bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 32: Characteristics of Hepatocellular Carcinoma in Nigerians with and without HIV
Authors: Davwar Pantong , Odeghe Emoubor , Duguru Mary , Oyeleke Ganiat , Nyam David , Okeke Edith , Lesi Olufunmi , Kim Kwang-youn , Imade Godwin , Akanmu Alani , Sagay Atiene , Robert Lewis , Hou Lifang , Murphy Rob , Hawkins Claudia
Published: July 2021

Purpose: Hepatocellular carcinoma (HCC) is a major public health problem in West African countries. HCC still has a strikingly high mortality in this region. Whether HIV also contributes to an increased risk of HCC is in this region is unclear. In this study we describe clinical, radiological and laboratory features as well as survival in Nigerians with HCC, with and without HIV infection, enrolled in an NCI-funded study.

Methods: This was a prospective, non-interventional study conducted at two Nigerian tertiary hospitals [Jos University Teaching Hospital and Lagos University Teaching Hospital. Subjects>18 years with HCC diagnosed according to AASLD criteria were included.

Results: 204 participants were included in this study [males 144 (71%), median age 50 yrs (IQR 19, 86); HIV-infected (25 (12%)]. 51(27.6%) of all subjects were anti-HCV positive [HIV-uninfected 46 (28.4%) vs. HIV-infected 5(21.7%); p=0.62]. 62% of anti-HCV positive patients at JUTH were confirmed to have active infection (HCV RNA>10IU/mL). Median CD4 T cell count among HIV-infected was 236.50 [61.00-479.00] cells/mm3. 72% of the HIV patients were on ART. Tumor mass diameter on computed tomography did not differ between subject groups [HIV-infected 6.5cm (1.80-80.00) vs. HIV-uninfected 8.9 cm (1-93.0); p=0.23). Overall median survival for both groups was 2.04 months CI (1.58, 4.47). The mean probability of survival at month 1 was 0.7 (95% CI, 0.6, 0.8).

Conclusion: A very short median survival was observed in this cohort of HIV-infected and uninfected Nigerian adults with HCC. Almost a third of all subjects were anti-HCV positive and two thirds of these subjects had active infection suggesting HCV infection is an important, risk factor for HCC in this setting.

Citation Format: Pantong Davwar, Emoubor Odeghe, Mary Duguru, Ganiat Oyeleke, David Nyam, Edith Okeke, Olufunmi Lesi, Kwang-youn Kim, Godwin Imade, Alani Akanmu, Atiene Sagay, Lewis Robert, Lifang Hou, Rob Murphy, Claudia Hawkins. Characteristics of Hepatocellular Carcinoma in Nigerians with and without HIV [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 32.
Abstract 36: Clinical Profiles and 1-Year Survival of Children with Acute Lymphoblastic Leukemia at Mbarara Regional Referral Hospital Cancer Unit
Authors: Zalwango Stella , Kalubi Peters , Atwiine Barnabas
Published: July 2021

Purpose: Acute lymphoblastic leukemia (ALL) is the commonest childhood cancer globally and mimics common childhood conditions, creating diagnostic challenges. We described the baseline feature at diagnosis and established 1-year overall survival.

Methods: In a retrospective cohort study, medical records of children <16 years of age diagnosed with ALL between 1st June 2016 and 31st May 2020 were reviewed. The frequencies and proportions of symptoms, signs, laboratory findings and treatment outcomes were extracted and described. 1-year overall survival was estimated using Kaplan Meier curves. Research and Ethics Committee of Mbarara University of Science and Technology provided ethics approval.

Results: Fifty one (51) children had been diagnosed with ALL at MRRH. They presented with fever, 44 (86.3%), weight loss 34(66.7%), cough 28(54.9%), bleeding tendencies 21(41.2%), limb pains 20(39.4%), and abdominal distension 8(15.7%). The signs were pallor, 44(86.3%), lymphadenopathy 39(76.5%), hepatosplenomegaly 37(72.5%), pyrexia 18(35.3%), bone tenderness 12(23.5%) and petieche 11(21.6%). Thirty (58.8%) children had leukocytosis (WBC>12 × 109/L), 15(29.4%) had WBC>50,000 and all children had anemia (Hb<11.0g/dl) at admission, 32 (62.7%) had severe anemia (Hb <7.0g/dl). Forty eight (94.1%) children had thrombocytopenia (<150.0 × 109/L), 32(62.7%) had severe thrombocytopenia (<50 × 109/L). 1-year overall survival was 63.6% (95%CI (49.8-77.5).

Conclusion: Children with ALL present with non-specific clinical features that can mimic other illnesses and 1-year overall survival was low at MRRH. Children with a combination of fever, pallor, bleeding; and leukocytosis, anemia and thrombocytopenia should be actively investigated for acute lymphoblastic leukemia for early treatment initiation.

