions, underscoring the need for patient-centred, context specific and intersectoral strategies to be considered in cancer planning to improve ovarian cancer care quality and equity in LMICs.

Overcoming barriers of cervical cancer elimination in India: A practice to policy level advocacy

India's ambitious goal of eliminating cervical cancer by 2030 faces significant challenges due to the high burden of disease, low screening rates, and sociocultural barriers. Despite the Government's focus on vaccination, addressing cervical cancer requires a more comprehensive approach that is multisectoral and consider practice to policy engagement. Addressing not only vaccination but also social barriers, healthcare infrastructure, and research is key to preventing and controlling this preventable disease. Fragmented health policies with limited coverage for cervical cancer, coupled with societal issues like stigma and limited access to healthcare, particularly in rural areas, pose significant challenges. Moreover, limited awareness of HPV and vaccines hinders progress. To effectively combat cervical cancer, India must prioritize a readiness assessment to evaluate past interventions, economic feasibility, and social issues before launching new programs. Improving healthcare infrastructure, training healthcare workers, and utilizing innovative models like mobile clinics can expand access to care. Public-private partnerships with incentives can also play a crucial role in mobilizing resources. Investing in culturally appropriate public awareness campaigns is essential to educate the population about HPV, cervical cancer, and prevention strategies. A robust pharmacovigilance program is necessary to ensure vaccine safety. Additionally, India should invest in science and technology to support long-term research efforts, while increasing understanding of population-specific predisposing factors for broader-spectrum vaccines and personalized approaches. A dedicated national policy with clear objectives, strategies, and accountability mechanisms is crucial for successful cervical cancer control. Learning from the experiences of other countries can inform policy development.

Eliminating HPV-caused cancers in Europe: Achieving the possible

The 690,000 cases of cancer caused worldwide each year by HPV (human papillomavirus) are among the easiest of all cancers to prevent. However, the actions so far taken in terms of both policy and practice by health systems in many European states have neither matched the scale of the problem nor seized the opportunities for disease prevention potentially offered by vaccination and screening. Treatments for HPV-caused cancers are also inequitably provided across the region and widespread misinformation about HPV undermines efforts to improve public health. The European Cancer Organisation's HPV Action Network has made the case for action for the elimination of all the cancers caused by HPV through gender-neutral vaccination, effective cervical cancer screening, better quality treatments, and public and professional education across Europe. The World Health Organisation's new global strategy for the elimination of cervical cancer (launched in November 2020), together with Europe's Beating Cancer Plan (February 2021), together provide a major opportunity to tackle decisively all the cancers caused by HPV. The Beating Cancer Plan, which was significantly influenced by evidence provided by the HPV Action Network, commits to supporting EU member states' efforts to extend routine vaccination of girls and boys and to creating a new EU-supported Cancer Screening Scheme to help Member States ensure that 90% of the EU population who qualify for cervical cancer screening are offered it by 2025. The goal of HPV cancer elimination is now both possible and achievable. The challenge is to ensure implementation and delivery by EU member states and more widely across the European region.

Economic evaluation of the one-dose HPV vaccination program in Nigeria

This study retrospectively examines the cost-effectiveness of the national HPV vaccination program using the program cost and coverage data in Nigeria. We conducted a cost-effectiveness analysis of the HPV vaccination program compared with no vaccination in Nigeria, adopting both health system and societal perspectives. A static Markov model simulating HPV infection and cervical cancer outcomes was developed for a cohort of girls aged 9-14 years, followed until age 100. The model comprised primarily the following health states: susceptible, cervical cancer, and death. It further incorporated three additional pathways for patients with cervical cancer, including those with successful treatment, with treatment failure, and with no treatment. The incremental cost-effectiveness ratio (ICER) was estimated at $268.67 per quality-adjusted life year (QALY) gained from the health system perspective and $217.85 per QALY gained from the societal perspective. Both ICERs were well below the cost-effectiveness threshold of one-time GDP per capita in Nigeria ($806.95). Key drivers of cost-effectiveness included vaccine cost, treatment success rate, cervical cancer treatment coverage, and cervical cancer utility values. The single-dose HPV vaccination program is highly cost-effective in Nigeria, compared to the status quo of no vaccination. To ensure long-term sustainability, the Nigerian government should strengthen financing mechanisms and the healthcare system to support the program. Single dose HPV vaccination is cost-effective in Nigeria. It is crucial to obtain sustainable vaccine financing and improve treatment to maintain the program impact.

