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Background: Breast and cervical cancers are two major cancers affecting women's health. Breast cancer is the most invasive cancer, and cervical cancer is the fourth most leading cause of death among women. Analysis of updated incidence data and their trends would help policymakers in planning and organizing programs to reduce the burden. This study aims to present regional variations in recent years and study trends of both the cancers in India. Materials and Methods: For recent incidence rates of cervical and breast cancers, data were obtained from the National Cancer Registry Programme (NCRP) reports (2009–2011) for 25 registries and of 2012–2014 for 27 registries. Trends were studied for data obtained from different NCRP reports for the years 1982–2014 in six major registries. One in number of person who developed cancer and the annual Percentage change in incidence were calculated along with the trend analysis for both the cancers. The Joinpoint Regression Model was used for trend analysis. Results: The age-adjusted rate (AAR) of incidence of breast cancer in the South region was 36.78 in 2009–2011 as against the North region with 41 in 2012–2014. One in number who develop breast cancer remains highest in the North-East region but changed from 167 in 2009 to 200 in 2012. Cervical cancer was also the highest in the North-East region during 2009 and 2012. There is an increase in the overall cervical cancer incidence with 24.3 AAR in 2009 to 28.0 in 2012 and one in 200 who develop cervical cancer in 2009 to 250 in 2012. The trend analysis for six major registries showed an increase in the incidence of breast cancer, with the highest increase in New Delhi (3.22), and decrease in the incidence of cervical cancer, with the highest decrease in Mumbai (−1.21). Conclusion: There has been an exponential increasing trend in breast cancer and a steep declining linear trend in cervical cancer, conferring an inverse relationship between the two cancers. This trend is present in all the major cancer registries.

Background Role of Oral Contraceptive (OC) as a risk factor for cervical cancer remained controversial and unclear. Objective To evaluate risk of cervical cancer in OC users and non-users through a comprehensive systematic review. Search strategy Literature search conducted in databases from January 1990 till August 2019 using various search terms. Selection criteria Primary research studies that evaluated and assessed the association of OC use with cervical cancer with study design of case control or cohort types published in English language. Data collection and analysis PRISMA guided review was done by two independent researchers. Effect size estimated by pooled Odds ratio with 95 % Confidence Interval (CI) in random effect models on OC pill use for the risk of cervical cancer. Results Review included 19 studies. Overall risk of invasive cancer on OC use was found to be significant with unknown status of HPV OR (95 % CI) as 1.51 (1.35, 1.68) and for unknown HPV as 1.66 (1.24, 2.21). Adenocarcinoma, squamous cell carcinoma and carcinoma in situ had significant association with OR (95 % CI) of 1.77 (1.4, 2.24), 1.29 (1.18, 1.42) and 1.7 (1.18, 2.44) respectively. Conclusion OC pills use had a definite associated risk for developing cervical cancer specially for Adenocarcinoma and longer duration of OC pills use.

Background: Incidence of common types of skin cancers in India is not reported and its comparison with global load would be helpful statistics. Aim: The aim of this study is to summarize and report recent skin cancer incidence in India and to compare it with the incidence globally. Materials and Methods: Age-specific rates and age-adjusted rates (AARs) of the incidence of skin cancer for all ages (0–75 years) were collected from India and the world, respectively, from the National Cancer Registry Programme and GLOBOCAN 2018. Results: The AAR per 100,000 of melanoma of the skin was highest in the North region of India for both males and females with 1.62 and with 1.21, respectively. The incidence of nonmelanoma of the skin or other skin cancers for males was highest in the East region with 6.2 and for females in Northeast with 3.49. Among nonmelanoma, northeast region showed the maximum incidence for both male (75.6) and female (43.6) sexes. Globally, AAR of melanoma of skin for males was highest in the Western Pacific region with 36.9 and for the females; AAR was highest in the European region with 31.7. The incidence of nonmelanoma of the skin or other skin cancers for males was highest in the Western pacific region with 225.4 and 68.6 for females. Conclusion: Summary of the incidence rates of melanoma and nonmelanoma skin cancers which shows that though there are regional variations of incidence in India is lower than that of in the West.

