bluuebunny/crossref_metadata_2025_split huggingface dataset:
Piloting a Model for Cervical Cancer Screening Through Community Outreach and Government Capacity Building in India
Authors: Foley Shaylen , Anand Meenu , Gupta Mridu , Saxena Swati , Ramakrishnan Mathangi , Sharma Tolsy 
Published: July 2024

PURPOSE India accounts for nearly a third of global cervical cancer deaths. These cancers can be prevented or detected early through screening. Despite the existence of a national guideline and program, cervical cancer screening availability at primary health centers (PHCs) in India is low, and programs target only symptomatic women. In communities there is lack of awareness, inaccessibility, and stigma. METHODS Cancer Awareness, Prevention, and Early Detection Trust (CAPED) is a community outreach organization that promotes cancer prevention and early detection in India. With support from American Cancer Society (ACS), CAPED implemented a cervical cancer awareness & screening project pilot in collaboration with the Gurugram Health Department, Haryana State from February to December 2022. The pilot used a collaborative model to engage leadership at all levels in the government health system–district, PHCs, community health workers (CHWs), and community members to increase cervical cancer screening uptake. The pilot involved six core areas of work (1) advocacy and coordination with the district-level leadership for the inclusion of asymptomatic women in government-led screening camps, (2) certification of PHC nurses to deliver cervical screening services, (3) training CHW on cervical cancer prevention and early detection, (4) support for CHW door-to-door mobilization in targeted villages, (5) logistic support at screening camps, and (6) navigation for women with positive screens. RESULTS CAPED India and Gurugram district health department successfully collaborated to train 213 CHWs and 61 PHC staff nurses covering 73 villages, who mobilized 5,653 women to get cervical cancer screening. Women who tested positive were navigated to further testing and/or treatment. This pilot project laid the foundation for the development of an Implementation Guide for Community Organisations to Strengthen Policy and Practice for Cervical Cancer Prevention. In 2024, this implementation guide will be used to replicate and validate the pilot project strategies and resources across two new geographies through partnership with local cancer organizations as implementing organizations. CONCLUSION Cervical cancer is preventable. This rapid presentation or poster will provide an overview of the 2022 pilot project, as well as current progress and lessons learned during the roll out and use of the implementation guide.
A Case-Case Comparison of Molecular Subtype for Breast Cancer, Younger and Older Age at Diagnosis, in Puerto Rico, 2010-2019
Authors: Velazquez Eugenia Torres , Rosario-Rosado Rosa V. , García-Berdecía Rafael , Climent Consuelo , Freudenheim Jo L. 
Published: July 2024

PURPOSE Breast cancer (BC) accounted for 28.9% of cancer cases and 18.9% of cancer deaths, an average of 437 deaths per year, among women in Puerto Rico (PR) between 2014 and 2018. Prognosis differs by molecular subtype; little is known about the distribution of these subtypes in the population in PR and whether there are differences in distribution by age. We described the distribution of breast cancer molecular subtypes and compared them for younger and older age at diagnosis among women in PR. METHODS This case-case study used data from the PR Central Cancer Registry (PRCCR). Included were women aged ≥21 with primary invasive BC, and information available on estrogen (ER) and progesterone receptor (PR) and HER2 status, with diagnosis between January 1, 2010 and December 31, 2019. Those with either ER+ or PR+ were classified as HR+, those with both ER- and PR- as HR-. BC subtypes were classified as: HR+/HER2-, HR+/HER2+, HR-/HER2-, and HR-/HER2+. Five categories of age were examined: ≤39, 40-49, 50-59, 60-69 and ≥70 years. We compared the distribution of BC subtypes by age at diagnosis with polytomous logistic regression, utilizing HR+/HER2- subtype and the ≤39 age cases as the reference, adjusting for year of diagnosis and tumor stage. RESULTS Among 13,525 eligible cases, there were 674 aged ≥39 [5.0%], 1,988 aged 40-49 [14.7%], 3,108 aged 50-59 [23.0%], 3,884 aged 60-69 [28.7], and 3,871 aged ≥70 [28.6%]). Of the total, 9,634 (71.2%) cases were HR+/HER2-, 1,761 (13.0%) were HR-/HER2-, 1,456 (10.8%) were HR+/HER2+, and 674 (5.0%) were HR-/HER2+. Compared to cases ≤39, cases ≥70 years were less likely to have HR+/HER2+ tumors (adjusted OR: 0.31; 95% CI: 0.25, 0.40), HR-/HER2- (adjusted OR: 0.45;95% CI: 0.36, 0.56) and HER2-enriched (adjusted OR: 0.40;95% CI: 0.28, 0.57). CONCLUSION In this population-based study of women in PR, younger women had a higher likelihood of more aggressive BC molecular subtypes as compared to their older counterparts.
Stakeholders in Cancer Surveillance: Addressing Gaps in Data Sources
Authors: Ndlovu Babongile , Muchengeti Mazvita 
Published: July 2024

