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2.
Lancet Public Health ; 7(1): e36-e47, 2022 01.
Article in English | MEDLINE | ID: covidwho-1592783

ABSTRACT

BACKGROUND: The COVID-19 pandemic has affected sexual and reproductive health (SRH) service use and unmet need, but the impact is unknown. We aimed to determine the proportion of participants reporting sexual risk behaviours, SRH service use and unmet need, and to assess remote sexually transmitted infection (STI) testing service use after the first national lockdown in Britain. METHODS: We used data from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)-COVID cross-sectional, quasi-representative web survey (Natsal-COVID Wave 1). Adults aged 18-59 years who resided in England, Scotland, or Wales completed the survey between July 29 and Aug 10, 2020, which included questions about the approximate 4-month period after announcement of the initial lockdown in Britain (March 23, 2020). Quota-based sampling and weighting were used to achieve a quasi-representative population sample. Participants aged 45-59 years were excluded from services analysis due to low rates of SRH service use. Among individuals aged 18-44 years, we estimated reported SRH service use and inability to access, and calculated age-adjusted odds ratios (aORs) among sexually experienced individuals (those reporting any sexual partner in their lifetime) and sexually active individuals (those reporting any sexual partner in the past year). Unweighted denominators and weighted estimates are presented hereafter. FINDINGS: 6654 individuals had complete interviews and were included in the analysis. Among 3758 participants aged 18-44 years, 82·0% reported being sexually experienced, and 73·7% reported being sexually active. 20·8% of sexually experienced participants aged 18-44 years reported using SRH services in the 4-month period. Overall, 9·7% of 3108 participants (9·5% of men; 9·9% of women) reported being unable to use a service they needed, although of the participants who reported trying but not being able to use a SRH service at least once, 76·4% of participants also reported an instance of successful use. 5·9% of 1221 sexually active men and 3·6% of 1560 sexually active women reported use of STI-related services and 14·8% of 1728 sexually experienced women reported use of contraceptive services, with SRH service use highest among individuals aged 18-24 years. Sexually active participants reporting condomless sex with new partners since lockdown were much more likely to report using STI-related services than those who did not report condomless sex (aOR 23·8 [95% CI 11·6-48·9]) for men, 10·5 [3·9-28·2] for women) and, among men, were also more likely to have an unsuccessful attempt at STI-service use (aOR 13·3 [5·3-32·9]). Among 106 individuals who reported using STI testing services, 64·4% accessed services remotely (telephone, video, or online). Among 2581 women aged 25-59 years, 2·4% reported cervical screening compared with an estimated 6% in a comparable 4-month period before the pandemic. INTERPRETATION: Many people accessed SRH care during the initial lockdown; however, young people and those reporting sexual risk behaviours reported difficulties in accessing services and thus such services might need to address a backlog of need. FUNDING: Wellcome Trust, The Economic and Social Research Council, The National Institute for Health Research, Medical Research Council/Chief Scientist Office and Public Health Sciences Unit, and UCL Coronavirus Response Fund.


Subject(s)
COVID-19 , Health Services Accessibility , Patient Acceptance of Health Care/statistics & numerical data , Reproductive Health Services/statistics & numerical data , Sexual Behavior , Adult , Cross-Sectional Studies , Early Detection of Cancer , Female , Humans , Interviews as Topic , Male , Quarantine , Sexually Transmitted Diseases/prevention & control , Surveys and Questionnaires , United Kingdom , Uterine Cervical Neoplasms/prevention & control , Young Adult
3.
Euro Surveill ; 26(50)2021 Dec.
Article in English | MEDLINE | ID: covidwho-1592477

ABSTRACT

While many European Union/European Economic Area (EU/EEA) countries recently expanded human papillomavirus (HPV) vaccination to boys, HPV vaccine supply is currently limited for girls in low- and middle-income countries (LMIC) that are severely affected by HPV.Globally, about 50% of countries have introduced HPV vaccination. Some LMIC with high burden of cervical cancer have not yet introduced HPV vaccination, or are reaching suboptimal vaccination coverage. While WHO issued a call for cervical cancer elimination in 2018, a global shortage of HPV vaccines is currently predicted to last at least until 2024.We reviewed national policies of EU/EEA countries and recommendations of the World Health Organization (WHO) Strategic Advisory Group of Experts on immunisation to discuss current challenges and dose-sparing options. Several EU/EEA countries have extended HPV vaccination to boys and the European Cancer Organisation has issued a resolution for elimination of all HPV-associated cancers in both sexes. The European Centre for Disease Prevention and Control concluded in its 2020 guidance that cost-effectiveness of extending routine vaccination to boys depends on several context-specific factors. The extension of HPV vaccination to boys in EU/EEA countries may affect global availability of vaccines. Temporary dose-sparing options could be considered during the COVID-19 post-pandemic period.


