Impact of the COVID-19 pandemic on the hospital attendance of patients with primary cervical cancer in Heilongjiang, China.

Information regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on cervical cancer in mainland China is lacking. We explored its impact on the hospital attendance of patients with primary cervical cancer. We included 1918 patients with primary cervical cancer who initially attended Harbin Medical University Cancer Hospital between January 23, 2019, and January 23, 2021. Attendance decreased by 31%, from 1135 in 2019 to 783 in 2020, mainly from January to June (𝜒2 = 73.362, P < .001). The percentage of patients detected by screening decreased from 12.1% in January-June 2019 to 5.8% in January-June 2020 (𝜒2 = 7.187, P = .007). Patients with stage I accounted for 28.4% in 2020 significantly lower than 36.6% in 2019 (𝜒2 = 14.085, P < .001), and patients with stage III accounted for 27.1% in 2020 significantly higher than 20.5% in 2019 (𝜒2 = 11.145, P < .001). Waiting time for treatment was extended from 8 days (median) in January-June and July-December 2019 to 16 days in January-June (𝜒2 = 74.674, P < .001) and 12 days in July-December 2020 (𝜒2 = 37.916, P < .001). Of the 179 patients who delayed treatment, 164 (91.6%) were for the reasons of the healthcare providers. Compared to 2019, the number of patients in Harbin or non-Harbin in Heilongjiang Province and outside the province decreased, and cross-regional medical treatment has been hindered. The COVID-19 pandemic has negatively impacted cervical cancer patient attendance at the initial phase. These results are solid evidence that a strategy and mechanism for the effective attendance of cervical cancer patients in response to public health emergencies is urgently needed.

Plants to drugs: A case study of human papilloma virus and traditional chinese medicine

Various types of viral diseases are emerging as the largest menace human beings have faced in the last few decades. Since the arrival of human immunodeficiency virus, the world has seen the emergence of deadly viruses like bird flu, Ebola, Nypah, Hanta, SARS, MERS, and currently the SARS-CoV-2. Other viral diseases like herpes, human papilloma virus, and hepatitis have become so common that despite their widespread infection rates, causes of liver and cervical cancer and consequent mortalities, they have not caught the attention of the general people in a way SARS-CoV-2 has done. Unlike small pox, polio, several types of hepatitis, and, to a certain extent, HPV, most other viral diseases have proved difficult to cure with vaccines or drugs. As with many other diseases, plants can form a possible source of therapeutics for HPV. There are around 250,000 species of flowering plants in the world;each species contain a range of phytochemicals with diverse pharmacological activities. For instance, over four dozen plants have been identified with antiviral activity against herpes virus, while a number of other plants and phytochemicals have shown promise against various viruses. Promising antiviral phytochemicals include coumarins, terpenoids, flavonoids, polyphenols, and alkaloids. This chapter will attempt to summarize the present state of knowledge regarding plants, formulations, and phytochemicals (against HPV) and discuss the potential of drug discovery from the promising phytochemicals. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

COVID-19 as a catalyst for reimagining cervical cancer prevention.

Cervical cancer has killed millions of women over the past decade. In 2019 the World Health Organization launched the Cervical Cancer Elimination Strategy, which included ambitious targets for vaccination, screening, and treatment. The COVID-19 pandemic disrupted progress on the strategy, but lessons learned during the pandemic - especially in vaccination, self-administered testing, and coordinated mobilization on a global scale - may help with efforts to achieve its targets. However, we must also learn from the failure of the COVID-19 response to include adequate representation of global voices. Efforts to eliminate cervical cancer will only succeed if those countries most affected are involved from the very start of planning. In this article we summarize innovations and highlight missed opportunities in the COVID response, and make recommendations to leverage the COVID experience to accelerate the elimination of cervical cancer globally.

Does HPV vaccination initiation at age 9, improve HPV initiation and vaccine series completion rates by age 13?