Objective: The ASCO/CAP guidelines for reporting HER2 in breast cancer, first released in 2007, aimed to standardize the reporting protocol, and were updated in 2013 and 2018, to ensure right treatment. Several studies have analyzed the changes attributed to 2013 updated guidelines, and majority of them found increase in positive and equivocal cases. However, the precise implication of these updated guidelines is still contentious, in spite of the latest update (2018 guidelines) addressing some of the issues. We conducted systematic review and meta- analysis to see the impact of 2013 guidelines on various HER2 reporting categories by both FISH and IHC. Materials and Methods: After extensively searching the pertinent literature, 16 studies were included for the systematic review. We divided our approach in three strategies: (1) Studies in which breast cancer cases were scored for HER2 by FISH or IHC as a primary test concurrently by both 2007 and 2013 guidelines, (2) Studies in which HER2 results were equivocal by IHC and were followed by reflex-FISH test by both 2007 and 2013 guidelines, and (3) Studies in which trends of HER2 reporting were compared in the two periods before and after implementation of updated 2013 guidelines. All the paired data in these respective categories was pooled and analyzed statistically to see the overall impact of the updated guidelines. Results: In the first category, by pooled analysis of primary FISH testing there has been a significant increase in the equivocal cases (P < 0.001) and positive cases (P = 0.037). We also found 8.3% and 0.8% of all the negative cases from 2007 guidelines shifted to equivocal and positive categories, respectively. Similarly by primary IHC testing there has been a significant increase in both equivocal cases (P < 0.001) and positive cases (P = 0.02). In the second category of reflex-FISH testing there was a substantial increase in the equivocal cases (P < 0.0001); however there is insignificant decrease (10% to 9.7%; P = 0.66) in the amplified cases. In the third approach for evaluating the trend, with the implementation of 2013 guidelines, there was increase in the equivocal category (P = 0.025) and positive category (P = 0.0088) by IHC. By FISH test also there was significant increase in the equivocal category (P < 0.001) while the increase in the positive category was non-significant (P = 0.159). Conclusions: The updated 2013 guidelines has significantly increased the positive and equivocal cases using primary FISH or IHC test and with further reflex testing, thereby increasing the double equivocal cases and increasing the cost and delaying the decision for definite management. However, whether the additional patients becoming eligible for HDT will derive treatment benefit needs to be answered by further large clinical trials.

Background: Repeated cross-sectional serosurveys in the same geographic area establish the trend of the evolving pandemic. We present the findings of the third round of a national serosurvey to estimate the seroprevalence of SARS-CoV-2 infection among the general population and health care workers of India. Methods: We conducted the third population-based serosurvey between Dec 18, 2020 and Jan 6, 2021 in the same 700 villages or wards from 70 districts in 21 states across India, which were selected for the first and second serosurveys. We enrolled from each district, at least 400 individuals aged ≥ 10 years from general population and 100 HCWs from sub-district level public health facilities. Serum samples from general population were tested for the presence of IgG antibodies against nucleocapsid (N) and spike protein (S1-RBD) of SARS-CoV-2 using the Abbott and Siemens assays respectively, whereas sera from HCWs were tested for anti-S1-RBD. For general population, sera positive for either of the antibodies were considered positive, while sera positive for anti-S1-RBD were considered as positive for HCW. Weighted seroprevalence estimates were adjusted for sensitivity and specificity of respective assays. Findings: Of the 28,598 sera from general population, 4585 (16%) had IgG antibodies against N, 6647 (23.2%) against S1-RBD and 7436 (26%) against either. The weighted and assay characteristic adjusted seroprevalence against either of the antibodies was 24.1 (95%CI: 23.0% to 25.3%). Seroprevalence was lower in rural areas (21.4%, 95% CI: 20.3% to 22.6%) compared to urban non-slum (29.4%, 95% CI: 26.9% - 32.1%) and slum areas (34.6%, 95% CI: 31.0% to 38.3%). Among 7385 HCWs, the seroprevalence of anti-S1-RBD IgG antibodies was 25.6% (95% CI: 23.5% to 27.8%). Interpretation: Nearly one in four individuals aged 10 years or older from general population as well as HCWs were exposed to SARS-CoV-2 by December 2020 amounting to 271 million infections in India. Funding Statement: Indian Council of Medical Research Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare no competing interests Ethics Approval Statement: The project was approved by Institutional Human Ethics Committee at ICMR-National Institute of Epidemiology.