Citation Format: Stella Zalwango, Peters Kalubi, Barnabas Atwiine. Clinical Profiles and 1-Year Survival of Children with Acute Lymphoblastic Leukemia at Mbarara Regional Referral Hospital Cancer Unit [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 36.
Abstract 38: Setting up a Cancer Clinic in a Low-and-Middle-Income Country (LMIC) in Sub-Saharan Africa: A Case of Taita Taveta County in Kenya.
Authors: Kitur Gloria , Achieng Emmah , Mwakichako Rebecca , Kimotho Felix , Asirwa Chite
Published: July 2021

Purpose: Quality Cancer treatment is expensive and not accessible to all in LMIC settings in sub-Saharan Africa including Kenya. Despite having a cancer diagnosis, patients and their families not living in major towns and cities, have to travel far to seek treatment incurring cost in transport, upkeep during treatment and out of pocket expenditure to access care.

Methods: International Cancer Institute in Eldoret-Kenya, partnered with Taita Taveta County to implement a cancer and other non-communicable disease (NCD) project in August 2020. Taita Taveta County established a technical working group (TWG) in September 2020 to oversee the project activities and identified space and staff to set up a new cancer clinic. ICI provided technical support in project planning, budgeting, capacity/needs assessment, training and mentorship of healthcare providers; and running joint cancer clinics.

Results: Periodic review meetings between ICI and Taita Taveta County TWG identified lack of: qualified staff to provide cancer care; cancer screening supplies; and drug stock-outs. In September 2020, ICI and its strategic partners supported Taita Taveta County to launch a Cancer Clinic to provide basic Cancer care. ICI offered trainings and continuous medical education on cancer for 91 healthcare providers both online (26) and on-site (65); ICI provided cervical, breast and prostate cancer screening supplies; established a revolving fund pharmacy as a stop gap measure to drug stock-outs; and held joint cancer clinics twice a month where mentorship and skills training for county staff paired with ICI staff across various disciplines was achieved resulting in the first patient receiving chemotherapy in November 2020; histopathology support was provided for 151 samples.

Conclusion: The process of setting up a cancer clinic in a low resource setting requires a systematic needs assessment approach; identifying a core team early that outlines output measures of interest; and having strategic partnership guiding step-by-step developments.

Citation Format: Gloria Kitur, Emmah Achieng, Rebecca Mwakichako, Felix Kimotho, Chite Asirwa. Setting up a Cancer Clinic in a Low-and-Middle-Income Country (LMIC) in Sub-Saharan Africa: A Case of Taita Taveta County in Kenya. [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 38.
Abstract 41: International Collaborative Rwanda Endoscopy Week Conferences Demonstrate Feasibility and identify H. pylori Testing as an Important Target for Capacity-Building Interventions
Authors: Gangasani Nikitha , Rutaganda Eric , Shikama Felcien , Bensen Steve , Dusabejambo Vincent , Chamberlin Mary
Published: July 2021

Purpose: Gastrointestinal (GI) endoscopy is a growing field in Rwanda, a country of 12.6 million with significant GI morbidity and mortality. Endoscopy alongside Helicobacter pylori identification and eradication aids in GI cancer prevention and diagnosis in this population. Our collaborative training-focused endoscopy conference provides preliminary data to focus future training and capacity building programs in Rwanda to improve oncologic outcomes.

Methods: Since 2017, ‘Rwanda Endoscopy Week' (REW) is held annually at multiple hospitals throughout Rwanda. It consists of several days of didactic training in endoscopy, oncology and research, followed by a week of endoscopy procedures performed jointly by visiting and hosting endoscopists, and ending with a summary of results of didactic and endoscopic activity.

Results: Four (4) hospitals performed 244 training endoscopies in 2017 and 448 cases in 2018. In 2019 this expanded to 668 endoscopies performed at 7 hospitals, including academic, district, and private hospitals. The case distribution remained similar over 3 years at 86.0% (1170/1360) upper endoscopies, 13.2% (180/1360) colonoscopies, and 0.7% (10/1360) endoscopic retrograde cholangiopancreatographies. Thirty-nine (5.8%, 39/668) patients had a tumor finding suspicious for gastric (4.0%, 27/668), colorectal (1.5%,10/668), ampullary (0.1%, 1/668), or gallbladder (0.1%, 1/668) malignancy. 54% of patients receiving endoscopy were tested for H. Pylori (367/669); 38% of those tested had inconclusive results (141/367) and 20% were positive (74). There were 2 non-serious bleeding events.

Conclusions: Participation by Rwandan urban, district, public and private hospitals in a cooperative international GI training conference has experienced a nearly three-fold increase in patients and identified malignant pathology while maintaining safe endoscopic care over a three-year period. H. pylori, ubiquitous in this population, is an important risk factor for gastric cancer and gastric diseases. Necessary next steps include increased training and capacity-building interventions to improve the quality of the testing and surveillance of those treated.