Vaccination for Human Papillomavirus (HPV) is important to reduce rates of cervical and oropharyngeal cancer. We aimed to evaluate if a program to initiate HPV vaccination at 9 years improved initiation and completion rates by 13 years of age. Data on empaneled patients aged 9-13 years from January 1, 2021 to August 30, 2022 were abstracted from the electronic health record. Primary outcome measures included HPV vaccination initiation and series completion by 13 years of age. The secondary outcome measure was missed opportunities for HPV vaccination. In total, 25,888 patients were included (12,433 pre-intervention, and 13,455 post-intervention). The percentage of patients aged 9-13 with an in-person visit who received at least 1 dose of HPV vaccine increased from 30% pre-intervention to 43% post-intervention. The percentage of patients who received 2 doses of vaccine increased from 19.3% pre-intervention to 42.7% post-intervention. For the overall population seen in-person, initiation of HPV vaccination by age 13 years increased from 42% to 54%. HPV completion increased as well (13% to 18%). HPV vaccination initiation at 9 years of age may be an acceptable and effective approach to improving vaccination rates.

Human Papillomavirus: Challenges and opportunities for the control of cervical cancer.

Viruses are the most abundant and genetically diverse entities on the planet, infect all life forms and have evolved with their hosts. To date, 263 viral species have been identified that infect humans, of which only seven are considered type I oncogenic. Human papillomavirus (HPV) is the main virus associated with cancer and is responsible for practically all cases of cervical carcinoma. Screening tests for early detection have been available since the 1960s. Undoubtedly, the entailment between knowledge of HPV biology and the natural history of cervical cancer has contributed to the significant advances that have been made for its prevention since the 21st century, with the development of prophylactic vaccines and improved screening strategies. Therefore, it is possible to eradicate invasive cervical cancer as a worldwide public health problem, as proposed by the WHO with the 90-70-90 initiative based on vaccination coverage, screening, and treatment, respectively. In addition, the emerging knowledge of viral biology generates opportunities that will contribute to strengthening prevention and treatment strategies in HPV-associated neoplasms.

Experiences with thermal ablation for cervical precancer treatment after self-collection HPV-based screening in the ASPIRE Mayuge randomized trial.

Cervical cancer remains a significant public health burden in low-resourced countries. Thus, the WHO prioritized cervix screening, and recently recommended thermal ablation treatment for cervical precancer. However, there is limited information on side effects during treatment and recovery, and acceptability among those treated. The ASPIRE Mayuge trial recruited women to participate in self-collection cervix screening between 2019 and 2020 (N = 2019). Screen-positive women (N = 531, 26.3%) were referred for visual inspection with acetic acid and thermal ablation treatment, per Uganda Ministry of Health recommendations; 71.2% of those referred attended follow-up. Six months post-screening, a subset of trial participants were recontacted. Those who received thermal ablation completed a survey assessing side effects during and after the procedure, and willingness to recommend the treatment to others. We summarized the results to describe the side effects and acceptability of thermal ablation treatment. Of 2019 participants, 349 (17%) received thermal ablation. A subset of 135 completed the follow-up survey, where 90% reported pain during treatment; however, intensity and duration were low. Over a third of women reported problems with recovery for reasons including pain, discharge and bleeding. Regardless, 98% reported they would recommend the treatment to others. The use of thermal ablation to treat cervical precancer appears to be highly acceptable in this population. While many women reported side effects during the procedure and recovery, the majority said they would recommend the treatment to others. However, given the substantial proportion who reported problems with recovery, efforts should be made to provide additional resources to women after receiving thermal ablation treatment for cervical precancer.

Frequency of cervical hpv in women with COVID-19 infection

Aim: At the beginning of 2020, the Coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus emerged in China. While there are several studies currently being performed to investigate the multi-organ symptoms of COVID-19 infection, significant attention has yet to be paid to its presence in the cervix. This article aims to establish a medical hypothesis of its association with HPV infection as well as the potential impact of COVID-19 infection on the female genital tract. Material(s) and Method(s): This prospective cohort study was performed in ... Research and Training Hospital between January 1 and July 30, 2020. Cervicovaginal samples (co-test) were taken at the gynecological oncology unit, and both HPV screening and Pap smear were studied with the liquid-based method. Two groups of patients who were confirmed by PCR test to have had COVID-19 infection in the last 6 months and patients who did not have a history of infection were included in the study. Result(s): A total of 310 participants were evaluated in the study. Of these participants, 30 (9.7%) were confirmed to have undergone COVID-19 by PCR test. There was no significant difference between the total positive smear results in both groups. However, the rate of HPV-16 positive patients was significantly higher in the COVID-19 group (2.5% vs 10.0%, p=0.027). Discussion(s): As a result, COVID-19 infection may increase the frequency of HPV-16. Apart from this, it can be said that this increase is not reflected in the frequency of cervical cytopathology.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Pregnancy trends and associated factors among Kenyan adolescent girls and young women pre- and post-COVID-19 lockdown