Background: India witnessed a severe second wave of COVID-19 during March and June 2021. We did the fourth nationwide serosurvey to estimate prevalence of SARS-CoV-2 antibodies in the general population aged >=6 years and health care workers (HCWs). Methods: We did a cross-sectional study between 14 June and 6 July 2021 in 700 clusters in the same 70 districts across 21 states/Union Territory. From each district, a minimum of 400 individuals aged >=6 years from general population and 100 HCWs from the district public health facilities were included. The serum samples were tested for the presence of IgG antibodies against S1-RBD and nucleocapsid protein of SARS-CoV-2 using chemiluminescence immunoassay. We estimated the weighted and test adjusted seroprevalence of IgG antibodies against S1-RBD and/or nucleocapsid protein along with 95% CI. Findings: Of the 28,975 sera tested, the weighted and test adjusted prevalence of IgG antibodies against S1-RBD and/or nucleocapsid protein among the general population aged >=6 years was 67.6% (95% CI: 66.4 – 68.7). The seroprevalence increased with age and was not different in rural and urban areas. Compared to unvaccinated adults (62.3%, 95% CI: 60.9 – 63.7), seroprevalence was significantly higher among individuals who received one (81.0%, 95% CI: 79.6 - 82.3) and two doses (89.8%, 95% CI: 88.4 - 91.1). The seroprevalence of IgG antibodies among 7,252 health care workers was 85.2% (95% CI: 83.5 - 86.7). Interpretation: Nearly one third of the population is still seronegative. It is necessary to accelerate the coverage of COVID-19 vaccination among adults and continue adherence to non-pharmaceutical interventions. Funding: Indian Council of Medical Research. Declaration of Interest: None to declare. Ethical Approval: The Institutional Human Ethics Committee of the ICMR National Institute of Epidemiology, Chennai approved the study protocol.

Introduction/Background There are a few scattered primary level studies from various regions of the globe proving impact of co-morbidities on survival in ovarian cancer patients. In last 20 years, there has been improvement in survival among ovarian cancer patients. Radical surgical approaches and advancements in chemotherapeutic agents have primarily contributed for same. Pre-existing uncontrolled co-morbidities impact ovarian cancer survival directly and indirectly. This affects the performance status of the patient leading to delay in treatment or aversion from radical surgical approaches thereby not achieving the goal of optimal treatment. It may also lead to a less aggressive chemotherapeutic modifications of using lower doses or single agent chemotherapy. The objective of this study was to systematically review the literature and summarize prevalence of various comorbidities with evaluation of impact of the Charlson Co-morbidity Index (CCI) on survival in ovarian cancer patients. Methodology Primary studies were identified by following a defined search strategy on the prevalence of co-morbidity and survival pattern among ovarian cancer patients. This study has been conducted in accordance with PRISMA guidelines for systematic review. Co-morbidity assessment in the included studies had been done through the Charlson Co-morbidity Index (CCI) tool. Qualitative summarization of data from included studies for prevalence of various co-morbidities and influence of CCI score on survival in ovarian cancer patients has been performed. Results Common co-morbidities prevalent in ovarian cancer patients were hypertension (11% to 26%), cardio vascular disease (4.5% to 12%) and diabetes (2.5% to 8.3%). Less commonly occurring co-morbidities were liver disease, renal disease, neurological problems and collagen vascular disease. Majority of ovarian cancer patients lie in CCI score 0 (68% - 76%). The range for one year% survival for CCI score 0 was 73 to 80%, for CCI score 1–2 : 58 to 71% and CCI score 2+ : 43 to 53%. The range five year% survival for CCI score 0 was 37 to 43%, for CCI score 1–2 : 24 to 30% and CCI score 2+ : 12 to 23%. Conclusion Co-morbidities plays an important role in survival outcomes among ovarian cancer patients. Overall one year% and five year% survival decreases with increase in the CCI index score. Disclosures The authors have no conflict of interest.

