Pub Date : 2019-10-15DOI: 10.1200/jgo.2019.5.suppl.44
G. Oxnard, E. Klein, M. Seiden, E. Hubbell, Oliver Venn, A. Jamshidi, N. Zhang, J. Beausang, S. Gross, K. Kurtzman, E. Fung, J. Yecies, R. Shaknovich, Alexander P. Fields, M. Sekeres, D. Richards, P. Yu, A. Aravanis, A. Hartman, Minetta C. Liu
44 Background: A noninvasive cfDNA blood test detecting multiple cancers at earlier stages could decrease cancer mortality. In earlier discovery work, whole-genome bisulfite sequencing outperformed whole-genome and targeted sequencing approaches for multi-cancer detection across stages at high specificity. Here, multi-cancer detection and TOO localization using bisulfite sequencing of plasma cfDNA to identify methylomic signatures was evaluated in preparation for clinical validation, utility, and implementation studies. Methods: 2301 analyzable participants (1422 cancer [ > 20 tumor types, all stages], 879 non-cancer) were included in this prespecified substudy from the Circulating Cell-free Genome Atlas (CCGA) (NCT02889978) study - a prospective, multi-center, observational, case-control study with longitudinal follow-up. Plasma cfDNA was subjected to a targeted methylation sequencing assay using high-efficiency methylation chemistry to enrich for methylation targets, and a machine learning classifier determined cancer status and tissue of origin (TOO). Observed methylation fragments characteristic of cancer and TOO were combined across targeted regions and assigned a relative probability of cancer and of a specific TOO. Results: Performance is reported at 99% specificity (ie, a combined false positive rate across all cancer types of 1%), a level required for population-level screening. Across cancer types, sensitivity ranged from 59 to 86%. Combined cancer detection (sensitivity [95% CI]) was 34% (27-43%) in stage I (n = 151), 77% (70-83%) in stage II (n = 171), 84% (79-89%) in stage III (n = 204), and 92% (88-95%) in stage IV (n = 281). TOO was provided for 94% of all cancers detected; of these, TOO was correct in > 90% of cases. Conclusions: Detection of multiple deadly cancers across stages using methylation signatures in plasma cfDNA was achieved with a single, fixed, low false positive rate, and simultaneously provided accurate TOO localization. This targeted methylation assay is undergoing validation in preparation for prospective clinical investigation as a cancer detection diagnostic. Clinical trial information: NCT02889978.
{"title":"Simultaneous multi-cancer detection and tissue of origin (TOO) localization using targeted bisulfite sequencing of plasma cell-free DNA (cfDNA).","authors":"G. Oxnard, E. Klein, M. Seiden, E. Hubbell, Oliver Venn, A. Jamshidi, N. Zhang, J. Beausang, S. Gross, K. Kurtzman, E. Fung, J. Yecies, R. Shaknovich, Alexander P. Fields, M. Sekeres, D. Richards, P. Yu, A. Aravanis, A. Hartman, Minetta C. Liu","doi":"10.1200/jgo.2019.5.suppl.44","DOIUrl":"https://doi.org/10.1200/jgo.2019.5.suppl.44","url":null,"abstract":"44 Background: A noninvasive cfDNA blood test detecting multiple cancers at earlier stages could decrease cancer mortality. In earlier discovery work, whole-genome bisulfite sequencing outperformed whole-genome and targeted sequencing approaches for multi-cancer detection across stages at high specificity. Here, multi-cancer detection and TOO localization using bisulfite sequencing of plasma cfDNA to identify methylomic signatures was evaluated in preparation for clinical validation, utility, and implementation studies. Methods: 2301 analyzable participants (1422 cancer [ > 20 tumor types, all stages], 879 non-cancer) were included in this prespecified substudy from the Circulating Cell-free Genome Atlas (CCGA) (NCT02889978) study - a prospective, multi-center, observational, case-control study with longitudinal follow-up. Plasma cfDNA was subjected to a targeted methylation sequencing assay using high-efficiency methylation chemistry to enrich for methylation targets, and a machine learning classifier determined cancer status and tissue of origin (TOO). Observed methylation fragments characteristic of cancer and TOO were combined across targeted regions and assigned a relative probability of cancer and of a specific TOO. Results: Performance is reported at 99% specificity (ie, a combined false positive rate across all cancer types of 1%), a level required for population-level screening. Across cancer types, sensitivity ranged from 59 to 86%. Combined cancer detection (sensitivity [95% CI]) was 34% (27-43%) in stage I (n = 151), 77% (70-83%) in stage II (n = 171), 84% (79-89%) in stage III (n = 204), and 92% (88-95%) in stage IV (n = 281). TOO was provided for 94% of all cancers detected; of these, TOO was correct in > 90% of cases. Conclusions: Detection of multiple deadly cancers across stages using methylation signatures in plasma cfDNA was achieved with a single, fixed, low false positive rate, and simultaneously provided accurate TOO localization. This targeted methylation assay is undergoing validation in preparation for prospective clinical investigation as a cancer detection diagnostic. Clinical trial information: NCT02889978.