PURPOSE Having accurate cancer incidence estimations is essential in informing decision making, driving policy and supporting intervention and evaluation programs. In South Africa (SA), cancer is a reportable medical condition that every healthcare worker is obliged to report to the National Cancer Registry (NCR) as per Regulation No 380 of the National Health Act (Act 61 of 2003). Regulation 380 also mandates the NCR to establish population-based cancer registries (PBCRs) across SA. This reports aims to describe the cancer surveillance status in SA and identify gaps in cancer surveillance. METHODS The NCR conducts pathology-based cancer registration at national level and PBCRs at sentinel sites. The national pathology registry uses passive surveillance methods and miss cases that are diagnosed elsewhere. In order for SA to be able to produce accurate cancer incidence data, there needs to be four population-based cancer registries (PBCRs). The pioneering PBCR was established in 2017 from Ekurhuleni district. In PBCRs, all cancer data sources are explored, such as medical files, pathology reports, pharmacy prescription, cancer screening, hospital admission, hospice, private practitioner's consultation, radiology, discharge, mortuary and outpatient registers. International Classification of Diseases for Oncology-3 guidelines are used for coding the site and morphology of each case. An annual cancer incidence report is released within a 2-3-year lag period. RESULTS There is currently no existing accurate incidence estimation for cancers in SA. The pathology registry, due to its nature is incomplete and in addition not all pathology groups comply to reporting. In PBCRs, a significant number of data sources are inaccessible due to non-compliance and fear of sharing confidential patient medical records. PBCRs are costly to run and there is no funding permanently allocated to it and its operations rely on grant funding. Stakeholders are not well-informed of their roles in cancer surveillance. CONCLUSION All healthcare providers need to adhere to Regulation 380 and report cancers to NCR.
Successful Establishment of a National Cancer Control Program (NCCP) and Cancer Registry in Eswatini: Lessons to Inform NCCPs in Low- and Mid-Income Countries
Authors: Dlamini Xolisile , Nhlengetfwa Velephi 
Published: July 2024

PURPOSE Eswatini's 2017 baseline assessment revealed severe cancer service gaps in infrastructure, personnel, training, research, number served locally. We present the Ministry of Health’s (MOH) success in establishing the national cancer control unit (NCCU) and national cancer registry (NCR). METHODS MOH led the development of the 2019-2023 national cancer control strategic plan (NCCSP) and established the NCCU in 2019. The NCCU, staffed with a manager and 3 personnel implemented the NCCSP prioritizing cancer prevention (health promotion and screening), diagnosis, treatment, palliative care and survivorship programs. Inter-government, public-private, local and international partnerships led to widespread stakeholder engagement, community advocacy procurement of cancer screening and diagnosis equipment, staff training, and establishment of oncology services such chemotherapy. A NCR was introduced. Cancer prevention and palliative care interventions were integrated into NCCU activities. We report key progress indicators between 2019-2022. RESULTS Between 2019-2022, 2930 cancers were captured in the NCR. Cervical (59.2%), prostate (30.4%) and breast (19.5%) cancers were commonest, and 4% of cancers were among children. There was a 31-fold increase in the number of cancer patients receiving chemotherapy locally: from 52 to 1631 patients. International referrals for cancer management declined 7-fold from 217 to 30. Patient navigators/escorts were introduced in 2021, and by 2022 had supported linkage of 1,509 patients to cancer services. Nationally, 1141 health workers have been trained to provide palliative care and 1447 patients were receiving palliative care services in 2022. National rollout of adolescent HPV vaccination is ongoing. The NCCU is currently engaged in 15 research protocols, of which 9 are utilizing NCR data for student MPH/PHD programs. CONCLUSION Establishment of the NCCU and implementation of the NCCSP has led to coordinated efforts in cancer prevention, diagnosis and management, and more cancer-care needs met locally.
Surgical Demand and Migratory Patterns: A 10-Year Forecast for Hepatectomy in Oncology in the Northern Region of Brazil
Authors: Da Silva Vieira Laynara Vitória , da Silva Meneses Beatriz , Dornelas Luana Baptistele , Eduarda de Aguiar Tavares Marcella 
Published: July 2024

