Barriers to early diagnosis of cervical cancer: a mixed-method study in Côte d'Ivoire, West Africa

Screening and identification analysis of core markers for leukemia and cervical cancer: Calmodulin 3 as a core target

Leukemia is a type of malignant tumor affecting hematopoietic system. Cervical cancer is a malignant tumor of female reproductive tract. The relationship between Calmodulin 3 (CALM3) and leukemia, cervical cancer remains unclear. Leukemia dataset GSE26294 and cervical cancer dataset GSE173097 profiles were downloaded from gene expression omnibus. Principal component analysis, differentially expressed genes (DEGs) screening, weighted gene co-expression network analysis (WGCNA), functional enrichment analysis, gene set enrichment analysis, immune infiltration analysis, protein-protein interaction network construction and analysis, survival analysis were performed. Gene expression heatmaps were plotted. Comparative Toxicogenomics Database (CTD) was used to find diseases most related to core genes. 77 DEGs were identified. According to gene ontology, in biological process category, they were mainly enriched in cell proliferation, immune response, and apoptotic process. In cellular component category, they were mainly enriched in nucleus and Golgi apparatus. In molecular function category, they were mainly enriched in DNA binding, protein binding, transcription factor activity. In Kyoto encyclopedia of gene and genome analysis, they were mainly enriched in cell adhesion molecules, Wnt signaling pathway, cAMP signaling pathway, cGMP-PKG signaling pathway, and basal cell carcinoma. The soft-threshold power in WGCNA was set to 1, generating 6 modules. Finally identifying 3 core genes (CALM3, secreted frizzled-related protein 4, plasminogen). CTD analysis revealed that core genes were related to leukemia, coagulation disorders, vaginal tumors, cervical tumors, autoimmune diseases, and inflammation. CALM3 is lowly expressed in leukemia samples and highly expressed in cervical cancer samples.

Individual-Level Factors that Contribute to Delayed Cervical Cancer Diagnosis among Patients in Kenya; A Hospital-Based Assessment

Cervical cancer ranks 4th as the most prevalent cancer among women worldwide. In Kenya, it is the 2nd most frequently diagnosed cancer and the leading cause of cancer-related deaths among women. Globally, more than 50% of Cervical Cancer diagnoses are made late, with this proportion rising to over 80% in developing countries. This study aimed to determine the individual-level factors contributing to delayed cervical cancer diagnosis. A cross-sectional hospital-based study was adopted to collect data on; Socio-demographics, affordability and use of health insurance, Cervical cancer and Human Papillomavirus (HPV) screening awareness, Prior HPV screening, Diagnosis circumstances, Time taken to seek medical attention, Fears and social support experiences, from 139 cervical cancer patients systematically sampled at the Kenyatta National Hospital, using a semi-structured questionnaire. Additionally, 8 Key Informants were purposively selected, to provide in-depth information. Associations between stage at diagnosis and individual-level factors were tested using logistic regression at 95% Confidence Interval. The mean age was 51 years and all participants were African and Christians. Majority (63.31%) were married and educated up to primary level, and more than half (61.15%) were unemployed. The prevalence of delayed diagnosis was 86(61.9%). The Risk Factors for delayed diagnosis were; Older age; 50-59 (p-value=0.049) & 60-69 years (0.013), Lack of HPV screening awareness (P-value=0.017), and Seeking medical attention only due to a symptomatic trigger (P-value=0.030). In corroboration, qualitative information reported that, inability to afford diagnosis costs, lack of awareness and poor medical care seeking habits, contribute to delayed diagnosis. The study identified gaps in awareness of Cervical Cancer and HPV screening among women and affordability of diagnosis costs. More community-level awareness should be created and, increase of centers and resources for diagnosis and free screening. Women should also be encouraged to pay for the National Health Insurance Fund (NHIF), so as to lessen their financial burden of diagnosis.

Early age at menarche and history of sexually transmitted infections significantly predict cervical cancer screening uptake among women aged 25-49 years: evidence from the 2021 Côte d'Ivoire demographic and health survey

INTRODUCTION

Cervical cancer is the second dominant type of cancer among Ivorian women with an estimated age-standardised incidence and mortality rate of 31.2 cases and 22.8 deaths per 100,000 women in 2020, respectively. The Ivorian government through its Ministry of Health implemented the National Cancer Control Programme (NCCP) in 2003 with the aim of improving the prevention, early detection and treatment of cancers in Côte d'Ivoire. Yet, there is a low uptake of CCS (1.2%). Thus, making CCS uptake an important public health concern in the country. Understanding of the extent to which reproductive factors predict CCS uptake is limited in literature. This study aimed to investigate reproductive factors as a predictor of women's uptake of CCS in Côte d'Ivoire.