Background & objectives: Population-based seroepidemiological studies measure the extent of SARS-CoV-2 infection in a country. We report the findings of the first round of a national serosurvey, conducted to estimate the seroprevalence of SARS-CoV-2 infection among adult population of India. Methods: From May 11 to June 4, 2020, a randomly sampled, community-based survey was conducted in 700 villages/wards, selected from the 70 districts of the 21 States of India, categorized into four strata based on the incidence of reported COVID-19 cases. Four hundred adults per district were enrolled from 10 clusters with one adult per household. Serum samples were tested for IgG antibodies using COVID Kavach ELISA kit. All positive serum samples were re-tested using Euroimmun SARS-CoV-2 ELISA. Adjusting for survey design and serial test performance, weighted seroprevalence, number of infections, infection to case ratio (ICR) and infection fatality ratio (IFR) were calculated. Logistic regression was used to determine the factors associated with IgG positivity. Results: Total of 30,283 households were visited and 28,000 individuals were enrolled. Population-weighted seroprevalence after adjusting for test performance was 0.73 per cent [95% confidence interval (CI): 0.34-1.13]. Males, living in urban slums and occupation with high risk of exposure to potentially infected persons were associated with seropositivity. A cumulative 6,468,388 adult infections (95% CI: 3,829,029-11,199,423) were estimated in India by the early May. The overall ICR was between 81.6 (95% CI: 48.3-141.4) and 130.1 (95% CI: 77.0-225.2) with May 11 and May 3, 2020 as plausible reference points for reported cases. The IFR in the surveyed districts from high stratum, where death reporting was more robust, was 11.72 (95% CI: 7.21-19.19) to 15.04 (9.26-24.62) per 10,000 adults, using May 24 and June 1, 2020 as plausible reference points for reported deaths. Interpretation & conclusions: Seroprevalence of SARS-CoV-2 was low among the adult population in India around the beginning of May 2020. Further national and local serosurveys are recommended to better inform the public health strategy for containment and mitigation of the epidemic in various parts of the country.

Background: Leukemia and lymphoma are the most prevalent cancers globally among children. Objective: To provide an updated review on incidence of childhood leukemia and lymphoma incidence from Population Based Cancer Registries (PBCRs) in India. Methods: Data obtained on cancers in childhood for either sex in age groups of 0–14 years from National Cancer Registry Programme Reports (NCRP).The indicators of age-specific rate (ASpR), age-adjusted-rate (AAR) per million (pm) and number of incident cases for leukemia and lymphomas were noted for the years 2012–2014. The summarization of 24 PBCRs data was compiled in six regions of India. Results: Ratio of female to male cases ranged from 1: 0.9 to 1:5.6 for leukemia and 1:1.0 to 1:4.1 for lymphoma. For boys, AAR ranged from 0.0 pm/year (North East) to 101.4 pm/year (North). For girl's incidence ranged from 0.0 pm/year in West and North East to 62.3 pm/year in North region of India. For boys Age Specific Rate (ASpR) pm for all leukemia type was ranged from 0.0 to 9.9 among under five years while in case of girls ASpR pm for all leukemia ranged from 0.0 to 6.4 among 5–9 years of age. ASpR for all types of lymphoma ranged from 0.0 to 3.2 in boys among 5–9 years of age while in girls the range was from 0.0 to 1.5 among 10–14 years of age. Conclusion: Lymphoma and leukemia cases were maximum in North region of India. Male preponderance of leukemia and lymphoma in the Indian setting could be multifactorial including possible gender bias as well as disease biology. Keywords: Childhood cancer incidence, Lymphoma, Leukemia, India

