bluuebunny/crossref_metadata_2025 huggingface dataset:
Stakeholders' Experiences, Knowledge and Perspectives Regarding Care Quality for Breast Cancer in South-West Nigeria
Authors: Alabi Adewumi , Ainsworth Victoria , Lawal Abdulrazzaq , Kizub Darya , Chin Jennifer , Omidiji Olubukola , Adegboyega Bolane , Sowunmi Anthonia , Ogunyemi Doyin , Swanson William , Joseph Adedoyin , Ngwa William
Published: July 2024

PURPOSE

The majority of breast cancer cases seen in LMIC present in advanced stages where the disease has spread. Breast cancer patients in Nigeria face numerous barriers to and delays in care ranging from individual to structural issues. The ability to seek treatment starts with the personal recognition of the signs and symptoms of breast cancer. This is often hindered by lack of knowledge about breast cancer in the community, and among local healthcare practitioners resulting in many instances of misdiagnosis, which contributes to delays in patient care. To evaluate patient lived experiences and healthcare provider perspectives about breast cancer care in South-West Nigeria.

METHODS

A mixed method study was conducted in 2 phases: Phase I: 3 Focus group discussions were conducted at the NSIA-LUTH Cancer Centre in Lagos, Nigeria. The three focus groups had up to six participants each a total of 23 participants. Phase II: A pre and post-survey of a continuing medical education course focused on breast cancer was delivered to 70 healthcare providers in South-west Nigeria. Provider responses and causes for delays and barriers were extracted and analyzed. Ethical approval was obtained from Institutional HREC.

RESULTS

Data from our study reports that 70% of patients receive help from family to fund treatment highlighting why cancer can be a poverty trap for families and the need for universal health insurance. Our study also reports 42% of healthcare providers feeling only “somewhat” qualified to deal with breast cancer, highlighting the significant need for more education, with a further 14% feeling neutral or negative about their qualification, a potential contributing factor in negative interactions recalled by patients. Half of the focus group participants had a positive interaction with their doctors, with the rest reporting neutral (19%) or even negative (31%) interactions. Fear of mastectomy was a perceived barrier to care for 90% of healthcare providers while 87% and 86% of providers perceived seeking spiritual and herbal treatments as the largest delays of care.

CONCLUSION

With the success of the course and the inspiration of breast cancer survivors, a proposed expansion into community awareness is planned along with enlisting local practitioners in the fight against breast cancer in hopes of lowering the barriers to and delays of care in Nigeria.
The Economic Burden of Cervical Cancer on Women and Families in Uganda
Authors: Dau Hallie , Nankya Esther , Naguti Prisculla , Basemera Miriam , Payne Beth A. , Vidler Marianne , Singer Joel , McNair Avery , AboMoslim Maryam , Smith Laurie , Orem Jackson , Nakisige Carolyn , Ogilvie Gina
Published: July 2024

PURPOSE

There is little research on how a cervical cancer diagnosis financially impacts women and their families in low-and middle-income countries, including the burden of out-of-pocket costs. The objective of this analysis is to describe the economic burden of cervical cancer treatment, including how this differs by socio-economic status (SES) in Uganda.

METHODS

We conducted a cross-sectional study from September 19, 2022 to January 17, 2023. Women were recruited from the Uganda Cancer Institute and Jinja Regional Referral Hospital and were eligible for this study if they were ≥ 18 years, being treated for cervical cancer, and provided consent. Participants completed a 45-minute survey which included questions about their out-of-pocket costs, unpaid labor, and changes in their family’s economic situation. A wealth index was constructed from the participant’s ownership of household items to determine their SES. Descriptive statistics were reported.

RESULTS

Of the 338 participants who completed the survey, 183 were from the lower SES. Women from the lower SES were significantly more likely to be older, have primary school education, and have a more advanced stage of cervical cancer. Both groups of women reported paying out-of-pocket for cervical cancer care (higher SES 95.5%, lower SES 92.3%). Only 15/338 participants stopped treatment because they could not afford it. Women of a lower SES were significantly more likely to report borrowing money (p-value=0.004) and selling possessions to pay for cancer care (p-value=0.006). With regards to unpaid labor, women from both groups reported decreasing the amount of time that they spent caring for their children since their cervical cancer diagnosis.

CONCLUSION

Regardless of their SES, women in Uganda incur out-of-pocket costs related to their cervical cancer treatment. However, there are inequities as women from the lower SES groups were more likely to borrow funds to afford treatment. Alternative payment models and further financial support could help alleviate the financial burden of cervical cancer care on women and families in Uganda. The results of this analysis can be used to demonstrate the indirect economic impact that a cervical cancer diagnosis has on not only women but their families as well. This in turn can be as evidence to expand global cervical cancer screening programs and eliminate cervical cancer worldwide.
The Impact of YAP-Mediated Hippo Signaling in Obesity and Triple Negative Breast Cancer
Authors: Dave Krisha , Cui Xin , Zhu Yueming , Wan Yong
Published: July 2024

PURPOSE

Obesity is one of the most prevalent and modifiable risk factors for chronic diseases such as cancer. Recent meta-analyses suggests that breast cancer-specific death among obese women is elevated 1.3-fold in comparison to normal weight woman. There is also an increased risk of developing triple negative breast cancer (TNBC) in women with a higher waist/hip ratio. However, the underlying pathophysiology linking obesity, adiposity, and TNBC needs further investigation.

