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ABSTRACT We describe the outcomes of The Extension for Community Healthcare Outcomes-Elimination of Cervical Cancer in The Americas (ECHO-ELA) program, which was developed as a tri-lateral cooperation between Pan American Health Organization (PAHO), the U.S. National Cancer Institute (NCI) and The University of Texas MD Anderson Cancer Center (MD Anderson). The program's purpose is to disseminate strategies for cervical cancer prevention and is structured around the three pillars of the World Health Organization's (WHO) Cervical Cancer Elimination Strategy and the associated 90-70-90 target goals. The target audience includes health authorities from Latin American and Caribbean countries, as well as PAHO's non-communicable disease Focal Points in country offices as well as clinical and public health collaborators. The virtual sessions are held in Spanish for 1.5 hours every month using the ECHO® format. From May 2020 to June 2021, 14 ECHO sessions were held with an average of 74 participants per session (range: 46 - 142). We conducted two anonymous surveys (baseline and follow up) and two focus groups. Respondents stated that the topics they learned the most about included the state of HPV vaccination in the region and strategies for implementing HPV vaccination. Identified needs included support between ECHO sessions and country-specific technical assistance. The ECHO-ELA program provides a forum for increased collaboration between countries in Latin America/Caribbean and the dissemination of best-practice strategies to reach the WHO Cervical Cancer Elimination target goals.
RESUMEN Se describen los resultados del programa ECHO® (Extension for Community Healthcare Outcomes) para la eliminación del cáncer cervicouterino en las Américas (ECHO-ELA), que se concibió como una cooperación trilateral entre la Organización Panamericana de la Salud (OPS), el Instituto Nacional del Cáncer de los Estados Unidos (NCI) y el centro contra el cáncer MD Anderson (MD Anderson) de la Universidad de Texas. La finalidad del programa es difundir las estrategias para la prevención del cáncer cervicouterino, y está estructurado en torno a los tres pilares de la estrategia para la eliminación del cáncer cervicouterino de la Organización Mundial de la Salud (OMS) y los objetivos 90-70-90 conexos. El público destinatario comprende autoridades de salud de países de América Latina y el Caribe, así como los puntos focales de la OPS para las enfermedades no transmisibles en las Representaciones en los países, además de colaboradores en el ámbito clínico y de la salud pública. Las sesiones virtuales se llevan a cabo en español, durante 1,5 horas cada mes, utilizando el formato ECHO®. De mayo del 2020 a junio del 2021 se celebraron 14 sesiones de ECHO, con un promedio de 74 participantes por sesión (límites: 46-142). Se realizaron dos encuestas anónimas (al inicio y de seguimiento) y dos grupos de opinión. Los encuestados declararon que los temas sobre los que más aprendieron fueron la situación de la vacunación contra el VPH en la región y las estrategias para poner en marcha la vacunación contra el VPH. Entre las necesidades mencionadas figuraban el apoyo entre las sesiones de ECHO y la asistencia técnica específica para cada país. El programa ECHO-ELA brinda un foro para una mayor colaboración entre los países de América Latina y el Caribe y para difundir las estrategias sobre las mejores prácticas, a fin de alcanzar los objetivos de la OMS de eliminación del cáncer cervicouterino.
RESUMO Este trabalho descreve os resultados do programa Extension for Community Healthcare Outcomes para eliminação do câncer do colo do útero nas Américas (ECHO ELA), desenvolvido na forma de cooperação trilateral entre a Organização Pan-Americana da Saúde (OPAS), o Instituto Nacional do Câncer dos Estados Unidos (NCI) e o MD Anderson Cancer Center da Universidade do Texas (MD Anderson). O programa visa a disseminar estratégias para a prevenção do câncer do colo do útero e está estruturado em torno dos três pilares da estratégia de eliminação do câncer do colo do útero da Organização Mundial da Saúde (OMS) e das Metas 90-70-90 associadas. O público-alvo inclui autoridades sanitárias de países da América Latina e do Caribe, bem como os pontos focais de doenças não transmissíveis nas representações da OPAS nos países, além de colaboradores clínicos e de saúde pública. Todos os meses, são realizadas sessões virtuais de uma hora e meia em espanhol usando o formato ECHO®. No período de maio de 2020 a junho de 2021, foram realizadas 14 sessões do ECHO, com uma média de 74 participantes por sessão (variação: 46 a 142). Foram realizadas duas enquetes anônimas (linha de base e acompanhamento) e dois grupos focais. Os entrevistados afirmaram que os tópicos sobre os quais mais aprenderam foram a situação da vacinação contra o HPV na região e as estratégias para implementar a vacinação contra o HPV. As necessidades identificadas incluíam apoio entre as sessões do ECHO e assistência técnica específica para o país. O programa ECHO ELA oferece um fórum para aumentar a colaboração entre os países da América Latina e do Caribe e difundir melhores práticas para atingir as metas de eliminação do câncer do colo do útero da OMS.