PURPOSE This article aims to forecast the 10-year demand for hepatectomy among liver cancer patients in Northern Brazil and assess the potential need for inter-regional collaboration based on migration patterns. METHODS An observational study following the STROBE checklist. Annual estimates of surgical procedures carried out by region were obtained from data from the Department of Informatics of the Unified Health System of Brazil (DataSus). Patient's identities are preserved, and the conduction of any research with data from DATASUS is ethically approved. All hepatectomy procedures in oncology (Code: 0416040101) were considered based on the PICO principle: People with liver cancer in Brazil from November 2013 to November 2023 (Population);hepatectomy in oncology and total costs for the surgical procedure according to the patient's place of residence and according to the patient's place of hospitalization (Interest);Brazilian North Region (Context). Forecasting models using historical surgical volume data to predict annual oncology hepatectomy surgeries for the next ten years (2024 - 2033). Total expenditure figures by patient place of residence and by place of hospitalization were also calculated using ARIMA (R programming 4.0). RESULTS The ARIMA forecast predicts an average annual demand of 45 (95% CI: 21.37-68.63) hepatectomy procedures for oncology patients residing in the northern region. Conversely, the forecast for in-region hospitalizations is 40 (95% CI: 17.19-62.81) patients per year. By 2033, an estimated 3.2 (95% CI: -0.35-6.75) patients from the Northern Region are expected to migrate annually to other Brazilian regions for hepatectomy procedures. The total estimated expenditure in 2033 for patients in the northern region is R$194,680.1 (95% CI: R$110,723.103 - R$278,637.1). However, the estimate of expenses for hospitalizations in the north region based on data from the following 10-years (2024 to 2033) indicates a value of R$166,798 (95% CI: R$86,991.96 - R$246,605.0), indicating that there may be a trend toward underfunding for inpatients in the northern region over the next 10-years. CONCLUSION Migratory trends in liver neoplasm surgery might endure in northern Brazil for the next decade. To ensure safe, affordable, and timely cancer surgery nationwide, inter-regional collaboration is essential for delivering impactful liver neoplasm surgical treatment.
The Impact of Honey on Chemotherapy and Radiation-induced Oral Mucositis
Authors: Chu Kevin 
Published: July 2024

PURPOSE Integrative nursing framework and Faye Abdellah’s 21 Nursing Problems theory guided this review focusing on holistic care including cost efficient complementary therapies such as honey addressing social problems, such as poverty. These theories are based on meta-theoretical perspectives consistent with nursing values, beliefs, and theoretical perspectives. Chemotherapy and radiation-induced mucositis, the inflammation and ulceration of the oral mucosa, affects 40% of chemotherapy patients and 90% of head and neck cancer patients receiving the addition of radiotherapy. Honey has been reported as an effective supportive care for reducing mucositis. The purpose of this literature review was to determine if honey can be used as adjuvant therapy to reduce the frequency and severity of OM in adult oncology patients undergoing chemotherapy and/or radiation. METHODS A literature review was performed using PubMed, CINAHL, and OVID Medline databases limited to primary studies from the past 5 years using the search terms, “honey AND mucositis,” “honey AND oncology,” “honey AND chemotherapy,” and “honey AND radiation.” After an initial review of 41 articles, results included 5 studies who met the criteria three randomized control trials (RCT), a single-blinded RCT study and a double-blinded RCT trial. RESULTS Honey products demonstrated statistically significant results (p < .05) in lower grades of OM and delayed weight loss. Several of the studies showed that the honey intervention groups maintained a mild mucositis score of 2 or less. One randomized control trial (N = 72) using a thyme honey oral rinse showed a better quality of life throughout the intervention and at 6 months follow-up. CONCLUSIONS The supporting evidence identifies honey as a possible cost-efficient improvement to patient care. When compared to conventional treatments, honey performed better at preventing OM from advancing beyond grade 2. Further study is needed to explore the correlation between honey, OM grade level and weight loss prevention.
Training Non-Oncologist Healthcare Providers to Manage Oral Endocrine Therapy for Breast Cancer
Authors: Ndayishimiye Aimable , Fehr Alexandra , Rugema Vestine , Cubaka Vincent Kalumire , Niyibizi Jean Claude , Sebishyimno Francois , Umwizerwa Aline , Nsabimana Nicaise , Shyirambere Cyprien , Fadeli Temidayo 
Published: July 2024

