Burden of cervical neoplasia in mid-western rural Nepal: a population-based study

Mass Media Exposure and Cervical Cancer Screening in Rural Sub-Saharan Africa: A Multi-Country Cross-Sectional Analysis

Background and Aims

Cervical cancer is a pressing global public health challenge, with sub-Saharan Africa (SSA) experiencing disproportionately high incidence and mortality rates compared to other regions. Early detection through screening and timely treatment is essential for mitigating the burden of this disease. Evidence suggests that mass media exposure can play a pivotal role in increasing cervical cancer screening uptake. This study aimed to examine the prevalence of cervical cancer screening in SSA and to identify factors associated with screening uptake, with a specific focus on the influence of mass media among rural women.

Methods

The analysis utilized data from the Demographic and Health Surveys (DHS) conducted in 11 SSA countries, encompassing responses from 72,565 rural women of reproductive age (15-49 years). The primary outcome variable was cervical cancer screening status. Descriptive statistics, including frequencies and cross-tabulations, were employed to characterize the sample. Given the skewed distribution of the outcome variable, complementary log-log regression models were applied to estimate adjusted odds ratios (AORs) in both bivariate and multivariable analyses. Robustness of the statistical models and their fitness were rigorously assessed to ensure the validity of the findings.

Results

The overall prevalence of cervical cancer screening among women in the 11 countries was 8.47%. Women with exposure to mass media were significantly more likely to undergo screening. Specifically, women who watched television less than once a week (AOR = 1.22, 95% CI: 1.07-1.38) or at least once a week (AOR = 1.39, 95% CI: 1.26-1.53) had higher odds of being screened compared to those with no exposure to television. Similar positive associations were observed for radio and newspaper/magazine exposure. Women who listened to the radio at least once a week (AOR = 1.59, 95% CI: 1.45-1.74) and those who read newspapers/magazines at least once a week (AOR = 1.68, 95% CI: 1.48-1.90) demonstrated increased odds of undergoing screening. Additional predictors of screening included older age, higher education levels, greater wealth, higher parity, and fewer barriers to accessing healthcare, such as not needing permission or assistance to seek care.

Conclusion

This study highlights the critical role of mass media-television, radio, and newspapers/magazines-in promoting cervical cancer screening among rural women in SSA. Public health stakeholders and governments should prioritize leveraging these platforms to design and disseminate culturally tailored campaigns aimed at overcoming barriers to screening in rural communities. By optimizing the reach and effectiveness of mass media, particularly traditional channels prevalent in rural SSA, cervical cancer screening rates can be significantly improved, thereby reducing the disease burden in the region.

Health beliefs and practices regarding cervical cancer screening among women in Nepal: A descriptive cross-sectional study

The health beliefs and practices regarding cervical cancer screening among women in the mountainous and Terai region of Nepal were investigated and examined for the differences. A descriptive cross-sectional study was conducted with a purposive sample of 216 in mountainous and 294 in Terai. The interview tools were a socio-demographic scale, a Nepalese Health Belief Model Scale for Cervical Cancer followed by the Screening Test. Chi-square test, binary logistic regression, Mann-Whitney U, and Kruskal-Wallis were used to analyze the data. The results showed that the screening rate was low for both regions with a significant difference in the benefit of screening and health motivation. Being older and having a positive family history of cervical cancer were shown to be predictors screening practice. Women from both groups preferred female doctors for screening. Culturally appropriate educational interventions focused on the benefits and obstacles of screening is needed to improve the beliefs of cervical cancer and screening and increase the screening rate. Nurses need to be aware of health beliefs regarding cervical cancer during cervical screening and education.

Systematic screening for cervical cancer in Dakar region: prevalence and correlation with biological and socio-demographic parameters

Background

Cervical cancer is a major public health problem. In 2018, globally 569,847 cervical cancer were diagnosed and 311,000 deaths were projected due to this preventable disease. Worldwide, therefore, the cervical cancer disease ranks as the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women in 2018.

The high rate of dysplasia in Senegal and the absence of well-organized screening programs informed this study, which aims to determine the prevalence of cervical dysplasia and its relationship to biological and socio-demographic characteristics.

