Secular trends in incidence and mortality of cervical cancer in India and its states, 1990-2019: data from the Global Burden of Disease 2019 Study

Analysis of time trends of prevalence of high-risk HPV infections, high grade cervical precancer and cervical cancer disease in women from Eastern India over 20 years - Pooled analysis from three studies

BACKGROUND

Cervical cancer remains a leading cause of cancer related morbidity and mortality among women worldwide, particularly in low-and middle- income countries (LMICs). The incidence of cervical cancer has declined in India over the last two decades despite the lack of any organised population-based screening programme or HPV vaccination. This study analyses the trends in high-risk human papilloma virus (hrHPV) prevalence and CIN 2 + detection and examines the influence of sociodemographic factors in West Bengal, India from over a span of two decades.

METHODS

Data from three cervical cancer screening studies conducted in rural West Bengal were analysed between 2001 and 2021. A total of 80,988 women aged 30-60 years were screened using Hybrid Capture II© (HC II) test. Detection rates of CIN 2 + were stratified by age, education and marriage. Logistic regression models were used to identify factors influencing high risk HPV positivity and CIN 2 + prevalence.

RESULTS

The overall high risk HPV positivity rate remained relatively stable (5 %) across the study periods with no significant difference between self-collected and provider collected samples. However, CIN 2 + detection rates declined significantly from 5.7/1000 in 2001-2003 to 2/1000 in 2018-2021 (adjusted odds ratio [OR]:0.27; 95 % confidence interval [CI]:0.12-0.46). Higher education (OR: 0.64; 95 % CI: 0.45-0.88) and delayed age at marriage (OR: 0.62; 95 %CI: 0.31-1 for age>21) were associated with lower CIN 2 + risk.

CONCLUSION

The findings of the study indicate that the observed decline in CIN 2 + prevalence in West Bengal can be attributed to improved education, delayed age at marriage, reduced fertility rate and women's empowerment, which can explain the gradual reduction in cervical cancer incidence in India. However, the cervical cancer incidence in India remains above WHO elimination targets. Expedited implementation of HPV vaccination and strengthening screening programmes are necessary to sustain and accelerate progress towards elimination of cervical cancer.

Unraveling HPV-associated cancer complexity: From molecular insights to innovative therapies

Human papillomavirus (HPV) contributes to a high global incidence of sexually transmitted infections, predominantly associated with cervical cancer, as well as head and neck, penile, anal, vaginal, and vulvar cancers. Despite efforts through improved screening and HPV vaccination campaigns, challenges persist, influencing the frequency of HPV-related malignancies. Collaborative scientific endeavors strive to pioneer groundbreaking approaches, aiming to alleviate the adverse consequences of HPV-related malignancies on individuals and communities. The present review is focused on exhaustively covering HPV-associated cancers, particularly cervical cancer. This study highlights the initiation, progression, immune invasion, and treatment strategies of HPV-associated cancers. The role of viral oncoproteins E6 and E7 responsible for immune evasion and subsequent latent infection is also elaborated. The article also sheds light on the pivotal role of HPV vaccination in averting high-risk HPV infections and associated cancers. The scope of this review encompasses HPV-associated cancer epidemiology, regional disparities, and the distinctive challenges faced in the context of India. This will be a value addition to the knowledge repertoire beneficial for creating awareness and designing health policies.

Identification of differentially expressed MiRNA clusters in cervical cancer

BACKGROUND

Aberrant miRNA expression has been associated with cervical cancer (CC) progression. The present study aimed to identify the miRNA clusters (MCs) altered in CC, identify their clinical utility, and understand their biological functions via computational analysis.

METHODS

We used small RNA sequencing and qRT‒PCR to identify and validate abnormally expressed MCs in cervical squamous cell carcinoma (CSCC) samples. We compared our data with publicly available CC datasets to identify the differentially expressed MCs in CC. The potential targets, pathways, biological functions, and clinical utility of abnormally expressed MCs were predicted via several computational tools.

RESULTS

Small RNA sequencing revealed that 229 miRNAs belonging to 48 MCs were significantly differentially expressed in CSCC (p-value ≤ 0.05). Validation by qRT‒PCR confirmed the downregulation of members of the miR-379/656, namely, hsa-miR-376c-3p (2.8-fold; p-value 0.03), hsa-miR-494-3p (3.4-fold; p-value 0.02), hsa-miR-495-3p (eightfold; p-value 0.01), and hsa-miR-409-3p (fivefold; p-value 0.03), in CSCC samples compared with normal samples. The prognostic model generated via miRNA expression and random forest analysis showed robust sensitivity and specificity (0.88 to 0.92) in predicting overall survival. In addition, we report 22 prognostically important miRNAs in CC. Pathway analysis revealed the enrichment of several cancer-related pathways, notably p53, the cell cycle, viral infection and MAPK signalling. CDC25A, CCNE1, E2F1, CCNE2, RBL1, E2F3, CDK2, RBL2, E2F2 and CCND2 were identified as the top ten gene targets of MC. Drug‒gene interaction analysis revealed enrichment of 548 approved drugs and 62 unique genes.

CONCLUSION

Our study identified MCs, their target genes, their prognostic utility, and their potential functions in CC and recommended their usefulness in CC management.

Identification of Biomarkers for Cervical Cancer Radiotherapy Sensitivity and Survival Prognosis

INTRODUCTION

Radiotherapy resistance leads to treatment failure and disease progression in patients with cervical cancer. This study aims to elucidate the molecular underpinnings of radiotherapy response in cervical cancer by identifying radiotherapy sensitivity genes (RSGs).

METHODS

We utilized two GEO expression profiling datasets (GSE3578 and GSE6213) comprising cervical cancer biopsy samples taken before and during radiotherapy to identify differentially expressed genes (DEGs) using the RankProd meta-analysis approach. Subsequent analysis was conducted using data from the TCGA-CESE project to further determine the RSGs and investigate their associations with survival prognosis, immune cell infiltration, and drug sensitivities. The differential expressions of the candidate RSGs were validated in an independent set of cervical cancer patients by qPCRs.

RESULTS

A total of 518 DEGs were identified, with 305 genes upregulated and 213 genes down-regulated during radiotherapy. Six key RSGs were identified as significantly associated with radiotherapy response. Cox regression analysis revealed that upregulations of IL1RAP and GPR15 were associated with an increased risk of poor survival prognosis. Functional enrichment analysis highlighted the involvement of these genes in critical biological processes such as cytokine signaling and immune regulation. Correlation analyses demonstrated significant associations between RSG expressions and M2 macrophage and γδT cell abundances in tumor microenvironment, as well as drug sensitivities. The expression of IL1RAP was significantly higher in the complete response group, supporting the bioinformatic finding.

CONCLUSION

Our findings on RSGs could potentially serve as potential biomarkers for predicting radiotherapy response and as therapeutic targets to enhance the efficacy of radiotherapy.