METHODS

Colony formation assays were performed where cells were infected with control or shYAP lentivirus for 48 hours before 400 4T1 cells per well were seeded into a six-well plate. Seeded colonies were treated with stromal conditional medium (SCM) or adipocyte conditional medium (ACM) for 10 days. Cells were fixed with 4% paraformaldehyde for 15 min at room temperature, followed by staining with 0.025% crystal violet for 30 minutes. For Western blotting, cells were harvested and lysed in 1x SDS loading buffer. The protein concentration was determined using Bio-Rad protein reagent. Antibodies against YAP and HRP-conjugated goat anti-rabbit secondary antibody (Promega) were used. Signals were detected with ECL reagents (Bio-Rad). Semi-quantification of data was performed using NIH ImageJ.

RESULTS

This study establishes a mechanistic link between obesity-altered metabolism and dysregulated proteasomal pathways, specifically the YAP-mediated Hippo cascade. Results show that the Hippo signaling pathway is highly regulated in obese mice in comparison to normal controls, as supported by RNA-sequencing. KEGG data also depicts other genes in oncogenic metabolic pathways as present in obese mice. Furthermore, data from clonogenic assays on three TNBC cell lines treated with ACM show increased cancer cell colony formation efficiency, suggesting that adipocyte secretome can increase tumor growth. In addition, YAP expression levels are elevated in the breast cancer cells under ACM treatment, and the knockdown of YAP diminishes the tumor inductive effect driven by ACM. Thus, this study uncovers the clinical relevance of the Hippo-YAP axis in regulating obesity-related breast cancer.

CONCLUSION

In conclusion, the study suggests that adipocyte secretome affects tumor proliferation and progression, as observed by experimentation on TNBC cell lines using ACM/SCM and testing for YAP expression levels. Future directions would studying the effect of the YAP inhibitor on ACM treated tumor cell growth.
The Increase in Deaths From Breast Cancer in Brazil: An Analysis of a Decade
Authors: Pires Rafaela , Afonso Mariana , Loureiro Yasmin
Published: July 2024

PURPOSE

Analyze the increase in the number of deaths from breast cancer in Brazil between 2012 and 2022.

METHODS

Descriptive cross-sectional epidemiological study based on secondary data from the Mortality section of the DATASUS platform from 2012 to 2022. The variable analyzed was the number of deaths from breast cancer in the Brazilian population. In addition, data from the National Cancer Institute (INCA) regarding the estimated number of breast cancer cases for 2012 and 2022 was used as a secondary data source.

RESULTS

In 2012, a total of 13,755 deaths from breast cancer were recorded in Brazil by the SUS (Brazil's public health system). In the subsequent ten years, this number gets more significant. There were 14,394 deaths from this cause in 2013, 14,789 in 2014, 15,600 in 2015, 16,259 in 2016, 16,932 in 2017, 17,770 in 2018, 18,300 in 2019, 18,036 in 2020, 18,365 in 2021 and 19,371 in 2022. Therefore, when comparing directly 2012 and 2022, it reveals a total increase of 134.57% in the number of deaths from breast cancer. Furthermore, according to the National Cancer Institute, the estimated number of cases of breast cancer in 2012 was 52,680, and in 2022 was 66,280, representing a growth of 125,81%.

CONCLUSION

Notably, there was a considerable increase in breast cancer deaths over the analyzed decade. This increase is related to the change in the women's way of life since they are more concerned about their health today. In the last ten years in Brazil, public health campaigns for breast cancer awareness have grown significantly, encouraging women to be attentive to symptoms by self-touching and to do medical exams regularly. As a result, the number of diagnoses increased, as well as the number of deaths, not necessarily meaning that more women have breast cancer compared to previous years, but more women are having the diagnosis and being aware that they have the disease.
The Role of Racial Disparities in Gene Expression Profiling for the Prediction of Therapeutic Response in Patients With Breast Cancer
Authors: Ani Angela , Achi Franklyn , Okafor Michael , Ohayi Samuel Robsam , Agu Kenneth , Ghasi Samual , Okoli Uzoamaka
Published: July 2024

PURPOSE

Genetic variations affecting gene expression play a crucial role in breast cancer chemotherapy response. This study investigates how gene expression profiles impact treatment outcomes and explores racial disparities in chemotherapy response among breast cancer patients.

METHODS

Utilizing data from The Cancer Genome Atlas (TCGA) via Cbioportal, gene expression profiles of 8,132 breast cancer patients from 23 studies were analysed. 2030 patients were categorized into 1,743 white and 287 black. Among them, 407 received cyclophosphamide, 291 received doxorubicin, and 215 received tamoxifen or combination therapy. Mutual exclusivity was assessed, and P-values were calculated using Fisher's exact test, assuming the null hypothesis that the frequency of alteration occurrence in a pair of genes is proportional to independent occurrences in each gene. The enrichment of genes between patients of European ancestry and African descent was analysed. Kaplan-Meier plots were generated, and P-values from the log-rank test were determined to assess survival differences.

RESULTS

Significant differences in gene expression profiles were observed between white and black/African American patients. Notably, the GCA (p < 0.001) gene, encoding a calcium-binding protein abundant in immune cells, showed complete alteration in less than 1% of white patients and was absent in black/African American patients. Commonly expressed genes with variations in both racial groups included TP53, PIK3CA, IGLV3-25, CSMD1, ERBB2, MYC, TTN, CDK12, and CASC8. Ethnicity influenced chemotherapy response, with patients of European ancestry exhibiting superior overall survival. Both racial groups showed heightened response to cyclophosphamide but reduced response to tamoxifen.

