International Journal of Health Policy and Management

International Journal of Health Policy and Management

Priority Setting for Improvement of Cervical Cancer Prevention in Iran

Document Type : Original Article

Authors
Azam Majidi 1
Reza Ghiasvand 1, 2
Maryam Hadji 1
Azin Nahvijou 1
Azam-Sadat Mousavi 3
Minoo Pakgohar 4
Nahid Khodakarami 5
Mehrandokht Abedini 6
Farnaz Amouzegar Hashemi 7
Marjan Rahnamaye Farzami 8
Reza Shahsiah 9
Sima Sajedinejhad 10
Mohammad Ali Mohagheghi 1
Fatemeh Nadali 11
Arash Rashidian 12
Elisabete Weiderpass 13, 14, 15, 16
Ole Mogensen 17
Kazem Zendehdel 1, 18
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
10.15171/ijhpm.2015.201
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
Subjects
  1. Nathalie B, O’Neal Eckert L, Andreas U, Paul B. Comprehensive Cervical Cancer Control: A Guide to Essential Practice  . 2nd ed. Austuralia: World Health Organization; 2014.
  2. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189(1):12-19.
  3. Campbell CMP, Menezes LJ, Paskett ED, Giuliano AR. Prevention of invasive cervical cancer in the United States: past, present, and future. Cancer Epidemiol Biomarkers Prev. 2012;21(9):1402-1408. doi:10.1158/1055-9965.EPI-11-1158
  4. Barnholtz-Sloan J, Patel N, Rollison D, Kortepeter K, MacKinnon J, Giuliano A. Incidence trends of invasive cervical cancer in the United States by combined race and ethnicity. Cancer Causes Control. 2009;20(7):1129-1138. doi:10.1007/s10552-009-9317-z
  5. Vaccarella S, Lortet-Tieulent J, Plummer M, Franceschi S, Bray F. Worldwide trends in cervical cancer incidence: impact of screening against changes in disease risk factors. Eur J Cancer. 2013;49(15):3262-3273.
  6. Zwaveling S, Mota SCF, Nouta J, et al. Established human papillomavirus type 16-expressing tumors are effectively eradicated following vaccination with long peptides. J Immunol. 2002;169(1):350-358. doi:10.4049/jimmunol.169.1.350
  7. Dikshit R, Gupta PC, Ramasundarahettige C, et al. Cancer mortality in India: a nationally representative survey. Lancet. 2012;379(9828):1807-1816. doi:10.1016/s0140-6736(12)60358-4
  8. Wasti S, Ahmed W, Jafri A, Khan B, Sohail R, Hassan S. Analysis of cervical smears in a Muslim population. Ann Saudi Med. 2004;24:189-192.
  9. Badar F, Anwar N, Meerza F, Sultan F. Cervical carcinoma in a Muslim community. Asian Pac J Cancer Prev. 2007;8(1):24.
  10. GLOBOCAN 2012. Estimated Cancer Incidence, mortality and prevalence worldwide in 2012;  2014. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx
  11. Khorasanizadeh F, Hassanloo J, Khaksar N, et al. Epidemiology of cervical cancer and human papilloma virus infection among Iranian women - analyses of national data and systematic review of the literature. Gynecol Oncol. 2013;128(2):277-281. doi:10.1016/j.ygyno.2012.11.032
  12. Bhurgri Y, Nazir K, Shaheen Y, et al. Patho-epidemiology of cancer cervix in Karachi South. Asian Pac J Cancer Prev. 2007;8(3):357.
  13. Wong YL, Chinna K, Mariapun J, Shuib R. Correlates between risk perceptions of cervical cancer and screening practice. Prev Med. 2013;57:S24-S26.
  14. De Alba I, Hubbell FA, McMullin JM, Sweningson JM, Saitz R. Impact of US citizenship status on cancer screening among immigrant women. J Gen Intern Med. 2005;20(3):290-296. doi:10.1111/j.1525-1497.2005.40158.x
  15. Sengul D, Altinay S, Oksuz H, Demirturk H, Korkmazer E. Population-based cervical screening outcomes in Turkey over a period of approximately nine and a half years with emphasis on results for women aged 30-34. Asian Pac J Cancer Prev. 2014;15:2069-2074. doi:10.7314/APJCP.2014.15.5.2069
  16. Behnamfar F, Azadehrah M. Factors associated with delayed diagnosis of cervical cancer in iran-a survey in isfahan city. Asian Pac J Cancer Prev. 2014;16(2):635-639. doi:10.7314/apjcp.2014.15.5.2069
  17. Mitton C, Donaldson C. Health care priority setting: principles, practice and challenges. Cost Eff Resour Alloc. 2004;2(1):3. doi:10.1186/1478-7547-2-3
  18. World Health Organization (WHO). Priority Setting Methodologies in Health Research:A workshop convened by WHO's Cluster on Information, Evidence and Research (IER), its Department for Research Policy and Cooperation (RPC) and the Special Programme for Research and Training in Tropical Diseases (TDR). Geneva: WHO; 2008.
  19. Bryant J, Sanson-Fisher R, Walsh J, Stewart J. Health research priority setting in selected high income countries: a narrative review of methods used and recommendations for future practice. Cost Eff Resour Alloc. 2014;12:23. doi:10.1186/1478-7547-12-23
  20. Forman D, Bray F, Brewster D, et al. Cancer Incidence in Five Continents. Lyon: IARC; 2013.
  21. Viergever RF, Olifson S, Ghaffar A, Terry RF. A checklist for health research priority setting: nine common themes of good practice. Health Res Policy Syst. 2010;8:36.