Estimation of burden of cancer incidence and mortality in India: based on global burden of disease study 1990-2021

BACKGROUND

Cancer poses a significant public health challenge in India, making it crucial to predict its future impact for effective healthcare planning. This study forecast cancer incidence, mortality, and disability-adjusted life years (DALYs) in India from 2022 to 2031.

METHODS

We extracted age-standardized data on incidence, prevalence, DALYs, and mortality from 1990 to 2021 from the Global Burden of Disease (GBD) study. We used Decadal Average Percentage Change techniques to identify trends in cancer burden over decades and the Autoregressive Integrated Moving Average (ARIMA) method were used for forecasting. The ARIMA (2,2,2) model was identified as the best for predicting cancer incidence, ARIMA (0,3,3) for DALYs, and ARIMA (0,2,2) for mortality.

RESULTS

The cancer incidence rate is expected to rise from 529.40 (95% CI: 525.41-533.38) in 2022 to 549.17 (95% CI: 487.43-610.92) per 100,000 population in 2031. The DALYs rate is projected to decrease from 2001.53 (95% CI: 1964.24-2038.82) in 2022 to 1842.08 (95% CI: 1273.57-2410.60) per 100,000 population in 2031, indicating improvements in cancer burden management. Mortality rates are forecasted to increase slightly, from 71.52 (95% CI: 69.91-73.12) in 2022 to 73.00 (95% CI: 60.88-85.11) per 100,000 population in 2031. Overall, while incidence and mortality rates show a slight upward trend, the DALYs rate is projected to decrease, reflecting potential advancements in cancer management and treatment over the forecast period.

CONCLUSIONS

Over the next decade, cancer incidence and mortality are expected to increase in India, highlighting the need for enhanced prevention, early detection, and proper treatment strategies. Despite these increases, the anticipated decrease in DALYs suggests potential advancements in cancer management, warranting further investigation into the drivers of this positive trend and measures to sustain it.

A Systematic Review of Cervical Cancer Mobile Applications and a Future Directions for Developers

OBJECTIVE

The objective of this study is to evaluate the quality of mobile health (mHealth) applications that promote cervical cancer awareness and provide screening assistance, with an emphasis on apps available on the Google Play Store and iOS.

METHODS

From December 2023 to February 2024, we assessed mobile applications focused on cervical cancer screening that are available on Google Play and Apple iTunes. The "Cervical Cancer," "Mobile Application," "Pap Test," "Cervical Cancer Guide," "Human Papillomavirus," plus "Cervical Screening are the keywords used to search the applications." Data collection includes features such as application name, pricing, download metrics, invention date, last update, affiliation, online access, login requirements, and notification functionality, which were gathered in Excel. Interrater reliability based on four reviewers' independent judgments, varied from 0.75 to 0.83.

RESULT

In our research, we found 25 apps (16 on the Google Play Store and 9 on iOS). After a thorough review, only 14 relevant apps were included. According to the MARS rating, Rise Against Cancer received the highest score (3.9), followed by FightHPV and Cervical Cancer Forum (3.8). Rise Against Cancer (29), HPV Vaccine (28), and CDC STI Tx Guidelines (28) scored highest in the APPLICATIONS rating system. Hope 4 All and OCI Cervibreast closely matched the statements, meeting seven of the thirteen requirements each.

CONCLUSION

Future app developers should produce user-friendly, often updated mHealth applications that include high-quality cervical cancer awareness and screening content. These apps should provide validated information and pleasant graphic effects.

Investigation of In Vitro Anti-cancer and Apoptotic Potential of Onion-Derived Nanovesicles Against Prostate and Cervical Cancer Cell Lines

Plant-derived compounds have recently garnered significant interest in the field of medicine due to their rich repertoire of phytochemicals, which holds promise for exploring novel therapies to treat cancer. This study embarks on the first-time investigation of the anti-cancerous effect of onion-derived nanovesicles (ODNVs). ODNVs were isolated employing differential centrifugation followed by ultracentrifugation and subsequent characterization using dynamic light scattering (DLS), field emission scanning electron microscopy (FESEM), and Fourier transform infrared spectroscopy (FTIR). Furthermore, we delineated the anti-cancerous effect of ODNVs on two cancer cell line models HeLa (cervical cancer) and PC-3 (prostate cancer) using MTT assay, DAPI-based DNA damage using immunofluorescence microscopy, colony formation assay, migration assay, cell cycle analysis, and evaluation of apoptosis using flow cytometry and western blotting. The findings revealed dose- and time-dependent anti-proliferative effects of ODNVs on both HeLa and PC3 cell lines, accompanied by selective cytotoxicity against cancer cells. Additional results highlighted that ODNVs prevented colony growth and induced S-phase cell cycle arrest. Apoptosis induction was evaluated through alterations in nuclear morphology and the number of apoptotic cells, which increased significantly after ODNV treatment in both cancer cell lines. Furthermore, annexin V/PI staining evaluation of apoptotic cells by flow cytometry demonstrated that ODNV treatment significantly increased the number of apoptotic cells in both PC-3 and HeLa cells. Finally, Western blot analysis indicated changes in apoptosis-related proteins including bcl-2, bax, and caspase-3, emphasizing that the anti-cancerous effect of ODNVs is attributed to the induction of apoptosis and suggests the  unexplored anti-cancerous potential of ODNVs.

Prioritizing cervical cancer candidate genes using chaos game and fractal-based time series approach

Cervical cancer is one of the most severe threats to women worldwide and holds fourth rank in lethality. It is estimated that 604, 127 cervical cancer cases have been reported in 2020 globally. With advancements in high throughput technologies and bioinformatics, several cervical candidate genes have been proposed for better therapeutic strategies. In this paper, we intend to prioritize the candidate genes that are involved in cervical cancer progression through a fractal time series-based cross-correlations approach. we apply the chaos game representation theory combining a two-dimensional multifractal detrended cross-correlations approach among the known and candidate genes involved in cervical cancer progression to prioritize the candidate genes. We obtained 16 candidate genes that showed cross-correlation with known cancer genes. Functional enrichment analysis of the candidate genes shows that they involve GO terms: biological processes, cell-cell junction assembly, cell-cell junction organization, regulation of cell shape, cortical actin cytoskeleton organization, and actomyosin structure organization. KEGG pathway analysis revealed genes' role in Rap1 signaling pathway, ErbB signaling pathway, MAPK signaling pathway, PI3K-Akt signaling pathway, mTOR signaling pathway, Acute myeloid leukemia, chronic myeloid leukemia, Breast cancer, Thyroid cancer, Bladder cancer, and Gastric cancer. Further, we performed survival analysis and prioritized six genes CDH2, PAIP1, BRAF, EPB41L3, OSMR, and RUNX1 as potential candidate genes for cervical cancer that has a crucial role in tumor progression. We found that our study through this integrative approach an efficient tool and paved a new way to prioritize the candidate genes and these genes could be evaluated experimentally for potential validation. We suggest this may be useful in analyzing the nucleotide sequences and protein sequences for clustering, classification, class affiliation, etc.