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65926847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cervical cancer remains the eighth leading cause of cancer mortality among women in Taiwan. Despite availability of a National Health Insurance program with free yearly screenings, Papanicolaou testing and human papillomavirus (HPV) vaccination rates have been historically low in Taiwan. Even in the United States, cervical cancer screening rates for Asian women are significantly lower than other ethnic groups. The goal is to direct future interventions by providing insight on barriers leading to low screening and vaccination rates among Taiwanese and Asian women. Anonymous surveys without patient identifiers were randomly administered to patients at a traditional Chinese medicine clinic in Hualien City in June 2018. Inclusion criterion was females. No exclusion criteria were defined. Participants provided written consent. Sixty-three completed surveys were received. A χ2 test was used to determine statistical significance (α = 0.05). Formal education level correlated with increased knowledge of HPV ( P = .001), its route of transmission ( P = .044), its link to genital cancer ( P = .0024), and HPV vaccination ( P = .0039). Women were more likely to have Papanicolaou smears if they were older than 30 years of age ( P = .0033), visited the gynecologist ( P < .001), or were recommended one by their physicians ( P < .001). Although 57% of respondents knew of the HPV vaccine, only 19% were vaccinated. Among those not vaccinated, most cited reasons included an inability to find a physician providing it (23.5%), safety concerns (16.4%), belief that it encourages sexual behavior (14.5%), and high out-of-pocket expense (9.1%). Knowledge of HPV does not predict a higher adherence to cervical screening guidelines. Instead, diligent physician recommendations on Papanicolaou smears can elevate adherence rates among patients. Significant contributors to low HPV vaccination rates in rural Taiwan include lack of awareness and access to the vaccine. Our study emphasizes the physician-patient relationship as a means to target vulnerable populations and increase rates of cervical cancer screening and HPV vaccination.
{"title":"Cross-Sectional Study on Perceptions Regarding Cervical Cancer Screening and Human Papillomavirus Vaccination Among Female Patients in Rural Taiwan","authors":"Ruixuan Zhang, M. Bach, J. Yip, Athena W. Lin","doi":"10.1200/jgo.19.23000","DOIUrl":"https://doi.org/10.1200/jgo.19.23000","url":null,"abstract":"Cervical cancer remains the eighth leading cause of cancer mortality among women in Taiwan. Despite availability of a National Health Insurance program with free yearly screenings, Papanicolaou testing and human papillomavirus (HPV) vaccination rates have been historically low in Taiwan. Even in the United States, cervical cancer screening rates for Asian women are significantly lower than other ethnic groups. The goal is to direct future interventions by providing insight on barriers leading to low screening and vaccination rates among Taiwanese and Asian women. Anonymous surveys without patient identifiers were randomly administered to patients at a traditional Chinese medicine clinic in Hualien City in June 2018. Inclusion criterion was females. No exclusion criteria were defined. Participants provided written consent. Sixty-three completed surveys were received. A χ2 test was used to determine statistical significance (α = 0.05). Formal education level correlated with increased knowledge of HPV ( P = .001), its route of transmission ( P = .044), its link to genital cancer ( P = .0024), and HPV vaccination ( P = .0039). Women were more likely to have Papanicolaou smears if they were older than 30 years of age ( P = .0033), visited the gynecologist ( P < .001), or were recommended one by their physicians ( P < .001). Although 57% of respondents knew of the HPV vaccine, only 19% were vaccinated. Among those not vaccinated, most cited reasons included an inability to find a physician providing it (23.5%), safety concerns (16.4%), belief that it encourages sexual behavior (14.5%), and high out-of-pocket expense (9.1%). Knowledge of HPV does not predict a higher adherence to cervical screening guidelines. Instead, diligent physician recommendations on Papanicolaou smears can elevate adherence rates among patients. Significant contributors to low HPV vaccination rates in rural Taiwan include lack of awareness and access to the vaccine. Our study emphasizes the physician-patient relationship as a means to target vulnerable populations and increase rates of cervical cancer screening and HPV vaccination.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jgo.19.23000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41399789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The National Cancer Institute (NCI)–Designated Cancer Centers (NDCCs) are active in global oncology research and training, leading collaborations that contribute to the evidence to support global cancer control. To better understand global oncology activities led by NDCCs, the National Cancer Institute Center for Global Health (NCI-CGH) collaborated with ASCO to conduct the 2018 NCI/ASCO Global Oncology Survey of NDCCs. The 70 NDCCs received a two-part survey that focused on global oncology programs at NDCCs and non–National Institutes of Health (NIH)–funded global oncology projects with an international collaborator led by the NDCCs. Sixty-five NDCCs responded to the survey, and 57 reported non–NIH-funded global oncology projects. Data were cleaned, coded, and analyzed by NCI-CGH staff. Thirty NDCCs (43%) report having a global oncology program, and 538 non–NIH-funded global oncology projects were reported. Of the NDCCs with global oncology programs, 17 report that trainees complete rotations outside the United States, and the same number enroll trainees from low- and middle-income countries (LMICs). In addition, 147 (28%) of the non–NIH-funded projects focused on capacity building or training, the second highest category after research. Of the 30 top project collaborator countries, 17 were LMICs. Compared with the NCI-funded international grant portfolio, non–NIH-funded global oncology projects were more likely to focus on prevention (12% NCI-funded v 20% non–NIH-funded); early detection, diagnosis, and prognosis (23% v 30%); and cancer control, survivorship, and outcomes research (13% v 22%). This survey shows that there is a substantial amount of global oncology research and training supported by NDCCs, and much of this is happening in LMICs. Results of the 2018 Global Oncology Survey can be used to foster opportunities for NDCCs to work collaboratively on activities and to share their findings with relevant stakeholders in their LMIC collaborator countries.