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Background: Cancer cervix, a preventable disease continues to be a cause of great concern to women’s health, being associated with agonizing morbidity and high mortality. Approximately 493,100 new cases and more than 273,000 deaths occur each year, among women worldwide.IN India the screening is largely based on pap smear, which is cumbersome procedure due to transportation of samples and follow up of patients are not usually feasible. Visual inspection with Acetic acid (VIA) is simple and easy to teach procedure. Follow-up of patients usually doesn’t require.Methods: This study includes a total of 1000 patients who attended OPD of gynecology. Each patient is subjected to VIA examination. Biopsy is taken from women with abnormal findings on VIA. The objectives of this study were to evaluate the sensitivity and specificity and positive predictive value of inspection of cervix with acetic acid in precancerous lesions of cervix.Results: When biopsy is taken as reference standard, VIA has sensitivity of 97.7%, specificity of 76.6%, PPV of 62.9% and NPV of 98.5%. The accuracy rate for VIA is 84.8%.Conclusions: VIA is highly sensitive for diagnosis and treatment of cervical pathology at the same sitting. It can be done cost effectively in low resource set up.
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Cervical cancer is commonly caused by infection with human papilloma virus(HPV) and some risk factors are involved in the etiology of it.1 All over the world 437000 people are diagnosed with cervical disorders and half of them die due to cervical cancer.2 Annually 12000 new cases of cervical cancer are detected and 5000 women die because of it. In Spain about 2000 women are determined in the 3rd and 4th stage of the disease per year.3 Over the period 2000-2008 cervical cancer rate is 8 %among all cancers in Mongolia. Approximately 16 % of women’s cancer is cervical cancer. 4 In developing nations prevalence rate of cervical cancer is higher because of malnutrition, quality and framework for early detection are not satisfying and some reproductive risk factors also influence on it. 5 Worldwide diagnosing early and rapid management of precancerous condition and cervical abnormalities turn into main issue. Therefore based on these detection of premalignant lesion of cervix by colposcopy the main objective of the study. The overall goal of the study is to detect the premalignant lesion of cervix by colposcopy and determine of some risk factors and study the results.A total of 71 women, who are treated in Women’s inflammatory disease unit, Infertility and Women’s endocrine disorder unit are recruited for the cross sectional study. The women, who conducted the study were selected by accidently and colposcopy was done. They also have completed special questionnaires. The data were analyzed using the SPSS 19.0, Windows Office. The average age of the women was 38±9.4. Colposcopy was done 90.1% (n=64) of women, 9.9% (n=7) of women had not colposcopy. Among the women who had colposcopy, biopsies were taken 56.3% (n=36). During colposcopy we analyzed condition of cervix then we took biopsy from suspected areas and sent it histology laboratory. We compared predictive diagnosis, histology results after colposcopy and 33.3% (n=12) were identified as normal, CIN I was 52.7%, (n=19), CIN II was 5.5% (n=2), CINIII was 2.7% (n=1), cervical cancer is confirmed in 5.5% (n=2). We studied risk factors that can influence the cervical disorders among the women recruited in the study and age of first sexual intercourse (r=0.356, p=0.033), number of abortion (r=0.412, p=0.029) were statistically significant. However age of the women, parity, usage of contraceptive pills, smoking, number of sexual partners were statistically not significant.(p>0.05) When women’s age of first sexual intercourse is younger, cervical cancer disorder occurs30% greater comparing to women having first sexual intercourse later, (p<0.05, R=0.3), when number of abortion increases cervical cancer disorder increases 40%(p<0.05, R=0.41).F-1 to recruit osteoprogenitor /mesenchymal stem cells in the bone regeneration process.
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El cáncer de cérvix es la causa más común de muerte por cáncer ginecológico en el mundo. Debido al incremento del diagnóstico de esta enfermedad en estadios tempranos en mujeres en edad fértil, hacemos énfasis en los nuevos conceptos de preservación de la fertilidad y tratamiento quirúrgico mínimamente invasivo. El cono frío de cérvix con o sin linfadenectomía pélvica representa un esquema de tratamiento adecuado para el manejo de cáncer de cérvix en estadio IA1-2 en pacientes que desean conservar su fertilidad. Sin embargo, su potencial curativo no ha sido explorado extensamente en lo que concierne a la enfermedad en estadios IB1. En el Instituto Nacional de Enfermedades Neoplásicas (INEN), desde hace cinco años se ha iniciado el manejo individualizado de estas pacientes por la mayor demanda de pacientes jóvenes, quienes desean preservar la fertilidad, con el consentimiento informado de las pacientes y con resultados óptimos hasta la actualidad. Se presenta cuatro casos de cáncer de cérvix en estadios IA2 y IB1 con factores patológicos de riesgo bajo, en quienes se planteó cirugía conservadora para la preservación de la fertilidad. Se les realizó cono frío del cérvix y linfadenectomía pélvica bilateral laparoscópica. Los resultados demostraron que la cirugía conservadora en estadios tempranos de cáncer de cérvix de riesgo bajo es factible en mujeres jóvenes, logrando preservar su fertilidad, con las mismas tasas de curación que la cirugía radical.