Hematological Parameters at Baseline: A Novel Prognostic Factor for Cervical Cancer Patients Undergoing Concurrent Chemoradiotherapy in South India

Introduction In cervical cancer treatment, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and albumin-globulin ratio (AGR) are being studied as potential prognostic markers for predicting the effectiveness of concurrent chemoradiotherapy (CCRT). This study aims to investigate the relationship between these biomarkers and survival outcomes in cervical cancer patients undergoing CCRT. Materials and methods This retrospective study was conducted at Amrita Institute of Medical Sciences between January 2016 and December 2019. It included patients at any stage who received definitive CCRT and were followed for at least two years post-treatment. Patients who had initial surgery and those lost to follow-up were excluded. Results The study included 123 patients with a median age of 68. Most patients had stage IIB (39%) and squamous cell carcinoma (76.4%). With a median follow-up of 56 months, the five-year overall survival (OS) was 66.8%, progression-free survival (PFS) was 94%, and recurrence-free survival (RFS) was 81.2%. AGR (p = 0.001), NLR (p = 0.0001), and PLR (p = 0.001) were found to be significantly associated with OS, NLR (p = 0.002) and AGR (p = 0.001) significantly affected RFS, while only PLR (p = 0.02) significantly affected PFS on univariate analysis. NLR significantly impacted OS (p = 0.003) and RFS (p = 0.03) on multivariate analysis. Conclusion The results of our study showed that increased NLR and elevated levels of albumin indicate a higher likelihood of mortality. Furthermore, a higher NLR was linked to an increased probability of recurrence in patients with cervical cancer who received primary treatment with CCRT. Therefore, the identification of predictive biomarkers could significantly improve the assessment of progression risk, aiding in the selection of the most suitable treatment and personalized therapy.

Cancer burden across the South Asian Association for Regional Cooperation in 2022

Objective

The objective of this study is to present a cross-sectional analysis of cancer burden in the South Asian Association for Regional Cooperation (SAARC) region and explain unique characteristics of its cancer burden as compared with the rest of the world.

Methods and analysis

Using publicly available data from the Global Cancer Observatory (GCO) and the World Bank, we collected cancer statistics and population statistics for Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka from 2017 to 2022.

Results

The number of newly diagnosed cases in the region was 1 846 963, representing 9.3% of the incidence worldwide. As defined by the GCO, the crude incidence rate (CIR) (per 100 000) of cancer in SAARC was 97.3 compared with the worldwide rate of 235.5. The crude mortality rate (per 100 000) in SAARC was 63.4, compared with 123.6 globally. However, the mortality to incidence ratio (MIR) (per 100 000) was 0.65, compared with 0.49 globally.

Conclusion

Our research highlights SAARC's unique cancer landscape with low incidence (CIR) and mortality (CMR) but elevated MIR compared with global figures. These findings underscore the need for a united, contextually relevant approach to addressing the burden of cancer in SAARC. In particular, investment in collaborative, tailored cancer care programmes will build the SAARC region's capacity to address the growing cancer challenge.

Burden of cervical cancer in India: estimates of years of life lost, years lived with disability and disability adjusted life years at national and subnational levels using the National Cancer Registry Programme data

BACKGROUND

Cervical cancer is ranked as the second most common cancer in India. This study aims to assess the cervical cancer burden at the national and subnational level in India, projecting it for the year 2025 in terms of years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs).

METHODS

Twenty-eight population based cancer registries within the National Cancer Registry Programme network contributed cancer incidence and mortality data for this analysis. The DisMod-II tool, WHO lifetables, disability weights, mortality to incidence ratio, sample registration system, and census data were used to estimate the burden of cervical cancer. The projection estimates for 2025 were performed using a negative binomial regression model.

RESULTS

In 2016, the cervical cancer burden in India was 223.8 DALYs per 100,000 women. The highest age-standardised DALYs were found in the northeast region (290.1 DALYs per 100,000 women) and the lowest in the eastern region (156.1 DALYs per 100,000 women). The states of Mizoram, Arunachal Pradesh, Karnataka, and Nagaland had a higher cervical cancer burden with DALYs exceeding 300 per 100,000 women. The projected cervical cancer burden for India in 2025 was estimated to be 1.5 million DALYs.

CONCLUSIONS

The study has found a significant cervical cancer burden across the regions of India, providing a baseline for monitoring impact of actions. Enhancing awareness of cervical cancer, advocating for the significance of screening, and promoting HPV vaccination among adolescents, families, and communities through informative communication campaigns are essential steps in managing and ultimately eliminating cervical cancer in India.

CRISPR-Based Biosensors for Medical Diagnosis: Readout from Detector-Dependence Detection Toward Naked Eye Detection

The detection of biomarkers (such as DNA, RNA, and protein) plays a vital role in medical diagnosis. The CRISPR-based biosensors utilize the CRISPR/Cas system for biometric recognition of targets and use biosensor strategy to read out biological signals without the employment of professional operations. Consequently, the CRISPR-based biosensors demonstrate great potential for the detection of biomarkers with high sensitivity and specificity. However, the signal readout still relies on specialized detectors, limiting its application in on-site detection for medical diagnosis. In this review, we summarize the principles and advances of the CRISPR-based biosensors with a focus on medical diagnosis. Then, we review the advantages and progress of CRISPR-based naked eye biosensors, which can realize diagnosis without additional detectors for signal readout. Finally, we discuss the challenges and further prospects for the development of CRISPR-based biosensors.

lncRNAs and cyclin-dependent kinases: Unveiling their critical roles in cancer progression

Long non-coding RNAs (lncRNAs) are a diverse class of RNA molecules that do not code for proteins but play critical roles in gene regulation. One such role involves the modulation of cell cycle progression and proliferation through interactions with cyclin-dependent kinases (CDKs), key regulators of cell division. Dysregulation of CDK activity is a hallmark of cancer, contributing to uncontrolled cell growth and tumor formation. These lncRNA-CDK interactions are part of a complex network of molecular mechanisms underlying cancer pathogenesis, involving various signaling pathways and regulatory circuits. Understanding the interplay between lncRNAs, CDKs, and cancer biology holds promise for developing novel therapeutic strategies targeting these molecular targets for more effective cancer treatment. Furthermore, targeting CDKs, key cell cycle progression and proliferation regulators, offers another avenue for disrupting cancer pathways and overcoming drug resistance. This can open new possibilities for individualized treatment plans and focused therapeutic interventions.