Subject(s)
Alphapapillomavirus , COVID-19 , Papillomavirus Infections , Papillomavirus Vaccines , Uterine Cervical Neoplasms , European Union , Female , Humans , Immunization , Male , Morals , Papillomavirus Infections/prevention & control , SARS-CoV-2 , Uterine Cervical Neoplasms/prevention & control , Vaccination
4.
Int J Gynaecol Obstet ; 155 Suppl 1: 123-134, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1575902

ABSTRACT

Despite the evidence supporting the relevance of obesity and obesity-associated disorders in the development, management, and prognosis of various cancers, obesity rates continue to increase worldwide. Growing evidence supports the involvement of obesity in the development of gynecologic malignancies. This article explores the molecular basis governing the alteration of hallmarks of cancer in the development of obesity-related gynecologic malignancies encompassing cervical, endometrial, and ovarian cancers. We highlight specific examples of how development, management, and prognosis are affected for each cancer, incorporate current knowledge on complementary approaches including lifestyle interventions to improve patient outcomes, and highlight how new technologies are helping us better understand the biology underlying this neglected pandemic.


Subject(s)
Endometrial Neoplasms , Genital Neoplasms, Female , Ovarian Neoplasms , Uterine Cervical Neoplasms , Female , Genital Neoplasms, Female/epidemiology , Humans , Obesity/complications , Obesity/epidemiology , Ovarian Neoplasms/epidemiology , Ovarian Neoplasms/etiology
7.
Reprod Health ; 18(1): 228, 2021 Nov 13.
Article in English | MEDLINE | ID: covidwho-1515447

ABSTRACT

OBJECTIVE: To assess the effect of a blended educational program to promote performing the PST among Iranian women. DESIGN: In a randomized control trial four main variables; knowledge, attitude, self-efficacy, and practice about PST was evaluated using a man-made questionnaire for PST. SETTING: Women aged 18-49 living in Andimeshk (Khuzestan, Iran), covered by 16 health centers, participated in study from November 2019 till April 2019. METHOD: The educational intervention conducted to increasing women's performing the PST. The experimental group received an intervention, whereas the control group received usual care. Participants were tested at four-time points: pre-test (baseline), post-test 1 (immediately after the program's completion) post-test 2 (4 weeks after the program's completion) and post-test 3 (12 weeks after the program completion). RESULTS: A total of 84 women with average aged 32.27 (42 in the experimental group, 42 in the control group) were recruited from 16 health centers in Andimeshk, southern Iran. Significant group differences were found at different times in knowledge, attitude, self-efficacy, and practice about PST. CONCLUSION: A blended method was effective in sustaining the effects of the educational program in the experimental group. The development of appropriate teaching method on restricted situation such as COVID-19 pandemic to promote participation is suggested.


Cervical cancer is the fourth most common cancer among women. The Pap-test is considered the most economical and efficient method for screening cervical cancer and is a simple method without any side effects. Given that awareness with proper methods regarding the initial symptoms, timely diagnosis and treatment are vital for controlling cancer.In this study, we assessed the effect of a blended educational program to promote performing Pap-test among 84 Iranian women. Therefore, a study to assess four main variables; knowledge, attitude, self-efficacy, and practice about PST was designed. We asked women aged 18­49 living in Andimeshk (Khuzestan, Iran) covered by 16 health centers. The educational program to increase women's performance in the PST using online technology regarding participants' convenience, accessibility, and availability of educational content. Women were divided into two groups. One group received an educational program, the second group remained in control and did not receive any education. All women were asked for their knowledge, attitude, self-efficacy and practice of PST three times immediately, 4 and 12 weeks after one-month training.Our assessment showed significant group differences at different times in knowledge, attitude, self-efficacy, and practice about PST.In conclusion, effective online education in sustaining the effects of the educational program in the experimental group happened. Moreover, we experienced an appropriate teaching method for restricted situations such as the COVID-19 pandemic to promote educational participation.