CONCLUSION

Patients of European ancestry had better survival rates compared to black or African American patients, possibly due to differences in gene expression profiles amongst other factors. However, the specific role of the GCA gene in breast cancer pathogenesis remains unclear. Understanding gene expression patterns, particularly in tumour-infiltrating lymphocytes, may shed light on immune responses in breast cancer. Racial disparities in gene expression profiles significantly impact chemotherapy response and patient outcomes, highlighting the need for further research into genetic determinants and immune responses to refine therapeutic interventions. This study highlights the importance of personalized treatment strategies informed by genetic and racial considerations in breast cancer management.
Transcriptomic Features Associated to Neoadjuvant Chemotherapy Response in Four Molecular Breast Cancer Subtypes
Authors: Guevara-Nieto Hedda Michelle , Parra-Medina Rafael , Orozco Carlos Alberto , Mejia-Garcia Alejandro , Zabaleta Jovanny , Lopez-Kleine Liliana , Combita-Rojas Alba Lucia
Published: July 2024

PURPOSE

Breast cancer (BC) represents a major public health issue. The effectiveness of neoadjuvant chemotherapy (NAC) varies among breast cancer patients, with some experiencing incomplete pathological responses. This variability in treatment response may be attributed to differences in tumor heterogeneity and its microenvironment (TME). This study investigates gene expression patterns associated to non-response to NAC in invasive BC patients, emphasizing the role of genes, pathways and the variability among BC subtypes.

METHODS

A transcriptomic study analyzed 58 baseline samples from women with advanced breast cancer at the Colombian National Cancer Institute, categorizing them into 29 NAC responders and 29 non-responders. The study comprised gene expression comparison, enrichment analysis, tumor microenvironment estimation via xCell, and therapeutic efficacy of targeted drugs using PrRophetic package.

RESULTS

Different gene expression profiles distinguished responders from non-responders among various breast cancer subtypes, highlighting immune-related pathways like IL-17 and TNF signaling, B and T cell receptor signaling, complement and coagulation cascades, natural killer cell-mediated cytotoxicity, and NF-kB signaling. Non-responders in Luminal B HER2- subtype exhibited increased endothelial cells and immune and microenvironment scores, while Luminal B HER2+ non-responders showed higher levels of CD4 Tcm, CD4 Tem, and megakaryocytes. Sensitivity to multiple potential therapeutic drugs (Lestaurtinib, Avagacestat, GSK3 inhibitor, Veliparib, Tretinoin, Afatinib, Vinorelbine, RSK1 inhibitor, Motesanib) varied distinctly among non-responders.

CONCLUSION

Immune-related genes and diverse immune cell subtypes within the TME correlate with response to NAC, with significant changes observed between response groups and subtypes. Comprehensive detection and evaluation of TME components are crucial for predicting NAC efficacy and preventing disease relapse. These findings underscore the importance of studying mixed populations to uncover novel insights and address disparities.
Vaccine Attitudes Among Parents: Comparing HPV and COVID-19 Vaccines Perceptions in Healthcare Workers' and the General Population in Japan
Authors: Jamil Hasan , Abubakar Aminu , Gilmour Stuart , Ozaki Akihiko , Tabuchi Takahiro
Published: July 2024

PURPOSE

This study explores attitudes towards HPV and COVID-19 vaccinations among parents of healthcare workers and the broader Japanese population, emphasizing parental decisions about vaccinating daughters. It contrasts these attitudes with those of healthcare workers, providing insights into vaccine acceptance and hesitancy.

METHODS

Data from the 2022 Japan COVID-19 and Society Internet Survey (JACSIS) were used for a cross-sectional analysis. Subjects included parents of healthcare workers and the general population with daughters born between 1997 and 2010. The survey assessed willingness to vaccinate against HPV and COVID-19 under various conditions, like doctor advice and media reports. Responses were captured on a Likert scale and aggregated into a composite vaccination propensity score. This score was compared between parents of healthcare workers and other respondents using an independent samples t-test.

RESULTS

The analysis included 965 participants, with 70 medical workers and 895 non-medical workers. No significant difference was observed in attitudes towards the COVID-19 vaccine between medical and non-medical workers (p-value = 0.0655). In contrast, a significant difference was observed in attitudes towards the HPV vaccine (t = 2.7017, df = 80.296, p-value = 0.008413). Medical workers were more willing to vaccinate their daughters against HPV (mean score = 2.7) compared to their counterparts in other occupations (mean score = 1.3).