Role of TIM-1 in the development and treatment of tumours

T-cell immunoglobulin and mucin structural domain 1 (TIM-1, also known as hepatitis A virus cell receptor 1) is a co-stimulatory molecule that is expressed predominantly on the surface of T cells. TIM-1 promotes the activation and proliferation of T cells, cytokine secretion, and can also be overexpressed in various types of cancer. Upregulation of TIM-1 expression may be associated with the development and progression of cancer. After reviewing the literature, we propose that TIM-1 affects tumour development mainly through two pathways. In the Direct pathway: overexpression in tumours activates tumour-related signaling pathways, mediates the proliferation, apoptosis, invasion and metastasis, and directly affects tumour development directly. In the indirect pathway: In addition to changing the tumour microenvironment and influencing the growth of tumours, TIM-1 binds to ligands to encourage the activation, proliferation, and generation of cytokines by immune cells. This review examines how TIM-1 stimulates the development of tumours in direct and indirect ways, and how TIM-1 is exploited as a target for cancer therapy.

Assessment of secular trends of three major gynecologic cancers burden and attributable risk factors from 1990 to 2019: an age period cohort analysis

BACKGROUND

This study aims to assess the long-term trends in the burden of three major gynecologic cancers(GCs) stratified by social-demographic status across the world from 1990 to 2019. To assess the trends of risk factor attributed mortality, and to examine the specific effects of age, period, cohort behind them in different regions.

METHODS

We extracted data on the mortality, disability-adjusted life years(DALYs), and age-standardized rates(ASRs) of cervical cancer(CC), uterine cancer(UC), and ovarian cancer(OC) related to risks from 1990 to 2019, as GCs burden measures. Age-period-cohort analysis was used to analyze trends in attributable mortality rates.

RESULTS

The number of deaths and DALYs for CC, UC and OC increased since 1990 worldwide, while the ASDRs decreased. Regionally, the ASDR of CC was the highest in low SDI region at 15.05(11.92, 18.46) per 100,000 in 2019, while the ASDRs of UC and OC were highest in high SDI region at 2.52(2.32,2.64), and 5.67(5.16,6.09). The risk of CC death caused by unsafe sex increased with age and then gradually stabilized, with regional differences. The period effect of CC death attributed to smoking showed a downward trend. The cohort effect of UC death attributed to high BMI decreased in each region, especially in the early period in middle, low-middle and low SDI areas.

CONCLUSIONS

Global secular trends of attributed mortality for the three GCs and their age, period, and cohort effects may reflect the diagnosis and treatment progress, rapid socioeconomic transitions, concomitant changes in lifestyle and behavioral patterns in different developing regions. Prevention and controllable measures should be carried out according to the epidemic status in different countries, raising awareness of risk factors to reduce future burden.

Development and validation of a nomogram for predicting sever cancer-related fatigue in patients with cervical cancer

OBJECTIVE

Cancer-related fatigue (CRF) has been considered the biggest influencing factor for cancer patients after surgery. This study aimed to develop and validate a nomogram for severe cancer-related fatigue (CRF) patients with cervical cancer (CC).

METHODS

A cross-sectional study was conducted to develop and validate a nomogram (building set = 196; validation set = 88) in the Department of Obstetrics and Gynecology of a Class III hospital in Shenyang, Liaoning Province. We adopted the questionnaire method, including the Cancer Fatigue Scale (CFS), Medical Uncertainty in Illness Scale (MUIS), Medical Coping Modes Questionnaire (MCMQ), Multidimensional Scale of Perceived Social Support (MSPSS), and Sense of Coherence-13 (SOC-13). Binary logistic regression was used to test the risk factors of CRF. The R4.1.2 software was used to develop and validate the nomogram, including Bootstrap resampling method, the ability of Area Under Curve (AUC), Concordance Index (C-Index), Hosmer Lemeshow goodness of fit test, Receiver Operating Characteristic (ROC) curve, Calibration calibration curve, and Decision Curve Analysis curve (DCA).

RESULTS

The regression equation was Logit(P) = 1.276-0.947 Monthly income + 0.989 Long-term passive smoking - 0.952 Physical exercise + 1.512 Diagnosis type + 1.040 Coping style - 0.726 Perceived Social Support - 2.350 Sense of Coherence. The C-Index of the nomogram was 0.921 (95% CI: 0.877∼0.958). The ROC curve showed the sensitivity of the nomogram was 0.821, the specificity was 0.900, and the accuracy was 0.857. AUC was 0.916 (95% CI: 0.876∼0.957). The calibration showed that the predicted probability of the nomogram fitted well with the actual probability. The DCA curve showed when the prediction probability was greater than about 10%, the benefit of the nomogram was positive. The results in the validation group were similar.

CONCLUSION

This nomogram had good identifiability, accuracy and clinical practicality, and could be used as a prediction and evaluation tool for severe cases of clinical patients with CC.

What rate of Iranian women perform Pap smear test? Results from a meta-analysis

In this study, an attempt was made to estimate the aggregated proportion of Pap smear test uptake among women in Iran from 2012 to 2022 using meta-analysis. The data collection process involved reviewing records registered in databases between January 1, 2012, and September 11, 2022. The final data was analyzed using random effects models, and potential heterogeneity was assessed using the I2 index. To examine publication bias, Egger's test and Funnel Plot were employed. Sensitivity analysis, specifically single study exclusion Meta-analysis, was conducted to assess the influence of each individual study on the aggregated percentage of Pap smear test uptake. A total of 28,754 women were included across the 33 articles analyzed. The pooled percentage of Pap smear test uptake for both one-time and regular screenings was found to be 46.52% (95% CI: 40.91 to 52.14) and 17.80% (95% CI: 12.42 to 23.18), respectively. No significant evidence of publication bias was detected, although the influence of smaller studies was confirmed. Sensitivity analysis indicated that the overall rate of Pap smear test uptake was not highly sensitive to the results of individual studies. The findings emphasize the low rate of regular Pap smear testing among Iranian women and suggest that tailored interventions considering cultural and geographical factors specific to different provinces in Iran could help increase the utilization of this screening service.

Investigation of in-vitro Anti-Cancer and Apoptotic Potential of Garlic-Derived Nanovesicles against Prostate and Cervical Cancer Cell Lines

OBJECTIVE

Investigate the anti-cancerous potential of garlic-derived nanovesicles (GDNVs), exploring their cytotoxic effects on HeLa and PC-3 cell lines, and elucidate the underlying mechanisms, including apoptosis induction and inhibition of epithelial-mesenchymal transition (EMT).

METHODS

GDNVs were isolated using differential centrifugation and ultracentrifugation. Characterization was performed through dynamic light scattering (DLS), field-emission scanning electron microscopy (FESEM), and Fourier-transform infrared spectroscopy (FTIR). Cytotoxicity assessments on HeLa and PC-3 cell lines using MTT assay. Apoptosis induction was evaluated through nuclear morphology changes and quantification of apoptotic cells using DAPI and PI/annexin V analysis. Western blot of apoptosis-related proteins (bcl-2, bax, caspase-3) was analysed. Anti-metastatic potential was assessed using wound healing assay and EMT transition inhibition.

