Background:Cervical cancer is a major cause of cancer mortality in women and more than a quarter of its global burden is contributed by developing countries. In India, in spite of alarmingly high figures, there is no nationwide government-sponsored screening program. This study was conducted to assess the burden of cervical cancer in India and review the performance characteristics of available cervical cancer screening tools, so as to provide evidence-based recommendations for application of most practically suited screening test to be used in resource-poor field settings.Materials and Methods:MEDLINE and Web of Science electronic database were searched from January 1990 to December 2015, using the keywords such as “cervical cancer”, “screening”, “early detection”, “cervical cytology” and “visual inspection”, and their corresponding MeSH terms in combination with Boolean operators “OR, AND.” Two authors independently selected studies that are published in English and conducted in India. A total of 11 studies were found to be relevant and eligible to be included in the present study.Results:In India, cervical cancer contributes to approximately 6–29% of all cancers in women. The age-adjusted incidence rate of cervical cancer varies widely among registries; highest is 23.07/100,000 in Mizoram state and the lowest is 4.91/100,000 in Dibrugarh district. The pooled estimates of sensitivity and specificity of visual inspection with acetic acid (VIA), magnified VIA, visual inspection with Lugol's iodine (VILI), cytology (Pap smear), and human papillomavirus DNA were found to be 67.65% and 84.32%, 65.36% and 85.76%, 78.27% and 87.10%, 62.11% and 93.51%, and 77.81% and 91.54%, respectively.Conclusions:In developing countries because of lack of necessary infrastructure and quality control, high-quality cytology screening may not be feasible for wide-scale implementation. Hence, cervical cancer screening program based on visual screening test such as VIA/VILI should be adopted as an integral part of primary health-care setup in resource-poor countries like India.

Context:Breast cancer (BC) is one of the major causes of cancer mortality in India. Late-stage diagnosis of BC is associated with poor survival. Identification of factors affecting late presentation of the disease could be an effective step to reduce BC mortality.Aims:To study the association of sociodemographic factors with BC stage at diagnosis.Settings and Design:The study is a retrospective analysis from the case records from a single institution.Subjects and Methods:Data for the year 2008 was collected from the hospital records. A total of 1210 cases were included for the analysis. Sociodemographic factors included were age, place of residence, religion, marital status, level of education, and occupation. Other study variables were family history, presence of comorbidity, and stage at diagnosis.Statistical Analysis:Association between sociodemographic factors by stage at diagnosis was tested using Chi-square statistics, with odds ratios (ORs) estimated through logistic regression modeling.Results:In the study cohort, 46% patients had reported at early stages and 54% at advanced stages. All factors were evaluated for being predictors of disease stage at presentation using univariate and multivariate logistic regression model. Women from urban background were less likely to present with advanced stage disease (OR = 0.64; 95% confidence interval [CI]: 0.49–0.84) as compared to rural women. Similarly, illiterate women were also more likely to present with advanced-stage disease (OR = 1.55; 95% CI: 1.16–2.09).Conclusions:This data clearly indicate that the patients of rural background and of low education status are more likely than their respective counterparts to have an advanced stage of BC diagnosis. Our results may be considered the keys to determining how stage variation may be related to patients and community characteristics and where limited resources need to be invested to ensure early diagnosis of BC.

Introduction:Carcinoma of the buccal mucosa is the most common oral cavity cancer in the Indian subcontinent. The aim of this study was to analyze the outcome and evaluate prognostic factors in surgically treated buccal mucosa squamous cell carcinoma (BMSCC) patients.Materials and Methods:A retrospective study was performed by reviewing the medical records of 409 pathologically proven buccal mucosa cancer patients, who were diagnosed and surgically treated in Tata Memorial Hospital between January 1, 2006, and December 31, 2008.Results:The overall 5-year survival of the cohort was found to be 54.1%. The stage-wise survival rate for tumor, node, metastasis (TNM) Stage I, II, III, and IV patients was found to be 85.2%, 82.9%, 56.3%, and 42.6% (P < 0.00), respectively. On multivariate Cox proportional hazard analysis, the presence of comorbidity, histological tumor size, pathological lymph node status, tumor differentiation, perineural invasion, and extracapsular spread were found to be independently associated with overall survival.Conclusion:BMSCC is an aggressive malignant tumor. In addition to TNM classification, other clinical and pathological factors also have a significant role in BMSCC prognostication. Hence, there is a need to move beyond TNM and develop a more inclusive, flexible, and easy to use prognostic system.

Context:Cancer of the cervix is the most common genital tract malignancy in the female and is a major public health problem in the developing countries. Study of the sociodemographic and clinical profile of patients is the first step in planning control measures and treatment facilities.Aims:The aims of the study were to determine the sociodemographic and clinical profile of cervical cancer patients and study their association with other tumor-related factors.Settings and Design:This is a record-based retrospective study from a single institution.Subjects and Methods:The data on sociodemographic and clinical factors of 765 cervical cancer patients visited and treated at tertiary care cancer hospital in Mumbai in 1 year period were analyzed.Statistical Analysis:Data were analyzed using descriptive statistics. Kruskal–Wallis and Chi-square test were used to assess relationship between variables.Results:The median age of the cohort was 54 years and interquartile range was 16 years. Nearly 53.6% of patients were illiterate. About 88.10% of patient's had squamous cell carcinoma. Only 13% of cases had early stage disease and 77% of patient's had not taken any treatment before coming to the hospital. Of the total, about 26% patients also had concomitant comorbidities, of which hypertension was found to be the leading comorbid condition. Stage of disease was found to be significantly (P < 0.05) associated with age and educational status.Conclusion:This study highlights certain important baseline characteristics of cervical cancer patients. This basic information on profile of patients can help plan and optimum utilization of hospital services, especially in resource-poor countries like India.

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Background: Inflammation seems to play a very crucial role in the growth and progression of many cancers. It has been reported that a peripheral blood count has been used as a cost-effective and simple parameter of systemic inflammation in critically ill patients. The aim of this study is to investigate whether components of WBC counts can predict the prognosis of patients with cervical cancer. Methods: Medical records of 549 cervical cancer patients diagnosed between 1 January 2008 to 31 December 2008 were retrospectively analyzed. Receiver operating characteristic curve analysis and Cox proportional hazards model were applied to evaluate the effect of white blood cell (WBC) counts on overall survival. Results: The 5-year overall survival of the cohort was found to be 67.7%. On the basis of univariate analysis elevated monocyte count (≥0.515 10 9 /L) and lower lymphocyte count (≤2.075 10 9 /L) were associated with poor overall survival (OS) (p=0.016 and 0.002 respectively). Multivariate Cox proportional hazard analysis showed that higher monocyte and lower lymphocyte levels were a significant independent predictors for worse OS (HR = 1.555, 95% CI = 1.125-2.149; P=0.008) and (HR = 1.712, 95% CI = 1.232-2.379; P= 0.001) respectively. The advanced overall stage and treatment were also found to be independent indicators for poor OS. Conclusions: Pretreatment monocyte and lymphocyte count is an independent predictor of prognosis in cervical cancer patients. Thus it may be a cost effective marker to predict the outcome of cervical cancer patients.

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