Priority Setting for Improvement of Cervical Cancer Prevention in Iran

Document Type: Original Article

Authors

1 Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran

2 Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway

3 Department of Genecology Oncology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

5 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

6 Deputy of Public Health, Maternal Office, Ministry of Health and Medical Education, Tehran, Iran

7 Radiotherapy Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran

8 Central Reference Laboratory, Ministry of Health and Medical Education, Tehran, Iran

9 Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran

10 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

11 Faculty of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran

12 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

13 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

14 Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway

15 Department of Research, Cancer Registry of Norway, Institute of PopulationBased Cancer Research, Oslo, Norway

16 Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland

17 Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark

18 Cancer 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

Main Subjects


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