RESULTS

Garlic-derived nanovesicles (GDNVs), characterized by a size of 134.2 nm, demonstrated a substantial and dose- as well as time-dependent anti-proliferative impact on HeLa and PC-3 cell lines. The induction of apoptosis was unequivocally established through discernible modifications in nuclear morphology. The apoptotic cell count in HeLa and PC-3 cells increased by 42.4 ± 4.2% and 38.2 ± 3.2%, respectively. Comprehensive Western blot demonstrated alterations in the expression of key apoptotic regulators, namely bcl-2, bax, and caspase-3, providing robust evidence for the initiation of apoptosis. Furthermore, GDNVs exerted a significant inhibitory effect (p < 0.001) on the migratory potential of both HeLa and PC-3 cells. Moreover, there was a discernible association between GDNVs and the suppression of Epithelial-Mesenchymal Transition (EMT), emphasizing their role in impeding the metastatic potential of these cancer cell lines.

CONCLUSION

This study establishes, for the first time, the anti-cancerous potential of GDNVs. The observed dose- and time-dependent anti-proliferative effects, selective cytotoxicity, apoptosis induction, and anti-migratory potential highlight GDNVs as a promising candidate for cancer treatment.

CRISPR-Cas12a-enhanced mass spectrometric DNA nanomachine for HPV-16 detection in human serum

Cervical cancer is the second most harmful cancer to women, while human papillomavirus (HPV)-16 is the main cause of cervical cancer. Early virus screening can reduce the risk of death, but is sometimes challenged by the low concentration and complicated matrix in physiological samples such as human serum. Herein, we report a CRISPR-Cas12a-enhanced mass spectrometric 3D DNA nanomachine for HPV-16 detection in human serum. Thanks to the high sensitivity of the CRISPR-Cas12a-enhanced 3D DNA nanomachine, and the high matrix-tolerance of elemental mass spectrometry, the proposed method was successfully applied for direct human serum analysis with a low detection limit of 1.2 pM.

Gender-Neutral HPV Vaccine in India; Requisite for a Healthy Community: A Review

Human papillomavirus (HPV) affects approximately 80% of individuals, irrespective of gender, and is implicated in various cancers. Existing HPV vaccines, while safe and effective, do not sufficiently protect males when administered solely to females. This review, triggered by the urgent need to address this gap and reduce the associated stigma, aims to evaluate the introduction of a gender-neutral HPV vaccine, GARDASIL-9, in India. The primary objective is to assess the necessity and feasibility of incorporating the gender-neutral HPV vaccine into India's national immunization program. This integration is crucial to ensure equitable access for all children and to mitigate the substantial burden of HPV. A literature search was conducted using databases such as Google Scholar, PubMed, government websites, and relevant publications. Keywords included "gender-neutral vaccine", "HPV vaccine", and "Indian population". The central research question guiding this review is: How necessary and feasible is the inclusion of a gender-neutral HPV vaccine in India's national immunization schedule to ensure equitable access for all children and reduce the HPV burden? The review inclusion criteria comprised studies addressing the prevalence of HPV infections, HPV vaccination awareness among both genders, the cost-effectiveness of gender-neutral vaccines, current HPV vaccination status, and future perspectives specific to India. Studies not meeting these criteria were excluded. The review highlights that introducing a gender-neutral HPV vaccine in India is imperative. Including males in vaccination efforts significantly reduces the overall disease burden and helps in reducing the stigma associated with HPV. A comprehensive vaccination program, bolstered by education and awareness campaigns, and its inclusion in the national immunization schedule is essential. This approach ensures equitable access to the vaccine for all children, fostering a healthier community, preventing HPV-related cancers, and enhancing public health outcomes in India.

Geospatial mapping of public sentiment and infodemic on human papillomavirus vaccination in India: An indication to formulation of strategies for effective implementation

The implementation of Human Papillomavirus (HPV) vaccination is crucial for eliminating cervical cancer in India. The infodemic, characterised by misleading information, could hinder the successful implementation of the initiative. Misinformation related to the HPV vaccine, such as rumours, has been reported and circulated, contributing to an alarming pattern of vaccine hesitancy observed on social media. This study aimed to identify the public sentiment towards HPV vaccination based on the 'Behavioral and Social Drivers (BeSD)' framework through geospatial, content and sentiment analysis. A total of 1,487 tweets were extracted. After preprocessing, 1010 tweets were identified for sentiment and content analysis. The sentiments expressed towards the HPV vaccine are mixed, with a generally positive outlook on the vaccines. Within the population, there is a pervasive proliferation of misinformation, primarily focusing on vaccine safety and efficacy, contentious subjects, ethical considerations, and a prevalent sense of uncertainty in selecting the appropriate vaccine. These observations are crucial for developing targeted strategies to address public concerns and enhance vaccination rates. The insights gained from these results will guide policymakers, healthcare practitioners, and public health organisations to implement evidence-based interventions, thereby countering vaccine hesitancy and improving public health outcomes.

Establishment of prediction models to predict survival among patients with cervical cancer based on socioeconomic factors: a retrospective cohort study based on the SEER Database

OBJECTIVE

To construct and validate predictive models based on socioeconomic factors for predicting overall survival (OS) in cervical cancer and compare them with the American Joint Council on Cancer (AJCC) staging system.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

We extracted data from 5954 patients who were diagnosed with cervical cancer between 2007 and 2011 from the Surveillance, Epidemiology, and End Results Database. This database holds data related to cancer incidence from 18 population-based cancer registries in the USA.

OUTCOME MEASURES

1-year and 5-year OS.

RESULTS

Of the total 5954 patients, 5820 patients had 1-year mortality and 5460 patients had 5-year mortality. Lower local education level [Hazard ratios (HR): 1.15, 95% confidence interval (CI): 1.04 to 1.27, p= 0.005] and being widowed (HR 1.28, 95% CI 1.06 to 1.55, p=0.009) were associated with a worse OS for patients with cervical cancer. Having insurance (HR 0.75, 95% CI 0.62 to 0.90, p=0.002), earning a local median annual income of ≥US$56 270 (HR 0.83, 95% CI 0.75 to 0.92, p<0.001) and being married (HR 0.79, 95% CI 0.69 to 0.89, p<0.001) were related to better OS in patients with cervical cancer. The predictive models based on socioeconomic factors and the AJCC staging system had a favourable performance for predicting OS in cervical cancer compared with the AJCC staging system alone.

CONCLUSION

Our proposed predictive models exhibit superior predictive performance, which may highlight the potential clinical application of incorporating socioeconomic factors in predicting OS in cervical cancer.

