Runge Ava S, Bernstein Megan E, Lucas Alexa N, Tewari Krishnansu S
Department of Medical Education, University of California, Irvine School of Medicine, Irvine, CA, USA.
Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of California, Irvine Medical Center, Orange, CA, USA.
Gynecol Oncol Rep. 2019 May 21;29:40-47. doi: 10.1016/j.gore.2019.05.008. eCollection 2019 Aug.
Cervical cancer is the most common cancer in Tanzania. After excluding human immunodeficiency virus, lower respiratory infections, malaria, diarrheal diseases, and tuberculosis, cervical cancer kills more women than any other form of illness in the country. Unfortunately, Tanzania has a low doctor-to-patient ratio (1:50,000) and nearly 7000 women die each year from this disease. The clinical problem is further magnified by the country's lack of resources and prevailing poverty, sporadic cervical cancer screening, prevalence of high-risk oncogenic human papillomavirus subtypes, and relatively high rates of human immunodeficiency virus co-infection. In recent years, addressing the cervical cancer problem has become a priority for the Tanzanian government. In this systematic review of 39 peer-reviewed publications that appeared in the PubMed/MEDLINE (NCBI) database from 2013 to 2018, we synthesize the growing body of literature to capture current trends in Tanzania's evolving cervical cancer landscape. Six domains were identified, including risk factors, primary prevention, barriers to screening, treatment, healthcare worker education, and sustainability. In addition to traditional risk factors associated with sexual behavior, acetowhite changes observed during visual inspection of the cervix with acetic acid, lower education, rural setting, and HIV positivity also have a noteworthy clinical impact.
宫颈癌是坦桑尼亚最常见的癌症。在排除人类免疫缺陷病毒、下呼吸道感染、疟疾、腹泻病和结核病之后,宫颈癌导致该国死亡的女性比任何其他疾病都多。不幸的是,坦桑尼亚的医患比例很低(1:50000),每年有近7000名女性死于这种疾病。该国资源匮乏、普遍贫困、宫颈癌筛查零星开展、高危致癌性人乳头瘤病毒亚型流行以及人类免疫缺陷病毒合并感染率相对较高,进一步加剧了这一临床问题。近年来,解决宫颈癌问题已成为坦桑尼亚政府的一项优先任务。在对2013年至2018年发表于PubMed/MEDLINE(美国国立医学图书馆)数据库的39篇同行评议出版物进行的这项系统评价中,我们综合了越来越多的文献,以把握坦桑尼亚不断变化的宫颈癌形势的当前趋势。确定了六个领域,包括危险因素、一级预防、筛查障碍、治疗、医护人员教育和可持续性。除了与性行为相关的传统危险因素外,在宫颈醋酸目视检查中观察到的醋酸白改变、低教育水平、农村地区以及艾滋病毒阳性也具有显著的临床影响。