{"title":"Global Oncology Research and Training Collaborations Led by the National Cancer Institute (NCI)–Designated Cancer Centers: Results From the 2018 NCI/ASCO Global Oncology Survey of NCI-Designated Cancer Centers","authors":"K. Duncan, R. Abudu, M. Cira, D. Pyle","doi":"10.1200/jgo.19.11000","DOIUrl":"https://doi.org/10.1200/jgo.19.11000","url":null,"abstract":"The National Cancer Institute (NCI)–Designated Cancer Centers (NDCCs) are active in global oncology research and training, leading collaborations that contribute to the evidence to support global cancer control. To better understand global oncology activities led by NDCCs, the National Cancer Institute Center for Global Health (NCI-CGH) collaborated with ASCO to conduct the 2018 NCI/ASCO Global Oncology Survey of NDCCs. The 70 NDCCs received a two-part survey that focused on global oncology programs at NDCCs and non–National Institutes of Health (NIH)–funded global oncology projects with an international collaborator led by the NDCCs. Sixty-five NDCCs responded to the survey, and 57 reported non–NIH-funded global oncology projects. Data were cleaned, coded, and analyzed by NCI-CGH staff. Thirty NDCCs (43%) report having a global oncology program, and 538 non–NIH-funded global oncology projects were reported. Of the NDCCs with global oncology programs, 17 report that trainees complete rotations outside the United States, and the same number enroll trainees from low- and middle-income countries (LMICs). In addition, 147 (28%) of the non–NIH-funded projects focused on capacity building or training, the second highest category after research. Of the 30 top project collaborator countries, 17 were LMICs. Compared with the NCI-funded international grant portfolio, non–NIH-funded global oncology projects were more likely to focus on prevention (12% NCI-funded v 20% non–NIH-funded); early detection, diagnosis, and prognosis (23% v 30%); and cancer control, survivorship, and outcomes research (13% v 22%). This survey shows that there is a substantial amount of global oncology research and training supported by NDCCs, and much of this is happening in LMICs. Results of the 2018 Global Oncology Survey can be used to foster opportunities for NDCCs to work collaboratively on activities and to share their findings with relevant stakeholders in their LMIC collaborator countries.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jgo.19.11000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44019779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stella O. Odedina, I. Ajayi, I. Morhason-Bello, Adedokun Babatundetuk, D. Huo, O. Olopade, O. Ojengbede
Educating women on how to examine their breasts can raise breast cancer awareness and early detection rates, especially in low- and middle-income countries. In this study, the influence of a teaching session on breast self-examination (BSE) during pregnancy was evaluated. A quasi-experimental study design was used. A total of 1,248 pregnant women whose pregnancies had a gestational age of 26 weeks or less were recruited from three antenatal clinics representing three tiers of the health care system in Nigeria. They were interviewed using a structured questionnaire, including BSE practice, and taught how to perform BSE using the MammaCare technique at recruitment. At 6 months postpartum, 729 participants were available for phone interview on BSE practice. Adherence to BSE was measured as a binary outcome comparing BSE performances at recruitment with follow-up. Conditional logistic regression analysis was used to determine the differences in BSE practices pre- and postintervention. Multiple logistic regression was used to identify predictors for adherence to BSE training at α = 0.05. Participants’ mean age was 30.4 ± 4.9 years, 401 (55.0%) attended a secondary health facility for antenatal care, and 78 (10.7%) had breast disorders at recruitment. Two hundred fifty-three (34.7%) said they practiced BSE before recruitment, and 380 (52.1%) did so at follow-up (odds ratio, 1.91; CI, 1.51 to 2.42). Women less likely to adhere were those with breast disorders detected at recruitment (adjusted odds ratio [aOR], 0.55; CI, 0.32 to 0.95) and women recruited from primary and secondary health facilities compared with those from a tertiary health facility (aOR, 0.41; CI, 0.17 to 0.98; aOR, 0.18; CI, 0.11 to 0.29, respectively). Educational interventions can significantly improve screening practices, even if only one session, and should serve as an integral control for breast cancer.