“That’s our culture…”: Understanding cervical cancer stigma through Caribbean voices

Cervical cancer remains a major public health concern in the Caribbean, where cultural beliefs, stigma, and healthcare barriers hinder prevention and early detection. While stigma has been recognized as a barrier globally, few studies have qualitatively examined how cervical cancer stigma is constructed and experienced within Caribbean cultural contexts. This study uniquely explores the intersecting social and cultural factors influencing cervical cancer-related stigma, screening behaviors, and HPV vaccination in Grenada, Jamaica, and Trinidad and Tobago, filling a critical research gap in understanding stigma beyond patient populations and across national settings. A qualitative study was conducted using nine focus groups with 69 participants (54 women, 15 men) recruited from community organizations, health centers, and cancer support networks. Semi-structured interviews explored perceptions of cervical cancer, its causes, screening, and healthcare experiences. Thematic analysis identified key patterns in stigma and barriers to prevention. Six major themes emerged: (1) Cancer-related stigma and fear, with fatalistic views of cancer as a death sentence; (2) Cultural beliefs, including associations between cervical cancer, promiscuity, and divine punishment; (3) Knowledge gaps and misinformation, contributing to screening and vaccine hesitancy; (4) Gender and societal expectations, reinforcing stigma and discouraging health-seeking behaviors; (5) Health system challenges, such as healthcare mistrust, confidentiality concerns, and financial constraints; and (6) Family history concerns, where secrecy surrounding cancer within families limited awareness and early detection. Women in low-income settings faced compounded barriers due to gendered norms, limited education, and economic constraints. Healthcare confidentiality concerns further discouraged prevention. Addressing these challenges requires culturally tailored public health campaigns, stronger confidentiality protections, and expanded access to affordable screening and treatment. A regionally coordinated approach to HPV vaccination and cervical cancer prevention is needed to reduce stigma and improve equitable access to care across the Caribbean. This study identifies key policy gaps in cervical cancer prevention and HPV vaccination. Findings highlight the need for improved confidentiality protections, enhanced healthcare system trust, and culturally relevant public health interventions to combat stigma and misinformation. Policies should also increase financial access to screening and promote family health communication to improve awareness of hereditary cancer risks. Addressing these gaps can reduce stigma, increase screening and vaccination uptake, and improve cervical cancer outcomes across the region.

Attitudes and barriers to intervention research targeted at improving cervical cancer screening uptake in Sub-Saharan Africa: A survey of researchers’ perspectives

Cervical cancer remains a major public health crisis in Sub-Saharan Africa, partly due to low screening rates. Despite the need for intervention research to inform strategies to increase screening participation, limited research has explored the specific challenges faced by researchers conducting intervention research on cervical cancer screening in this region. This study examined researchers' attitudes and perceived barriers to conducting intervention research aimed at enhancing cervical cancer screening uptake in the region. The study also identified factors associated with endorsing a higher number of barriers. An online survey was conducted among researchers who had published studies on cervical cancer screening in Sub-Saharan Africa between 2010 and 2020. Data on attitudes, perceived barriers, sociodemographic and research experience characteristics were collected. Descriptive statistics and linear regression analysis were used to analyse data. One hundred and fifty-seven researchers from 17 sub-Saharan African countries completed the survey (response rate: 26.5 %). Most participants acknowledged the necessity of increasing intervention research to improve screening uptake. Common perceived barriers included insufficient funding (89 %), slow ethical and regulatory approvals (61 %), and challenges in measuring screening uptake (57 %). Less experienced researchers were more likely to endorse a greater number of barriers. Researchers recognised the importance of intervention research to improve cervical cancer screening uptake in Sub-Saharan Africa. However, they faced significant barriers, particularly relating to funding, regulatory processes, and measurement challenges. Researchers with less experience in research perceived more barriers, indicating a need for targeted support. A coordinated response is required to address these barriers. Priorities include investing in context-specific research, streamlining ethics and regulatory processes, enhancing early-career researcher training, and establishing dedicated funding for intervention studies. Future efforts should focus on country-specific research, regional ethics harmonisation, and sustainable capacity-building initiatives.

Where are the inequalities in ovarian cancer care in a country with universal healthcare? A systematic review and narrative synthesis

Patients diagnosed with ovarian cancer from more deprived areas may face barriers to accessing timely, quality healthcare. We evaluated the literature for any association between socioeconomic group, treatments received and hospital delay among patients diagnosed with ovarian cancer in the United Kingdom, a country with universal healthcare. We searched MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED, PsycINFO and HMIC from inception to January 2023. Forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts, and full-text articles. UK-based studies were included if they reported socioeconomic measures and an association with either treatments received or hospital delay. The inclusion of studies from one country ensured greater comparability. Risk of bias was assessed using the QUIPS tool, and a narrative synthesis was conducted. The review is reported to PRISMA 2020 and registered with PROSPERO [CRD42022332071]. Out of 2876 references screened, ten were included. Eight studies evaluated treatments received, and two evaluated hospital delays. We consistently observed socioeconomic inequalities in the likelihood of surgery (range of odds ratios 0.24-0.99) and chemotherapy (range of odds ratios 0.70-0.99) among patients from the most, compared with the least, deprived areas. There were no associations between socioeconomic groups and hospital delay. Ovarian cancer treatments differed between socioeconomic groups despite the availability of universal healthcare. Further research is needed to understand why, though suggested reasons include patient choice, health literacy, and financial and employment factors. Qualitative research would provide a rich understanding of the complex factors that drive these inequalities.