Objective: To study and compare the national and regional incidences and risk of developing of neoplasms of individual urogenital sites using 2012 – 2014 reports from the National Cancer Registry Programme (NCRP) data. Materials and Methods: A number of incident cases, age-adjusted rates (AARs), and cumulative risk (0 – 64 years) pertaining to urogenital neoplasms, along with the ICD-10 codes, were extracted. Data on indicators, namely number of incident cases, AARs and one in a number of persons develop cancer were summarized for both the sexes in each of the cancer registries and presented region-wise in the form of ranges. Results: The proportion of all urogenital neoplasms in comparison to all cancers was 12.51% in women and 5.93% in men. Risk of development of urogenital cancers for women was maximum (1 in 50) in the North-eastern region, followed by Rural West, South, and North. For men, the risk of developing neoplasms of urogenital sites was highest (1 in 250). For the neoplasms of the renal pelvis and ureter, both the incidence and risk were quite low for all genders across all the regions. Cervical neoplasms had the highest incidence (4.91 – 23.07) among female genital neoplasms, while prostate had the highest incidence (0.82 – 12.39) among male genital neoplasms. Conclusion: Making people aware of urogenital neoplasms and their risk factors are important for the public health awareness point of view. Centers that deal with either management of urogenital cases or/and screening of genital neoplasms could serve as the designated centers for creating such awareness.

Introduction Smokeless tobacco products have been linked to precancerous and cancers of oral cavity for long. Evidence was available on the association between smokeless tobacco (SLT) products and oral cancers at regional but not at global level. Present meta-analysis is aimed to evaluate the risk of oral cancer with the use of SLT products among “ever” versus “never” users. Method Studies published for the period (1960–2016) are retrieved using Pubmed, Indmed, EMBASE, and Google Scholar search engines for the subject “ever” versus “never” users of SLT products and estimated the risk association with oral cancer. Summary odds ratios (relative risk) are estimated and meta-analysis was performed using random-effects model. Results Thirty-seven studies from four of six WHO regions, Southeast Asia region (SEAR), the Eastern Mediterranean Region (EMR), Europe, and region of Americas (North and South) are included in the analysis. Significant risk with SLT products with oral cancer was found for SEAR (4.44, 95% CI = 3.51 to 5.61) and for EMR (1.28, 95% CI = 1.04 to 1.56). Significantly higher risk (p < .001) was found for females (5.83, 95% CI = 2.93 to 11.58). Product wise analysis for different SLT products revealed various levels of risk viz. gutkha (8.67, 95% CI = 3.59 to 20.93), pan tobacco / betel liquid (7.18, 95% CI = 5.48 to 9.41), oral snuff (4.18, 50% CI = 2.37 to 7.38), Mainpuri tobacco (3.32, 95% CI = 1.32 to 8.36), and snus (0.86, 95% CI = 0.58 to 1.29). Conclusion A significant positive association was observed between SLT use and the risk of oral cancer, in SEAR, EMRs, and among women users. Implications The present meta-analysis demonstrates SLT product use and the risk of oral cancer at global level. Moreover, the present analysis provided data on the risk associated with individual SLT product. The results fulfil the gap in the data on independent effect of individual SLT product use on the outcome of oral cancer at global level, conclusively. Chewing SLT products was associated with higher risk of oral cancer than other types of SLT. This can serve as a useful tool for policy makers in forming strict policies in controlling SLT menace. Hence, we propose that in addition to smoking, efforts should be directed towards SLT product cessation as well in reducing oral cancer incidence.