Citation Format: Nikitha Gangasani, Eric Rutaganda, Felcien Shikama, Steve Bensen, Vincent Dusabejambo, Mary Chamberlin. International Collaborative Rwanda Endoscopy Week Conferences Demonstrate Feasibility and identify H. pylori Testing as an Important Target for Capacity-Building Interventions [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 41.
Abstract 42: Patient-Provider Communication in the Setting of Advanced Cancer: Experience and Views from Rwanda
Authors: Uwamahoro Pacifique , Tuyishime Hubert , Cubaka Vincent , Mpanumusingo Egide , Ho Anita , Van Loon Katherine , DeBoer Rebecca J.
Published: July 2021

Purpose: Caring for patients with advanced cancer involves complex patient-provider communication (PPC), including disclosure of diagnosis, discussion of prognosis, decision-making about treatment, delivery of bad news, and transitions in goals of care. Values and norms that influence PPC differ across diverse cultural and socioeconomic contexts. We aimed to characterize PPC experiences and preferences among patients and providers at Butaro Hospital in Rwanda, understand facilitators and barriers to high quality PPC, and collect suggestions for improvement.

Methods: We conducted semi-structured interviews with a purposive sample of 11 oncology providers and 11 adult patients with advanced cancer. Interviews were recorded, transcribed, translated to English, coded using software, and analyzed using framework thematic analysis.

Results: Participants reported both strengths and opportunities for improvement in PPC at Butaro. Strengths include routine explanation of diagnosis, treatment plan, and potential side effects, aided by a consent form and a dedicated counselor. Patients reported that PPC focuses on symptoms and treatment plan discussion, but is limited in truth telling about prognosis, especially when goals of care transition from curative to palliative. Facilitators to quality PPC include multidisciplinary team commitment, patient trust toward providers, provider communication style, and strong resilience in distressing clinical situations. While patients perceived power imbalance between patients and providers as the main barrier to PPC, providers cited inadequate time due to work overload, discomfort facing sad situations, and unfavorable physical environment as main barriers. Suggestions to improve PPC include training providers in communication skills, patient and family education and empowerment, more time and private spaces, and standardizing approaches to harmonize PPC.

Conclusion: PPC at Butaro works well though there is room for improvement. Understanding how cultural norms and values regarding poor prognoses influence patient and provider communication preferences can inform strategies to improve PPC and ensure patient-centered care in Rwanda and similar settings.

Citation Format: Pacifique Uwamahoro, Hubert Tuyishime, Vincent Cubaka, Egide Mpanumusingo, Anita Ho, Katherine Van Loon, Rebecca J. DeBoer. Patient-Provider Communication in the Setting of Advanced Cancer: Experience and Views from Rwanda [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 42.
Abstract 50: Factors Affecting the Aggressiveness of Hepatocellular Carcinoma among Hepatitis C Related Cirrhosis Patients
Authors: Elmoneim Randa Salah Abd , Sedki Fathalla , Mohey Aida , Hassouna Ehab , Tayae Eman
Published: July 2021

Purpose: The study was conducted to assess possible epidemiological, clinical and laboratory factors predicting the aggressiveness of Hepatocellular carcinoma (HCC) in HCV-related liver cirrhosis patients.

Methods: A comparative hospital-based cross-sectional study was conducted. Exclusion criteria were HBsAg positive patients, and patients undergoing any treatment modalities for HCC. Complete history was taken focusing on signs and symptoms of the chronic liver disease, and clinical examination was done.

Results: Among 173 patients, only 14.4% of the patients were classified as Child A. In near percentages, patients with Child B represented 43.4%, and patients with Child C were 42.2% of the studied patients. Most of the patients were males (75.7%), while the rest were females (24.3%). Patients were divided to 2 groups: group (I) included 36 patients with non-aggressive HCC (score = 4), and group (II) included 137 patients with aggressive HCC (score > 4) according to the aggressiveness index (AgI) described by Carr et al that takes in count AFP, Maximum Tumor Diameter, number of nodules and presence of portal vein thrombosis. HCC patients in group (II) were 1.9 times more likely to have positive HBc Ab as compared to patients in group (I) where (OR = 1.9, CI = 1.3 - 3.6). Multiple logistic regression analysis for predicting the aggressiveness of HCC explains that 86.7% of factors (age, Child Pugh score, BCLC staging, Gamma glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), Platelets, HBcore ab and AFP) were contributing to aggressiveness among HCC-Hepatitis C related cirrhosis patients (R 2 = 0.867) with overall significant where chi-square = 21.876, p = 0.001.

Conclusion: In conclusion, age, platelets, Child Pugh score, BCLC staging, HBcore ab, ALP, GGT and AFP are significant predictors for the aggressiveness of HCC.

Citation Format: Randa Salah Abd Elmoneim, Fathalla Sedki, Aida Mohey, Ehab Hassouna, Eman Tayae. Factors Affecting the Aggressiveness of Hepatocellular Carcinoma among Hepatitis C Related Cirrhosis Patients [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 50.
Abstract 52: Pediatric, Adolescent, and Young Adult Cancer in an HIV-Infected Rural Sub-Saharan African Population
Authors: Johnson Kimberly , Bahar Ozge Sensoy , Nattabi Jennifer , Migadde Herbert , Ssentumbwe Vicent , Damulira Christopher , Kivumbi Apollo , Niyonzima Nixon , Ssewamala Fred
Published: July 2021

Purpose: Youth living with HIV (YLWHIV) have an increased cancer risk. Although cancer risk has been greatly reduced in HIV-infected populations since anti-retroviral therapy (ART) became widely available, adherence is still an issue among YLWHIV. Our objective is to describe the prevalence of medical record (MR) reported suspected cancers in a contemporary cohort of YLWHIV aged 10 to 24 years in southern Uganda.