PURPOSE Oral endocrine therapy (OETs) is a crucial component of breast cancer management. However, they have traditionally only been available at tertiary cancer centers. Recent studies at Butaro Cancer Center of Excellence (BCCOE), in Northern Rwanda revealed sub-optimal adherence to OETs. Patients reported challenges including travel-related costs to BCCOE. To alleviate these challenges, we implemented a program that decentralizes the distribution of OETs to hospitals located in other provinces. METHODS In July 2023, before decentralization, we conducted a 5-day training of healthcare providers to empower them with skills and knowledge on clinical breast cancer management including OET management. Trainees included 5 internists, 3 general practitioners, 3 pharmacists and 9 nurses selected from 4 participating hospitals. Training included 2 days for theory and 3 days of experiential site visits. Trainees took pre- and post-assessments (20 questions) of their knowledge to evaluate the effectiveness of the training and assess the knowledge gained. Each test was graded and given a score from 0-100;mean results were compared between the pre and post-assessments. We also surveyed trainees to obtain feedback on the details of the training and their opinions on the next steps. RESULTS The mean scores (standard deviation) were 62 (22) and 89 (15) for the pre-and post-assessments, respectively, with a p-value < 0.0001 (T-test). Most trainees agreed/strongly agreed that the training was well organized (100%), relevant (100%), informative (100%), and effective (95%). Majority of trainees noted high levels of commitment and confidence in applying learned skills, with mean ratings of 9.07/10 and 8.73/10, respectively. Trainees recommended expansion of OET training to more hospitals and more healthcare providers, as well as incorporating more practical exercises and mentorship. CONCLUSION There was an increase in scores between the pre and post-assessments. We demonstrated that an abbreviated 5-day short course including theory and experiential components could impart knowledge and skills of OET management to non-oncology clinicians. The decentralization project was rolled out with longitudinal support and mentorship. Future studies will evaluate the impact of the decentralization program and provide a basis for future broader expansion of cancer care in Rwanda.
A Novel Mechanism for Chromatin Bridge Sensing by the Abscission Checkpoint in Human Cells
Authors: Petsalaki Eleni , Balafouti Sofia , Zachos George 
Published: July 2024

PURPOSE Chromatin bridges are DNA strings that link anaphase poles or daughter nuclei and are associated with carcinogenesis. In response to chromatin bridges, mammalian cells delay abscission by activating the abscission checkpoint which delays completion of cytokinesis in order to prevent chromatin breakage or tetraploidization by furrow regression. We recently showed that in cytokinesis with chromatin bridges a biochemical pathway including MRN complex, ATM and Chk2 promotes INCENP localization to the midbody to delay abscission and prevent chromatin breakage. METHODS In this study we used site directed mutagenesis, RNA silencing, time lapse and confocal microscopy, FISH, BrdU labeling, TUNEL assay and differential retention assay. RESULTS Here, we show that spontaneous or replication stress-induced chromatin bridges derived from catenated DNA exhibit “knots” of tangled, overtwisted DNA next to the midbody. Topoisomerase IIα (Top2a), an enzyme that relaxes supercoils and untangles catenated DNA forms irreversible Top2-DNA cleavage complexes (Top2ccs) on DNA knots. Inhibition of Top2a results in diminished localization of Rad17, MRN, ATM, Chk2 and CPC complex to the DNA bridges and induces chromatin bridge breakage. Furthermore, proteolytic degradation of Top2ccs is required for localization of Rad17 to the bridge DNA. In turn, Rad17 promotes recruitment of the MRN complex to DNA knots and downstream abscission checkpoint signaling to delay abscission and prevent chromatin bridge breakage in cytokinesis. In contrast, chromatin bridges generated by dicentric chromosomes do not exhibit DNA knots or Top2ccs next to the midbody, and fail to recruit Top2a, Rad17 and other downstream proteins and are unable to induce an abscission delay. CONCLUSION Our results describe a novel mechanism by which the abscission checkpoint detects chromatin bridges in human cells, through generation of irreversible Top2ccs on DNA knots. Because chromosomal instability is a major cause of cancer, identifying new genes that protect genome integrity is very important for cancer research.
Utility of Colonoscopy for the Screening and Management of Cervical Cancer in Africa: A Cross-Sectional Analysis of Providers' Training and Practices
Authors: Domgue Joel Fokom , Dille Issimouha , Gnangnon Freddy , Kapambwe Sharon , Bouchard Celine , Mbatani Nomonde , Gauroy Flodie , Ambounda Nathalie , Yu Robert , Sidibe Fatoumata 
Published: July 2024