Globally, COVID-19 has had a negative impact on health systems and health outcomes, with evidence of differential gender impacts emerging. The COVID-19 timeline of events spanning from closures and restrictions to phased reopenings is well-documented in Kenya. This unique COVID-19 situation offered us the opportunity to study a natural experiment on pregnancy trends and outcomes in a cohort of Kenyan adolescent girls and young women (AGYW), enrolled in the KENya Single-dose HPV-vaccine Efficacy (KEN SHE) Study. The KEN SHE Study enrolled sexually active AGYW aged 15–20 years from central and western Kenya. Pregnancy testing was performed at enrollment and every 3 months. We determined pregnancy incidence trends pre- and post-COVID-19 lockdown, pregnancy outcomes (delivery, spontaneous, or induced abortion), and postabortion and postpartum contraceptive uptake. Kaplan–Meier survival estimates of incidence rates were used to estimate the cumulative probability of pregnancy during the study period. Cox regression was used to investigate factors associated with pregnancy incidence. Of the 2,223 AGYW included in the analysis, median age was 18.6 IQR (17.6–20.3), >90% had at least secondary school education, 95% were single at the time of enrollment, and 82% had a steady/primary sexual partner. Pregnancy incidence peaked at 2.27 (95% CI [1.84, 2.81])/100 women-years of observation at the end of the first quarter of 2020, a period coinciding with the government-imposed lockdown. AGYW had 60% increased risk of being pregnant during the lockdown when compared to prelockdown period (HR = 1.60, 95% CI [1.25, 2.05]). Among the 514 pregnancies reported, 127 (25%) ended in abortion, of which 66 (52%) were induced abortions. Our findings demonstrate the adverse sexual and reproductive health (SRH) consequences of the COVID-19 pandemic and the lockdown measures among AGYW. As services continue to be disrupted by the pandemic, there is an urgent need to strengthen and prioritize AGYW-centered SRH services, including contraception and safe abortion.

ASSOCIATION OF SOCIAL DETERMINANTS OF HEALTH AND COVID-19-RELATED BEHAVIORS WITH CERVICAL CANCER SCREENING IN HISPANIC WOMEN

While cervical cancer is highly preventable through early detection, Hispanic women are 40% more likely to develop cervical cancer and 20% more likely to die from the disease compared to non-Hispanic Whites (NHWs) in the U.S. Specifically, the COVID-19 pandemic resulted in decreased screenings due to safety concerns;however, very limited information is available to evaluate the COVID-19 disruptions on cervical cancer screenings among Hispanics. This study investigated the association of social determinants of health (SDOH) and COVID-19-related behaviors with cervical cancer screening among Hispanic women. The National Institutes of Health (NIH) All of Us data was utilized, in which Hispanic (N = 37,253), NHW (N = 75,756), and non-Hispanic Black (NHB;N = 32,325) women aged 21 to 65 years were included. Within- and between-group characteristics were analyzed using descriptive statistics. Differences in measured variables between Hispanic and NHW women were investigated by performing Wilcoxon test/Student's t-test for continuous variables and Pearson chi-square/Fisher's exact test for categorical variables. Logistic regression models were used to estimate nonadherence to cervical cancer screening. Data analysis was performed in R using Jupyter Notebook in the All of Us research workbench. The rate of cervical cancer screening averaged 2-3% for all ethnic groups, with Hispanic women consistently averaging lower than NHB and NHW women in 20172020 (p<.05). There was a noticeable drop in cervical cancer screening rates (0.92-1.03%) in 2021. Among the women adherent to cervical cancer screening, Hispanics demonstrated non-optimal SDOH and poorer general health status and lifestyle habits, as well as tended to be obese compared to NHWs. In Hispanics, social distance-related stress was significantly associated with adherence to cervical cancer screening during COVID-19 (p=.034). In the adjusted regression model with demographics, health status, and COVID-19 factors, the age group of 41-50, higher income, human papillomavirus (HPV) vaccination, and more social distance-related stress were associated with lower odds of nonadherence. Better general health status and 2nd COVID-19 vaccination were associated with higher odds of nonadherence. Our results suggest that SDOH and COVID-19-related behaviors are associated with cervical cancer screening in Hispanics. The knowledge gained could provide new insights into outreach efforts to prevent Hispanic individuals at risk from suffering the consequences of delayed screening and diagnosis and later-stage presentation of cervical cancer. The findings will inform future public health guidelines for planning Pap and HPV screening.