CONCLUSION

The study reveals a distinct divergence in vaccine acceptance in Japan: while COVID-19 vaccination attitudes are uniform across different groups, parents of healthcare workers demonstrate a higher acceptance of HPV vaccination than the general public. This indicates that vaccine perceptions are significantly influenced by specific disease characteristics and accessible information, rather than a uniform vaccination viewpoint. The findings emphasize the need for targeted, disease-specific public health campaigns, particularly for HPV vaccines. Adapting successful strategies from COVID-19 vaccination drives, such as clear communication of benefits, countering hesitancy with trusted medical advice, and widespread public campaigns, could improve HPV vaccine acceptance. In this context, the influential role of healthcare workers and their families in advocating for vaccines becomes vital for enhancing public perception and increasing uptake of the HPV vaccine.
Two Novel Precursors of HIV-1 Proteases Inhibitors as a Novel Anticancer Therapy: Real Time Metabolic Profile Analysis of Leukemia and Myeloma Cell Lines
Authors: Sichetti Mariza , Giglio Eugenia , Giuseffi Martina , Mecca Marisabel
Published: July 2024

PURPOSE

As of today, the central role of mitochondrial metabolism associated with tumorigenesis and progression of malignancies has been deeply investigated. Moreover, oxidative phosphorylation inhibition shows that aerobic glycolysis alone is not sufficient to sustain cancer cell survival. In this study, we used Agilent Seahorse XF-Pro Analyzer to investigate the effect of two different HIV-1 protease inhibitor precursor, by interrogating mitochondrial respiration and glycolysis of live cells in real time.

METHODS

The Agilent Seahorse XF-Pro Analyzer is a fully integrated 96-wells instrument that measures in real time, directly into the cell culture plate, the flux of oxygen (oxygen consumption rate, OCR) and protons (extracellular acidification rate, ECAR) of respectively mitochondrial respiration and glycolysis. The Seahorse ATP rate assay kit is used a fluorescent biosensor cartridge, able to measure pH and oxygen levels in the medium. Data were expressed as a percentage of OCR or ECAR change comparing metabolic rate after compound exposure to a pre-exposure baseline. Two multiple myeloma cell lines (MM1S and RPMI-8226) and a chronic lymphocytic leukemia cell line (HG3) were treated for 24h with HIV-1 protease inhibitor precursor of Darunavir (RDD-19 and RDD-142). Peripheral blood mononuclear cells (PBMCs) isolated from healthy donators were used as control.

RESULTS

In the experimental protocol used, we observed that the mitochondrial respiration rates markedly decrease in response to RDD-19 and RDD-142 in all cell lines. In particular, in HG3 (chronic lymphocytic leukemia) cells the effect of RDD-142 compared to RDD-19 and DMSO (negative control) is extremely significant. Interestingly, the mitochondrial ATP production decreases in parallel with the slightly increase of glycolytic rate suggesting a compensatory effect in cellular survival.

CONCLUSION

The Warburg effect postulated that the increase of glycolysis rate drives malignant transformation. However, the importance of mitochondrial respiration contribution and subsequent energy production still have a fundamental role in tumor growth. Our data confirms this argument and suggests that respiration-deficient cancer cells have a severely compromised ability for tumor progression. In particular, our finding shed light on further investigation of RDD-19 and RDD-142 as promising anticancer candidates on leukemia and myeloma cells.
A Novel Mechanism Promotes Actin Patch Formation to Prevent Chromatin Bridge Breakage in Cytokinesis
Authors: Balafouti Sofia , Zachos George , Petsalaki Eleni
Published: July 2024

PURPOSE

Chromatin bridges are strands of incompletely segregated DNA connecting the anaphase poles or daughter nuclei. If unresolved, chromatin bridges can break in cytokinesis leading to micronuclei formation and accumulation of DNA damage. To prevent this, human cells form accumulations of polymerized actin (actin patches) at the base of the intercellular canal to stabilize chromatin bridges however, the molecular mechanisms involved are incompletely understood.

METHODS

To investigate these mechanisms, we analyzed carcinoma cells by confocal or live-cell fluorescence microscopy. Also, to detect proteins from cell lysates we used molecular techniques, such as western blotting and GST-pull downs.

RESULTS

In the present study, we identify small GTPases and downstream signaling components which control the growth or contraction of filamentous actin fibers, that localize to actin patches and are required for stable chromatin bridges in cytokinesis. Inhibition of these actin regulators reduces actin patch formation and promotes chromatin bridge breakage. Furthermore, chromatin breakage in cells deficient for the above proteins is not caused by premature abscission, but correlates with reduced actin patches compared with wild-type cells. We also propose that DNA bridges generate tension inside the nucleus which is then transmitted through specific mechanosensitive complexes to the cell cytoskeleton to promote generation of actin patches in the cytoplasm.

CONCLUSION

This study identifies a novel signaling pathway that prevents chromatin bridge breakage by promoting actin patch formation in cytokinesis in human cells. Because chromatin breakage can lead to genomic instability that is associated with cancer formation or progression, understanding how cells stabilize chromatin bridges may help us understand mechanisms of tumorigenesis.
Assessing Differences in Healthcare Access for Women in Rural Uganda by HIV Status
Authors: Sheehan Mia , Dau Hallie , AboMoslim Maryam , Naguti Priscilla , Mwandacha Nelly , Booth Amy , Smith Laurie , Orem Jackson , Ogilvie Gina , Nakisige Carolyn
Published: July 2024

PURPOSE

Although a preventable disease, cervical cancer is a leading cause of cancer death among women in low- and middle-income countries (LMICs). Uganda has one of the highest cervical cancer incidence rates, largely due to limited accessibility and availability of screening services. Human immunodeficiency virus (HIV) positive women are significantly more likely to develop cervical cancer and face barriers to accessing healthcare when compared to HIV-negative women. As such, HIV-positive women represent a priority population for cervical cancer prevention. This study aims to compare how HIV-positive and HIV-negative women in rural Uganda access health services to inform the integration of cervical cancer screening with HIV care.