Cave Soil Streptomyces sp. strain YC69 Antagonistic to Chilli Fungal Pathogens Exhibits In Vitro Anticancer Activity Against Human Cervical Cancer Cells

Cancer is one of the fatal diseases and has high mortality worldwide, and the major drawback with the cure is the side effects from the chemotherapeutic agents. The increased multidrug resistance among microbial pathogens is a serious threat to plant and animal health. There is an urgent need for an alternative that can battle against pathogens and can be used for cancer treatment. Presently, actinomycetes were isolated from cave soil, and the crude extract obtained from the potent isolate was analyzed with gas chromatography-mass spectrometry (GC-MS) and high-performance thin layer chromatography (HPTLC) to identify bioactive metabolites. The crude extract was examined for in vitro antimicrobial activity on human pathogens and antifungal activity on plant pathogens. The isolate Streptomyces sp. strain YC69 exhibited antagonistic activity and antimicrobial activity in a dose-dependent manner, with the highest inhibition in Staphylococcus aureus. GC-MS revealed many bioactive compounds, and HPTLC depicted metabolite fingerprints. The antifungal activity exhibited a delayed lag phase in growth curve assay and distorted and collapsed cells of Fusarium oxysporum in scanning electron microscopy (SEM) images. In the MTT assay, the IC50 of 41.98 µg/ml against HeLa cells was obtained with clear evidence for deformed cells and blebbing of the cell membrane. The results from the current study suggest that the crude extract from Streptomyces sp. strain YC69 contains antimicrobial metabolites that can inhibit pathogenic microbes in plants and humans. The MTT assay results conclude that further studies on purification may lead to the use of Streptomyces sp. strain YC69 as a source for anti-oncogenic compounds.

Survival Rate in Cancer Cervix Patients in a Regional Cancer Centre of South India: A Retrospective Analysis

Context

Carcinoma Cervix is one of the leading prevalent cancers in India especially in rural population and causes a significant mortality. WHO has launched many projects for prevention, screening and treatment plans. Even after many projects, Cervical Cancer persists as a heavy burden public health problem in rural India.

Aims

To calculate survival of cancer cervix patients in a rural population-based RCC and to discuss the factors affecting it.

Methods and Material

A hospital-based gathering of retrospective data of the patients diagnosed with carcinoma cervix over 5 years from January 2013 to December 2017 (single institution analysis). We included 751 patient's data from our cancer registry for analysis. Data related to demographics, treatment and follow up records were taken and statistical analysis done.

Results

The survival rates were 64.0%, 50.0%, 36.9% and 17.5% for Stage I, Stage II, Stage III and Stage IV, respectively. The best survival outcomes were for those treated with only surgery. Involvement of nodes had poor survival than those with no involvement. Various patient-related factors like Religion, Education and Marital status are found to be non-significant factors even-though they have survival differences. STAGE of the disease emerged as a significant prognostic factor.

Conclusion

Our study concluded that higher stage and nodal involvement had poor outcomes and also lower survival compared to Western and Indian literature. We should also address all the socio-economic factors that affects survival. Randomized prospective studies are needed to evaluate the effect of socio-economic factors on survival.

Changing patterns of cancer burden among elderly across Indian states: Evidence from the global burden of disease study 1990-2019

Objective

To investigate the trends and patterns of the cancer burden among the elderly in different regions of India at a subnational level.

Methods

Data were extracted from the Global Burden of Disease (GBD) Studies India Compare 2019. Prevalence rate, disability-adjusted life years (DALY), and annual percentage change techniques were used to analyze data.

Results

The three age groups with the highest prevalence of cancer were those aged 60-64 years, 65-69 years, and 70-74 years. In 2019, The prevalence of cancer among the elderly ranged from 7048.815 in Karnataka to 5743.040 in Jharkhand. Kerala has the most significant annual percentage change in the cancer prevalence rate of 0.291 between 1990 and 2019. The highest DALY rate was observed among individuals aged 80-84 years in 2019. That year, the DALY rate among the elderly was 8112.283 in India. The top five cancers with higher DALY rates among the elderly in India in 2019 were tracheal, bronchus, and lung cancer (908.473), colon and rectum cancer (752.961), stomach cancer (707.464), breast cancer (597.881), and lip and oral cavity cancer (557.637).

Conclusion

Elderly individuals demonstrated a higher vulnerable to cancer compared to other age groups. There is a need for state-specific government intervention to minimize the risk of cancer among the elderly due to the heterogeneity in the burden of cancer across Indian states.

Sensitive and Amplification-Free Electrochemiluminescence Biosensor for HPV-16 Detection Based on CRISPR/Cas12a and DNA Tetrahedron Nanostructures

Rapid and accurate detection of biomarkers was very important for early screening and treatment of diseases. Herein, a sensitive and amplification-free electrochemiluminescence (ECL) biosensor based on CRISPR/Cas12a and DNA tetrahedron nanostructures (TDNs) was constructed. Briefly, 3D TDN was self-assembled on the Au nanoparticle-deposited glassy carbon electrode surface to construct the biosensing interface. The presence of the target would activate the trans-cleavage activity of Cas12a-crRNA duplex to cleave the single-stranded DNA signal probe on the vertex of TDN, causing the Ru(bpy)32+ to fall from the electrode surface and weakened the ECL signal. Thus, the CRISPR/Cas12a system transduced the change of target concentration into an ECL signal enabling the detection of HPV-16. The specific recognition of CRISPR/Cas12a to HPV-16 made the biosensor have good selectivity, while the TDN-modified sensing interface could reduce the cleaving steric resistance and improve the cleaving performance of CRISPR/Cas12a. In addition, the pretreated biosensor could complete sample detection within 100 min with a detection limit of 8.86 fM, indicating that the developed biosensor possesses the potential application prospect for fast and sensitive nucleic acid detection.

Carcinoma cervix: A single institute experience from Kashmir, Northern India

Background

Carcinoma cervix is the fourth most commonly diagnosed cancer worldwide, with an estimated 604,000 new cases and 342,000 deaths worldwide in 2020. Carcinoma cervix is an uncommon malignancy in Kashmir. In this retrospective study, we have tried to find clinicopathological characteristics of carcinoma cervix along with the survival rates at our tertiary care hospital.

Materials and Methods

Case records of cervical cancer patients registered from January 1, 2015, to January 1, 2019, were retrieved. A total of 138 patients was registered. 22 had undergone surgery, and out of these 17 had received postoperative radiotherapy. 109 patients were treated with definitive chemoradiation and 13 with palliative radiotherapy. Descriptive statistics were used to summarize patient and treatment-related variables, and Kaplan-Meier analysis was performed for survival analysis.

Results

A total of 138 cases that were registered from 2015 to 2019 were included in this study. The median age at the presentation was 56 years. Most of the patients had a performance status of 1 (98 patients (71.01)). Most of the patients 110 (79.71%) were married before 20 years of age, only 1 patient was unmarried, and 85 (61.59) patients were multiparous in our study group. Only 14 (10.14%) patients in our study group had a history of oral contraceptive use and most of them were non-smokers [124 (89.80%)]. Multiple marriages were present in 8 (5.79%) patients only. The most common presenting symptom was bleeding per vagina (78.26%), and the maximum number of patients fall in the post-menopausal group (67.39%). 116 patients had squamous cell carcinoma histology while 10 patients had adenocarcinoma histology. Most of the patients had stage II and stage III disease (85 patients). At last, follow up out of 138 patients 75 (54.35) were alive. 3 year disease-free survival was 54.34% and 3-year overall survival was 72.46%.

