A systematic review of the cost-effectiveness of interventions to increase cervical cancer screening among underserved women in Europe

A Combination of Flavonoids Suppresses Cell Proliferation and the E6 Oncogenic Pathway in Human Papillomavirus-Transformed Cells

Despite the availability of excellent HPV-specific vaccines, HPV-related conditions and, notably, their related neoplastic diseases are expected to impact human health for many years to come. Polyphenols and flavonoids are a large class of natural products, credited with a wide range of pharmacological properties including antineoplastic activity. However, the currently available data depict a rather heterogeneous and sometimes contradictory landscape, and no univocal conclusions can be drawn. To shed light on such a controversial issue, a restricted list of promising polyphenols were evaluated for their antineoplastic activity on HPV-transformed cells. Among them, Kaempferol, Galangin, and Luteolin proved to have distinct anti-clonal activity with ID50 values, respectively, of 1.25, 6.25, and 3.0 microMolar, and three other compounds, namely, Chrysin, Quercetin, and Apigenin, showed fair although less intense activity with ID values, respectively, of 25.0, 40, and 25 microMolar. Interestingly, a distinct anti-proliferative effect could also be suggested for Kaempferol, Luteolin, and Apigenine. Cooperative anti-clonal effects could be suggested for binary and ternary compositions made of Kaepferol, Galangin, and Luteolin once combined at concentrations ranging from 2 to 8 microMolar. At these concentrations, the single components and the triple combination induced distinct cell cycle modulation associated with marked restoration of the p53 and p21Cip1/Waf1 levels, consistent with the disruption of the E6/E6AP interaction whose continuous activity is necessary for both the induction and maintenance of the viral-induced neoplastic phenotype.

Economic Evaluations of Interventions Addressing Inequalities in Cancer Care: A Systematic Review

OBJECTIVES

Although substantial evidence exists on the costs and benefits of cancer care and screening programs for the general population, economic evidence of interventions addressing inequalities is less well known. This systematic review summarized economic evaluations of interventions addressing inequalities in cancer screening and care to inform decision makers on the value for money of such interventions.

METHODS

Embase, MEDLINE, Cochrane Library, EconLit, and Scopus databases were searched for studies published from database inception to October 27, 2023. Studies were eligible for inclusion if they were economic evaluations of interventions to improve or address inequalities in cancer care among disadvantaged population groups. Study characteristics and cost-effectiveness results (US dollars 2023) were summarized. Study quality was assessed by 2 authors using the Drummond checklist.

RESULTS

The searches yielded 2937 records, with 30 meeting the eligibility criteria for data extraction. In most of the studies (n = 27, 90%), interventions were considered cost-effective in addressing inequalities in cancer care and screening among disadvantaged populations. Notably, 60% of the studies were rated as high quality, 33.3% as good, and 6.7% as fair quality.

CONCLUSIONS

This systematic review identified cost-effective strategies addressing inequalities in cancer screening and care that have the potential to be replicated in other locations. The interventions were mainly focused on screening programs, and few addressed equity gaps around risk reduction and diagnostic and treatment outcomes. This underscores the need for targeted approaches to address inequalities in under-researched priority population groups along the cancer care continuum.