PURPOSE Cervical cancer is a public health issue in Africa with devastating socioeconomic consequences due to the lack of organized screening programs. The success of screening programs depends on the appropriate investigation and management of women who test positive for screening. Colposcopic assessment following positive screening results is a critical issue in Africa. This study aimed to assess the utilization of colposcopy by providers in the region. METHODS A cross-sectional study was conducted in 2021-2022 among healthcare providers involved in cervical cancer prevention activities in Africa. They were invited to report prior colposcopy training, whether they performed colposcopy and the indications of colposcopy in their practice. RESULTS Of the 130 providers from 23 African countries who responded to the survey (mean age [SD]: 39.0 years [9.4]), half were female (65 [50.0%]), and 90.7% were working in urban areas. Overall, only 12.6% of respondents indicated having received prior training on colposcopy, and 11.7% reported that they were performing colposcopy in their current practice. Among the providers who reported performing colposcopy in their practice, colposcopy was indicated for routine visual screening in 21.2% of clinicians, to visualize the transformation zone in 15.2% of respondents, to assess vascularization of cervical mucosa in 33.3% of respondents, and to determine treatment modality in 12.1% of respondents. CONCLUSION Providers training and utilization of colposcopy for cervical cancer screening remain suboptimal in Africa. To address this situation in the region, further training is needed to improve providers' knowledge and engagement. With the development of lower-cost and portable colposcopes, efforts to equip cervical cancer prevention programs and facilities with colposcopy should be enhanced to ensure that women can be screened and managed appropriately.
Vaginal Stenosis in Patients Treated With Radiotherapy for Cancer of the Cervix in Uganda
Authors: Nakaganda Annet , Kagwa Agnes , Nassolo Cissy , Mulumba Yusuf , Tumwiine Aggrey , Lasebikan Nwamaka , Mulamira Pius , Kanyike Daniel 
Published: July 2024

PURPOSE The occurrence of Vaginal Stenosis (VS) is likely to be underreported and never treated in resource-limited settings. This study aimed to assess the incidence, risk factors, and clinical manifestation(s) of radiation-induced VS in patients with cervical cancer in Uganda. METHODS A retrospective cohort study was conducted in April-July 2022 for patients diagnosed with cervical cancer and treated with radiotherapy in 2019 at the Uganda Cancer Institute (UCI). Data was abstracted on patient demographics, stage of disease, type/technique/modality of radiotherapy received, incidence, grade/severity of vaginal stenosis, and treatments administered. Descriptive and Logistic Regression was used for data analysis using Excel and Stata. RESULTS 363 patients enrolled in the study. Overall mean age was 50.6 years. Eight percent of patients were diagnosed at stage IB, 46.3% at stage II, 38.3% at stage III, 5.5% at stage IV and 1.9% were not staged. 101(28%) patients were excluded from the analysis due to missing radiotherapy treatment chart data. VS incidence was 5.3% (N= 14); 36% with CTCAE v4.03 Grade 1 VS, 14% with Grade 2, and 50% with Grade 3 VS. However, 94.7% had no documented assessment of the presence or absence of VS in their medical records. Apart from the total dose of radiotherapy (OR=1.0, p=0.045), other known risk factors were not statistically significant in predicting VS such as: tumor extension to the vagina (OR=2.4, p=0.190), receiving both external beam radiotherapy and brachytherapy (OR=2.6, p=0.100)), age (OR=1.0, p=0.077) and hyper-fractionation (OR=10.2, p=0.065). Sexual dysfunction was the most reported (71%) manifestation and 79% of VS occurred within one year of radiation treatment. CONCLUSION The reported radiation-induced VS incidence was low at UCI. This may be due to significant underreporting of VS in patients records as most of the identified cases were patient-reported versus physician-reported during examination. Since, there is no uniformly adopted method or grading system for VS at UCI, underreporting of VS may be related to low physician knowledge/practice to identify/diagnose VS and lack of patient education about the possible side effects associated with radiotherapy treatment. Hence, deploying a physician VS education program and a prospective study would provide a more accurate estimate of VS incidence in Uganda and other resource-limited settings.