{"title":"Influence of a Teaching Session on Breast Self-Examination and Adherence Among Pregnant and Lactating Women in Ibadan, Nigeria","authors":"Stella O. Odedina, I. Ajayi, I. Morhason-Bello, Adedokun Babatundetuk, D. Huo, O. Olopade, O. Ojengbede","doi":"10.1200/jgo.19.18000","DOIUrl":"https://doi.org/10.1200/jgo.19.18000","url":null,"abstract":"Educating women on how to examine their breasts can raise breast cancer awareness and early detection rates, especially in low- and middle-income countries. In this study, the influence of a teaching session on breast self-examination (BSE) during pregnancy was evaluated. A quasi-experimental study design was used. A total of 1,248 pregnant women whose pregnancies had a gestational age of 26 weeks or less were recruited from three antenatal clinics representing three tiers of the health care system in Nigeria. They were interviewed using a structured questionnaire, including BSE practice, and taught how to perform BSE using the MammaCare technique at recruitment. At 6 months postpartum, 729 participants were available for phone interview on BSE practice. Adherence to BSE was measured as a binary outcome comparing BSE performances at recruitment with follow-up. Conditional logistic regression analysis was used to determine the differences in BSE practices pre- and postintervention. Multiple logistic regression was used to identify predictors for adherence to BSE training at α = 0.05. Participants’ mean age was 30.4 ± 4.9 years, 401 (55.0%) attended a secondary health facility for antenatal care, and 78 (10.7%) had breast disorders at recruitment. Two hundred fifty-three (34.7%) said they practiced BSE before recruitment, and 380 (52.1%) did so at follow-up (odds ratio, 1.91; CI, 1.51 to 2.42). Women less likely to adhere were those with breast disorders detected at recruitment (adjusted odds ratio [aOR], 0.55; CI, 0.32 to 0.95) and women recruited from primary and secondary health facilities compared with those from a tertiary health facility (aOR, 0.41; CI, 0.17 to 0.98; aOR, 0.18; CI, 0.11 to 0.29, respectively). Educational interventions can significantly improve screening practices, even if only one session, and should serve as an integral control for breast cancer.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jgo.19.18000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65922700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Musa, O. Silas, S. Mehta, R. Murphy, Lifang Hou
In absolute numbers, Nigeria is one of the countries with the highest burden and mortality as a result of invasive cervical cancer (ICC), with more than 53 million women at risk. The coverage for available cervical cancer screening by conventional cytology is less than 9% of the population. Also, the lack of a national human papillomavirus vaccination program and organized cervical cancer screening services could partly be responsible for the more than 14,000 new ICC cases and 8,000 deaths attributable to ICC in Nigeria every year. Furthermore, the prevailing challenges of diagnosis at advanced stages in more than 80% of ICC cases with a paucity of trained oncologists and poor treatment infrastructures often result in high death rates. These problems make the use of appropriate technology to improve screening, early detection, and treatment of precancerous conditions a novel strategy for achieving quality cancer care in our setting. The objective of this study was to discuss our experience with use of available and resource-appropriate technology to improve cervical cancer care and outcomes in Jos, Nigeria. A critical review of cervical cancer prevention, diagnosis, and treatment facilities and outcomes in Nigeria was done. This background information provided justification for the use of resource-appropriate technology for improving quality of cervical cancer prevention and treatment outcomes in resource-limited settings. We also gleaned from specific experiences of cervical cancer screening, follow-up, and treatment of both precancer and early invasive cervical cancer in Jos, Nigeria. The main factors responsible for increasing burden and poor cervical cancer outcomes in Nigeria and other resource-limited settings in sub-Saharan Africa include: HIV infection; lack of organized cervical cancer screening programs, with poor coverage even when opportunistic screening is available; weak health care system; illiteracy; and poor human papillomavirus vaccination coverage. Some of the major challenges in treatment of cervical cancer include: late presentation, with poor treatment infrastructures; paucity of trained gynecologic oncologists, medical oncologists, and other disciplines needed to improve quality of cancer care; and poor access to available prevention and treatment services, with limited/no health insurance coverage. Resource-limited settings should leverage the widespread availability of mobile phones to improve cervical cancer education and scheduling for screening, follow-up, and treatment of precancerous conditions. Also, the use of radio talks can reach women in remote locations. Adoption and use of novel testing technology, such as self-sample collection for human papillomavirus DNA testing, is also advocated. Our team in Jos, with collaboration with Northwestern University, is also looking ahead through molecular research on how epigenetic and microbiome biomarkers could improve prevention and early detection of precancer and ICC as a
