Literature review on cervical cancer
Review of cervical cancer research in : zaridah s, mog ukmthematic stream: vaccines download here the ct: despite cervical cancer being potentially preventable, it is the second most common cancer among women in malaysia. One hundred and five articles related to cervical cancer were found in a search through a database dedicated to indexing all original data relevant to medicine published in malaysia between the years 2000-2013. Fifty seven articles were selected and reviewed for the articles’ clinical relevance and future research implications. This article reviews the various aspects of cervical cancer in malaysia, mainly persistent infection of high risk human papillomavirus (hpv), primary prevention (hpv vaccination), screening method (pap smear issues), and the attitude and knowledge of various groups of malaysian women that contributed to the failure to reduce the incidence and mortality of cervical cancer. Most of the studies focused on prevention, pap smear issues, hpv dna testing, hpv vaccination and various recommendations for prevention of cervical cancer. There is also a large gap in clinical studies on the outcome, management and survival of cervical cancer patients in j malaysia vol 69 supplement a august n 1: review of iology/ malaysian national cancer registry report (2003) found that the most frequently occurring cancers in malaysian women (in descending order) cancers of the breast, cervix, colon, ovary, leukaemia, and lungs. This was higher than other asian and western countries, and even globally (national cancer registry, 2003). Deaths from cervical cancer are rare amongst young women but its incidence increased from the age of 30 years and peaked at 60-69 years. Ministry of health malaysia reported an average of 2000 to 3000 hospital admissions of cervical cancer cases per year in the country; most of them presenting late into the disease[2]. The mortality rate due to cervical cancer in malaysia is more than two times higher than the netherlands, united kingdom and finland. Even with the introduction of screening programmes and immunisation against cervical cancer, the mortality rate has not decreased to a desirable level. It costs about rm312 million (usd76 million) to manage cervical cancer (from prevention to managing invasive diseases) annually in malaysia.
M aljunid discussed the burden of cervical cancer in malaysia and the potential cost and consequences of human papillomavirus (hpv) vaccination4. Since cervical cancer is treated primarily within regional hospitals, while precancerous lesions are treated within an ambulatory care set up, the burden was estimated as the direct, indirect and total annual costs associated with cervical cancer and precancerous lesions in malaysia. This retrospective study to estimate the burden associated with cervical cancer was conducted at four hospitals4. The average cost of atypical squamous cell of undetermined significant (ascus), cervical intraepithelial neoplasia 1 (cin1), and cin 2/3 in malaysia were rm898, rm1453, rm1948 respectively compared to rm10,540 for cervical cancer. A prevalence-based model that used 1-year cross-sectional data was developed to estimate the number of events (cases of precancerous lesions, cervical cancer and genital warts) and costs (direct+indirect) that could be avoided by vaccination, data from world health organization (who) and global cancer incidence, mortality and prevalence (globocan) estimated 4696 prevalent cases of cervical cancer annually in malaysia. There were 1372 cases estimated for precancerous lesions (ascus, cin 1 and cin 2/3), with the cost of outpatient treatment calculated as rm1,501,171, making the direct total management of hpv related disease to be rm39,153,699, with an additional rm12. Et al, in her supplementary paper, recommended that the bulk of effort in managing cervical cancer should be allocated for preventive strategies – mainly screening, followed by combined screening-vaccination. Papillomavirus and cervical world health organization (who) had linked persistent high risk hpv infection, particularly hpv 16 and 18, to cervical cancer. It is the persistent high risk hpv infection that puts the infected individual at high risk to develop cin 3 and cervical cancer later on [6]. An independent, prospective, multi-centred, hospital-based cross-sectional studies involving malaysia, vietnam, singapore, south korea and the philippines evaluate the prevalence of human papillomavirus (hpv) in women older than 21 years old with invasive cervical cancer (icc) and high-grade precancerous lesions[9]. Therefore, recommended implementation of a comprehensive cervical cancer screening and anti-hpv-16/18 vaccination program is an important and urgent measure for reducing the burden of cervical cancer in malaysia and singapore[10]. There are three modalities of cervical cancer prevention: primary prevention by preventing hpv infection, sexual abstinence and healthy lifestyle, and hpv vaccination.