METHODS

This cross-sectional study recruited women living in the South Busoga District Reserve from January to August 2023. Women were eligible if they were aged 30 to 49 years old, had no history of cervical cancer screening or treatment, had no previous hysterectomy, and could provide informed consent. Participants completed a survey administered by village health teams, which included questions on HIV status, demographics, healthcare access, and services received. The data was analyzed using bivariate descriptive statistics, including chi-square and Fisher's exact tests.

RESULTS

Among the 1437 participants included in the analysis, 8.8% were HIV-positive. The majority of the respondents were between 30-39 years of age, were married, had received primary education or higher, and were farmers. The majority of women in both groups had accessed outreach visits (HIV-positive = 89.0%, HIV-negative = 85.8%) and health centers (HIV-positive = 96.1%, HIV-negative = 80.2%). The most commonly received services among both groups of women at outreach visits and health centers were immunization and antenatal care, respectively.

CONCLUSION

Our study demonstrated that there were no significant differences in healthcare access between HIV-positive and HIV-negative women in rural Uganda. Additionally, the high usage of healthcare services by women living with HIV suggests that the integration of cervical cancer and HIV screening may facilitate early detection and prevention of cervical cancer among this population. This can reduce the burden of disease in Uganda and further contribute to the World Health Organization's initiative to eradicate cervical cancer.
Building a Laparoscopic Urology Cancer Program in an Academic Tertiary Hospital in Southern Nigeria
Authors: Oyetola Okonji Nkemdilim Ifeyinwa , Osaghae Samuel Omoregie , Osaigbovo Emmanuel Osaro , Ozah Ehiremen , Obasuyi Joseph
Published: July 2024

PURPOSE

Despite being the mainstay in early renal cancer treatment worldwide, due to the proven advantages of significantly reduced morbidity, reduced blood loss, better cosmetic appearance, and early discharge, laparoscopic cancer surgeries are rarely performed in low and middle-income countries in Nigeria This is largely due to a dearth of laparoscopic Urology cancer training programs in majority of Nigeria. This paper aims to describe the pilot implementation of a laparoscopic renal training workshop in one of the flagship tertiary teaching hospitals in the southern geopolitical zone of Nigeria, as a means of capacity building for improved renal oncologic outcomes.

METHODS

The 1st advanced laparoscopic Urology workshop was conducted at the University of Benin Teaching Hospital from the 11th- 15th of September 2023. Fourteen Participants were nominated across 3 hospitals that offer open renal Urologic surgeries for renal pathologies, including renal malignancies in 2 of the 6 states in the South-South region of Nigeria. Following the training, pilot implementation of laparoscopic renal cancer surgery was done in consenting patients in one of the centers. The study endpoints were implementation outcomes of reach during the training workshop and feasibility of the program, and its descriptive statistics were computed.

RESULTS

The reach of the training workshop among Urology consultants was 75% (n=6). The reach among Urology trainees was 67% (n=4). Laparoscopic surgery was executed in 67% (n=10) of patients. Male to female ratio was 1:1. Age range 21-67 years. Rate of conversion to open surgery was 20% (n=2). Postoperative surgical morbidity was recorded in 10% (n=1). Postoperative hospital stay was 3-5 days. There was no requirement for blood transfusion and no mortality was recorded. Participants reported a high rate of relevance of the training on their knowledge, acquisition of intended skills and intent to use the skills gained to perform laparoscopic urology surgeries. Challenges faced were lack of adequate urology laparoscopy instruments, out of pocket financing of surgeries and limited capability of the improvised lap trainers/ simulators.

CONCLUSION

Notwithstanding the challenges, the lap program was feasible to implement in a low resource setting. The success of the 1st advanced Urology Laparoscopic training program in UBTH projects the effectiveness of cancer training programs in low and middle income countries.
Cancer Burden in Rwanda: 5 Years Diagnostic Experience at University of Teaching Hospital of Butare, Rwanda
Authors: Fathima Samreen , Hategekimana Elise
Published: July 2024

PURPOSE

Cancer is recognized as a global problem. Recent reports indicate that 1 in 5 men and 1 in 6 women worldwide will develop cancer in their lifetime. In 2018, 18.1 million new cases were reported worldwide, with many of them occurring in low- and middle-income countries. Approximately 1 million new cases are diagnosed annually in Africa. The University Teaching Hospital of Butare (CHUB) diagnoses many cancer cases annually at Anatomical Pathology Laboratory, but there is no consensus or study as to which types of cancers predominate and how patient care can be enhanced in future. In this study, we studied the status of cancer burden based on types at CHUB, Rwanda. We reviewed the different types of diagnosis made and the associated demographics.

METHODS

This retrospective study included all anatomical pathology reports seen between 2018-2022 at CHUB. Anatomical pathology reports were examined, and cases were classified based on age, sex, district/location, and diagnosis of malignancy. Cancer types were grouped according to the 10th revision of the International Classification of Diseases.

RESULTS

A total of 8085 specimens reports were examined. Of the 8085 specimens, 1709 (21%) had diagnosis of malignancy and 6376 specimens had a benign diagnosis. Of the 1709 specimens, 990 were female patients and 717 were male patients. Diagnosis of Carcinoma (1365), sarcoma (109), lymphoma (99), melanoma (59), and non-differentiated (45) was made. In patients less than 15 years old, lymphoma had the highest rate of diagnosis, followed by sarcoma. Of all diagnosed cancers, cervix was most prevalent followed by stomach, prostate, breast, and skin. Cervical carcinoma was most prevalent in females and prostate in males.