{"title":"Use of Appropriate Technology to Improve Cervical Cancer Prevention and Early Detection: Experience in Jos, Nigeria","authors":"J. Musa, O. Silas, S. Mehta, R. Murphy, Lifang Hou","doi":"10.1200/jgo.19.16000","DOIUrl":"https://doi.org/10.1200/jgo.19.16000","url":null,"abstract":"In absolute numbers, Nigeria is one of the countries with the highest burden and mortality as a result of invasive cervical cancer (ICC), with more than 53 million women at risk. The coverage for available cervical cancer screening by conventional cytology is less than 9% of the population. Also, the lack of a national human papillomavirus vaccination program and organized cervical cancer screening services could partly be responsible for the more than 14,000 new ICC cases and 8,000 deaths attributable to ICC in Nigeria every year. Furthermore, the prevailing challenges of diagnosis at advanced stages in more than 80% of ICC cases with a paucity of trained oncologists and poor treatment infrastructures often result in high death rates. These problems make the use of appropriate technology to improve screening, early detection, and treatment of precancerous conditions a novel strategy for achieving quality cancer care in our setting. The objective of this study was to discuss our experience with use of available and resource-appropriate technology to improve cervical cancer care and outcomes in Jos, Nigeria. A critical review of cervical cancer prevention, diagnosis, and treatment facilities and outcomes in Nigeria was done. This background information provided justification for the use of resource-appropriate technology for improving quality of cervical cancer prevention and treatment outcomes in resource-limited settings. We also gleaned from specific experiences of cervical cancer screening, follow-up, and treatment of both precancer and early invasive cervical cancer in Jos, Nigeria. The main factors responsible for increasing burden and poor cervical cancer outcomes in Nigeria and other resource-limited settings in sub-Saharan Africa include: HIV infection; lack of organized cervical cancer screening programs, with poor coverage even when opportunistic screening is available; weak health care system; illiteracy; and poor human papillomavirus vaccination coverage. Some of the major challenges in treatment of cervical cancer include: late presentation, with poor treatment infrastructures; paucity of trained gynecologic oncologists, medical oncologists, and other disciplines needed to improve quality of cancer care; and poor access to available prevention and treatment services, with limited/no health insurance coverage. Resource-limited settings should leverage the widespread availability of mobile phones to improve cervical cancer education and scheduling for screening, follow-up, and treatment of precancerous conditions. Also, the use of radio talks can reach women in remote locations. Adoption and use of novel testing technology, such as self-sample collection for human papillomavirus DNA testing, is also advocated. Our team in Jos, with collaboration with Northwestern University, is also looking ahead through molecular research on how epigenetic and microbiome biomarkers could improve prevention and early detection of precancer and ICC as a","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jgo.19.16000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49000001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Joel, Dorcas Mduma, Jackline Mawolle, Jane Rogathi
Cervical cancer is a major public and global health problem. According to the WHO, it is the fourth leading cancer among women worldwide, with most women being from low- or middle-income countries. It is the leading cause of cancer-related morbidity and mortality among women of reproductive age in Tanzania, where approximately 4,216 women die as a result of the disease annually. Women with HIV/AIDS, multiple sexual partners, history of human papillomavirus infections, contraceptive use, and early onset of sexual activity have increased risk of the disease, including among university students. Poor knowledge and limited screening programs are major contributors. This study was aimed at assessing the level of knowledge and use of cervical cancer screening among university female students in Moshi municipality. A cross-sectional study was conducted from June to July 2018 involving undergraduate female students age 18 years and older at three different universities in the Moshi municipality. A total of 322 participants were identified using multistage sampling; data were collected through a self-administered semistructured questionnaire and analyzed using SPSS version 20. Ninety-two participants (28.6%) had good knowledge, 104 (32.3%) had satisfactory knowledge, and 126 (39.1%) had poor knowledge. About 299 (92.9%) had heard about cervical cancer. The most frequent sources of information were the media (168 [52.2%]); family, neighbors, and friends (106 [32.9%]), health workers (102 [31.7%]); and teachers (75 [23.3%]). Few reported other sources of information. Only 31 women (9.6%) had been screened for cervical cancer. The reasons given for not attending cervical cancer screening were “I have just not decided” (114 [30.4%]), “I am healthy” (81 [21.6%]), “I’m not informed” (49 [13.0%]), and “It may be painful” (42 [11.2%]); 89 women (23.7%) reported other reasons. Lack of proper knowledge about cervical cancer contributes to low-screening use. Promotion to increase awareness about cervical cancer screening through radio, television, social media, and clubs would be of great importance. Although a lot has been done by the government and other stakeholders regarding screening, the campaigns should focus not only on women but also on university students specifically, who are more likely to have multiple sexual partners and to have engaged in sexual activity at younger than 18 years.