Secondary cervical cancer prevention is through the detection and treatment of precancerous or preinvasive lesion; and tertiary prevention is the detection and treatment of the early stage of cancer. All the studies below concluded that overall knowledge on hpv infection, vaccination and cervical cancer is poor and that knowledge and attitude translated to vaccine acceptance. There is a need to improve women’s awareness and knowledge, and improve their attitude towards hpv cross-sectional studies on teenagers’ knowledge of cervical cancer and its prevention were conducted; one in sarawak involving 76 students12 and the other involving eight schools in kuala lumpur13. Of students were aware of cervical cancer (the highest rate of awareness involving the chinese students). Race, socioeconomic status, father’s education level, mother’s education level and cervical cancer awareness were associated with the knowledge of cervical cancer prevention (p< 0. Both studies concluded that most students had low knowledge of cervical cancer and its prevention but they had a positive attitude toward vaccination. Therefore, suitable educational programmes should be developed to improve the knowledge of secondary school students on the prevention of cervical cancer. M et al concluded that medical students had the highest level of knowledge of cervical cancer, hpv infection and hpv vaccination compared to dentistry and pharmacy students15. Questionnaire which assessed the knowledge and attitudes of 449 young rural women in malaysia towards hpv, hpv vaccination, and cervical cancer revealed extremely poor 34 a review of cervical cancer research in malaysia med j malaysia vol 69 supplement a august 2014 knowledge emphasising the importance of educating rural residents on hpv. Acceptance of hpv vacination was significantly associated with knowledge of cervical screening and cervical cancer risk factors. World health organization (who) recommended that routine hpv vaccination be included in national immunisation ah ezat compare and look at cost effectiveness of hpv vaccination in prevention of cervical cancer in cross sectional economic burden study with 502 respondents were interviewed from six public gynecology-oncology hospitals in 2006-2009. This study concluded vaccination increase life expectancy with better quality of life (qol) of women when cancer can be avoided.
Since malaysian women attitude regarding screening is doubtful , vaccination of young women is a more cost effective strategy against cervical cancers. Prevention of cervical cancer:Screening cervical cancer fulfills the criteria for an effective screening program because it is a major health problem, has a preinvasive stage, and is treatable at an early stage. Cervical cancer screening had shown to be a cost-effective mean of controlling the cancer and pap smear screening is recognised for secondary prevention. Many healthy life style campaign and publicity were made to promote this procedure, yet it did not achieve above 70-80% coverage of the population to reduce cervical cancer morbidity and mortality[23]. World health organization recommends that routine hpv vaccination should be included in national immunisation programmes if prevention of cervical cancer constitutes a public health priority, taking into account that vaccine introduction is programmatically feasible and financing can be secured[24]. This mean that screening will still remain an important strategy to combat cervical cancer and every effort is needed to ensure that the investments made in screening are effective and efficient[25]. Article on the challenges of cervical cancer screening in malaysia revealed that the lack of manpower and facilities of health care system contributed to poor pap smear coverage23. Of the pap smears done in hospital universiti sains malaysia and kota bharu hospital was not taken from the transformation zone of the cervix, where 95% of preinvasive lesions and cervical cancers occur[26]. Interviewees’ perceptions were explored on current and organised cervical screening program based on their expertise and experience. In their opinion, the opportunistic cervical screening program failed to address the needs assessment of the program mainly in four aspects: 1) the receiver i. Smear subsequent visits or follow of the approaches that fulfilled all these criteria is an organised cervical screening program with a systematic call, recall, follow-up and surveillance system . Prospective randomised controlled study of 250 women in klang who attended cervical screening and had a normal pap smear in the previous year, and were due for a repeat smear were recruited and randomly assigned to four different methods of recall for repeat smear.
Knowledge and lly, women’s attitudes and beliefs towards cervical cancer and the importance of screening test will affect their uptake and compliance of pap smear. Studies in various group of women of different ages, involving rural, urban and even university students to assess knowledge on cervical cancer, pap smear screening, hpv infection and hpv vaccination, in the hope that the results can be used to plan strategies to prevent a potentially preventable cervical cancer. Questionnaire survey was done on 221 cervical cancer patients at eight hospitals with gynaeoncologist, in women aged 25-85 years. The survey concluded, a large number of cervical cancer patients had inadequate knowledge and had not had a pap smear within three years preceding cancer development. Result strongly showed the need for an effective cervical screening program which is proactive, consistent, and has a systematic follow ity / source of one study, more than half of the participants (57. Of the teachers felt the government should provide more information to educate the public about cervical cancer and the vaccine. This review concluded that a national school-based hpv immunisation program can be implemented effectively in a multiethnic, cultural and religious country despite limited knowledge of hpv-related pathology among teachers[38]. Malay muslim physicians considered cultural sensitivity an issue when recommending hpv vaccines more than paediatricians and family physicians who were more likely to agree that acceptance is better if vaccines were recommended as prevention against cervical cancer rather than a sexually transmitted disease. Agreed that the hpv vaccines show great promise in cervical cancer prevention in the country. In 2007, 23% of cervical cancer patients who were surveyed had no education and 38% had only primary school education. Improving screening coverage will remain an important strategy for combating cervical cancer in focus should be on the policy-making context, improving awareness and the screening infrastructure, and making the service better accessible to women. A possible solution may be to implement worksite cervical screening programs in which eligible women can be easily tracked and invited to have a pap test[43].
