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Priority Setting for Improvement of Cervical Cancer Prevention in Iran

Article 2, Volume 5, Issue 4, April 2016, Page 225-232  XML PDF (965 K)
Document Type: Original Article
DOI: 10.15171/ijhpm.2015.201
Authors
Azam Majidi1 ; Reza Ghiasvand1 2 ; Maryam Hadji1 ; Azin Nahvijou1 ; Azam-Sadat Mousavi3 ; Minoo Pakgohar4 ; Nahid Khodakarami5 ; Mehrandokht Abedini6 ; Farnaz Amouzegar Hashemi7 ; Marjan Rahnamaye Farzami8 ; Reza Shahsiah9 ; Sima Sajedinejhad10 ; Mohammad Ali Mohagheghi1 ; Fatemeh Nadali11 ; Arash Rashidian12 ; Elisabete Weiderpass13 14 15 16 ; Ole Mogensen17 ; Kazem Zendehdel 1 18
1Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
2Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
3Department of Genecology Oncology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
4Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
5Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
6Deputy of Public Health, Maternal Office, Ministry of Health and Medical Education, Tehran, Iran
7Radiotherapy Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
8Central Reference Laboratory, Ministry of Health and Medical Education, Tehran, Iran
9Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
10Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
11Faculty of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
12Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
13Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
14Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
15Department of Research, Cancer Registry of Norway, Institute of PopulationBased Cancer Research, Oslo, Norway
16Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
17Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
18Cancer Model Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background
Cervical cancer is the fourth most common cancer among women worldwide. Organized cervical screening and vaccination against human papilloma virus (HPV) have been successful interventions for prevention of invasive cervical cancer (ICC). Because of cultural and religious considerations, ICC has low incidence in Iran and many other Muslim countries. There is no organized cervical screening in these countries. Therefore, ICC is usually diagnosed in advanced stages with poor prognosis in these countries. We performed a priority setting exercise and suggested priorities for prevention of ICC in this setting.
 
Methods
We invited experts and researchers to a workshop and asked them to list important suggestions for ICC prevention in Iran. After merging similar items and removing the duplicates, we asked the experts to rank the list of suggested items. We used a strategy grid and Go-zone analysis to determine final list of priorities for ICC prevention in Iran.
 
Results
From 26 final items suggested as priorities for prevention of ICC, the most important priorities were developing national guidelines for cervical screening and quality control protocol for patient follow-up and management of precancerous lesions. In addition, we emphasized considering insurance coverage for cervical screening, public awareness, and research priorities, and establishment of a cervical screening registry.
 
Conclusion
A comprehensive approach and implementation of organized cervical screening program is necessary for prevention of ICC in Iran and other low incidence Muslim countries. Because of high cost for vaccination and low incidence of cervical cancer, we do not recommend HPV vaccination for the time being in Iran.
Keywords
Invasive Cervical Cancer (ICC); Priority Setting; Screening; Prevention and Control; Iran
Main Subjects
Evidence-Based Policy
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