CONCLUSION

Cancer cases and the number of diagnosed specimens increased in 2020. The number of histologically diagnosed cancers is still low considering 4 million people who can access care at CHUB. Gastric cancer is a major concern as it comes second behind cervix by only 5 cases in the last 5 years. Major challenges of further classifications of sarcomas, lymphomas and non-differentiated cancers are due to lack of immunohistochemistry, as well as population sensitization for screening and early diagnosis.
Correlation Studies Are Essential for Achieving World Health Organization Cervical Screening Targets
Authors: Suba Eric , Neethling Greta , Boaz Mwesigwa , Van Duong Dang , Grzybicki Dana
Published: July 2024

PURPOSE

Cervical screening prevents cervical cancer by detecting and eradicating pre-cancerous cervical lesions before they progress to cancers. The World Health Organization global strategy to accelerate the elimination of cervical cancer as a public health problem sets the following two targets regarding cervical screening: 70% of the world's women should be screened with a high-performance test, and 90% of women with cervical disease should receive appropriate follow-up care. Quality management is the clinical discipline that assesses whether those targets are met.

METHODS

Correlation studies (CS) are quality management methods that compare cervical screening test results with follow-up cervical biopsy test results and assess whether those pairs of results are concordant, discordant, or missing. CS assess whether women with abnormal cervical screening test results have received appropriate follow-up care. CS determines whether cervical screening tests are high-performing by assessing whether cervical disease-detection rates are in control, relative to local benchmarks. Because CS detect medical errors, there are psychological, professional, and financial obstacles that hamper implementation of CS. In 1988, the US Federal Government mandated implementation of certain types of CS throughout the USA. Because there is little data regarding implementation of CS in LMICs, we surveyed practitioners in LMICs, in person and by videoconference, regarding local practices for implementation of CS in LMICs.

RESULTS

Where implemented, CS provides information critical to assuring the effectiveness of cervical cancer prevention efforts in LMICs. However, there are significant obstacles to implementing CS in LMICs.

CONCLUSION

In LMICs, expanding information-sharing networks among clinical practitioners, improving quality management training in CS, and implementing appropriate changes to healthcare regulations will help meet cervical screening targets set by WHO and thereby improve the effectiveness of global cervical cancer prevention efforts.
Dietary Patterns and Risk of Breast Cancer in Africa: A Systematic Review
Authors: Dabar Anita , Akinsolu Folahanmi Tomiwa , Abodunrin Olunike , Olagunju Mobolaji , Adekola Bukola Marylyn , Aleru Elizabath , Ajala Lydia , Samuel Ekundayo , Mustahpa Adetoun
Published: July 2024

PURPOSE

Breast cancer is one of the leading causes of cancer affecting women worldwide. The etiology of cancer is multifactorial and includes both non-modifiable factors such as age, race, and ethnicity and modifiable factors such as dietary patterns, level of physical activity, and alcohol consumption. Most epidemiological studies investigating the role of dietary patterns in the development of breast cancer are mostly performed in Western countries, and thus dietary patterns in Africa and breast cancer are less understood. It is therefore imperative to identify specific African diets or food groups that can be linked to the development of breast cancer. To systematically review and identify studies that investigate the role of African dietary patterns or food groups in the development of breast cancer.

METHODS

Studies that were published between January 2010 and June 2023. Articles that focused on groups, single food groups, or nutrients were included in the search. Search terms were combined using Boolean operators: breast cancer AND (diet OR dietary patterns) AND Africa AND women. Scopus, PubMed, Web of Science, and Google Scholar were used as databases to search for relevant articles. Studies that met the inclusion criteria were included in the review. A total of 13 articles met the search criteria. The quality of each article was appraised. Using relevant tools. Using a data extraction form, relevant information was extracted from the 13 articles.

RESULTS

Diets rich in fruits, vegetables, and lean proteins may reduce breast cancer risk, while processed foods may contribute to increased risk.

CONCLUSION

There is a need for a culturally sensitive yet scientifically informed approach to dietary guidelines in African countries aimed at breast cancer prevention.
Distribution and Types of High-Risk Human Papillomavirus Genotypes and Associated Cervical Neoplastic Lesions in Women Living With HIV Infection in Jos Nigeria
Authors: Magaji Francis , Cosmas Nanma , Acheng Shedrach , Nenrot Danjuma , Asufi Joyce , Christian Elizebeth , Olugbenga Silas , Sagay Solomon , Murphy Robert , Lifang Hou , Achenbach Chad , Musa Jonah
Published: July 2024

PURPOSE

The distribution of high-risk human papillomavirus (hrHPV) genotypes in women living with HIV (WLWH) and cervical neoplastic lesion (CNL) are not clearly predictable. We sought to determine prevalence of hrHPV genotypes, distribution, risk of multiple hrHPV and CNL in WLWH in Jos, Nigeria.