Rm32 million) of the annual expenditure was allocated for pap smear screening while 68% (rm167 million) were used for managing invasive cervical cancer. Introduction of widespread vaccination of females against hpv can potentially prevent 89% of cervical cancer cases at steady rate and this could potentially lead to an annual savings of over rm45 million in terms of hpv related treatment costs[3]. The ultimate success of hpv vaccines in reducing the incidence of cervical cancer will be dictated by its uptake and affordability since there are no health insurance coverage for hpv vaccines. This study compared the performance of nested my/gp polymerase chain reaction (pcr) and fda approved-hybrid capture ii (hcli) using clinical cervical scrapings from 40 patients. Another study of 200 cervical swab samples by chong also concluded that pcr was a reliable method to detect hpv11. The expression of cytokeratin 19 and tetranectin could be explored for further role in cervical cancer treatment and monitoring[46]. The increased p16ink4a immunopositivity in hsil and scc appears in line with the integrated existence of the hrhpv and may provide more insightful information on risk of malignant transformation of cervical squamous intraepithelial lesions than mere hrhpv detection[48]. Stain was used to study the involvement of bcl-2 and bax proteins in cervical carcinogenesis. Bcl-2 and bax appeared to be upregulated at different stages of cervical carcinogenesis, bcl-2 in hsil and bax after invasion. A retrospective study on 61 cases of cervical neoplasms comprising 25 cases of cin 3 and 36 scc, all cases were evaluated by immunohistochemistry using ki-67 and p53 monoclonal antibodies. In conclusion, ki-67 and p53 may serve as helpful adjuncts to routinely-stained histological sections in differentiating between cin 3 and automated cervical pre-cancerous diagnostic system was proposed to be developed to reduce detection error due to poor diagnostic skill of the cytotechnologists and cytopathologists. The automatic diagnostic system used a new algorithm that is referred as region-growing- based features extraction (rgbfe) to extract the features of cervical cell (i.
These features will then be fed into the h2mlp network, which classify the cervical cells into normal, lsil or hsil cell. A study evaluating fourier transform infrared (ftir) spectroscopy as a new tool for screening of cervical cancer compared with cervical cytology (gold standard), a total of 800 cervical scrapings were taken by cytobrush and placed in thinprep medium. This study suggests that ftir spectroscopy could be used as an alternative method for screening for cervical cancer[52]. Retrospective study that was aimed at evaluating the role of ct scan in predicting parametrium involvement in the early stage of cervical carcinoma was conducted in a gynaecologic oncology centre, hospital alor star from january 2004 till december 2008. All 104 patients with operable stage i and ii cervical cancer had pelvic ct scan for evaluation of parametrium involvement. Respectively; indicating that ct scan had high specificity but low sensitivity in determining parametrial involvement in early stage of cervical cancer[53]. Al jashamy reported a retrospective study of 77 cervical cases from the histopathology laboratory of ipoh hospital from 1st january, 2005 to 31st december, 2006this study showed cervical intraepithelial neoplasia (cin) was found in 33/77 (42%) cases, cervical carcinoma in 12/77 (15. Retrospective study by hospital universiti sains malaysia to determine the five-year survival rate among patients with cervical cancer who were treated, found that the overall fiveyear survival was 39. One study review of 55 patients with figo ib1 lymph nodes negative cervical cancer managed from 1997-1999 post radical hysterectomy, adjuvant rt was tailored according to the gynecology oncology (gog) risk score. In his review of pregnant mothers with malignant conditions, recommended colposcopy and a directed biopsy if an abnormality was detected at colposcopy. Performing a cold knife cervical cone procedure during pregnancy can cause significant morbidity, excessive cervical bleeding in 5±15% and up to 25% spontaneous abortion rate. Radiotherapy is an effective therapy for cervical cancer in pregnancy; the complications were similar to those in non-pregnant patients[57].
A combination of hpv vaccination and pap smear screening programmmes was shown to be cost effective to prevent cervical cancer. There is a large gap in knowledge, attitude and practices among malaysian women on cervical cancer screening. The psychosocial aspect and economic burden formed a difficult barrier that affect cervical cancer screening and prevention programme. Promoting and performing pap smear or hpv dna cervical sampling during home visits or work place visits, having a dedicated team, and following the school health team study’s recommendations that should be considered include promoting awareness among medical practitioners, and including men in promotional campaigns. Another recommendation is linking with data of the national registration department, so that women could be invited for screening at regular intervals after they reach the eligible n 3: future research is a large gap in clinical research on cervical cancer. In terms of cervical cancer treatment, patients should have more options, for example radical surgery and adjuvant chemotherapy, for women who refused radiotherapy. The taboos of modern treatment and belief in traditional complementary medicine can be explored to curb the misconception of cervical cancer treatment, as there were patients who, although were diagnosed early, delayed treatment for traditional options and only presented to hospital at an advanced stage; thus leading to poorer prognosis. There is also a need to explore other screening methods such as cervical smear self sampling for hpv dna screening that could possibly increase screening coverage. Sponsored clinical critical trends in clinical ing an advanced nursing to ure renewals by es & ce-based g student nurse ture review: cervica... Nursingcenter to get uninterrupted access to this s section editor(s): risser, nancy mn, rn, c, anpmurphy, mary cpnp, phd, literature review jd, gibb rk, geevarghese s, et al: cervical carcinoma in the elderly. Age is an important factor for the allocation of treatment and for survival for patients with invasive cervical cancer. Between january 1986 and july 2003, 1582 patients with invasive cervical cancer were evaluated and managed at a hospital in missouri, including 197 patients age > 70 years.
