SRHR Evidence (Best practice, Systematic reviews)
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Item Assessing the impact of contraceptive use on reproductive cancer risk among women of reproductive age—a systematic review(Frontiers in Global Women's Health, 2024-11-13) Mortazavi, Julie; Jahanfar, Shayesteh; Lapidow, Amy; Cu, Cassandra; Al Abosy, Jude; Morris, Kathyrn; Becerra-Mateus, Juan Camilo; Steinfeldt, Meredith; Maurer, Olivia; Bohang, Jiang; Andrenacci, Paola; Badawy, Marwa; Ali, MoazzamBackground: Contraceptives play a crucial role in women's reproductive health, their hormonal components may be linked to cancer risks, specifically breast, and gynecological cancers. Given the high usage rates of hormonal contraceptives, it is vital to systematically evaluate their potential impact on cancer outcomes, especially among women with a family history of gynecological cancers. Objectives: This study aims to evaluate the evidence on the association between modern contraceptive use and the risk of breast and reproductive cancers (ovarian, endometrial, and cervical cancer) among women of reproductive age, to inform healthcare providers, women, and program managers about cancer outcomes related to contraceptive use. Methods: A systematic review was conducted according to PRISMA guidelines. Searches were performed in databases such as CINAHL, OVID Medline, EMBASE, and more from inception to February 2022. Eligible studies included randomized controlled trials, cohort studies, and case-control studies that compared cancer outcomes between contraceptive users and non-users. Data extraction, quality assessment, and meta-analyses were conducted following predefined protocols. Subgroup and sensitivity analyses examined variations in contraceptive methods, doses, and duration. Results: A total of 51 studies were included, comprising 2 RCTs and 49 observational studies. The review identified a significant reduction in ovarian and endometrial cancer incidence among contraceptive users. Hormonal contraceptive users had a 36% lower risk of ovarian cancer (RR 0.64, 95% CI 0.60–0.68), with specific reductions seen in combined oral contraceptive users (RR 0.62, 95% CI 0.57–0.68) and hormonal IUD users (RR 0.68, 95% CI 0.48–0.96). The rate ratio of cervical cancer was higher among non- users compared to hormonal contraceptive users when we pooled the results (1.28, 95% CI 1.21, 1.35). No significant association was found between contraceptive use and breast cancer risk among healthy women (RR 1.00, 95% CI 0.94–1.06). However, BRCA1/2 mutation carriers using oral contraceptives showed a heightened risk of breast cancer (HR 1.39, 95% CI 1.15–1.67). Conclusion: This systematic review highlights the protective effects of modern contraceptives against ovarian and endometrial cancers while identifying an increased risk of cervical. No significant breast cancer risk was found for healthy women, but BRCA1/2 mutation carriers faced increased risks. These findings underscore the need for personalized contraceptive counselling that considers cancer risk factors. Further research is needed to explore contraceptive impacts across different genetic profiles and dosing regimens. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, Prospero (CRD42022332647).Item WHO preferred product characteristics for therapeutic HPV vaccines(World Health Organization, 2024) World Health OrganizationItem Knowledge of Thai women in cervical cancer etiology and screening(Plos One, 2023-05-18) Khomphaiboonkij, Uraiwan; Sreamsukcharoenchai, Nattapong; Pitakkarnkul, Supakorn; Rittiluechai, Kristsanamon; Tangjitgamol, SiriwanKnowledge about cervical cancer screening and Human papilloma virus (HPV) influence on their awareness to the cervical cancer screening program. Most previous studies found inadequate knowledge and attitude among healthy women affect the low rate of screening. This study aimed to assess knowledge of cervical cancer screening and HPV in women who had abnormal cervical cancer screening in Bangkok. Thai women, aged ≥ 18 years old, who had abnormal cervical cancer screening and scheduled to colposcopy clinics of 10 participating hospitals were invited to participate in this cross-sectional study. The participants were asked to complete a self-answer questionnaire (Thai language). The questionnaire composed of 3 parts: (I) demographic data, (II) knowledge about cervical cancer screening and (III) knowledge about HPV. Among 499 women who answered the questionnaires, 2 had missing demographic data. The mean age of the participants was 39.28 ± 11.36 years. 