Conclusion

Carcinoma cervix is an uncommon malignancy in Kashmir because of different socio-cultural and religious practices but the response to treatment, toxicity profile, and survival are similar to the rest of the world.

Analysis of the Mortality Trends of 23 Major Cancers in the Indian Population Between 2000 and 2019: A Joinpoint Regression Analysis

PURPOSE

Cancer mortality trends have not been documented across the population of India. We, therefore, analyzed the overall and individual cancer mortality trends for 23 major cancers between 2000 and 2019 on the basis of Global Health Observatory (GHO) database.

MATERIALS AND METHODS

This study examined cancer mortality trends for 23 major cancer sites on the basis of 12.85 million cancer deaths obtained from the GHO of the WHO between 2000 and 2019. A joinpoint regression model was used to analyze the long-term trends of cancer mortality. Annual percentage change (APC) and average APC were estimated for various cancer sites.

RESULTS

Between 2000 and 2019, 12.85 million deaths occurred in India from 23 major cancers. The most common lethal cancers were mouth and oropharyngeal (15.6%), stomach (10.6%), lung (9.6%), breast (9%), and colorectal (8%) cancers. The mortality trend decreased by 0.19% annually among men and increased nonsignificantly by 0.25% among women; an increase of 0.02% was observed among combined sexes. Increasing mortality trends were seen among cancers of the lung, breast, colorectum, lymphoma, multiple myeloma, gallbladder, pancreas, kidney, and mesothelioma between 2000 and 2019. The highest annual increase in mortality was observed in pancreatic cancer among both sexes: 2.7%, 2.1% among men, and 3.7% in women. The cancers of the stomach, esophagus, leukemia, larynx, and melanoma showed a declining cancer mortality trend irrespective of sex.

CONCLUSION

A multifaceted strategy is required to tackle the rising cancer mortality rates in India; the best long-term strategy could be implementing awareness on cancer symptoms among the population as well as cancer prevention policies with improved health infrastructure and specifically dedicated human resources.

Genotypic Diversity of Human Papillomavirus (HPV) Types and Its Prevalence With Cervical Cancer (CC) in Central India

Background The high-risk human papillomavirus (hr-HPV) is linked with cervical cancer (CC), and the distinct proportional impact of each genotype on the prevalence of the disease depends on the area. Therefore, to find out the prevalence of HPV types in women with cervical lesions from central India, the current study was performed. Methodology Age, prior history of cervical disease, changes in lifestyle characteristics, menopausal status, and HPV vaccination status were all carefully gathered at enrollment for the 736 women (aged 21 to 60) screened in this cross-sectional study who were referred for regular screening of cervical during the study period. Cervix was examined for lesions by visual inspection with acetic acid (VIA) screening and HPV genotypes were identified by real-time polymerase chain reaction (RT-PCR). Result Among 736 women 215 (29.2%) were in the 21-30 age group, 321 (43.6%) in the 31-40 age group, 132 (17.9%) in the 41-50 age group, and 68 (9.3%) cases in >50 age group. According to education, there were 398 (54.1 %) with primary and below education, 115 (15.6%) with secondary education, and 223 (30.3%) with college and above education. HPV-16, 18, 31, and 45 each had a prevalence of 29.6%, 11.1%, 12.9%, and 9.2%, respectively, while the overall prevalence of hr-HP) was present in populations at 7.3% in individuals and 37.0% in combinations. Hr-HPV infection and prevalence were provocatively more (79.6%) in the VIA-positivity rate with CC. Conclusion Individual hr-HPV genotype prevalence was shown to be lower than with combinations (HPV-16, 18, 31, and 45). The HPV-16 genotype was identified to have a higher prevalence than HPV-18, 31, and 45. However, more awareness programs are needed for a better understanding of CC and HPV testing in central India.

Clinical and non-clinical determinants of cervical cancer mortality: A retrospective cohort study in Lagos, Nigeria

Introduction

Cervical cancer (CCa) is the fourth most frequent and a common cause of cancer mortality in women, the majority of whom live in low- and middle-income countries. Data on CCa mortality and its determinants have been poorly studied in Nigeria, resulting in a paucity of information that can assist patient management and cancer control policy.

Aim

The purpose of this study was to assess the mortality rate among CCa patients in Nigeria as well as the major factors influencing CCa mortality.

Study design

Data from the medical records of 343 CCa patients seen at the Lagos University Teaching Hospital and NSIA-LUTH Cancer Center from 2015 to 2021 were used in a retrospective cohort analysis. The hazard ratios (HR) and confidence intervals (CI) associated with the exposure variables and CCa mortality were calculated using Cox proportional hazard regression.

Results

The CCa mortality rate was 30.5 per 100 women-years after 2.2 years of median follow-up. Clinical factors such as HIV/AIDS (adjusted HR [aHR]: 11.9; 95% CI: 4.6, 30.4), advanced clinical stage (aHR: 2.7; 95% CI: 1.5, 4.7), and anemia at presentation (aHR: 1.8; 95% CI: 1.1, 3.0) were associated with a higher mortality risk, as were non-clinical factors such as age at diagnosis >50 years (aHR: 1.4; 95% CI: 1.0, 1.9) and family history of CCa (aHR: 3.5; 95%CI: 1.1, 11.1).

Conclusion

CCa has a high mortality rate in Nigeria. Incorporating these clinical and non-clinical factors into CCa management and control policies may improve women's outcomes.

An ultrasensitive electrochemical DNA biosensor for monitoring Human papillomavirus-16 (HPV-16) using graphene oxide/Ag/Au nano-biohybrids

A DNA-based electrochemical biosensor has been developed herein for the detection of Human papillomavirus-16 (HPV-16). HPV-16 is a double-stranded, non-enveloped, epitheliotropic DNA virus which responsible for cervical cancer. In this proposed biosensor, an indium tin oxide (ITO) coated glass electrode was modified for sensing HPV-16 using graphene oxide and silver coated gold nanoparticles. Subsequently, HPV-16 specific DNA probes were immobilized on a modified ITO surface. The synthesized nanocomposites were characterized by FE-SEM and UV-VIS spectroscopy techniques. Electrochemical characterization was performed by using cyclic voltammetry and electrochemical Impedance Spectroscopy methods. The hybridization between the probe and target DNA was analyzed by a reduction in current, mediated by methylene blue. The biosensor showed a qualitative inequity between the probe and target HPV-16 DNA. The developed biosensor showed high sensitivity as 0.54 mA/aM for the detection of HPV-16. In a linear range of 100 aM to 1 μM with 100 aM LOD, the proposed biosensor exhibited excellent performance with the rapid diagnosis. Thus, the results indicate that the developed HPV DNA biosensor shows good consistency with the present approaches and opens new opportunities for developing point-of-care devices. The diagnosis of HPV-16 infection in its early stage may also be possible with this detection system.

