Inequalities in cervical cancer screening in Eastern Europe: perspectives from Bulgaria and Romania

Todorova, Irina; Băban, Adriana; Alexandrova-Karamanova, Anna; Bradley, Janet

doi:10.1007/s00038-009-8040-6

Cited by 49 publications

(53 citation statements)

References 32 publications

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“…Romania has a higher incidence of cervical cancer than any other european country. in 2004, the uS had a 2.4 per 100,000 mortality rate due to cervical cancer; by contrast, the mortality rate in Romania was approximately 14.6 per 100,000 (1,2). The main cause of cervical cancer is high-risk (hr)-human papillomavirus (HPV) infection (3).…”

Section: Introductionmentioning

confidence: 99%

Quantitative analysis of the relationship between microRNA‑124a, -34b and -203 gene methylation and cervical oncogenesis

et al. 2010

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Abstract. cervical cancer is a leading cause of mortality in women. Molecular and epidemiological data have unequivocally confirmed that high-risk human papillomaviruses (HPVs) are a major etiological agent of this malignancy, as host epigenetic alterations are induced in response to viral infection. The present study evaluated the methylation status of cpG islands surrounding miR-124a, miR-34b and miR-203 in 29 cervical cancer precursor lesions, 31 cervical tumors and 30 normal control samples, with the aim of identifying potential markers of cervical cancer. Direct quantitative methylation-specific PCR (qMSP) was used to evaluate the degree of methylation in the samples. HPV DNA was detected and genotyped using the Linear Array HPV Genotyping Test. Data were statistically analyzed using the Kruskal-Wallis test. Differences in miRNA hypermethylation between the tumor and control samples were highly significant for all the genes tested (p<0.0001). Significant results were also obtained regarding the hypermethylation of miR-124a and miR-203 in the precursor lesions compared to the control samples. among the 29 patients with precursor lesions, 68.97% (20/29) presented high risk (hr)-HPV genotypes and 31.03% (9/29) were diagnosed with low risk (lr)-HPV. Significant results (p=0.0266) were obtained for miR-124a (hr-HPV group, mean 41.32; lr-HPV group, mean 6.74), revealing a strong association between the methylation process and the hr-HPV genotype. Borderline results (p=0.058) were obtained for miR-203 (hr-HPV group, mean 44.05; lr-HPV group, mean 3.33). These results confirm the involvement of epigenetic alterations in cervical oncogenesis. The lr-HPV precursor lesions had a methylation percent pattern similar to that of the normal samples, while the results for the hr-HPV precursor lesions and tumors indicate a possible involvement of the hr-HPV genotype in the miRNA methylation process.

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Section: Introductionmentioning

confidence: 99%

Quantitative analysis of the relationship between microRNA‑124a, -34b and -203 gene methylation and cervical oncogenesis

et al. 2010

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“…It is of concern since immigrant women come from developing countries where cervical cancer rates are high. Studies conducted in their countries of origin 7,13 have shown that low utilization of cervical screening programs is associated with the fact that women have to pay for this service. This is a free public service in Spain' however, we do not know whether those immigrant women who have health insurance are aware of that.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,4,6,[7][8][9][10][12][13][14][15] In addition to these variables, there is also evidence that women attending more cervical screenings are those who use more health services. 11 In our study midwives said that women who come in for a visit, especially pregnancy care, are offered to participate in the CCPP.…”

Section: Discussionmentioning

confidence: 99%

Detección precoz de cáncer de cérvix según los discursos de las matronas de atención primaria en Segovia, España

Otero¹,

Sanz²,

Blasco³

2011

Rev. Saúde Pública

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OBJECTIVE:To analyze the discourses of primary care midwives on access to and utilization of the Cervical Cancer Prevention Program. METHODS:A qualitative study was conducted in an area of low population density with a high proportion of rural population in Segovia, Spain, between 2008 and 2009. Semi-structured interviews were carried out. Ten primary care midwives were interviewed covering the 16 basic health districts of the city. Data analysis was based on grounded theory methodology. RESULTS:Access to and utilization of the Cervical Cancer Prevention Program was associated with attendance to midwife visits, women's experiences with cervical smears and their perception of risk of cervical cancer. Geographic distance to the health center, diffi cult access to immigrant women who have no health insurance, and being unaware of the program offered are some of the perceived barriers. Social exclusion is also perceived as a barrier of access to and utilization of the program. The recommendation to participate in the program made by the primary care physician was identifi ed as the main facilitator. CONCLUSIONS:The midwives perceived inequalities in access to and utilization of the Cervical Cancer Prevention Program that are associated to individual characteristics of women, and contextual characteristics such as the geographical environment where they live and Program's infrastructure. There is inequality of access to care of underrepresented groups of women such as immigrant women and those residing in rural areas.

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“…However, this document has been criticized for its inconformity with the principles of evidence-based policy making (Salchev et al 2008). Specifically, screening coverage is low, at least in the case of cervical screening (Todorova et al 2009), and health promotion programs lack the commitment needed to achieve substantial reductions in CVD risk. The introduction of clinical pathways as a payment mechanism for hospitals through the National Health Insurance Fund has led to distortion of morbidity statistics due to preferential coding of diagnoses that are reimbursed at a higher rate and this may complicate the monitoring of disease outcomes related to prevention programs (Rechel 2009).…”

Section: Current Public Health Infrastructurementioning

confidence: 99%

Perceived barriers to the development of modern public health in Bulgaria: a qualitative study

Scott

Powles

Thomas

et al. 2010

Int J Public Health

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Inequalities in cervical cancer screening in Eastern Europe: perspectives from Bulgaria and Romania

Cited by 49 publications

References 32 publications

Quantitative analysis of the relationship between microRNA‑124a, -34b and -203 gene methylation and cervical oncogenesis

Quantitative analysis of the relationship between microRNA‑124a, -34b and -203 gene methylation and cervical oncogenesis

Detección precoz de cáncer de cérvix según los discursos de las matronas de atención primaria en Segovia, España

Perceived barriers to the development of modern public health in Bulgaria: a qualitative study

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