Background: The first round of national serosurvey in India was conducted in May-June 2020 among adults from 21 States. The second serosurvey was conducted in August-September 2020 to estimate the nationwide seroprevalence for SARS-CoV-2 infection in the general population aged ten years and above. Methods: The household serosurvey was conducted among individuals aged ten years and above in the same 700 villages and wards from 70 districts selected during the first serosurvey. Blood samples were tested using the Abbott SARS-CoV-2 IgG assay. Seroprevalence was estimated after applying the sampling weights and adjusting for clustering and assay characteristics. In order to compare the adult seroprevalence between the two surveys, we randomly selected one adult serum sample from each household. Findings: The weighted and adjusted prevalence of infection among 29,082 individuals aged ten years and above was 6·6% (95% CI: 5·8% - 7·4%). The seroprevalence among adults was 7·1% (95% CI: 6·2% – 8·2%). Seroprevalence was similar across age groups, sex, and occupation. Seroprevalence was highest in urban slum areas followed by urban non-slum and rural areas. We estimated a cumulative 74·3 million infections in the country, with 26 – 32 infections for every reported COVID-19 case by August 2020. Interpretation: Nearly one in 15 individuals aged ten years and above had SARS-CoV-2 infection by August 2020. The adult seroprevalence increased ten times between May and August 2020. Lower infection to case ratio in August compared to May reflects a substantial increase in testing across the country. Funding: The study was funded by the Indian Council of Medical Research, New Delhi, India. The study sponsor was involved in reviewing the study design, writing of the manuscript and the decision to submit the paper for publication. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The authors obtained written informed consent from individuals aged 18 years and older. We obtained assent from children aged between 10–17 years, and written informed consent from their parents or guardians prior to the survey. The Central Ethics Committee of Health Research of Indian Council of Medical Research and the Institutional Human Ethics Committee of ICMR-National Institute of Epidemiology, Chennai approved the study protocol.

Background: Tobacco related cancers (TRC) account for major share of all cancers and updated of incidence data are helpful in policy changes. The aim was to present an update of TRCs on age-adjusted incidence data and corresponding lifetime risk of developing TRC for different regions of the country. Methods: The data for this study were obtained from published reports of 25 population-based cancer registries (PBCRs) in India. The PBCRs in different parts of India were divided into seven regions such as North, South, Central, Northeast, West, Rural West, and East. Data indicators such as age-adjusted rates (AARs) of incidence and the cumulative risks of TRCs up to the age of 64 years for each of the 10 TRC sites of either sex in each of 25 registries were obtained from the National Cancer Registry Programme reports. Results: Among all TRCs, esophagus, lung, hypopharynx, and mouth are the leading sites for both males and females. Males in Northeast region had the highest risk 1 in 27 of developing esophageal cancer, 1 in 67 for cancer of lungs and hypopharynx, followed by 1 in 143 for both mouth and tongue cancers. Females also had the highest risk of esophagus and lungs (1 in 63 female) and cancer of mouth (1 in 250) in Northeast region. Proportion of TRC in comparison of all cancer ranged from 11–25% for men and 3–18% for women. Conclusions: Proportion of TRC in relation to all cancers was still high in different registries of India including the Northeast region.