Perspectives on Self-Sampling for Cancer Screening From Staff at Federally Qualified Health Centers in Rural and Segregated Counties: A Preliminary Qualitative Study.

BACKGROUND: Self-sampling for colorectal and cervical cancer screening can address the observed geographic disparities in cancer burden by alleviating barriers to screening participation, such as access to primary care. This preliminary study examines qualitative themes regarding cervical and colorectal cancer self-sampling screening tools among federally qualified health center clinical and administrative staff in underserved communities. METHODS: In-depth interviews were conducted with clinical or administrative employees (≥18 years of age) from FQHCs in rural and racially segregated counties in Pennsylvania. Data were managed and analyzed using QSR NVivo 12. Content analysis was used to identify themes about attitudes towards self-sampling for cancer screening. RESULTS: Eight interviews were conducted. Average participant age was 42 years old and 88% of participants were female. Participants indicated that a shared advantage for both colorectal and cervical cancer self-sampling tests was their potential to increase screening rates by simplifying the screening process and offering an alternative to those who decline traditional screening. A shared disadvantage to self-sampling was the potential for inaccurate sample collection, either through the test itself or the sample collection by the patient. CONCLUSIONS: Self-sampling offers a promising solution to increase cervical and colorectal cancer screening in rural and racially segregated communities. This study's findings can guide future research and interventions which integrate self-sampling screening into routine primary care practice.

A randomised controlled trial of volitional and motivational interventions to improve cervical cancer screening uptake.

OBJECTIVE: Cervical cancer is the fourth most common cancer to occur in women worldwide. In the UK, the NHS cervical screening programme invites eligible individuals to take part in screening every 3-5 years. At present, around 70% of individuals attend screening when invited. The present study aimed to test the effectiveness of a volitional and a motivational intervention alone and in combination on screening uptake at 16-week follow up. METHODS: 14,536 participants were recruited from the list of eligible participants invited for screening in Yorkshire, Humber and the North East regions of England in December 2021. They were randomised to a social norm-based motivational intervention (SNA); implementation intention-based Volitional Help Sheet (VHS); combined intervention (SNA + VHS); or treatment as usual control. The primary outcome was screening uptake measured via patient screening records at 16 weeks. RESULTS: Of the 14,466 participants with eligible data for analysis, 5793 (40.0%) attended for cervical cancer screening in the 16 weeks after the intervention mailing. Both age and deprivation influenced screening uptake, with lower uptake in the youngest individuals and those from more deprived areas. Compared to control, there was no evidence of any benefit from the VHS implementation intervention alone (Adj.OR = 0.99, 95% CI 0.90 to 1.10), the SNA motivational intervention alone (Adj.OR = 0.89; 95% CI: 0.80 to 0.99), or the combined intervention (Adj.OR = 0.96, 95% CI 0.86 to 1.06). CONCLUSION: The study did not support any benefit of either VHS or SNA interventions alone or in combination on cervical cancer screening uptake. It did demonstrate alarmingly low levels of screening uptake at 16 weeks which were well below the average rate. Future research needs to urgently investigate and understand the barriers to uptake following on from the COVID-19 pandemic.

Best original research presented at the 23rd European Congress on Gynaecological Oncology-Best of ESGO 2022.

Best of ESGO 2022 includes a selection of best original research presented during the 23rd European Congress on Gynaecological Oncology between October 27 and 30, 2022 in Berlin. Out of 1107 submitted abstracts, authors of studies which obtained the highest scores in a blinded review process were invited to present their results during four oral sessions, young investigators session, and oral poster sessions. By means of this publication, we aim to provide readers with an overview of the best quality research presented at the European Society of Gynaecological Oncology (ESGO) 2022.