{"title":"Knowledge and Use of Cervical Cancer Screening Among University Female Students at Kilimanjaro, Tanzania","authors":"H. Joel, Dorcas Mduma, Jackline Mawolle, Jane Rogathi","doi":"10.1200/jgo.19.12000","DOIUrl":"https://doi.org/10.1200/jgo.19.12000","url":null,"abstract":"Cervical cancer is a major public and global health problem. According to the WHO, it is the fourth leading cancer among women worldwide, with most women being from low- or middle-income countries. It is the leading cause of cancer-related morbidity and mortality among women of reproductive age in Tanzania, where approximately 4,216 women die as a result of the disease annually. Women with HIV/AIDS, multiple sexual partners, history of human papillomavirus infections, contraceptive use, and early onset of sexual activity have increased risk of the disease, including among university students. Poor knowledge and limited screening programs are major contributors. This study was aimed at assessing the level of knowledge and use of cervical cancer screening among university female students in Moshi municipality. A cross-sectional study was conducted from June to July 2018 involving undergraduate female students age 18 years and older at three different universities in the Moshi municipality. A total of 322 participants were identified using multistage sampling; data were collected through a self-administered semistructured questionnaire and analyzed using SPSS version 20. Ninety-two participants (28.6%) had good knowledge, 104 (32.3%) had satisfactory knowledge, and 126 (39.1%) had poor knowledge. About 299 (92.9%) had heard about cervical cancer. The most frequent sources of information were the media (168 [52.2%]); family, neighbors, and friends (106 [32.9%]), health workers (102 [31.7%]); and teachers (75 [23.3%]). Few reported other sources of information. Only 31 women (9.6%) had been screened for cervical cancer. The reasons given for not attending cervical cancer screening were “I have just not decided” (114 [30.4%]), “I am healthy” (81 [21.6%]), “I’m not informed” (49 [13.0%]), and “It may be painful” (42 [11.2%]); 89 women (23.7%) reported other reasons. Lack of proper knowledge about cervical cancer contributes to low-screening use. Promotion to increase awareness about cervical cancer screening through radio, television, social media, and clubs would be of great importance. Although a lot has been done by the government and other stakeholders regarding screening, the campaigns should focus not only on women but also on university students specifically, who are more likely to have multiple sexual partners and to have engaged in sexual activity at younger than 18 years.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jgo.19.12000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47233542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kochheiser, Toyin I G Aniagwu, P. Adejumo, O. Olopade
Breast cancer is the leading cause of cancer-related death among women, and ovarian cancer has the highest case fatality rate of all gynecologic cancers. In Nigeria, approximately 80% of breast and ovarian cancer cases are diagnosed at advanced stages. Genetic testing has the potential to reduce the morbidity and mortality associated with late cancer diagnosis. The introduction of genetic testing for cancer risk assessment at University College Hospital (UCH), Ibadan will serve as a model for the rest of Nigeria. The objective of this study was to introduce genetic testing for cancer risk assessment in patients with breast and ovarian cancer in Ibadan, Nigeria and to determine the demographics of women undergoing testing and their perceptions concerning the benefits of and barriers to genetic testing. Patients with breast or ovarian cancer were recruited at UCH. All patients received genetic counseling and had the opportunity to consent to the Color Genomics Hereditary Cancer Panel Test, free of charge, after due ethical approval. Patients were tested for 30 gene mutations with known associations to eight hereditary cancers. After testing, patients completed a semistandardized questionnaire assessing their sociodemographic information, family cancer history, and perceived benefits and barriers to genetic testing. Seven patients with ovarian cancer and 40 patients with breast cancer received genetic counseling, and all chose to undergo subsequent genetic testing. The average age at testing was 49 years, and the average age at cancer diagnosis was 47 years. Eight women reported a known family cancer history, and there were more perceived benefits than barriers to genetic testing. The genetic test results revealed 27 negative mutations, 16 variants of unknown significance, and four pathogenic mutations. Patients with breast and ovarian cancer at UCH associate genetic testing with benefits for their care. These results suggest potential for growth and sustainability of genetic testing for cancer risk management in Nigeria.
