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      Cervical cancer prevention in Senegal: an International Cooperation Project Report

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          Abstract

          Background: Cervical cancer is the second most common women’s cancer in less developed regions and it is the leading cause of cancer mortality among women in Senegal. Because of the high costs, cervical cancer prevention is very rare in developing countries and it is often based on visual inspection methods. The University of Parma (CUCI) and the MANI association have developed a cervical cancer screening project addressed to rural Senegal communities. The aim of the project was to disseminate the cytocervical sampling technique among Senegalese nurses and midwives, as a completion to the local visual inspection method. Other objectives were to verify the prevalence of precancerous lesions and to evaluate cervical cancer knowledge and attitudes among women who participated at the screening campaign. Interventions: A theoretical and practical training plan on cervical cancer screening was provided to the local health workers at various levels. The screening was performed through a first step visual inspection exam to 203 women, followed by a Pap smear in case of positive outcome. 20 women participated also to a structured interview. Results: The Pap smear material was adequate in all the samples collected where this indicates that the objective to disseminate cervical cancer screening techniques has been achieved. Of the 203 women involved in the screening project, 68 were tested positive at the first step and 38 of them were submitted to Pap tests. Conclusion: The difficulties encountered confirm how Pap tests have overall proved inordinately complex and expensive for developing countries. It seems more sensible to deal first with global health in terms of basic hygienic sanitation, including an educational component in screening programs in order to sensitize women to the risk factors of cervical cancer.

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          Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial.

          Cervical cancer is the most common cancer among women in developing countries. We assessed the effect of screening using visual inspection with 4% acetic acid (VIA) on cervical cancer incidence and mortality in a cluster randomised controlled trial in India. Of the 114 study clusters in Dindigul district, India, 57 were randomised to one round of VIA by trained nurses, and 57 to a control group. Healthy women aged 30 to 59 years were eligible for the study. Screen-positive women had colposcopy, directed biopsies, and, where appropriate, cryotherapy by nurses during the screening visit. Those with larger precancerous lesions or invasive cancers were referred for appropriate investigations and treatment. Cervical cancer incidence and mortality in the study groups were analysed and compared using Cox regression taking the cluster design into account, and analysis was by intention to treat. The primary outcome measures were cervical cancer incidence and mortality. Of the 49,311 eligible women in the intervention group, 31,343 (63.6%) were screened during 2000-03; 30,958 control women received the standard care. Of the 3088 (9.9%) screened positive, 3052 had colposcopy, and 2539 directed biopsy. Of the 1874 women with precancerous lesions in the intervention group, 72% received treatment. In the intervention group, 274,430 person years, 167 cervical cancer cases, and 83 cervical cancer deaths were accrued compared with 178,781 person-years, 158 cases, and 92 deaths and in the control group during 2000-06 (incidence hazard ratio 0.75 [95% CI 0.55-0.95] and mortality hazard ratio 0.65 [0.47-0.89]). VIA screening, in the presence of good training and sustained quality assurance, is an effective method to prevent cervical cancer in developing countries.
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            Cervical cancer: the sub-Saharan African perspective.

            Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in developing countries. While incidence and mortality rates of cervical cancer have fallen significantly in developed countries, 83% of all new cases that occur annually and 85% of all deaths from the disease occur in developing countries. Cervical cancer is the most common cancer among women in sub-Saharan Africa. The incidence is on the increase in some countries. Knowledge and awareness of this disease on the continent are very poor and mortality still very high. Facilities for the prevention and treatment of cervical cancer are still very inadequate in many countries in the region. Governments in sub-Saharan Africa must recognise cervical cancer as a major public health concern and allocate appropriate resources for its prevention and treatment, and for research. Indeed, cervical cancer in this region must be accorded the same priority as HIV, malaria, tuberculosis and childhood immunisations.
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              Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries

              Early age at first sexual intercourse (AFSI) has long been associated with an increased risk of invasive cervical carcinoma (ICC). Age at first pregnancy (AFP) and ICC have been investigated less, although AFSI and AFP are strongly interrelated in most developing countries. A pooled analysis of case–control studies on ICC from eight developing countries with 1864 cases and 1719 controls investigated the roles of AFSI, AFP, and ICC risk. Age at first sexual intercourse, AFP and age at first marriage (AFM) were highly interrelated and had similar ICC risk estimates. Compared with women with AFSI ⩾21 years, the odds ratio (OR) of ICC was 1.80 (95% CI: 1.50–2.39) among women with AFSI 17–20 years and 2.31 (95% CI: 1.85–2.87) for AFSI ⩽16 years (P-trend <0.001). No statistical interaction was detected between AFSI and any established risk factors for ICC. The ICC risk was 2.4-fold among those who reported AFSI and AFP at ⩽16 years compared with those with AFSI and AFP at ⩾21 years. These data confirm AFSI and AFB as risk factors for ICC in eight developing countries, but any independent effects of these two events could not be distinguished.
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                Author and article information

                Journal
                Acta Biomed
                Acta Biomed
                Acta bio-medica : Atenei Parmensis
                Mattioli 1885 (Italy )
                0392-4203
                2018
                : 89
                : Suppl 6
                : 29-34
                Affiliations
                [1 ] University Hospital of Parma, Italy
                [2 ] Department of Medicine and Surgery, University of Parma, Italy
                Author notes
                Correspondence: Simona Gabrielli University Hospital of Parma, Italy E-mail: simona.gabriels@ 123456gmail.com
                Article
                ACTA-89-29
                10.23750/abm.v89i6-S.7460
                6357602
                30038201
                bd84c903-97f4-41b3-8a61-88b9e80362ce
                Copyright: © 2018 ACTA BIO MEDICA SOCIETY OF MEDICINE AND NATURAL SCIENCES OF PARMA

                This work is licensed under a Creative Commons Attribution 4.0 International License

                History
                Categories
                Original Article: Clinical Variables in Healthcare

                cervical cancer,prevention,screening,cervix,pap test,pap smear,international cooperation,senegal,global health

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