METHODS

Study was carried out from a cohort of study participants in the u54 NIH/NCI funded project titled ‘Epigenomic biomarkers of HIV-Associated Cancers in Nigeria’ (U54CA221205) in Jos, Nigeria. WLWH who were CC-free (n=22), precancer (61) and CC (n=17) gave informed consent and participated in the study between Oct’-2019 & Sept’- 2022. Information on socio-demographic and clinical history were obtained using structured questionnaire. Cervical-vaginal specimens collected, HPV DNA detection and genotyping performed using Anyplex-II HPV28 kit (Seegene, Korea). Prevalence and distributions of hrHPV genotypes determined and logistic regression analysis used to analyze associations between multiple hrHPV and CNL.

RESULTS

Of the 101 WLWH, median age was 50.00 (IQR 43-57), median duration of HIV infection was 12 years (IQR 9-14), and median age at sexual debut was 18 years (IQR 16-20). History of multiple sexual partners (MSP) was 70.3%. The overall hrHPV prevalence was 57.4%, with single hrHPV in 29.7% and multiple hrHPV in 27.7%. The three commonest hrHPV genotypes were HPV 16 (12.9%), HPV 31 (10.9%), and HPV 45/52/58 (9.9%). HPV genotypes 16/18/other-hrHPVs was 10.9%, and HPV 31/33/45/52/58 without HPV 16 or 18 was 11.9%. HPV 16 was higher for precancer, and CC compared with CC-free (46.1% vs 38.5% vs 15.4%, p=0.113) and HPV 31/other-hrHPVs was higher in precancer and CC (71.4% vs 28.6% vs 0%, p=0.282) and other-hrHPVs without genotype 16 or 18 was higher in precancer compared with CC-free and CC (82.3% vs 5.9% vs 11.8%, p=0.141). History of MSP (aOR=8.18, 95% CI 1.44, 59.04), age at first cervical cancer screening (aOR=7.5, 95% CI 1.29, 63.23), and duration of HIV infection in years (aOR=0.86, 95% CI 0.73, 0.99), were independently associated with multiple hrHPV genotypes.

CONCLUSION

There is high prevalence of multiple hrHPV genotypes with diverse distribution. Universal HPV vaccination and HPV DNA testing for cervical cancer screening in HIV clinics may lead to reduction in incidence of CNL among the most at risk population.
Effectiveness of an Educational Intervention to Improve Safe Handling of Chemotherapeutic Drugs Among Healthcare Workers in Vietnam
Authors: Nguyen Cham , Nguyen Kim Hoa , Nguyen Mai Anh , Nguyen Thu Namg , Le Son , Tran Kim Cuc , Nguyen Ha , Pham Ha , Nguyen Hoai Thu , Tong Xuan Vinh , Trinh Hieu , Le Thanh Chi , Mai Loan , Nguyen Luu Hoang , Nguyen Ngoc , Hermiston Michelle , Bui Lan Ngoc
Published: July 2024

PURPOSE

To ensure the safety of patients and healthcare workers (HCWs), guidelines for the safe handling of hazardous drugs, such as chemotherapy agents, and the provision of personal protective equipment (PPE) are critical. These guidelines and PPE are only effective if they are followed. In developing countries, models to improve PPE compliance to reduce HCWs occupational exposure are required. This pilot aims to evaluate PPE compliance following an educational program in four hospitals caring for children with cancer in Vietnam.

METHODS

Healthcare workers classified as doctors, nurses, pharmacists, pharmacy technicians, and ancillary staff from pediatric hematology oncology and pharmacy departments from four hospitals undertook a 90-minute educational program. The educational intervention included a video on the management of hazardous drug spills and slides presentation on principles of safe hazardous drugs handling facilitated by trainers at each facility. Compliance was monitored monthly for 3 months following the intervention. Participants completed pre- and post- intervention online anonymous knowledge questionnaire. T and Ï‡2-tests are used for statistical analyses.

RESULTS

We conducted a total of 2894 direct observations for PPE compliance, including 1,129 pre-intervention and 1765 post-intervention. PPE compliance increased significantly from baseline 44% to 79%; P < 0.001. Compliance improved on all indications and professional categories following the introduction of the educational intervention. Greatest significant improvements were seen with disposal or cleaning (62 vs 7%; P < 0.001), administration (59 vs 25%; P < 0.001), and physician group (58 vs 9%; P < 0.001), respectively. There was significant increase in mean total knowledge score post-intervention (17.7 ±2.1) than pre-intervention (15.5 Â±3.4) (p < 0.00001).

CONCLUSION

A simple educational model was implemented in four Vietnamese hospitals that revealed good PPE compliance. Safe handling knowledge of chemotherapeutic drugs increased during the intervention. This PPE compliance model could be used in developing countries where resources are limited.
Emerging Evidence on Induction Chemotherapy and Implications for Care of Cervical Cancer Patients in Low Resource Settings
Authors: Lawal Ishak , Olayiwola Ololade Kehinde , Faurk Halima , Abdullahi Habiba Ibrahim , Ahmadu Oiza Tessy , Yaqub Habeebu Mohammed , Folasire Ayorinde , Kwis Samuel , Musa Ali Gombe , Otene Samuel A.
Published: July 2024

PURPOSE

Induction chemotherapy followed by chemoradiation was found to further improve both overall survival (OS) and progression free survival (PFS) for locally advance cervical cancer in a phase 3 INTERLACE trial. This is a significant improvement in the care of cervical cancer since the 1999 clinical announcement of chemoradiation as the standard of care by National Institute of Health (NIH). We hereby propose exploration of the application of the study to improve cervical cancer care in low resource settings.