{"title":"Genetic Testing for Cancer Risk Assessment in Patients With Breast and Ovarian Cancer in Ibadan, Nigeria","authors":"M. Kochheiser, Toyin I G Aniagwu, P. Adejumo, O. Olopade","doi":"10.1200/jgo.19.13000","DOIUrl":"https://doi.org/10.1200/jgo.19.13000","url":null,"abstract":"Breast cancer is the leading cause of cancer-related death among women, and ovarian cancer has the highest case fatality rate of all gynecologic cancers. In Nigeria, approximately 80% of breast and ovarian cancer cases are diagnosed at advanced stages. Genetic testing has the potential to reduce the morbidity and mortality associated with late cancer diagnosis. The introduction of genetic testing for cancer risk assessment at University College Hospital (UCH), Ibadan will serve as a model for the rest of Nigeria. The objective of this study was to introduce genetic testing for cancer risk assessment in patients with breast and ovarian cancer in Ibadan, Nigeria and to determine the demographics of women undergoing testing and their perceptions concerning the benefits of and barriers to genetic testing. Patients with breast or ovarian cancer were recruited at UCH. All patients received genetic counseling and had the opportunity to consent to the Color Genomics Hereditary Cancer Panel Test, free of charge, after due ethical approval. Patients were tested for 30 gene mutations with known associations to eight hereditary cancers. After testing, patients completed a semistandardized questionnaire assessing their sociodemographic information, family cancer history, and perceived benefits and barriers to genetic testing. Seven patients with ovarian cancer and 40 patients with breast cancer received genetic counseling, and all chose to undergo subsequent genetic testing. The average age at testing was 49 years, and the average age at cancer diagnosis was 47 years. Eight women reported a known family cancer history, and there were more perceived benefits than barriers to genetic testing. The genetic test results revealed 27 negative mutations, 16 variants of unknown significance, and four pathogenic mutations. Patients with breast and ovarian cancer at UCH associate genetic testing with benefits for their care. These results suggest potential for growth and sustainability of genetic testing for cancer risk management in Nigeria.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jgo.19.13000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49216235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with cancer in low- and middle-income countries face complex socioeconomic barriers within health systems that can lead to poor oncologic outcomes. Patient navigation has been shown to reduce disparities in oncologic outcomes in the United States. Belize, a middle-income country in Central America, has recently launched its first-ever public medical oncology program. Here, we report on the development of Directly Observed Care (DOC), a pilot patient navigation care model for patients with cancer in Belize, inspired from directly observed treatment for tuberculosis. DOC will be a patient-centered program, where a nurse trained in patient navigation will assume responsibility for proactively identifying barriers that Belizean patients with cancer face in access to care and working to remove them. This process will include patient education on cancer and its treatment, identification of financial barriers to care and potential funding sources, assistance with care logistics such as transportation and childcare, and referral to psychosocial support services for patients who need them. DOC will rely on an electronic patient-tracking platform, which will allow real-time tracking of all oncology patients and identify patients who miss or delay treatments. This will allow timely intervention and continuous quality monitoring of the program. In addition to patient navigation, DOC will seek to reduce delays in patient care by liaising with pathology and radiology services. The program is in its development and pilot phase. So far, approximately 100 patients have been seen for consultation. We intend to capture epidemiologic data about cancer in Belize, as well as real-time data about the progression of patients through their treatment course. We aim to identify critical delays to patients’ care and design interventions to address them. We believe that the DOC program will be particularly beneficial for the oncology patient population in Belize, because this population has a high burden of socioeconomic barriers to care and is largely unfamiliar with the complexity of oncologic care. We hypothesize that DOC can improve treatment appropriateness and timeliness and, thereby, patient outcomes in Belize.
{"title":"Directly Observed Care: An Innovative Oncology Care Model in Belize","authors":"Yannis K. Valtis, R. Yacab, F. Huang","doi":"10.1200/jgo.19.22000","DOIUrl":"https://doi.org/10.1200/jgo.19.22000","url":null,"abstract":"Patients with cancer in low- and middle-income countries face complex socioeconomic barriers within health systems that can lead to poor oncologic outcomes. Patient navigation has been shown to reduce disparities in oncologic outcomes in the United States. Belize, a middle-income country in Central America, has recently launched its first-ever public medical oncology program. Here, we report on the development of Directly Observed Care (DOC), a pilot patient navigation care model for patients with cancer in Belize, inspired from directly observed treatment for tuberculosis. DOC will be a patient-centered program, where a nurse trained in patient navigation will assume responsibility for proactively identifying barriers that Belizean patients with cancer face in access to care and working to remove them. This process will include patient education on cancer and its treatment, identification of financial barriers to care and potential funding sources, assistance with care logistics such as transportation and childcare, and referral to psychosocial support services for patients who need them. DOC will rely on an electronic patient-tracking platform, which will allow real-time tracking of all oncology patients and identify patients who miss or delay treatments. This will allow timely intervention and continuous quality monitoring of the program. In addition to patient navigation, DOC will seek to reduce delays in patient care by liaising with pathology and radiology services. The program is in its development and pilot phase. So far, approximately 100 patients have been seen for consultation. We intend to capture epidemiologic data about cancer in Belize, as well as real-time data about the progression of patients through their treatment course. We aim to identify critical delays to patients’ care and design interventions to address them. We believe that the DOC program will be particularly beneficial for the oncology patient population in Belize, because this population has a high burden of socioeconomic barriers to care and is largely unfamiliar with the complexity of oncologic care. We hypothesize that DOC can improve treatment appropriateness and timeliness and, thereby, patient outcomes in Belize.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jgo.19.22000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43458660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To highlight the importance of adapting affordable, holistic point-of-care technology (POCT) and data management software to improve quality of cancer care in resource-limited settings. Cancer is the second leading cause of death globally and was responsible for an estimated 9.6 million deaths in 2018, with low- and middle-income countries accounting for as much as 70% of these deaths. In 2004, the WHO outlined a set of criteria, called the ASSURED guidelines, to promote affordable, sensitive, specific, user-friendly, rapid, robust, equipment-free, and deliverable to end-user POCT. Although advances in POC cancer technology are relatively underexploited, early successes show that the field has significant potential to contribute to improving cancer detection, diagnosis, and treatment in low- and middle-income countries. The current global disparity in cancer care can be addressed through mobilization of the research community to improve POCT, funding unique POCT concepts adapted for resource-limited settings, and training of scientists and engineers in designing robust data management software, such as the research electronic data capture for cancer research. Improving cancer care holistically requires use of POCT with designs adapted to resource-limited settings and leveraging software with robust features for cancer research.