Methods: A cohort of YLWHIV was assembled through MR reviews of patients 10 to 24 years old on the day of data abstraction across 35 Ugandan HIV care health facilities. Clinical data were abstracted to identify suspected cancer cases and information about HIV care.

Results: Among 3728 YLWHIV, we identified eight suspected cancer cases. The most common suspected types were Kaposi sarcoma (n=4) followed by lymphoma (n=3). Challenges encountered in data abstraction were missing data for several variables and confirmatory cancer diagnostic information. In follow-up of suspected cases referred for diagnosis at the Uganda Cancer Institute (UCI), none had diagnosis records in UCI files. In addition, ~18% of patients (n=686) were lost-to-follow-up (LTF) defined as not having returned to the clinic in >183 days and three patients died from presumed Kaposi sarcoma.

Conclusion: Although our results suggest that cancer is rare in YLWHIV, the possibility that the cancer burden is higher cannot be excluded due to incomplete information in MRs and high LTF rates. Further, our study raises concern that patients referred for diagnosis are not accessing potential life-saving care.

Citation Format: Kimberly Johnson, Ozge Sensoy Bahar, Jennifer Nattabi, Herbert Migadde, Vicent Ssentumbwe, Christopher Damulira, Apollo Kivumbi, Nixon Niyonzima, Fred Ssewamala. Pediatric, Adolescent, and Young Adult Cancer in an HIV-Infected Rural Sub-Saharan African Population [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 52.
Abstract 55: Cervical Cancer Prevention in sub-Saharan Africa: A Policy Analysis
Authors: Akanda Rifa , Moucheraud Corrina
Published: July 2021

Purpose: We analyzed the presence and comprehensiveness of cervical cancer control policies in sub-Saharan Africa, where cervical cancer is the leading cause of cancer death for women.

Methods: Publicly-available policies for primary, secondary, and tertiary cervical cancer prevention were collected, and scored for comprehensiveness based on elements included (e.g. vaccination schedule and target age, screening age interval and strategy, precancerous lesion removal method, cancer treatment approach, and presence of palliative care) (summed score, possible range 0- 12). We compared the median number of policy points for countries based on policy environment (availability of other non-communicable disease policy), health financing (external and domestic health expenditures), economic status (poverty prevalence and income inequality), health outcomes (life expectancy, HIV prevalence, cervical cancer mortality), and sub-region.

Results: Policies from 47 countries in sub-Saharan Africa were analyzed. Policies were generally most comprehensive for secondary and primary prevention; only 19 countries had any tertiary prevention policy. It was more common for policies to include information about target age (for primary and secondary prevention), vaccine schedule, and screening method, and less common to include information about awareness-raising or accompanying behavior change approaches. Countries with greater external financing for health had more comprehensive cervical cancer policies, as did countries with higher HIV prevalence.

Conclusion: Cervical cancer control policies in Africa are highly variable in comprehensiveness. External factors, like the role of global donors, and internal factors, like local disease burden, may influence relative priority of cervical cancer prevention and therefore affect policy comprehensiveness. Future research should use mixed methods to explore reasons for this variation and identify areas for policy strengthening.

Citation Format: Rifa Akanda, Corrina Moucheraud. Cervical Cancer Prevention in sub-Saharan Africa: A Policy Analysis [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 55.
Abstract 57: Experiences and Beliefs Regarding Shared Decision-Making About Treatment of Incurable Cancer in Tanzania
Authors: Casey Megan , Athanas Raymond , Dharsee Nazima , Jazza Anna , Julius Kalunde , Semwaza Francis , Mushi Beatrice , Kadhim Emilie , Van Loon Katherine , Ho Anita , Deboer Rebecca
Published: July 2021

Purpose: Treatment decision-making in the setting of advanced cancer is often complex and culturally embedded. Potential benefits of treatment must be weighed against toxicities, economic burden, and social consequences. The standard of shared decision-making (SDM) between doctor and patient, rooted in the Western principle of patient autonomy, may not be readily transferable to other cultural and socioeconomic contexts, where different values and considerations may take precedence. This study aims to characterize the decision-making experiences and beliefs of stakeholders at Ocean Road Cancer Institute (ORCI) in Tanzania in order to inform communication guidelines and improvement strategies.

Methods: We conducted semi-structured interviews with a purposive sample of oncologists and nurses (n=13) and patients with advanced cancer (n=11) at ORCI. A diagram depicting paternalistic, informed, and shared approaches to decision-making was referenced during interviews. Interviews were recorded, transcribed verbatim, translated to English, coded using MAXQDA software, and analyzed using framework thematic analysis.

Results: Patients and providers reported heterogeneous decision-making experiences and preferences, with a trend toward greater patient engagement in recent years. Providers believed SDM is especially important when treatment goals are palliative and when out-of-pocket costs are significant, but favored paternalistic decision-making in the context of curative treatment and lower patient health literacy. Patients generally placed greater importance on providers' communication style and the quality of clinical care than engagement in SDM. Several participants perceived SDM to increase patient adherence to treatment. Barriers and facilitators of SDM were identified at the patient, provider, and healthcare system levels. Community misperceptions about cancer treatment was commonly cited as a barrier. Practical suggestions included communication skills training for providers, implementation of a clinical tool for decision-making, and increased patient and public education about cancer treatment.