Comparison of the AmpFire and MA-6000 polymerase chain reaction platforms for high-risk human papillomavirus testing in cervical precancer screening.

High-risk human papillomavirus (hr-HPV) testing for primary cervical precancer screening offers an opportunity to improve screening in low-middle income countries (LMICs). This study aimed to compare the analytic performances of the AmpFire and MA-6000 platforms for hr-HPV DNA testing in three groups of women screened for hr-HPV types in Ghana: group 1 with 33 GeneXpert-archived ThinPrep/liquid-based samples subjected to both tests, group 2 with 50 AmpFire-archived dry brush samples subjected to MA-6000 testing, and group 3 involving 143 cotton swab samples simultaneously subjected to both tests without archiving. The overall agreement rates were 73 %, 92 %, and 84 %, for groups 1-3, respectively, and 84 % (95 % CI, 78.6-88.6) for the entire group. Neither AmpFire nor MA-6000 was more likely to test hr-HPV positive in all three groups and the combined group. Group 1 showed fair agreement without statistical significance (κ = 0.224, 95 % CI, -0.118 to 0.565), while group 3 showed significant moderate agreement (κ = 0.591, 95% CI, 0.442-0.741). Group 2 showed an almost perfect significant level of agreement (κ = 0.802; 95 % CI, 0.616-0.987). Thus, both platforms showed statistically significant moderate to near-perfect agreement for detecting hr-HPV in cervicovaginal samples, with variation according to archiving conditions and duration between sample collection and retesting. For LMICs using these platforms for COVID-19 testing, as the COVID-19 pandemic subsides, the platforms can become available for running other tests such as hr-HPV DNA testing for cervical precancer screening.

Implementation of online workshops on image-guided adaptive brachytherapy (interventional radiotherapy) in locally advanced cervical cancer: Experience of BrachyAcademy.

PURPOSE: To provide educational support to brachytherapy users during the COVID-19 pandemic, online workshops were developed and implemented by BrachyAcademy, non-profit peer-to-peer educational initiative in Elekta. METHODS AND MATERIALS: In 2021-2022 two online workshops were organized. Participating teams had to send a clinical case of locally advanced cervical cancer (LACC) including brachytherapy Digital Imaging and Communications in Medicine (DICOM) files and questions to the faculty. During the workshop, feedback was given to each clinical case by five faculty members (two Radiation Oncologists, one Radiologist, two Medical Physicists). Participants competed a post-workshop questionnaire which included combination of qualitative and quantitative questions via yes/no responses, Likert scale, and 1 to 10 scale. RESULTS: Twenty-one teams from eight countries (Europe, Asia, Latin America) participated in two online workshops. The total number of participants was 49. The clinical cases represented LACC with The International Federation of Gynecology and Obstetrics (FIGO) stages from IB3 to IVA. During both, Workshop1 (W1) and Workshop 2 (W2) the following areas of improvement were identified: familiarity with the GEC ESTRO and The International Commission on Radiation Units & Measurements, Report 89 (ICRU 89) recommendations for contouring and planning based on clinical drawings and MRI sequencing choice; appropriate applicator selection; experience with interstitial needles; appropriate applicator reconstruction; dose optimization. The participants rated both workshops with overall scores 8,3 for W1, and 8,5 for W2. In 82% participants the training course fully met expectations for W1, and in 76% in W2. CONCLUSIONS: We successfully implemented the online workshops on image-guided adaptive brachytherapy (IGABT) in LACC. Main performance issues and areas for improvement were identified based on multidisciplinary discussion of participant's clinical cases through all steps of the brachytherapy procedure. We encourage teams to consider online workshops in addition to hands-on training.

The Phytochemical α-Mangostin Inhibits Cervical Cancer Cell Proliferation and Tumor Growth by Downregulating E6/E7-HPV Oncogenes and KCNH1 Gene Expression.