METHODS

We constructed a typical clinical course for a cervical cancer patient in low resource settings based on interactions with our patients needing radiotherapy services. We then conducted a desktop review of literature to broaden our understanding of interventions employed by other healthcare providers in low resource settings to provide care for cervical cancer patients needing radiotherapy services. Those interventions involving use of chemotherapy were further explored in the light of the findings of the INTERLACE trials for possible extrapolation of evidence.

RESULTS

The challenges of access to radiotherapy services in low resource settings is multifactorial including availability, affordability, accessibility, acceptability and sustainability factors. There are robust multinational collaborative efforts to address the availability factors with little or no considerations for the other factors. Chemotherapy similar to the protocol used in the INTERLACE trial has been innovatively used in various settings to provide some care for cervical cancer patients needing but not able to receive radiotherapy services due to various factors. There is however no documented evidence on impact of such innovations on the burden of cervical cancer in settings where they are applied.

CONCLUSION

The INTERLACE trial has opened a new frontier on the role of chemotherapy in the management of locally advanced cervical cancer that can be further explored to improve the outcome of care in resource constraints settings with limited access to radiotherapy services.
Epidemiological Analysis of Deaths for Malignant Bladder Neoplasia in Adults in the Last 4 Years in Brazilian Territory
Authors: Loureiro Yasmin Marques , Cruz Guihherme Ferreira , Borsa Eduarda Paica , Rodrigues Heitor Vieira , Paesi Dutra Pedro Henrique
Published: July 2024

PURPOSE

Bladder cancer represents a significant public health concern worldwide, with its incidence and socioeconomic impact standing out as persistent challenges. The objectives of this study were to analyze deaths related to malignant bladder neoplasms in Brazil between 2019 and 2022, conducting an analysis in relation to the age group, sex, and color/race of the patients, with the aim of providing an overview of mortality during this period.

METHODS

This is a cross-sectional, retrospective, descriptive study about deaths related to malignant bladder neoplasms in Brazil from 2019 to 2022. The data were gathered from the Brazilian Unified Health System (DATASUS) in the “Tabnet” section, selecting those that addressed the age group, sex, and color/race of the patient. The information was grouped in the four years in question based on the three variables mentioned and subsequently analyzed to establish an overview of mortality in the period.

RESULTS

The period and detailed age group accounted for a total of 10,073 deaths in Brazil. The highest number of deaths occurred in 2022 (26.92%), followed by 2021 (25.68%). There was an increase in total prevalence during the studied period, with the highest rate of increase between the years 2020 and 2021 (6.54%), followed by 4.83% between the years 2021-2022. Comparing 2019 with 2022, there was an increase of 15.60%, with the number of deaths in 2022 equivalent to 26.92% of the entire period studied. There were more deaths among male patients, with more than a 100% difference in prevalence between sexes throughout the entire period. The Caucasian population was the most affected, corresponding to 64.57% of deaths during this period.

CONCLUSION

Therefore, it is possible to understand, based on the epidemiological profile constructed, how deaths related to malignant bladder neoplasms in adults have been established in recent years. Thus, it is noted that mortality has increased, emphasizing the relevance of the problem. It was also possible to outline the most prevalent patient profile, which corresponds to male and Caucasian patients. Therefore, the broad development of measures to mitigate this alarming public health problem becomes relevant in Brazil.
Expansion of Cancer Diagnostics Reimbursement in Tbilisi, Georgia, Driven by Evidence-Based Economic Forecast Model
Authors: Verdzadze Natia , Mallafré-Larrosa Meritxell , Polo Alfredo , Morand Mathieu , Khizanishvili Gvantsa
Published: July 2024

PURPOSE

In 2013, Georgia introduced a Universal Healthcare (UHC) program that has improved access to cancer care and reduced financial barriers for patients. While about 80% of the costs derived from cancer treatment are covered by the UHC insurance, diagnostics (including pathology and imaging) are not currently reimbursed. Thus, in Georgia a significant number of patients are diagnosed with advanced cancer. As part of the City Cancer Challenge (C/Can) initiative in Tbilisi operative as of 2019, a forecasting economic model was developed to provide the ministry of health (MoH) with robust evidence supportive of the inclusion of cancer diagnostics in the UHC program.

METHODS

A standard package of cancer diagnostic services was developed in accordance to local and international guidelines, including Tbilisi's local guidelines for the management of locally invasive breast carcinoma and invasive carcinoma of the cervix and those of the National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO). Seven tertiary care clinics (5 in Tbilisi and 2 outside the capital) were randomly selected to obtain pricing information on diagnostic procedures. The forecasted 5-year incidence rate for each cancer type was obtained from the Global Cancer Observatory (GCO) database, and an interpolation method was used to fill in estimates for interim years. For cancer types with unavailable GCO data, it was retrieved from the NCDC database, and an extrapolation method was used to predict future 10-year incidence rates. A budget forecast model was developed to estimate the investment required for cancer diagnostics over the next 10 years using a Markov model.

RESULTS

It was forecasted that to reimburse cancer diagnostic services in Georgia, approximately 48,580,647 GEL would be needed for 2024, 50,760,753 GEL for 2025 and 52,982,449 GEL for 2026.

CONCLUSION

In November 2023, the MoH officially announced that cancer diagnostic tests will be reimbursed as part of the UHC program as of March 2024. This significant step is a remarkable improvement in accessibility to cancer care services for the Georgian population, proving the need for contextual and robust evidence to inform policy making.