Conclusion: Understanding the nuanced views regarding SDM is important for development of culturally informed communication guidelines, tools, and training.

Citation Format: Megan Casey, Raymond Athanas, Nazima Dharsee, Anna Jazza, Kalunde Julius, Francis Semwaza, Beatrice Mushi, Emilie Kadhim, Katherine Van Loon, Anita Ho, Rebecca Deboer. Experiences and Beliefs Regarding Shared Decision-Making About Treatment of Incurable Cancer in Tanzania [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 57.
Abstract 63: Barriers and Facilitators of Cervical Cancer Screening Access in Belize: A Qualitative Analysis of Stakeholder Perspectives
Authors: Mittal Avni , Neibart Shane , Kulkarni Abha , Anderson Taylor , Tsui Jennifer , Hudson Shawna , Einstein Mark , Beer Natalia Largaespada , Kohler Racquel E.
Published: July 2021

Purpose: Cervical cancer is the fourth most common cancer among women worldwide. Belize has among the highest cervical cancer incidence and mortality rates of Latin American and Caribbean countries despite current programs to increase access to secondary prevention services. This study evaluates the perspectives of key stakeholders in the cervical cancer screening system in Belize to elucidate barriers and facilitators of cervical cancer screening services.

Methods: In 2018, semi-structured interviews discussing challenges and successes in cervical cancer screening were conducted with key stakeholders across the 6 districts of Belize. Interviews were transcribed and coded using thematic content analysis to identify salient themes. Themes were organized by levels of the Tappan model.

Results: A total of 47 interviews were conducted with healthcare providers (45%), administrators (17%), government officials (25%), and other stakeholders (13%). 78% of interviews were conducted in the public sector. Perceived barriers to cervical cancer screening were identified across 5 levels: (1) Individual (expectation of delay in Pap smear results and fear of a cancer diagnosis, reduces participation in screening); (2) Provider (responsibilities beyond the provision of screening service prevents clinics from offering services daily); (3) Organizational (insufficient space and training engenders diagnostic delays and possible misdiagnoses); (4) Community (screening limitations are more pronounced in rural vs. urban areas); and (5) Policy (limited budget allocated to equipment and staff restricts screening coverage). Salient facilitators were identified at the community and policy levels. At the community level, facilitators included resource-sharing between public and private sectors and the designation of personnel for rural outreach. Facilitators at the policy level included government coverage of screening costs and establishment of population-based screening targets.

Conclusion: Despite no-cost cervical cancer screening in Belize, barriers still exist. Overloaded provider responsibilities, geographic inaccessibility, and insufficient funding are insights that serve as potential areas for system strengthening.

Citation Format: Avni Mittal, Shane Neibart, Abha Kulkarni, Taylor Anderson, Jennifer Tsui, Shawna Hudson, Mark Einstein, Natalia Largaespada Beer, Racquel E. Kohler. Barriers and Facilitators of Cervical Cancer Screening Access in Belize: A Qualitative Analysis of Stakeholder Perspectives [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 63.
Abstract 71: Accelerated Epigenetic Age among HIV-infected Nigerian Women with Invasive Cervical Cancer
Authors: Musa Jonah , Kim Kyeezu , Zheng Yinan , Qu Yishu , Joyce Brian , Wang Jun , Travis Lois , Gursel Demirkan , Silas Olugbenga , Abdulkareem Fatimah , Imade Godwin , Akanmu Alani , Wei Jian-Jun , Kocherginsky Masha , Kim Kwnag-Youn , Wehbe Firas , Achenbach Chad , Anorlu Rose , Simon Melissa , Sagay Atiene , Ogunsola Folasade , Murphy Robert , Hou Lifang
Published: July 2021

Purpose: Invasive cervical cancer (ICC) is one of the HIV-associated cancers with a high burden in Nigeria. ICC occurs at relatively younger age in HIV infected women, with HIV known to promote aging and related diseases, including cancer. DNA methylation changes with increasing age, various health-related exposures, and age-related health outcomes, suggesting a role of DNA methylation in biological aging and disease. We sought to understand the effect of HIV infection on epigenetic age acceleration (EpiAgeAccel) in Nigerian women with ICC.

Methods: Epigenetic age (EpiAge) was estimated by Horvath's calculator using genome-wide methylation data in 116 cervical tissue samples from three groups of women: a) HIV positive with ICC (n=39); b) HIV positive and cancer-free (n=53); and c) HIV negative with ICC (n=24). EpiAgeAccel was computed as the regression residuals of EpiAge against chronological age (ChronAge), representing the independent deviation of EpiAge from ChronAge. We compared EpiAgeAccel across the 3 HIV/ICC groups using multiple linear regressions adjusting for ChronAge, education, parity, employment, cancer stage, body mass index, and study site. Among the ICC women, we compared EpiAgeAccel between 26 tumor tissues and their surrounding normal tissues using paired t-tests, stratified by HIV status.