Methods

This study is based on 1000 conventional smears collected during routine cervical cancer screening at the Gaspard Camara Health Center and the Histology - Embryology and Cytogenetics Laboratory of the Cheikh Anta DIOP University in Dakar. The smears were read according to the Bethesda and Richart systems. However, all data were returned to the Bethesda system using the correspondence table between the different classifications of squamous cell lesions of the cervix. Some of the patients with abnormal smears had colposcopy and if necessary a biopsy. Other patients with low-grade lesions were recommended to have their smears resumed in 6 months or 1 year later.

Results

Cytological analysis was performed for 1000 patients aged 16 to 82 years (mean age = 41 ± 11.16). Among these, 176 patients had abnormal smears, 23 had Atypical Squamous Cells of Undetermined Significance (ASCUS), 143 had a low-grade lesion, 9 had a high-grade lesion and 1 had carcinoma. Among the remaining 822 patients, cytological analysis revealed no suspected malignant lesions, but 623 among them had dystrophy and 2 were unsatisfactory. Among patients with abnormal smears, 104 patients (23 ASCUS + 71 low grade + 9 high grade + 1 carcinoma) had performed colposcopy, 40 of whom had normal colposcopy and 64 had abnormalities. Sixty-four (64) biopsies were performed. Four (4) were not satisfactory. However, for 26/60 biopsies, the histology was normal, 21/60 had a low grade, 11 displayed a high grade and only 2 had carcinoma. Among the 176 patients with abnormal smears, 72 low-grade patients had undergone cytological examination 6 months to 1 year later to determine the persistence, regression or progression of low-grade dysplasia. During follow-up, persistence was observed in 25% (n = 18) of cases, progression to High-grade squamous intraepithelial lesion (HSIL) was detected in 2.78% (n = 2), while 72.22% (n = 52) of the patients experienced regression.

Conclusion

In this study, the prevalence of abnormal smear was 17.60% for cytology. Meanwhile, the Colposcopy and histology confirmed just 3.40%. These results underline the interest and need for a review of the discrepancies observed between pathologists.

Infiltrating CD4 and CD8 lymphocytes in HPV infected uterine cervical milieu

PURPOSE

Tumor infiltrating lymphocytes (TILs) have been extensively described in anti-tumor immunity, but their functional alterations in the immunoediting processes during neoplastic progression in the uterine cervix are still not clear. Our aim was to gain insight into cervical tissue T cell populations, determine if there are any differences in the localization and quantity distribution of T lymphocytes, and to evaluate their role in disease regression or progression in the cervical neoplastic milieu.

PATIENTS AND METHODS

Serial section analysis of immunohistochemically stained CD4 and CD8 lymphocytes was performed on a total number of 72 samples, categorized into four cohorts: 23 HPV non-infected (HPV-) normal cervix, 20 HPV infected (HPV+) normal cervix, 17 HPV+ low grade cervical intraepithelial neoplasia (CIN), and 12 HPV+ high grade CIN.

RESULTS

Low infiltrating lymphocytes (ILs) in normal cervix and high ILs in CIN were observed, while the trend of ILs increased with increasing grade of CIN, which was statistically significant (P<0.0001). Quantitative and localization analysis between the subsets of T cells showed that, in the epithelial layer, infiltrating CD8+ lymphocytes (CD8+ILs) were significantly higher than CD4+ILs in HPV+ normal cervix, while the trend decreased with increasing grade of CIN (P=0.011). Whereas, in the stromal layer, CD4+ILs were predominant in all study groups and no statistical difference was found between these groups. However, tumor infiltrating CD8+ lymphocytes (CD8+TILs) were noted to be significantly higher than CD4+TILs in severe dysplastic cases.

CONCLUSION

T cell infiltrates were predominant as the grade of the lesion progressed into more advanced lesions, which likely represent the lesions that have persisted over time. The variation in the infiltration rate and the location of CD4+ILs and CD8ILs may suggest the efficacious role of CD8 T cells in eliminating HPV infected cervical epithelial cells and also provides insight into the complex role of TILs in facilitating and mediating sustained anti-tumor responses, hence preventing tumor outgrowth.