Cervical cancer is the most frequent cause of death by gynecologic cancer in the world. Due to increased diagnosis of early stage disease in childbearing age women new concepts in fertility preservation and minimally invasive surgical treatment are emphasized. Cervical cold conization with or without pelvic lymphadenectomy is appropriate treatment for stage IA1-2 cervical cancer in patients who desire fertility. However curative potential has not been extensively explored concerning to IB1 stage disease. In the past five years individualized treatment of these patients has been started at Instituto Nacional de Enfermedades Neoplasicas (INEN) due to increased demand of young patients who wish to preserve fertility, with informed consent of patients and good current results. Four cases of stages IA2 y IB1 cervical cancer with low-risk pathology factors with conservative surgery for fertility preservation are presented. Cervical cold conization and bilateral laparoscopic pelvic lymphadenectomy was performed. Results demonstrated that conservative surgery in low risk early stages cervical cancer is feasible in young women, with fertility preservation and same cure rates as radical surgery.
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Se estudió la incidencia de los principales factores de riesgo como: edad de inicio de las relaciones sexuales, promiscuidad, enfermedades de transmisión sexual y otros, en la aparición de lesiones neoplásicas de cuello uterino, iniciadas en mujeres infectadas por el virus del papiloma humano. Se incluyeron 230 mujeres; 93 con diagnóstico de neoplasias intraepiteliales (NIC) y 137 con carcinomas establecidos. Se halló un pico de incidencia entre 25 y 35 años, la edad de inicio de las relaciones sexuales y del primer embarazo fue 17 años, con 4 embarazos como promedio y que el 70 por ciento tuvo al menos una interrupción. El número de parejas osciló de 1 a 8 compañeros. El método anticonceptivo de elección fue el de los intrauterinos. Todas las pacientes mostraron niveles elevados de hormonas sexuales, el aumento de progesterona fue paralelo al avance de la enfermedad. La incidencia de enfermedades de transmisión sexual resultó mayor en las pacientes con NIC, igualmente estas fumaban más, pero consumían menos alcohol que aquellas con carcinomas establecidos. Se concluyó que los factores de riesgo podrían estar implicados en la progresión de lesiones iniciadas por la infección con el VPH.
Authors studied incidence of main risk factors including age at first sexual intercourse, promiscuity, sexual communicable diseases, etc related to appearance of cervical neoplasia lesions present in women infected by human papilloma virus (HPV). Study included 230 women; 93 diagnosed with intra-epithelial neoplasia (IEN), and 137 with established carcinoma. We found a peak incidence between 25 and 35 years, the age at first sexual intercourse and of the first pregnancy was at 17 years old, with 4 pregnancies as average, and that 70 percent has at least an interruption of them. Number of pairs fluctuated between one up to 8 partners. The contraceptive method chosen were the intrauterine ones. All patients showed high levels of sexual hormones, increase of progesterone was in parallel with the progression of disease. Incidence of sexual communicable diseases was higher in patients with IEN, they were strong smokers, but with a consumption lower than those with established carcinoma. We conclude that risk factors could be involved in progression of lesions started by HPV.
Subject(s)
Humans , Uterine Cervical Neoplasms/epidemiology , Risk FactorsABSTRACT
Se presenta una revisión bibliográfica de la asociación entre cáncer de cérvix y embarazo. Se analizan los siguientes puntos: diagnóstico, manejo, Influencia del embarazo sobre el comportamiento del cáncer e Implicaciones que éste tiene para la gestación. Se concluye que el factor pronóstico más Importante es el estadio del cáncer al momento de iniciar el tratamiento y que variables como el trimestre cuando se hace el diagnóstico, la edad y la paridad no tienen influencia pronóstica
This is a review of the literature on the association of cervical cancer and pregnancy; the following aspects are Included: diagnosis, treatment and the reciprocal influence of pregnancy and cancer. It is concluded that the main prognostical variable Is the stage of the cancer when treatment Is started, while gestational age, chronological age and parity have no prognostical influence