Results: EpiAgeAccel among HIV positive women with ICC was 4.5 years higher than HIV positive and cancer-free women (p=0.019). We did not find substantial differences in EpiAgeAccel between HIV-positive women with ICC and HIV-negative women with ICC. EpiAgeAccel was 7.9 and 2.9 years higher in tumor tissues compared to the surrounding normal tissues among HIV positive women (p=0.021) and negative women (p=0.295), respectively.

Conclusion: EpiAge is accelerated in cervical tissue of HIV-infected women with ICC. EpiAgeAccel may be a potential biomarker for ICC screening and early detection for women living with HIV in low- and middle-income countries.

Citation Format: Jonah Musa, Kyeezu Kim, Yinan Zheng, Yishu Qu, Brian Joyce, Jun Wang, Lois Travis, Demirkan Gursel, Olugbenga Silas, Fatimah Abdulkareem, Godwin Imade, Alani Akanmu, Jian-Jun Wei, Masha Kocherginsky, Kwnag-Youn Kim, Firas Wehbe, Chad Achenbach, Rose Anorlu, Melissa Simon, Atiene Sagay, Folasade Ogunsola, Robert Murphy, Lifang Hou. Accelerated Epigenetic Age among HIV-infected Nigerian Women with Invasive Cervical Cancer [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 71.
Abstract 72: Slow Progress in Low-Resource Environments: Is Lack of Education and Training in Cancer Prevention Key?
Authors: Varon Melissa , Shine Chang , Pimple Sharmila , Shastri Surendranath
Published: July 2021

Purpose: Explore attitudes about education and training in cancer prevention research and practice on dissemination and implementation of cancer prevention practices in India.

Methods: Conduct focus groups to understand how cancer prevention education and training – or their absence – influence dissemination and implementation of cancer prevention and control strategies from stakeholder groups: o Professionals with leadership responsibilities in cancer and public health, managing people and resources, and with experience working with patients and communities, clinicians and public health professionals, health administrators, government agencies, and non-profits; and o Patients with cancers for which prevention and early detection strategies exist.

Results: In focus group discussion guides, we consider how to appropriately probe aspects of individual and professional responsibility, leadership style, public and system capacity, cultural and educational influence, and surface other aspects important to the influence of education and training of professionals, leaders, and the public in cancer prevention and control. We expect to gain rich insight from leaders and professionals with knowledge of cancer prevention and control success achieved in developed countries and lived experience managing cancer resources for patients and systems in India. We also anticipate rich insight from survivors about their expectations of and experiences with oncology care for contrast and alignment of themes from leaders and professionals.

Conclusio:n Slow progress in dissemination and adoption of proven cancer prevention and control initiatives in LMICs creates critical opportunities missed. Through focus groups, we hope to unearth foundational barriers to cancer prevention in low-resource settings related to cancer prevention education and training for fuller NCI R01 dissemination science investigations in India and other low-resource settings that share the experience of preventable cancers diagnosed at advanced stage but are culturally different for comparison. Insight from such studies may reveal new directions for achieving high impact, long-term implementation of cancer prevention strategies.

Citation Format: Melissa Varon, Chang Shine, Sharmila Pimple, Surendranath Shastri. Slow Progress in Low-Resource Environments: Is Lack of Education and Training in Cancer Prevention Key? [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 72.
Abstract 74: Stakeholder Selected Strategies to Improve Breast Cancer Care in East Africa: Preliminary Implementation Outcomes and Impact Of COVID-19
Authors: Rositch Anne , Chao Christina , Kirahi Matogoro , Masalu Nestory , Faustine Lucas , Amango Leonard Washington
Published: July 2021

Purpose: Beyond limited resources, disparities in global breast cancer outcomes can be attributable to gaps in translating evidence-into-practice. Therefore, the novel “A.C.T.” framework aimed to Assess the local context, Couple evidence-based strategies to identified barriers, and then Test these strategies to improve breast cancer care practices.

Methods: Strategies to improve breast cancer care were selected by stakeholders based on feasibility, importance, and potential sustainability. The selected interventions focus on 1) delivery of clinical breast examinations; 2) workflow for diagnostic evaluations; and 3) initiating a breast cancer–specific multidisciplinary tumor board. The interventions were launched on January 31st, 2020 at the Zonal Hospital in Mwanza, Tanzania, which serves 14 million people. Here we present the 6-month interim pre- (August, 2019-January, 2020) vs. post- (March-August, 2020) implementation outcome analysis.

Results: An average of 20 vs. 37.2 women per month presented with breast concerns in the pre- vs. post-implementation period. Women receiving diagnostic testing (84% vs. 86%) and initiating treatment (29% vs. 30%) did not change from pre- to post-implementation. However, average time to first diagnostic test (11 vs. 4 days) and to first treatment (62 vs. 26 days) decreased from pre- to post-implementation. These improvements in breast care can likely be attributed to the CBE training workshop with 51 attendees, the training of 6 departments on the new clinical pathway for breast patients, and the creation of a multidisciplinary tumor board which held 20 meetings over 6 months, with an average of 4 specialties and 14 clinicians.