A multidisciplinary approach to strengthening patient navigation among gynaecologic malignancy patients at the Cancer Diseases Hospital in Zambia

Zambia has the third highest incidence of cervical cancer in the world. Patients with gynecological malignancy self-navigate by transmitting referral letters from practitioner to practitioner across different health levels and geographic localities. Specialized oncology services for women with gynecological malignancies are shared between two tertiary hospitals in the capital city: the Cancer Diseases Hospital and the Women and Newborn Hospital. In 2020, a two-day gynecological malignancies multidisciplinary tumor board workshop targeted clinical oncologists, surgical oncologists, radiologists, pathologists, medical social workers, and nursing and palliative care practitioners. It aimed at harmonizing the functions, goals, and benefits of a multidisciplinary approach to patient navigation and cancer care. Eleven participants from the six specialties attended the workshop. More than 70 % of the workshop participants have consistently attended the weekly virtual gynecological malignancies multidisciplinary tumor board meetings. Attendance of these meetings has expanded from practitioners within the capital Lusaka to other practitioners from all the nation's ten provinces. A virtual referral platform and patient dashboard were created. These platforms have improved the navigation of patients through the system via enhanced communication among practitioners. Patient navigation through a multidisciplinary approach in a low-middle-income country is feasible. Further quantitative work is required to establish how this intervention has improved patient care and clinical research efforts for women with gynecological malignancies in Zambia. Health service leaders in low-middle-income countries need to re-examine the workforce and financing to determine how navigation support can be implemented across the cancer care continuum.

Strategies and implementation outcomes of HPV-based cervical screening studies to prevent cervical cancer in India: A systematic review

As Indian states consider HPV testing for cervical screening, there is a need to review evidence from prior studies to inform program design and evaluate implementation research gaps. We conducted a systematic review of original articles in Medline, Embase, Global Health and Web of Science, published from 2000 to May 4, 2024. Articles describing use of HPV as a primary cervical screening test in India, in either community-based programs for the general population, or among women living with HIV, were included. We describe approaches to invitation, education, screening, and follow-up, and map determinants and outcomes to the RE-AIM and the Consolidated Framework for Implementation Research frameworks. Of 71 included articles (51 unique studies), 19 reported on screening among women living with HIV, while 52 were community-based (general population of women). Self-collection was offered by 15 studies and was acceptable to most screened women. Community-based programs were mainly facility or outreach-based, with three studies offering only home-based self-collection, including one that integrated with cardiovascular risk screening. Studies from northeastern and tribal populations were scarce. Only one self-collection study used a screen and treat (at second visit) approach, but did not report follow-up, while none offered immediate treatment following a point-of-care test. Community-based HPV testing, including self-collection, is feasible in India, with more research needed among underrepresented populations. Further implementation research is needed on integrating HPV screening with existing health systems, feasibility of HPV test and treat models and genotyping triage, to improve follow-up in low resource settings.

Implementation of a nationwide population-level cancer screening in Bhutan: A programmatic experience

This article delves into Bhutan's adept execution of a nationwide cancer screening initiative within the Health Flagship Programme, concentrating on gastric, cervical, and breast cancers. Despite challenges like the COVID-19 pandemic, infrastructure constraints, logistical complexities, health human resource shortages, and data management issues, the programme succeeded. The procurement and logistics management ensured the timely provision of essential medical equipment and test kits. Robust political commitment, a comprehensive advocacy programme, and community engagement were pivotal for the programme's success. Impressive screening coverage for all three cancers showcased the transformative impact on cancer care, integrating technology and fostering community involvement. Recommendations highlight the need for strengthened integration, strategic approaches, and ongoing evaluation, positioning Bhutan's programme as a potential model for nations facing similar health challenges.