  22. Al Eyd GJ, Shaik RB. Rate of opportunistic pap smear screening and patterns of epithelial cell abnormalities in pap smears in Ajman, United arab emirates. Sultan Qaboos University Medical Journal. 2012;12(4):473.
  23. Sancho-Garnier H, Khazraji YC, Cherif MH, et al. Overview of cervical cancer screening practices in the Extended Middle East and North Africa countries. Vaccine. 2013;31:G51-G57. doi:10.1016/j.vaccine.2012.06.046
  24. Nahvijou A, Hadji M, BaratiMarnani A, et al. A systematic review of economic aspects of cervical cancer screening strategies worldwide: discrepancy between economic analysis and policymaking. Asian Pac J Cancer Prev. 2014;15(19):8229-8237.
  25. Khodakarami N, Farzaneh F, Yavari P, Khayamzadeh M, Taheripanah R, Akbari ME. The New Guideline for Cervical Cancer Screening in Low Risk Iranian Women. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2014;17(95):8-17. [in persian].
  26. 26.   Cronjé H. Cervical screening strategies in resourced and resource-constrained countries. Best Pract Res Clin Obstet Gynaecol. 2011;25(5):575-584. doi:10.1016/j.bpobgyn.2011.05.002
  27. Nahvijou A, Sari AA, Zendehdel K, Marnani AB. Management of precancerous cervical lesions in iran: a cost minimizing study. Asian Pac J Cancer Prev. 2014;15(19):8209. doi:10.7314/apjcp.2014.15.19.8209
  28. Nwankwo K, Aniebue U, Aguwa E, Anarado A, Agunwah E. Knowledge attitudes and practices of cervical cancer screening among urban and rural Nigerian women: a call for education and mass screening. Eur J Cancer Care (Engl). 2011;20(3):362-367. doi:10.1111/j.1365-2354.2009.01175.x
  29. Eaker S, Adami HO, Sparen P. Reasons women do not attend screening for cervical cancer: a population-based study in Sweden. Prev Med. 2001;32(6):482-491. doi:10.1006/pmed.2001.0844
  30. Jalalvandi M, Khodadoostan M. Married women and pap smear, what they know? how they do? Iran J Nurs. 2005;18(41):139-144.
  31. Farzaneh F, Shirvani HE, Barouti E, Salehpour S, Khodakarami N, Alizadeh K. Knowledge and attitude of women regarding the human papillomavirus (HPV) infection, its relationship to cervical cancer and prevention methods. Med J Malaysia. 2011;66(5):468-473.
  32. Abedian Z, Dormahammadi M. Investigating awareness, attitude and practice of women who referred to health centers of Mashhad city toward Pop smear. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2013;15(36):22-28.
  33. Javanmanesh F, Dadkhah F, Zarepour N. Knowledge and awareness among Iranian women regarding the pap smear. Med J Islam Repub Iran. 2008;22(2):68-73.
  34. Zendehdel K, Sedigh Z, Hassanloo J, Nahvijou A. Audit of a nationwide pathology-based cancer registry in Iran. BCCR. 2011;2:7-13.
  35. Etemadi A, Sadjadi A, Semnani S, Nouraie SM, Khademi H, Bahadori M. Cancer registry in Iran: a brief overview. Arch Iran Med. 2008;11(5):577-580.
  36. Zendehdel K. Completeness and underestimation of cancer mortality rate in Iran: a report from Fars province in Southern Iran. Arch Iran Med. 2015;18(3):160.
  37. Arbyn M, Anttila A, Jordan J, et al. European Guidelines for Quality Assurance in Cervical Cancer Screening. Second edition--summary document. Ann Oncol. 2010;21(3):448-458. doi:10.1093/annonc/mdp471
  38. Andrae B, Kemetli L, Sparen P, et al. Screening-preventable cervical cancer risks: evidence from a nationwide audit in Sweden. J Natl Cancer Inst. 2008;100(9):622-629.
  39. Azerkan F, Sparen P, Sandin S, Tillgren P, Faxelid E, Zendehdel K. Cervical screening participation and risk among Swedish-born and immigrant women in Sweden. Int J Cancer. 2012;130(4):937-947. doi:10.1002/ijc.26084
  40. Cutts FT, Franceschi S, Goldie S, et al. Human papillomavirus and HPV vaccines: a review. Bull World Health Organ. 2007;85(9):719-726. doi:10.2471/blt.06.038414
  41. Stanley M. Human papillomavirus vaccines versus cervical cancer screening. Clin Oncol. 2008;20(6):388-394. doi:10.1016/j.clon.2008.04.006
  42. Khatibi M, Rasekh HR, Shahverdi Z. Cost-effectiveness evaluation of quadrivalent human papilloma virus vaccine for hpv-related disease in Iran. Iran J Pharm Res. 2014;13(Suppl):225.
  43. Chalmers I, Bracken MB, Djulbegovic B, et al. How to increase value and reduce waste when research priorities are set. Lancet. 2014;383(9912):156-165. doi:10.1016/s0140-6736(13)62229-1
  44. Neema S. Community participation in essential national health research process: Uganda's Experience. Report for COHRED's Working Group on Community Participation. Makerere Institute of Social Science, Makerere University, Uganda; 1999.
  45. Mbewu A, Mngomezulu K. Health Research in South Africa. The South African Health Review. Durban: Health Systems Trust; 1999.

 

  • Received Date 04 February 2015
  • Revised Date 06 November 2015
  • Accepted Date 16 November 2015
  • First Published Date 01 April 2016
  • Published Date 01 April 2016