Cervical cancer is the fourth most common cancer among women worldwide. The main factor associated with the onset and progression of this neoplasia is the human papillomavirus (HPV) infection. The HPV-oncogenes E6 and E7 are critical drivers of cellular transformation, promoting the expression of oncogenes such as KCNH1. The phytochemical α-mangostin (AM) is a potent antineoplastic and antiviral compound. However, its effects on HPV oncogenes and KCNH1 gene expression remain unknown. This study evaluated the effects of AM on cell proliferation, cell cycle distribution and gene expression, including its effects on tumor growth in xenografted mice. AM inhibited cell proliferation in a concentration-dependent manner, being the most sensitive cell lines those with the highest number of HPV16 copies. In addition, AM promoted G1-cell cycle arrest in CaSki cells, while led to cell death in SiHa and HeLa cells. Of interest was the finding of an AM-dependent decreased gene expression of E6, E7 and KCNH1 both in vitro and in vivo, as well as the modulation of cytokine expression, Ki-67, and tumor growth inhibition. On these bases, we suggest that AM represents a good option as an adjuvant for the treatment and prevention of cervical cancer.

HPV-Based Self-Sampling in Cervical Cancer Screening: An Updated Review of the Current Evidence in the Literature.

Identifying and reaching women at higher risk for cervical cancer is all-important for achieving the ambitious endpoints set in 2020 by the WHO for global cervical cancer control by 2030. HPV-based (vaginal) self-sampling (SS) represents a cost-effective screening strategy, which has been successfully implemented during the last decade both in affluent and constrained settings. Among other advantages, SS strategies offer convenience, diminished costs, flexibility to obtain a sample in the office or home, avoiding a pelvic exam and uncomfortable appointment with a healthcare professional, as well as social and cultural acceptability. SS implementation has been globally boosted during the COVID-19 pandemic. In pragmatic terms, social distancing, local lockdowns, discontinuation of clinics and reallocation of human and financial resources challenged established clinician-based screening; self-collection strategies apparently surpassed most obstacles, representing a viable and flexible alternative. With time, sufficient reassuring data has accumulated regarding specially designed SS devices, aspects of sample preparation, transport and storage and, importantly, optimization of validated PCR-based HPV testing platforms for self-collected specimens. Suboptimal rates of clinical follow-up post-SS screening, as well as overtreatment with reliance solely on molecular assays, have both been documented and remain concerning. Therefore, effective strategies are still required to ensure linkage to follow-up testing and management following positive SS results by trained health professionals with knowledge of HPV biology and management algorithms. Because of the prolonged SS screening intervals, implementation data are limited regarding subsequent screening rounds of SS-screened individuals; however, these are accumulating gradually. With further refinement of assays and validation of novel biomarkers in self-collected samples, there is a clear potential for increasing SS accuracy and PPV. The potential differentiation of self-collection protocols for vaccinated versus non-vaccinated individuals also represents an open issue. In conclusion, HPV-based self-collection techniques can effectively address limited uptake alongside other conventional cervical screening drawbacks; however, assays, logistics and infrastructures need further optimization to increase the efficacy, effectiveness and cost-effectiveness of SS approaches.

Impact of COVID-19 pandemic on breast and cervical cancer screening in Denmark: A register-based study.

Background: Denmark was one of the few countries where it was politically decided to continue cancer screening during the COVID-19 pandemic. We assessed the actual population uptake of mammography and cervical screening during this period. Methods: The first COVID-19 lockdown in Denmark was announced on 11 March 2020. To investigate possible changes in cancer screening activity due to the COVID-19 pandemic, we analysed data from the beginning of 2017 until the end of 2021. A time series analysis was carried out to discover possible trends and outliers in the screening activities in the period 2017-2021. Data on mammography screening and cervical screening were retrieved from governmental pandemic-specific monitoring of health care activities. Results: A brief drop was seen in screening activity right after the first COVID-19 lockdown, but the activity quickly returned to its previous level. A short-term deficit of 43% [CI -49 to -37] was found for mammography screening. A short-term deficit of 62% [CI -65 to -58] was found for cervical screening. Furthermore, a slight, statistically significant downward trend in cervical screening from 2018 to 2021 was probably unrelated to the pandemic. Other changes, for example, a marked drop in mammography screening towards the end of 2021, also seem unrelated to the pandemic. Conclusions: Denmark continued cancer screening during the pandemic, but following the first lockdown a temporary drop was seen in breast and cervical screening activity. Funding: Region Zealand (R22-A597).