Conclusions: Program adaptation and monitoring are still ongoing, but it will be difficult to evaluate the differing effects of the intervention and the COVID-19 pandemic on breast cancer care. This highlights the need to better study program interruptions and develop re-implementation criteria and protocols to better ensure program sustainability in light of ‘real world' challenges.

Citation Format: Anne Rositch, Christina Chao, Matogoro Kirahi, Nestory Masalu, Lucas Faustine, Leonard Washington Amango. Stakeholder Selected Strategies to Improve Breast Cancer Care in East Africa: Preliminary Implementation Outcomes and Impact Of COVID-19 [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 74.
Abstract 77: Health Care Providers and Traditional Healers Perspectives on Late Diagnosis of Breast Cancer in Tanzania: A Qualitative Study
Authors: Msoka Elizabeth F. , Gutnik Lily , Cyril Agnes M. , Kitali Brenda C. , Saria Vivian F. , Kwayu Jackline C. , Kavishe Adellaida A. , Msoka Perry C. , Herman Ayesiga , Serventi Furaha , Masenga Gilleard G. , Fayanju Oluwadamilola , Fish Laura , Mmbaga Blandina Th.
Published: July 2021

Purpose: In Tanzania, women are diagnosed at advanced breast cancer stages. The reasons for this are multifactorial and have not been systematically investigated in the Kilimanjaro Region. This study aimed to identify reasons for advanced stage breast cancer at time of diagnosis.

Methods: Four focus group discussions and 8 semi- structured in-depth interviews were conducted among health care providers (HCP) and traditional healers from five health care facilities (1 regional and 2 district hospitals) and two urban and rural communities in Kilimanjaro, Tanzania. Thematic coding via grounded theory technique was done by two independent reviewers.

Results: Twenty HCP (10 doctors and 10 nurses) and 8 traditional healers participated in the study. The average ages for doctors were 38, nurses 33, and traditional healers 50. Among HCP, the most common reasons for advanced stage breast cancer at time of diagnosis were patients initially seeking care from traditional healers, and patient distrust of conventional medicine. Among traditional healers, the most common reasons were: delayed initiation of biomedical treatment due to long turnaround of pathology results, inability to pay for diagnostic workup and treatment, and transportation issues. Both groups stated lack of patient breast cancer knowledge.

Conclusions: There was agreement that lack of adequate breast cancer knowledge and awareness as a very common reason for advanced disease presentation among HCP and traditional healers. Community health education must be designed to adopt socio-cultural and religious doctrines to alleviate the misconceptions and knowledge gap. Health system interventions are also needed to facilitate access to timely, affordable, and quality breast cancer diagnosis and treatment

Citation Format: Elizabeth F. Msoka, Lily Gutnik, Agnes M. Cyril, Brenda C. Kitali, Vivian F. Saria, Jackline C. Kwayu, Adellaida A. Kavishe, Perry C. Msoka, Ayesiga Herman, Furaha Serventi, Gilleard G. Masenga, Oluwadamilola Fayanju, Laura Fish, Blandina Th. Mmbaga. Health Care Providers and Traditional Healers Perspectives on Late Diagnosis of Breast Cancer in Tanzania: A Qualitative Study [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 77.
Abstract 86: Cancer Update in Rwanda (2009-2018)
Authors: Businge Lydia , Uwinkindi Francois , Hagenimana Marc , Murenzi Gad , Kubwimana Gallican , Musabyimana Francoise , Ingabire Charles , Munyaneza Athanase , Ingabire Cecile , Randall Thomas C , Anastos Kathryn , Castle Philip E
Published: July 2021

Purpose: In Rwanda, cancer prevalence and death have not been accurately documented up to 2018. In response, Rwanda, through the Ministry of Health and supported by Albert Einstein College of Medicine with funding from the U.S. National Cancer Institute, established a National Cancer Registry (NCR) in July 2018 to collect national cancer data. We aimed to determine the number of cancers by type, the distribution of cancers in the Rwandan population, and cancer trends over the last ten years in Rwanda. Methods: Registry data were collected over a ten-year period (2009-2018) from public and private health institutions and the National Institute of Statistics. Cancers were coded using the third edition of the International Classification of Diseases for Oncology (ICD-O3). Data entry and analysis were performed using CanReg5 system and IARCcrg quality control. The National Institute of Statistics of Rwanda provided an estimate of the country's population census for 2012 by age and sex, and the annual population was estimated assuming constant rates of change within age-sex groups.

Results: Over ten years (2009-2018), a total of 18,562 cancers were registered; 11,034 (59%) in women and 7,528 (41%) in men. Breast and cervical cancers were most common among women [n=2283 (21%) and n=2330 (21%), respectively] while prostate and stomach cancers were most common among men [n=976 (13%) and n=772 (10%), respectively]. Most cases were diagnosed in women aged 50-54 (n=1381) and 45-49 (n=1189) and men aged 60-64 (n=794) and 55-59 (n=756). Cancers diagnosed in Rwanda increased from 759 cases in 2009 to 2,862 cases in 2018.