Subject(s)
COVID-19 , Uterine Cervical Neoplasms , Early Detection of Cancer , Female , Health Knowledge, Attitudes, Practice , Humans , Iran , Pandemics , SARS-CoV-2 , Uterine Cervical Neoplasms/epidemiology
8.
Int J Mol Sci ; 22(18)2021 Sep 11.
Article in English | MEDLINE | ID: covidwho-1470886

ABSTRACT

During the last decade, we have persistently addressed the question, "how can the innate immune system be used as a therapeutic tool to eliminate cancer?" A cancerous tumor harbors innate immune cells such as macrophages, which are held in the tumor-promoting M2 state by tumor-cell-released cytokines. We have discovered that these tumor-associated macrophages (TAM) are repolarized into the nitric oxide (NO)-generating tumoricidal M1 state by the dietary agent curcumin (CC), which also causes recruitment of activated natural killer (NK) cells and cytotoxic T (Tc) cells into the tumor, thereby eliminating cancer cells as well as cancer stem cells. Indications are that this process may be NO-dependent. Intriguingly, the maximum blood concentration of CC in mice never exceeds nanomolar levels. Thus, our results submit that even low, transient levels of curcumin in vivo are enough to cause repolarization of the TAM and recruitment NK cells as well as Tc cells to eliminate the tumor. We have observed this phenomenon in two cancer models, glioblastoma and cervical cancer. Therefore, this approach may yield a general strategy to fight cancer. Our mechanistic studies have so far implicated induction of STAT-1 in this M2→M1 switch, but further studies are needed to understand the involvement of other factors such as the lipid metabolites resolvins in the CC-evoked anticancer pathways.


Subject(s)
Curcumin/therapeutic use , Glioblastoma/drug therapy , Neoplasms, Experimental/drug therapy , Uterine Cervical Neoplasms/drug therapy , Animals , Female , Glioblastoma/immunology , Glioblastoma/pathology , Humans , Killer Cells, Natural/immunology , Killer Cells, Natural/pathology , Mice , Neoplasms, Experimental/immunology , Neoplasms, Experimental/pathology , Nitric Oxide/immunology , T-Lymphocytes, Cytotoxic/immunology , T-Lymphocytes, Cytotoxic/pathology , Tumor-Associated Macrophages/immunology , Tumor-Associated Macrophages/pathology , Uterine Cervical Neoplasms/immunology , Uterine Cervical Neoplasms/pathology
11.
Viruses ; 13(3)2021 03 16.
Article in English | MEDLINE | ID: covidwho-1457709

ABSTRACT

BACKGROUND: Efficacy for cervical cancer prevention of opportunistic HPV vaccination in post-pubertal girls is lower than in 11-year-olds. METHODS: Women born between 1986 and 1992 vaccinated at 15-25 years of age (at least one dose of 4-valent HPV vaccine) and screened at 24-27 years of age were included. Frequency of opportunistic vaccination, overall and by birth cohort, was calculated; screening outcomes were compared between vaccinated and unvaccinated women. RESULTS: Overall, 4718 (4.9%) HPV-vaccinated, and 91,512 unvaccinated, women were studied. The frequency of vaccination increased by birth cohort, ranging between 1.8% and 9.8%; age at vaccination decreased progressively by birth cohort (p < 0.0001). Participation in screening was 60.8% among vaccinated, and 56.6% among unvaccinated, women (p < 0.0001). Detection rates (DR) for high-grade lesions were lower in vaccinated women (2.11‰ vs. 3.85‰ in unvaccinated, for CIN3+, p = 0.24; 0.0‰ vs. 0.22‰ for cancer). The DR of CIN3+ increased with age at vaccination, scoring respectively 0.0‰, 0.83‰, and 4.68‰ for women vaccinated when they were 15-16, 17-20, and 21-25 years old (p = 0.17). CONCLUSIONS: In comparison to unvaccinated women, higher compliance with cervical cancer screening invitation and lower CIN3+ DR among vaccinated women was observed. Age at vaccination was inversely correlated to vaccination efficacy.