METHODS

Data from the 2021 Côte d'Ivoire Demographic and Health Survey. A sample of 9,078 women aged 25-49 years were analyzed. The outcome variable was CCS uptake while other variables considered included age at menarche, history of STI, sexual debut, parity, age, educational level, wealth index, health insurance, place of residence, and media exposure. A multivariable logistic regression model was fitted to examine the association between the outcome of interest and predictors at 95% confidence interval.

RESULTS

Approximately, 7.52% of women aged 25-49 years had ever undergone testing for cervical cancer by a healthcare provider. Early menarche was associated with lower odds of CCS uptake [AOR = 0.78; CI = 0.65-0.95]. Compared to those who had no STI, women with a history of STI were more likely to screen for cervical cancer [AOR = 2.63; CI = 2.02-3.42]. Increasing age, higher educational attainment, having health insurance, and being exposed to media were significantly associated with CCS uptake.

CONCLUSION

In Cote d'Ivoire, age at menarche and STI history constitute reproductive factors that were significantly associated with women's uptake of CCS. It is imperative for public policy to focus on increasing CCS in these higher-risk women (i.e., women who experienced early menarche, women with early sexual debut and higher parity) through increased sensitization on cervical cancer risk factors.

Factors associated with late diagnosis of cervical cancer at two national referral hospitals, Kenya 2017: A case control study

Background

Cervical cancer is the leading cause of cancer mortality among women in Kenya. Two thirds of cervical cancer cases in Kenya are diagnosed in advanced stages. We aimed to identify factors associated with late diagnosis of cervical cancer, to guide policy interventions.

Methods

An unmatched case control study (ratio 1:2) was conducted among women aged ≥ 18 years with cervical cancer at Kenyatta National and Moi Teaching and Referral Hospitals. We defined a case as patients with International Federation of Gynecology and Obstetrics (FIGO) stage ≥ 2A and controls as those with stage ≤ 1B. A structured questionnaire was used to document exposure variables. We calculated adjusted odds ratio (aOR) to identify any associations.

Results

We enrolled 192 participants (64 cases, 128 controls). Mean age 39.2 (±9.3) years, 145 (76 %) were married, 77 (40 %) had primary level education, 168 (88 %) had their first pregnancy ≤ 24 years of age, 85 (44 %) were > para 3 and 150 (78 %) used contraceptives. Late diagnosis of cervical cancer was associated with cost of travel to cancer centres > USD 6.1 (aOR 6.43 95% CI [1.30, 31.72]), age > 50 years (aOR 4.71; 95% CI [1.18, 18.80]), anxiety over cost of cancer care (aOR 5.6; 95% CI [1.05, 32.72]) and ultrasound examination during evaluation of symptoms (aOR 4.89; 95% CI [1.07-22.42]). Previous treatment for gynecological infections (aOR 0.10; 95% CI [0.02, 0.47]) was protective against late diagnosis.

Conclusion

Cost of seeking care and the quality of the diagnostic process were important factors in this study. Decentralization of care, innovative health financing solutions and clear diagnostic and referral algorithms for women presenting with gynecological symptoms could reduce late-stage diagnosis in Kenya.

Emergency Presentation of Invasive Cervical Cancer in Late Pregnancy: A Case Report and Literature Review

Antepartum hemorrhage (APH) often prompts consideration of the presence of obstetric disorders. Here, we describe a case with active APH in which invasive cervical cancer was the cause. A 41-year-old woman, fifth gravida, fourth para (G5, P4), presented to the emergency department at 38 weeks of gestation with an acute severe attack of vaginal bleeding, which occurred immediately after a per-vaginal examination at another local institute. Despite initial stabilization measures and investigations to exclude common causes of APH, a protruding cervical mass was discovered during a Cusco speculum examination. The patient underwent an emergent cesarean section (CS). Postoperatively, the patient was referred to the gynecological oncology unit for further evaluation and management. Magnetic resonance imaging (MRI) confirmed the presence of a large cervical mass. A punch biopsy revealed squamous cell carcinoma (SCC) of the cervix. All these confirmed the condition as cervical carcinoma stage IB3. This case and literature review highlight the obstacles that might delay the diagnosis of cervical cancer and the importance of continuing the screening program strategies even during pregnancy to avoid complications of invasive cervical cancer. In addition, bleeding due to cervical cancer should always be considered one of the important differential diagnoses of APH even in full-term pregnancy.