Priority Setting for Improvement of Cervical Cancer Prevention in 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. Implications for policy makers • Policy-makers, scientific community, governmental agencies, private sectors, and non-governmental organizations (NGOs) should contribute to the planning and implementation of an organized cervical cancer prevention program. Cervical cancer screening and treatment services should be accessible and affordable for all women in the country • Improvement of population-based cancer registry program and establishment of cervical screening registry are necessary for regular monitoring and evaluation of the screening program and should be prioritized in parallel to screening program. • Funding agencies should support research priorities suggested in this study. The results from these studies can be used for improvement of invasive cervical cancer (ICC) prevention in the future. Implications for publicWe suggested prioritizing public awareness and providing necessary information to the women about cervical cancer prevention and importance of regular attendance in the cervical screening program. Women should consider the criteria of the national guideline for attendance in the screening program, including starting age, and screening intervals. As emphasized in this study, follow-up and management of the abnormal tests and precancerous lesions is crucial. Women who receive an abnorm...

Cost-Effectiveness of Different Cervical Screening Strategies in Islamic Republic of Iran: A Middle-Income Country with a Low Incidence Rate of Cervical Cancer

“…An organized program is usually monitored regularly to ensure the program’s coverage and quality. Based on a recent priority setting study, development and implementation of an organized screening program and decisions about the proper age, intervals, and tests for screening are considered important priorities for Iran [ 21 ].…”

Disparities in Cervical Cancer Screening Participation in Iran: A Cross-Sectional Analysis of the 2016 Nationwide Steps Survey

“…The advanced clinical stage, at which most cervical cancers are identi ed, is responsible for the poor prognosis and higher mortality rates. [4,5] The standard secondary prevention method for cervical cancer is cervical cytology, which has been established for more than four decades in most countries. [6] However, studies have documented large discrepancies in the effect of cytology screening programs on cervical cancer rates reduction.…”

Low level of awareness among Iranian women concerning cervical cancer and screening: the role of knowledge, risk perceptions and cues to action

“…High mortality from CC can be reduced significantly by comprehensive health programs for prevention, screening and early detection, effective treatment and care (1,5). The epidemiology of cervical cancer in Iran, both through the pathology-based cancer registry (ASR 2.2 per 100,000) (2, 6) and the population-based registries (6 per 100,000, 2012) (7,8), shows a low incidence but a high mortality rate to reported incidence (54%) (2). This means that cervical cancers are a health priority.…”

“…CC control guidelines, including the WHO guidelines for cervical cancer control (1), the WHO package of essential NonCommunicable Disease (NCD) interventions for Primary Health Care (PHC) in low resource settings (9) and cohort studies in 13 European countries show that integrated screening sequence modalities including HPV testing, visual inspection with acetic acid (VIA) and cytology testing within an organized testing strategy is the most efficient method for screening and prevention of CC (4,7,8,10,11), contributing to decreased cancer morbidity and mortality (12,13). Statistics in central Asian countries show an increasing rate of cervical cancer and related mortality (among generations after 1940-50) in the absence of organized and well-established screening programs (13).…”

“…In addition to the general phenomenon of changing sexual behavior and risk factors (13,14), social and cultural challenges regarding sexual education (14,15) point to the necessity of implementing well-organized screening programs including HPV testing and cytology (16). Combining integrated strategy of sequence of HPV and cytology testing (Papanicolaou test; Pap smear),and HPV vaccination for all girls by age 15, and access to treatment and care for identified CC cases provides an effective and feasible strategy for eliminating CC (7,8,17,18) The Islamic Republic of Iran is implementing an opportunistic testing strategy for cervical cancer screening (CCS), integrated in Public Health Care (PHC) services. This CCS program was exclusively cytology-based and testing was recommended every three to five years until the age of 65 years (19).…”