Subject(s)
Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/administration & dosage , Uterine Cervical Neoplasms/prevention & control , Adolescent , Adult , Early Detection of Cancer , Female , Humans , Italy/epidemiology , Mass Screening , Retrospective Studies , Young Adult
12.
Obstet Gynecol ; 136(3): 533-542, 2020 09.
Article in English | MEDLINE | ID: covidwho-1455364

ABSTRACT

OBJECTIVE: To assess surgical, oncologic, and pregnancy outcomes in patients undergoing radical vaginal, abdominal, or laparoscopic trachelectomy for the treatment of early-stage cervical cancer, using a methodic review of published literature. DATA SOURCES: PubMed, EMBASE, and Cochrane Library sources, including ClinicalTrials.gov, were searched from 1990-2019 with terms "cervical cancer" and "(vaginal, abdominal, open, minimally invasive, or laparoscopic) radical trachelectomy." Grey literature and unpublished data were omitted. METHODS OF STUDY SELECTION: After removal of duplicates from a combined EndNote library of results, 490 articles were reviewed using Covidence software. Two reviewers screened titles and abstracts, and then screened full texts. Selection criteria included articles that reported radical trachelectomy with lymph node assessment as primary therapy for cervical carcinoma, with stated follow-up intervals and recurrences. TABULATION, INTEGRATION, AND RESULTS: Variables of interest were manually extracted into an electronic database. A total 47 articles that reported on 2,566 women met inclusion criteria. Most tumors were of squamous histology (68.5%), stage IB1 (74.8%), 2 cm or less (69.2%), and without lymphovascular invasion (68.8%). Of planned trachelectomies, 9% were converted intraoperatively to hysterectomy. Separated by route of trachelectomy, 58.1%, 37.2%, and 4.7% were performed using radical vaginal, abdominal, and laparoscopic approaches, respectively. With median follow-up of 48 months (range 2-202 months) across studies, median recurrence rate was 3.3% (range 0-25%); median time to recurrence was 26 months (range 8-44 months). Median 5-year recurrence-free and overall survival were 94.6% (range 88-97.3%) and 97.4% (range 95-99%), respectively. The posttrachelectomy pregnancy rate was 23.9%, with a live-birth rate of 75.1%. CONCLUSION: Radical trachelectomy for fertility-preserving treatment of cervical cancer is widely reported in the literature, though publications are mainly limited to case reports and case series. Reported follow-up periods infrequently meet standard oncologic parameters but show encouraging recurrence-free and overall survival rates and pregnancy outcomes. Higher-level evidence needed for meta-analysis is lacking. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019132443.


Subject(s)
Trachelectomy , Uterine Cervical Neoplasms/surgery , Female , Humans , Neoplasm Staging , Pregnancy , Pregnancy Complications, Neoplastic/pathology , Pregnancy Complications, Neoplastic/surgery , Pregnancy Rate , Trachelectomy/methods , Treatment Outcome , Uterine Cervical Neoplasms/pathology
13.
Obstet Gynecol ; 135(5): 1070-1083, 2020 05.
Article in English | MEDLINE | ID: covidwho-1455363