Background Human papillomavirus (HPV) is recommended as a primary screening tool for cervical screening. Assessment of age-specific performance of newer HPV careHPV DNA testing is important as risk of cervical intraepithelial neoplasia (CIN) varies at different ages. We aim to evaluate care HPV in comparison to Papanicolaou (Pap) test and visual inspection of the cervix with acetic acid (VIA) cervical screening tests for the detection of high-grade CIN. Methods The cross sectional study was conducted in a rural population of North India. Ever-married women 30–59 years of age were invited for screening by careHPV (self-collected vaginal and physician-collected cervical samples), Pap test and VIA. Associations for trend in age for detecting histological-confirmed CINII+ and CINIII+ for each screening test were evaluated. Age-specific association with each screening test was evaluated. Results Of a total of 7761 women invited, 5032 were screened and analysis was performed on 4658 with all screen test results. No significant (p>0.05) association of age for any screening test in the detection of CINII+ or CINIII+ was observed. For the older age group, cervical HPV (CHPV) showed high sensitivity and specificity for CINII+ detection. Specificity of CHPV or vaginal HPV (VHPV) was equal or higher than Pap in all age groups. Conclusions Cervical screening options of CHPV or VHPV, or Pap, performed equally in the younger age group while CHPV might be an option for all ages in the detection of high-grade CIN.

Objective To evaluate the performance of careHPV DNA testing for human papillomavirus (HPV) on cervical and vaginal samples (CHPV and VHPV respectively) in adjunct screening together with visual inspection of the cervix by acetic acid (VIA) or Papanicolaou (Pap) tests in the detection of high-grade cervical intraepithelial neoplasia (CIN). Subjects and methods A cross-sectional study examined 4658 women 30–59 years of age by performing screening tests for HPV using careHPV on cervical and vaginal samples together with Pap and VIA. The CHPV and VHPV test results were presented as a ratio of viral load expressed in relative light units (RLUs) to the mean RLU from a positive control set at 1 pg/mL cut-off (CO). Performances of various pairs of screening tests in parallel and sequential settings were computed through the detection rates of CIN, percentages of unnecessary colposcopic referrals of screen positives, and compared with stand-alone tests. Results The screening positivity of CHPV, VHPV, Pap and VIA ranged from 2.4% to 5.5%. The highest sensitivity (72%) was observed for the combination of CHPV and VIA in parallel, followed by 65.6% for CHPV and Pap, and 59% for all other combinations (VHPV and Pap, VHPV and VIA, and VIA and Pap). The percentage of unnecessary colposcopic referrals in the parallel setting of CINII+ detection ranged from 2.8% to 6.0%. Sequential testing of CHPV or VHPV with other tests yielded very low sensitivities with a reduction in unnecessary colposcopic referrals. Conclusion Cervical careHPV testing (CHPV) in parallel with VIA was the option that performed best in the detection of high-grade CIN and could be a feasible option for low-resource countries (LRCs).

Introduction: Co-testing performance for detection of high grade Cervical Intraepithelial Neoplasia (CIN) has not been adequately addressed from Low Resource Countries (LRCs). Where isolated tests do not have adequate performance, further explorations are recommended. Aim: To evaluate the co-testing of conventional cervical screening tests such as Papanicolaou (Pap) and Visual Inspection Cervix with Acetic Acid (VIA), with care HPV on Cervical Samples (CHPV) or on Vaginal Samples (VHPV) in the detection of high grade CIN. Materials and Methods: The cross-sectional study was conducted on ever married women of age 30 to 59 years in a rural community of Dadri. Women were screened by CHPV, VHPV, and Pap and VIA methods. Confirmation of screen positives was done by histology. Sensitivity, Specificity and likelihood ratios of different combinations of test determined to evaluate the performance. Results: Total eligible women, 66.2% (5032/7604) responded for screening. Analysis was performed on 4658, after excluding those who did not complete all screenings. Co-testing of CHPV (OR=246) or VHPV (OR=278) with Pap had highest association. Positive likelihood ratios of CHPV and VHPV with Pap in CIN II+ detection rates were 13.0 and 11.8 and in CIN III+ the detection rates were 18.0 and 16.0 respectively. Higher sensitivities and specificities were observed in co-testing for CIN III+ detection as against CIN II+ lesions. Conclusion: Choice of co-testing in a pair of tests for detection of high grade CIN is likely to depend on whether screening is targeted for developed or low resource country. VIA in isolation might not yield optimal results for LRCs.