{"title":"Using Technology to Improve Quality of Cancer Care in Resource-Limited Settings","authors":"O. Silas, C. Achenbach, Lifang Hou, R. Murphy","doi":"10.1200/jgo.19.21000","DOIUrl":"https://doi.org/10.1200/jgo.19.21000","url":null,"abstract":"To highlight the importance of adapting affordable, holistic point-of-care technology (POCT) and data management software to improve quality of cancer care in resource-limited settings. Cancer is the second leading cause of death globally and was responsible for an estimated 9.6 million deaths in 2018, with low- and middle-income countries accounting for as much as 70% of these deaths. In 2004, the WHO outlined a set of criteria, called the ASSURED guidelines, to promote affordable, sensitive, specific, user-friendly, rapid, robust, equipment-free, and deliverable to end-user POCT. Although advances in POC cancer technology are relatively underexploited, early successes show that the field has significant potential to contribute to improving cancer detection, diagnosis, and treatment in low- and middle-income countries. The current global disparity in cancer care can be addressed through mobilization of the research community to improve POCT, funding unique POCT concepts adapted for resource-limited settings, and training of scientists and engineers in designing robust data management software, such as the research electronic data capture for cancer research. Improving cancer care holistically requires use of POCT with designs adapted to resource-limited settings and leveraging software with robust features for cancer research.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jgo.19.21000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43878792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Nassar, A. Tfayli, A. Itani, G. Chamandi, N. Zgheib, Joelle Makoukji, R. Boustany, R. Talhouk, R. Nasr
Breast cancer is the most prevalent female cancer and has a higher incidence in young Lebanese patients as compared with the West. Interestingly, this particularity of breast cancer in the Lebanese population was not found to be associated with higher BRCA1/2 gene mutations. Hence, our research focuses on investigating molecular mechanisms and associated epigenetic signatures that underlie breast cancer in young patients. We are specifically interested in microRNA (miRNA), small noncoding RNAs that act as master players at all stages of breast cancer development and that are increasingly recognized as potential diagnostic and prognostic biomarkers. We have previously shown that differential expression of certain miRNAs in Lebanese breast cancer tissues could be different than what is reported in the West. We recently assessed the miRNA microarray profile expression in Lebanese breast cancer tissues, performed a comparative miRNA profile analysis with matched American samples, and predicted the role of dysregulated miRNA in early breast cancer through mRNA-miRNA integration analysis. Although most of the dysregulated miRNA in Lebanese patients with breast cancer is similar to that in American population, differences in miRNA expression exist and can be attributed either to the patient’s age at diagnosis or to an ethnic variation. We are currently studying circulating miRNA in the blood of Lebanese patients with breast cancer, and a dysregulated signature will be presented. Our data provide a basis for additional investigation that should be performed to comprehend dysregulated miRNA implication in breast cancer, especially in young patients, and the role of circulating miRNAs as potential biomarkers for breast cancer early detection.
{"title":"microRNA in Early-Stage Breast Cancer in Lebanese Women","authors":"F. Nassar, A. Tfayli, A. Itani, G. Chamandi, N. Zgheib, Joelle Makoukji, R. Boustany, R. Talhouk, R. Nasr","doi":"10.1200/jgo.19.17000","DOIUrl":"https://doi.org/10.1200/jgo.19.17000","url":null,"abstract":"Breast cancer is the most prevalent female cancer and has a higher incidence in young Lebanese patients as compared with the West. Interestingly, this particularity of breast cancer in the Lebanese population was not found to be associated with higher BRCA1/2 gene mutations. Hence, our research focuses on investigating molecular mechanisms and associated epigenetic signatures that underlie breast cancer in young patients. We are specifically interested in microRNA (miRNA), small noncoding RNAs that act as master players at all stages of breast cancer development and that are increasingly recognized as potential diagnostic and prognostic biomarkers. We have previously shown that differential expression of certain miRNAs in Lebanese breast cancer tissues could be different than what is reported in the West. We recently assessed the miRNA microarray profile expression in Lebanese breast cancer tissues, performed a comparative miRNA profile analysis with matched American samples, and predicted the role of dysregulated miRNA in early breast cancer through mRNA-miRNA integration analysis. Although most of the dysregulated miRNA in Lebanese patients with breast cancer is similar to that in American population, differences in miRNA expression exist and can be attributed either to the patient’s age at diagnosis or to an ethnic variation. We are currently studying circulating miRNA in the blood of Lebanese patients with breast cancer, and a dysregulated signature will be presented. Our data provide a basis for additional investigation that should be performed to comprehend dysregulated miRNA implication in breast cancer, especially in young patients, and the role of circulating miRNAs as potential biomarkers for breast cancer early detection.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jgo.19.17000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41470427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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