ABSTRACT

OBJECTIVE: To perform a systematic review and meta-analysis evaluating the efficacy of adjuvant human papillomavirus (HPV) vaccination in preventing recurrent cervical intraepithelial neoplasia (CIN) 2 or greater after surgical excision. DATA SOURCES: Electronic databases (Cochrane, PubMed, EMBASE, MEDLINE, Scopus, and ClinicalTrials.gov) were searched for studies comparing surgical excision alone to surgical excision with adjuvant HPV vaccination for CIN 2 or greater. Studies published from January 1990 to January 2019 were included. METHODS: A total of 5,901 studies were reviewed. The primary outcomes evaluated included: recurrence of CIN 2 or greater, CIN 1 or greater, and HPV 16,18 associated CIN within 6-48 months. We used Covidence software to assist with screening, and meta-analysis was performed using Review Manager. TABULATION, INTEGRATION, AND RESULTS: Six studies met inclusion criteria and were included in the final analysis. In total 2,984 women were included; 1,360 (45.6%) received adjuvant HPV vaccination after surgical excision, and 1,624 (54.4%) received either placebo or surgical management alone for CIN 2 or greater. Recurrence of CIN 2 or greater occurred within 6-48 months in 115 women (3.9%) overall; however, recurrence was significantly lower for vaccinated women: 26 of 1,360 women (1.9%) vs 89 of 1,624 unvaccinated women (5.9%) (relative risk [RR] 0.36 95% CI 0.23-0.55). The risk of CIN 1 or greater was also significantly lower with adjuvant HPV vaccination, occurring in 86 of 1,360 vaccinated women (6.3%) vs 157 of 1,624 unvaccinated women (9.7%) (RR 0.67 95% CI 0.52-0.85). Thirty-five women developed recurrent CIN 2 or greater lesions specific to HPV 16,18; nine received adjuvant vaccination (0.9%) vs 26 who were unvaccinated (2.0%) (RR 0.41 95% CI 0.20-0.85). CONCLUSION: Adjuvant HPV vaccination in the setting of surgical excision for CIN 2 or greater is associated with a reduced risk of recurrent cervical dysplasia overall and a reduction in the risk of recurrent lesions caused by the most oncogenic strains (HPV 16,18). Human papillomavirus vaccination should therefore be considered for adjuvant treatment in patients undergoing surgical excision for CIN 2 or greater. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019123786.


Subject(s)
Cervical Intraepithelial Neoplasia/drug therapy , Neoplasm Recurrence, Local/prevention & control , Papillomavirus Infections/complications , Papillomavirus Vaccines/therapeutic use , Uterine Cervical Neoplasms/drug therapy , Adult , Cervical Intraepithelial Neoplasia/surgery , Cervical Intraepithelial Neoplasia/virology , Chemotherapy, Adjuvant , Female , Humans , Middle Aged , Neoplasm Recurrence, Local/virology , Papillomavirus Infections/virology , Treatment Outcome , Uterine Cervical Neoplasms/surgery , Uterine Cervical Neoplasms/virology , Young Adult
14.
Cancer Prev Res (Phila) ; 14(10): 919-926, 2021 10.
Article in English | MEDLINE | ID: covidwho-1450634

ABSTRACT

The World Health Organization global call to eliminate cervical cancer encourages countries to consider introducing or improving cervical cancer screening programs. Brazil's Unified Health System (SUS) is among the world's largest public health systems offering free cytology testing, follow-up colposcopy, and treatment. Yet, health care networks across the country have unequal infrastructure, human resources, equipment, and supplies resulting in uneven program performance and large disparities in cervical cancer incidence and mortality. An effective screening program needs multiple strategies feasible for each community's reality, facilitating coverage and follow-up adherence. Prioritizing those at highest risk with tests that better stratify risk will limit inefficiencies, improving program impact across different resource settings. Highly sensitive human papillomavirus (HPV)-DNA testing performs better than cytology and, with self-collection closer to homes and workplaces, improves access, even in remote regions. Molecular triage strategies like HPV genotyping can identify from the same self-collected sample, those at highest risk requiring follow-up. If proven acceptable, affordable, cost-effective, and efficient in the Brazilian context, these strategies would increase coverage while removing the need for speculum exams for routine screening and reducing follow-up visits. SUS could implement a nationwide organized program that accommodates heterogenous settings across Brazil, informing a variety of screening programs worldwide.


Subject(s)
COVID-19/complications , Cytodiagnosis/methods , Early Detection of Cancer/methods , Papillomaviridae/isolation & purification , Papillomavirus Infections/complications , SARS-CoV-2/isolation & purification , Uterine Cervical Neoplasms/diagnosis , Brazil/epidemiology , DNA, Viral/analysis , DNA, Viral/genetics , Female , Humans , Papillomavirus Infections/genetics , Papillomavirus Infections/virology , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/virology
15.
Prev Med ; 153: 106826, 2021 12.
Article in English | MEDLINE | ID: covidwho-1440420