Cervical cancer prevention in Southern Africa: A review of national cervical cancer screening guidelines in the Southern African development community

Cervical cancer poses a significant burden, particularly in low-and-middle income countries (LMIC) with limited access to healthcare. High-income countries have made progress in prevention, while LMIC face unacceptably high incidence and mortality rates, often lacking official screening recommendations. We analysed the presence and content of cervical cancer screening guidelines for the secondary prevention of cervical cancer in the Southern African Development Community (SADC) and compared it to the current World Health Organization (WHO) guidelines for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. A review of national cervical cancer guidelines across the SADC region was conducted. Data was obtained from government websites, international cancer control platforms, and WHO resources. Search terms included "cervical cancer" and "cervical cancer control guidelines", amongst others. There were no limitations on publication years, and the most recent versions of the guidelines were analysed, regardless of language. Each guideline was assessed for specific screening and treatment recommendations, in relation to the current WHO guidelines. Points were assigned for each data element. While most countries contributed data to this analysis there was a notable absence of adherence to the WHO guidelines. The most common screening method was naked eye visual inspection. There was a consensus on the age of screening initiation. Most countries recommended treatment by cryotherapy and loop excision. Effective cervical cancer screening programmes, guided by evidence-based recommendations, can enhance early intervention and outcomes. This study highlights the need for standardized and evidence-based cervical cancer screening guidelines in the SADC region, to reduce the burden of cervical cancer and improve the health outcomes of women in these areas.

Economic burden of breast, cervical, and oral cancer in Bangladesh: a cost-of-illness study

Breast, cervical, and oral cancers are leading causes of morbidity and mortality in Bangladesh, placing a heavy economic burden on households and the health system. Yet, this burden remains poorly understood, as no prior study has comprehensively examined their economic impact. Moreover, the profound psychological suffering experienced by patients are often overlooked in existing global evidence. Therefore, this study aims to estimate the comprehensive economic burden of breast, cervical, and oral cancers in Bangladesh from the household perspective. Using a cross-sectional design, primary data were collected through structured interviews with 346 cancer patients. A cost-of-illness approach was employed. Direct medical and direct non-medical costs were estimated based on respondent-reported expenditures. Indirect costs, i.e.income loss, were calculated using the human capital approach. Intangible costs, reflecting pain and discomfort, were quantified using the willingness-to-pay method. The average total cost per patient was US$12,117, with breast cancer accounting for the highest burden. Intangible costs comprised 47.7 % of the total, underscoring the substantial psychological impact of cancer on patients. The combined national economic burden exceeded US$1.17 billion. Catastrophic health expenditure was nearly universal (99.1 %), with average treatment costs exceeding the catastrophic threshold by 44-fold. Expenditures were significantly higher among wealthier households, patients with longer disease duration, and those seeking care from multiple facilities. Breast, cervical, and oral cancers impose a major financial and psychological burden on households in Bangladesh. The near-universal catastrophic health expenditure and high intangible costs highlight the urgent need for accessible and affordable cancer care. Policies should strengthen financial protection, decentralize diagnosis and treatment, introduce insurance with cancer-specific benefits, establish an effective referral system, integrate psychosocial support and strengthen early detection programs.

Suicide rates of cervical cancer patients in the United States – Who is most at risk? A retrospective study of 69,493 patients

This study aims to identify demographic and treatment factors associated with suicide risk among cervical cancer patients in the United States. Data were obtained from the SEER database (2000-2020). Women with cervical cancer and follow-up time were included. Demographics and treatment history for women who died by suicide were compared to those who did not using chi-square tests. Suicide rates were compared to age-matched U.S. WHO 2019 data with the Mantel-Haenszel test. Univariate logistic regression estimated odds ratios for suicide risk, and Kaplan-Meier survival analysis examined overall survival (excluding suicide) by demographic and treatment factors. Linear regression assessed the link between time from diagnosis to treatment and time from diagnosis to suicide. Among 69,493 cervical cancer patients diagnosed from 2000 to 2020, most were White (75.9 %), aged 30-49 (46.4 %), lower-middle income (52.0 %), from metropolitan counties (88.0 %), and had localized disease (35.0 %). Fifty-eight patients died by suicide, with a suicide risk 8.8 times higher than the general population. Younger age groups (15-29 and 30-49) had the highest risk, being 18.9 and 11.2 times more likely to die by suicide, respectively. Suicide risk was significantly associated with age, ethnicity, stage, year of diagnosis, and chemotherapy, with highest risk in younger, Non-Hispanic, localized stage, diagnosed from 2000 to 2005, and no chemotherapy (p < 0.05). Delayed treatment correlated with shorter time from diagnosis to suicide (R² = 0.124; p = 0.015). Suicide rates are significantly elevated among cervical cancer patients, especially in young, Non-Hispanic patients with localized disease and no chemotherapy. Delayed treatment was linked to shorter time to suicide, emphasizing the need for targeted mental health support.