Distribution of self-reported health in India: The role of income and geography

An important new large-scale survey database is brought to bear on measuring and analysing self-reported health in India. The most important correlates are age, income and location. There is substantial variation of health across the 102 'homogeneous regions' within the country, after controlling for household and individual characteristics. Higher income is correlated with better health in only 40% of India. We create novel maps showing regions with poor health, that is attributable to the location, that diverge from the conventional wisdom. These results suggest the need for epidemiological studies in the hotspots of ill-health and in regions where higher income does not correlate with improved health.

Challenges in Cervical Cancer Prevention: Real-World Scenario in India

Satinder KaurIn spite of global falling trends, cervical cancer remains a major healthcare challenge for India, South Asia Association for Regional Cooperation region, and other low- and middle-income countries. Our survey was to document the real-world challenges that still exist in India. A total of 316 eligible and complete responses to the 21 questions were analyzed. Screening of mothers and vaccinating their daughters was considered as the most important strategy to prevent cervical cancer by 65.8% (208/316). Screening was offered to all asymptomatic eligible females by 79% (250/316). Improvement in screening rates requires promoting the national program (67.7%; 214/316), strengthening existing infrastructure (62%; 196/316), regular training of primary healthcare workers (57.6%; 182/316), and increasing awareness among schools and colleges (57.9%; 183/316). Almost all responders (93%; 294/316) wanted to have human papillomavirus (HPV) vaccination included in the national immunization schedule. Cost of vaccine was considered a major roadblock. If it became available at INR 250 per dose, 96.8% (306/316) respondents would recommend it for all eligible patients. With the impending availability of this indigenous tetravalent HPV vaccine jointly produced by Department of Biotechnology, Govt of India and Serum Institute of India, the war against cervical cancer just got easier.

Colposcopy in the Primary Health Care: A Scoping Review

AIM

Low- and middle-income countries represent nearly 85% of all cervical cancer cases worldwide; thereby, it is extremely important to identify methods to improve the screening process. Therefore, this study aimed to summarize the primary characteristics of studies on accessibility, coverage, patient preferences, and factors associated with patient satisfaction or acceptance of colposcopy in primary healthcare.

METHODS

A search strategy, based on MeSH, Emtree, and free terms, was run through 5 databases (PubMed, Scopus, Embase, Ovid/Medline, and Web of Science). EndNote 20.1 © and Rayyan QCRI © were used for screening. A preset datasheet was used for data extraction.

RESULTS

The systematic search retrieved 1127 references, and after removing duplicates, screening the titles and abstracts, and reviewing the full text, 7 studies were included. The interrater reliability was 77.73% (kappa statistic = 0.1842). Most studies estimated the proportion of women that sought for colposcopy after a previous screening test for human papilloma virus. One study identifies barriers to colposcopy examination in women at risk of developing cervical cancer. Three studies assessed the decentralization of colposcopy from a tertiary healthcare center to a primary care center. Pap smear was the most common first-line screening test, followed by liquid-based cytology sample and visual inspection with acetic acid.

CONCLUSION

Only a few countries have investigated the use of colposcopy in primary care. Thus, barriers and the care structure for this implementation to be successful in reducing cervical cancer incidence and mortality should be identified.

Cervical Cancer in SAARC Countries

Purvish M. ParikhIn the year 2020, a total of 342 000 women were estimated to die of cervical cancer, of which 90%) were expected amongst low- and middle-income countries (LMIC). Globally incidence of cervical cancer has reduced as a result of improved personal hygiene, better living conditions and higher application of opportunistic screening programs. Yet GLOBOCAN shows that absolute number of cases are still increasing. We therefore conducted a 21 question multiple choice questionnaire online survey in Jan 2023 amongst 9 SAARC countries. A total of 367 replies were received and the representative answers for each country are being reported in this manuscript. A good possibility of achieving World Health Assembly target (Nov 17, 2020) was felt only by Bhutan and Nepal. For screening, most countries (Bhutan, India, Myanmar, Nepal, Pakistan and Sri Lanka) recommend for all asymptomatic eligible patients. Public health experts have suggested VIA / VILI as the best solution for LMICs. However, a dual screening strategy (HPV DNA plus) cytology was preferred by doctors in Afghanistan, Bhutan, India, Myanmar, Pakistan and Sri Lanka. Screening, triage and then treatment was the preferred by Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka. HPV vaccination was recommended in all girls between ages 10 to 26 years in Bangladesh, India, Myanmar, Nepal, Pakistan and Sri Lanka. All the 9 countries would use HPV vaccination to all eligible patients if the cost of the vaccine was reasonably low. Our survey clearly outlines challenges faced in tackling cervical cancer in SAARC countries. We also provide consensus regarding several potential solutions that can be used in both public and private cervical cancer control programs.

Gynaecological Oncology in India: Past, Present and Future

Gynaecological cancers contribute to a substantial portion of the global cancer burden. Traditionally, these cancers have been treated by generalists, including gynaecologists and surgeons. However, owing to increasing sophistication and challenges in their management, a new sub-speciality of Gynaecologic Oncology, dedicated to these women's comprehensive care, has emerged in recent times. The emergence and evolution of this sub-speciality will facilitate a holistic approach to treating women suffering from gynaecological cancers, including tailored surgical techniques, fertility preservation, precision medicine, hormone modulators, targeted therapy and immunotherapy, which can be achieved within the framework of multidisciplinary management. Hence, we decided to write this synopsis to shed light on the evolution of this discipline in India and offer current and future perspectives.

A swamp forest Streptomyces sp. strain KF15 with broad spectrum antifungal activity against chilli pathogens exhibits anticancer activity on HeLa cells

During the investigation, soil actinomycetes were isolated from Kathlekanu swamp forest and the crude ethyl acetate extract from the potent isolate KF15 was analysed with GC-MS and HPTLC to identify bioactive metabolites. The crude extract was examined for in-vitro antifungal activity on pathogens of chilli; MTT cytotoxicity assay was performed against HeLa cell line to determine the anticancer potential. The isolate Streptomyces sp. strain KF15 exhibited antagonistic activity against fungal pathogens by inhibiting growth and altering growth pattern with increased antimicrobial activity in dose-dependent manner. GC-MS revealed many bioactive compounds and HPTLC depicted metabolite fingerprint. The IC₅₀ of 99.85 µg/ml indicated the high potential of KF15 extract to prevent proliferation of HeLa cells. Therefore, the findings of this study indicate that the crude extract from Streptomyces sp. strain KF15 contains antifungal and anticancer metabolites; further study on purification could help in controlling many fungal diseases as well as cervical cancer in humans.