ABSTRACT

Worldwide, cancer screening faced significant disruption in 2020 due to the COVID-19 pandemic. If this has led to changes in public attitudes towards screening and reduced intention to participate, there is a risk of long-term adverse impact on cancer outcomes. In this study, we examined previous participation and future intentions to take part in cervical and colorectal cancer (CRC) screening following the first national lockdown in the UK. Overall, 7543 adults were recruited to a cross-sectional online survey in August-September 2020. Logistic regression analyses were used to identify correlates of strong screening intentions among 2319 participants eligible for cervical screening and 2502 eligible for home-based CRC screening. Qualitative interviews were conducted with a sub-sample of 30 participants. Verbatim transcripts were analysed thematically. Of those eligible, 74% of survey participants intended to attend cervical screening and 84% intended to complete home-based CRC screening when next invited. Thirty percent and 19% of the cervical and CRC samples respectively said they were less likely to attend a cancer screening appointment now than before the pandemic. Previous non-participation was the strongest predictor of low intentions for cervical (aOR 26.31, 95% CI: 17.61-39.30) and CRC (aOR 67.68, 95% CI: 33.91-135.06) screening. Interview participants expressed concerns about visiting healthcare settings but were keen to participate when screening programmes resumed. Intentions to participate in future screening were high and strongly associated with previous engagement in both programmes. As screening services recover, it will be important to monitor participation and to ensure people feel safe to attend.


Subject(s)
COVID-19 , Colorectal Neoplasms , Uterine Cervical Neoplasms , Adult , Colorectal Neoplasms/diagnosis , Communicable Disease Control , Cross-Sectional Studies , Early Detection of Cancer , Female , Health Knowledge, Attitudes, Practice , Humans , Intention , Mass Screening , Pandemics , SARS-CoV-2 , Uterine Cervical Neoplasms/diagnosis
16.
Curr Oncol ; 28(5): 3705-3716, 2021 09 24.
Article in English | MEDLINE | ID: covidwho-1438539

ABSTRACT

Despite a global and nationwide decrease, Native Americans continue to experience high rates of cancer morbidity and mortality. Vaccination is one approach to decrease cancer incidence such as the case of cervical cancer. However, the availability of vaccines does not guarantee uptake, as evident in the Coronavirus 2019 pandemic. Therefore, as we consider current and future cancer vaccines, there are certain considerations to be mindful of to increase uptake among Native Americans such as the incidence of disease, social determinants of health, vaccine hesitancy, and historical exclusion in clinical trials. This paper primarily focuses on human papillomavirus (HPV) and potential vaccines for Native Americans. However, we also aim to inform researchers on factors that influence Native American choices surrounding vaccination and interventions including cancer therapies. We begin by providing an overview of the historical distrust and trauma Native Americans experience, both past and present. In addition, we offer guidance and considerations when engaging with sovereign Tribal Nations in vaccine development and clinical trials in order to increase trust and encourage vaccine uptake.


Subject(s)
Cancer Vaccines , Papillomavirus Infections , Papillomavirus Vaccines , Uterine Cervical Neoplasms , Female , Humans , Papillomavirus Infections/prevention & control , Uterine Cervical Neoplasms/prevention & control
19.
Pan Afr Med J ; 39: 149, 2021.
Article in English | MEDLINE | ID: covidwho-1359430

ABSTRACT

Cervical cancer is the leading gynaecological malignancy in Zimbabwe, constituting 33% of all female cancers in 2016. Primary prevention through vaccination and secondary prevention through screening are important public health interventions to reduce the cervical cancer burden. Unfortunately, the ongoing COVID-19 pandemic has brought unprecedented challenges to healthcare delivery, posing threats to prevention efforts at a time when the public health sector is extremely fragile. The fragility of the sector has complicated treatment for cervical cancer before and during the COVID-19 pandemic, and is expected to worsen beyond the pandemic. A multi-sectoral intersection between public health experts, clinicians and communities is urgently required to restore preventive and treatment services for cervical cancer and reduce the increased burden, morbidity and mortality stemming indirectly from the pandemic.


Subject(s)
COVID-19 , Mass Screening/statistics & numerical data , Public Health , Uterine Cervical Neoplasms/prevention & control , Delivery of Health Care/organization & administration , Early Detection of Cancer/statistics & numerical data , Female , Humans , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/therapy , Zimbabwe
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