A modelled evaluation of the impact of COVID-19 on breast, bowel, and cervical cancer screening programmes in Australia.

Australia introduced COVID-19 infection prevention and control measures in early 2020. To help prepare health services, the Australian Government Department of Health commissioned a modelled evaluation of the impact of disruptions to population breast, bowel, and cervical cancer screening programmes on cancer outcomes and cancer services. We used the Policy1 modelling platforms to predict outcomes for potential disruptions to cancer screening participation, covering periods of 3, 6, 9, and 12 mo. We estimated missed screens, clinical outcomes (cancer incidence, tumour staging), and various diagnostic service impacts. We found that a 12-mo screening disruption would reduce breast cancer diagnoses (9.3% population-level reduction over 2020-2021) and colorectal cancer (up to 12.1% reduction over 2020-21), and increase cervical cancer diagnoses (up to 3.6% over 2020-2022), with upstaging expected for these cancer types (2, 1.4, and 6.8% for breast, cervical, and colorectal cancers, respectively). Findings for 6-12-mo disruption scenarios illustrate that maintaining screening participation is critical to preventing an increase in the burden of cancer at a population level. We provide programme-specific insights into which outcomes are expected to change, when changes are likely to become apparent, and likely downstream impacts. This evaluation provided evidence to guide decision-making for screening programmes and emphasises the ongoing benefits of maintaining screening in the face of potential future disruptions.

Comparing dosimetry of locally advanced cervical cancer patients treated with 3 versus 4 fractions of MRI-guided brachytherapy.

PURPOSE: To demonstrate the feasibility of treating cervical cancer patients with MRI-guided brachytherapy (MRgBT) using 24 Gy in 3 fractions (F) versus a standard, more resource-intensive regimen of 28 Gy in 4F, and its ability to meet EMBRACE II planning aims. METHODS AND MATERIALS: A retrospective review of 224 patients with FIGO Stage IB-IVA cervical cancer treated with 28 Gy/4F (n = 91) and 24 Gy/3F (n = 133) MRgBT between 2016-2021 was conducted. Multivariable linear regression models were fitted to compare dosimetric parameters between the two groups, adjusting for CTVHR and T stage. RESULTS: Most patients had squamous cell carcinoma, T2b disease, and were treated with intracavitary applicator plus interstitial needles (96%). The 28 Gy/4F group had higher CTVHR (median 28 vs. 26 cm3, p = 0.04), CTVIR D98% (mean 65.5 vs. 64.5 Gy, p = 0.03), rectum D2cm3 (mean 61.7 vs. 59.2 Gy, p = 0.04) and bladder D2cm3 (81.3 vs. 77.9 Gy, p = 0.03). There were no significant differences in the proportion of patients meeting the EMBRACE II OAR dose constraints and planning aims, except fewer patients treated with 28 Gy/4F met rectum D2cm3 < 65 Gy (73 vs. 85%, p = 0.027) and ICRU rectovaginal point < 65 Gy (65 vs. 84%, p = 0.005). CONCLUSIONS: Cervical cancer patients treated with 24 Gy/3F MRgBT had comparable target doses and lower OAR doses compared to those treated with 28 Gy/4F. A less-resource intense fractionation schedule of 24 Gy/3F is an alternative to 28 Gy/4F in cervix MRgBT.

Cervical cancer in sub-Saharan Africa: an urgent call for improving accessibility and use of preventive services.

Sub-Saharan Africa has the highest rates of cervical cancer in the world, largely attributed to low cervical cancer screening coverage. Cervical cancer is the most common cause of death among women in 21 of the 48 countries in sub-Saharan Africa. Close to 100% of all cases of cervical cancer are attributable to Human papillomavirus (HPV). HPV types 16 and 18 cause at least 70% of all cervical cancers globally, while types 31, 33, 45, 52, and 58 cause a further 20% of the cases. Women living with HIV are six times more likely to develop cervical cancer than those without HIV. Considering that sub-Saharan Africa carries the greatest burden of cervical cancer, ways to increase accessibility and use of preventive services are urgently required. With this review, we discuss the preventive measures required to reduce the burden of cervical cancer in sub-Saharan Africa, the challenges to improving accessibility and use of the preventive services, and the recommendations to address these challenges.