70% of them had experience of cervical cancer screening, with 22.7% had previous abnormal cytologic results. Out of 14 questions, the mean score of knowledge about cervical cancer screening was 10.04 ± 2.37. Only 26.9% had good knowledge about cervical cancer screening. Nearly 96% of woman did not know that screening should be done. After excluding 110 women who had never known about HPV, 25.2% had good knowledge about HPV. From multivariable analysis, only younger age (≤ 40 years) was associated with good knowledge of cervical cancer screening and HPV. In the conclusion, only 26.9% of women in this study had good knowledge regarding cervical cancer screening. Likewise, 20.1% of women who had ever heard about HPV has good knowledge about HPV. Providing information about cervical cancer screening and HPV should improve the women's knowledge and better adherence to the screening procedure.Item Detecting Human Papillomavirus Type 16 in Cervical Cancer Patients with Molecular Variation of Gene L1 in Riau Province Indonesia(Asian Pacific Journal of Cancer Prevention, 2022-01) Savira, Maya; S, Donel; Putra, Andani Eka; Yusrawati, Yusrawati; Lipoeto, Nur IndrawatiBackground: Cervical cancer is the second most deadly cancer in the world after breast cancer. The cancer is caused by infection of high risk Human Papillomavirus (HPV) type 16. It is often found in cervical cancer of which the genome structure is composed of L1 proteins. The L1 protein makes up the viral capsid that has an important role in causing the cervical epithelium. Several studies have found the differences in HPV nucleotides variants that lead to changes in amino acids that disrupt the structure, the natural function of the virus itself, and ultimately lead to changes in biological functions including host immunological recognition. Variation of the L1 gene also affects the effectiveness of existing vaccines. Methods: This research was a descriptive study conducted at the laboratory of microbiology, the Faculty of Medicine, Universitas Riau, Pekanbaru from February to August 2018. The study was aimed at looking at the molecular variations of the L1 HPV type 16 gene and examining phylogenic kinship. Results: The SNPs (Single Nucleotide Polymorphism) which occurred in 26 sample isolates are the substitution of C/G (6240), A/G (6432), T/G (6686), C/T (6824). These variations also cause changes in amino acids, insertion of ATC nucleotide bases (6902), and deletions of GAT bases (6954). Conclusion: There are molecular variations of the L1 HPV type 16 gene which can cause different host immune responses. Phylogenic kinship of HPV type 16 isolate in Riau is similar to Asian-American isolate.Item Value of diffusion-weighted imaging in preoperative evaluation and prediction of postoperative supplementary therapy for patients with cervical cancer(Annals of Translational Medicine, 2022-01) Liu, Liying; Wang, Shuo; Yu, Tao; Bai, Haoyan; Liu, Jingyu; Wang, Danbo; Luo, YahongBackground: With the continuous progress of medical imaging technology, evaluation of cervical cancer is increasingly dependent on imaging methods. Diffusion-weighted imaging (DWI) plays an important role, and apparent diffusion coefficient (ADC) value is a unique quantitative parameter in the research of cervical cancer. Methods: In this prospective study, a total of 273 patients diagnosed with stage IB1 to IIIC1 cervical cancer based on the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging guidelines who underwent pelvic 3.0T magnetic resonance imaging (MRI), including MRI and DWI, were enrolled, and the diagnostic value of preoperative staging of cervical cancer was compared between the MRI and DWI groups. The DWI group was used to explore the potential association of mean ADC (ADCmean) with different pathological characteristics and receiver operating characteristic (ROC) curves of ADCmean generated to predict the appropriate postoperative supplementary therapy. Results: The diagnostic coincidence rate of DWI was higher than that of MRI in preoperative staging of cervical cancer (χ2, P<0.05) and determined as stages IB1 + IB2 + IIA1 (90.91%), IB3 + IIA2 (93.48%), and IIIC1p (95.16%). The DWI staging results were consistent with postoperative pathological staging (Kappa value =0.865, P<0.001). We observed significant differences in ADCmean values in relation to pathological type, histological grade, depth of stromal infiltration, tumor diameter, lymphovascular invasion, and pelvic lymph node metastasis of cervical cancer (all P<0.05). The area under the ROC curve (AUC) was 0.815, with the best predictive value for postoperative supplementary therapy in cervical cancer (sensitivity 80.0%, specificity 74.0%) at ADCmean of 0.910×10−3 mm2/s. Conclusions: The DWI is a useful tool for preoperative evaluation of cervical cancer. In local cervical lesions, ADCmean varies in relation to different clinicopathological characteristics and a reference index of <0.910×10−3 mm2/s can be effectively applied to predict the need for postoperative supplementary therapy.