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Cancer du col de l’utérus : état des lieux après lancement d’un programme de lutte

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Abstract

Cervical cancer is the first gynecological cancer among African women in terms of frequency and mortality. This cancer is easily accessible to prevention by human papillomavirus (HPV) vaccination and screening by pap smears combined or not with HPV test. In Fianarantsoa, Madagascar, screening methods have been available since 2010. Objectives of this study are to assess medical and paramedical knowledge about cervical cancer history, emphasize reality of this disease in the region, and update prevention and management of precancerous lesions. We found a lack of knowledge concerning cervical cancer history by doctors, nurses, and midwives. Twenty-two invasive cervical cancers have been observed in oncology and gynecology services. None of those women had undergone a planned screening. Screening rate by visual inspection after acetate application was 0.47% and by sporadic pap smears was 1.86%. Positive test was observed in 10% and 8.5%, respectively. Fifty-three women have undergone cryotherapy for precancerous lesions within four years. This study shows that real incidence of cervical cancer must be very high in the community, here in the region and probably in Madagascar, contrasting with misunderstanding of medical and paramedical staff. Screening policy should be put in place and efforts need to be done to increase the level of screening rate and improve prognosis and mortality by cancer.

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Cervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. It is imperative for at least health professionals in developing countries like Pakistan to have a sound knowledge about the disease. This study was carried out to assess the knowledge and awareness about cervical cancer and its prevention amongst health professionals in tertiary care hospitals in Karachi, Pakistan. A cross-sectional, interview based survey was conducted in June, 2009. Sample of 400 was divided between the three tertiary care centers. Convenience sampling was applied as no definitive data was available regarding the number of registered interns and nurses at each center. Of all the interviews conducted, 1.8% did not know cervical cancer as a disease. Only 23.3% of the respondents were aware that cervical cancer is the most common cause of gynecological cancers and 26% knew it is second in rank in mortality. Seventy-eight percent were aware that infection is the most common cause of cervical cancer, of these 62% said that virus is the cause and 61% of the respondents knew that the virus is Human Papilloma Virus (HPV). Majority recognized that it is sexually transmitted but only a minority (41%) knew that it can be detected by PCR. Only 26% of the study population was aware of one or more risk factors. Thirty seven percent recognized Pap smear as a screening test. In total only 37 out of 400 respondents were aware of the HPV vaccine. This study serves to highlight that the majority of working health professionals are not adequately equipped with knowledge concerning cervical cancer. Continuing Medical Education program should be started at the hospital level along with conferences to spread knowledge about this disease.
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Cervical cancer is a leading cause of cancer-related death among women in developing countries. In such low-resource settings, cytology-based screening is difficult to implement, and less complex strategies may offer additional options. To assess the cost-effectiveness of several cervical cancer screening strategies using population-specific data. Cost-effectiveness analysis using a mathematical model and a hypothetical cohort of previously unscreened 30-year-old black South African women. Screening tests included direct visual inspection (DVI) of the cervix, cytologic methods, and testing for high-risk types of human papillomavirus (HPV) DNA. Strategies differed by number of clinical visits, screening frequency, and response to a positive test result. Data sources included a South African screening study, national surveys and fee schedules, and published literature. Years of life saved (YLS), lifetime costs in US dollars, and incremental cost-effectiveness ratios (cost per YLS). When analyzing all strategies performed as a single lifetime screen at age 35 years compared with no screening, HPV testing followed by treatment of screen-positive women at a second visit, cost $39/YLS (27% cancer incidence reduction); DVI, coupled with immediate treatment of screen-positive women at the first visit was next most effective (26% cancer incidence reduction) and was cost saving; cytology, followed by treatment of screen-positive women at a second visit was least effective (19% cancer incidence reduction) at a cost of $81/YLS. For any given screening frequency, when strategies were compared incrementally, HPV DNA testing generally was more effective but also more costly than DVI, and always was more effective and less costly than cytology. When comparing all strategies simultaneously across screening frequencies, DVI was the nondominated strategy up to a frequency of every 3 years (incremental cost-effectiveness ratio, $460/YLS), and HPV testing every 3 years (incremental cost-effectiveness ratio, $11 500/YLS) was the most effective strategy. Cervical cancer screening strategies that incorporate DVI or HPV DNA testing and eliminate colposcopy may offer attractive alternatives to cytology-based screening programs in low-resource settings.
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Cervical cancer is the most common cause of death from cancer among women in Thailand and in almost all patients, human papillomavirus (HPV) has been found. Various international studies indicate that the knowledge level vis-à-vis cervical cancer and HPV in the general population as well as healthcare professionals is low, but no such study has yet been done in Thailand. Our study's aim was to ascertain the level of knowledge, the attitudes and practices regarding cervical cancer among registered nurses working in Srinagarind (university) Hospital in an urban setting in Northeast Thailand. Systematic sampling was used and self-administered questionnaires were sent to 149 registered nurses; 133 (89.3%) of whom responded. Data were processed using descriptive statistics including frequency, percentages and the 95% CIs. The respondents' averaged 34.6 years of age (median, 33; range, 21-56) while 54.6% had sexual partners and 61.4% had had normal deliveries. The respective median knowledge score, interquartile range and mean knowledge score and range for cervical cancer vs. HPV vs. cervical cancer prevention were: 11.00, 5.0, 10.14 (95%CI 9.6, 10.7), 0-15 vs. 4.00, 2.0, 3.58 (95%CI 3.5-4.2), 0-7 vs. 8, 3.00, 7.5 (95%CI 7.1-7.9), 1-11. 66.2% would like to have prophylactic HPV vaccines because they thought that it would prevent HPV infection (77.3%) or prevent cervical cancer (39.1%), which are major misunderstandings. Almost all of the registered nurses working at Srinagarind Hospital have a moderate level of knowledge regarding cervical cancer and HPV but there are still some major misunderstandings; thus, educational pamphlets, notices and hospital announcements would be useful in increasing their knowledge.
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