Conclusion: In Rwanda, Cancers are more common in women and are diagnosed at an earlier age in women than in men. There has been a significant increase in documented cancers over 10 years, potentially related to significant improvements in diagnostic capacity within the Rwandan health system.

Citation Format: Lydia Businge, Francois Uwinkindi, Marc Hagenimana, Gad Murenzi, Gallican Kubwimana, Francoise Musabyimana, Charles Ingabire, Athanase Munyaneza, Cecile Ingabire, Thomas C Randall, Kathryn Anastos, Philip E Castle. Cancer Update in Rwanda (2009-2018) [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 86.
Abstract 89: National Cancer Control Committee (NCCC) as Cancer-Related Non-Governmental Organizations (NGOs) Alliance: Strengthening Partnerships among the NGOs as Part of the Cancer Control Program
Authors: Permata Tiara Bunga Mayang , Octavianus Steven , Gondhowiardjo Soehartati
Published: July 2021

Purpose: Cancer control efforts in any level need to be coordinated, as we know that we cannot defeat cancer with a single weapon or modality. This translates also for actions in the national level, which most ideally written in a comprehensive National Cancer Control Program (NCCP). As most commonly the NCCP is led by the government or Ministry of Health in the country, unfortunately resources are often found lacking. Therefore, partnerships from non-governmental institutions become crucial for the success of the NCCP.

Methods: The National Cancer Control Committee (NCCC) of Indonesia in the year 2014 – 2019 has cultivated strong partnerships with Non-Governmental Organizations (NGOs) working in cancer-relevant fields or survivors' groups in the country. Over the years, a total of 39 organizations were invited to participate in Focus Group Discussions (FGDs), Training of Trainers and Speakers (TOT and TOS), and various public awareness campaigns. These activities were spanned throughout the years but were always highlighted in the World Cancer Day February 4th annually.

Results: The NCCC has successfully served as a platform for cancer-related NGOs' alliance. All the organizations stated their support and gratitude that with the presence of NCCC, their work was more goal-oriented and reports were accounted in the national level. The NCCC had collected data from 24 NGOs of their activities and noted that there were more than 700 activities/events held by these various organizations in 1 year all over the country, which included activities on public awareness campaigns, cancer treatment services, supportive care services, human resource development, and data-based advocacy.

Conclusion: The NCCC might be the ideal platform to strengthen partnerships between cancer-related NGOs. It worked well to create equal partnerships between the organizations, connect them to the governments, and to be able to align the activities with efforts from the ministry and the NCCP.

Citation Format: Tiara Bunga Mayang Permata, Steven Octavianus, Soehartati Gondhowiardjo. National Cancer Control Committee (NCCC) as Cancer-Related Non-Governmental Organizations (NGOs) Alliance: Strengthening Partnerships among the NGOs as Part of the Cancer Control Program [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 89.
Abstract 90: Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening among HIV-Positive Women in Western Kenya
Authors: Mungo Chemtai , Ogollah Cyrillus , Ambaka Jennifer , Randa Magdalene , Guliam Anagha , Cohen Craig
Published: July 2021

Purpose: Adjunct cervical cancer screening methods, including cervicography, are under evaluation to improve the accuracy of HPV-based screening in low- and middle-income countries (LMICs). We evaluated the feasibility and acceptability of smartphone-based cervicography among HPV-positive women living with HIV (WLWH) in Western Kenya.

Methods: HPV-positive WLWH age 25-49 years enrolled in a clinical trial (NCT04191967) had digital images of the cervix taken using a smartphone by a nonphysician provider following visual inspection with acetic acid (VIA). All participants had colposcopy-directed biopsy prior to treatment. A questionnaire was administered to assess acceptability of cervicography. Cervical images were evaluated by three off-site colposcopists for quality, diagnostic utility, and assigned a presumed diagnosis. We determined the proportion of images rated as low, medium, or high quality, the interobserver agreement using Cohen's Kappa statistic, and the colposcopist's sensitivity and specificity for diagnosis of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared with histopathology.

Results: One hundred and sixty-four HPV-positive WLWH underwent cervicography during the study period. Mean age was 37.3 years. The vast majority of women, 99.4%, were comfortable having an image of their cervix taken as part of screening. Images from the first 94 participants were evaluated by off-site colposcopists, with a majority (70.9%) rated as high quality, and 86.9% of sufficient quality for diagnosis. Off-site colposcopists had a sensitivity ranging from 21.4% (95% CI 0.06-0.43) to 35.7% (95% CI 0.26-0.46), and specificity between 85.5% (95% CI 0.81-0.90) to 94.9% (95% CI 0.92-0.98) for diagnosis of CIN2+ compared to histopathology.

Conclusion: Cervicography by a nonphysician provider as an adjunct to HPV-based screening among WLWH in an LMIC setting is feasible and acceptable. However, low sensitivity for diagnosis of CIN2+ from cervical images by off-site expert colposcopists highlights the limitations of cervicography and need for a better triage test in this population.

Citation Format: Chemtai Mungo, Cyrillus Ogollah, Jennifer Ambaka, Magdalene Randa, Anagha Guliam, Craig Cohen. Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening among HIV-Positive Women in Western Kenya [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 90.