To compare viral load on careHPV DNA testing in self-collected vaginal (VHPC) and clinician-collected cervical (CHPC) samples for the detection of high-grade cervical intra-epithelial neoplasia (CIN).Cross-sectional study. Ever-married women aged 30-59 years were targeted for cervical screening. On attendance for screening, vaginal self-sampling was performed by the woman, and an auxiliary nurse midwife subsequently performed a per-speculum examination, collected a CHPV sample and a Pap smear, and made a visual inspection of the cervix with acetic acid. The ratio of viral load expressed in relative light units to positive controls set at a cut-off of 1pg/ml was used for careHPV quantitative assessment. The median viral load was compared using non-parametric tests. Receiver operating characteristic (ROC) curves were constructed for the detection of CINII+ and CINIII+ in CHPV and VHPV samples.Overall, the median viral load in the 4658 women screened was higher in CHPV samples compared with VHPV samples (9.8-fold higher in cases of high-grade CIN). The median viral load was significantly higher among Pap-positive women compared with Pap-negative women in both CHPV and VHPV samples (p0.01). Assessment by ROC analysis for the detection of high-grade CIN did not differ significantly between CHPV and VHPV samples.Viral load on careHPV testing was comparable between self- and clinician-collected samples for the detection of high-grade CIN. The self-sampling approach may be an option for screening in low-resource countries.

Objective To compare cervical care HPV screening in a rural community setting with other methods of cervical screening for the detection of high-grade cervical intra-epithelial neoplasia (CIN). Study design: Cross-sectional study. All ever-married women aged 30–59 years surveyed in an administrative area of Uttar Pradesh, India were targeted for screening by care HPV (cervical and vaginal samples), Pap test and visual inspection of the cervix following application of acetic acid (VIA). Women who screened positive were referred for colposcopy and the results were confirmed histologically. Sensitivity, specificity and predictive values for the detection of histological CINII+ and CINIII+ were assessed for each screening test. Results Sixty-five percent (5032/7704) of the women invited for cervical screening agreed to participate in the study. Screen-positive rates for cervical care HPV, vaginal care HPV, Pap test and VIA were 3%, 2%, 3% and 6%, respectively. Data for women who did not complete all screening modes, women lost to follow-up and women with missing histological results were excluded before data analysis, resulting in a final sample size of 4658. Cervical care HPV had high sensitivity (85%) for the detection of CINIII+ lesions and moderate sensitivity (53%) for the detection of CINII+ lesions. Sensitivities for the detection of CINIII+ and CINII+ were 54% and 41% for vaginal care HPV, 62% and 44% for Pap test, and 8% and 22% for VIA, respectively. Conclusion Cervical care HPV testing is superior to VIA and Pap test for the detection of high-grade CIN in a rural community setting.

Context: Studies related to need, problems, and quality of life in advanced cancer patients receiving palliative care are scarce in India. Aim: The aim of the study 'was to assess the quality of life, problems, and needs in advanced cancer patients receiving palliative care. Settings and Design: This was a cross-sectional survey in the palliative care outpatient department of a tertiary care hospital. Materials and Methods: Survey was conducted using structured questionnaires with tools of problems and need in palliative care and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL. Statistical Analysis Used: Survey results were presented for various palliative care needs and domains as per magnitude of palliative care received. Comparison of the scores for males and females was done using Mann–Whitney U-test. Results: More than 50% patients had difficulty in daily living and majority of patients (77%) had difficulty in doing heavy work. 82% patients presented with fatigue, 47% patients had issues regarding others being overconcerned, 71% were afraid of physical suffering, 77% faced difficulties in usual activities, and 80% felt the need for being informed about the possibility of treatment and side effects. Needs were more in female patients including a statistically significant difference in sleep quality (P < 0.05). Conclusions: Palliative care needs and quality of life in Indian patients with advanced cancer are of concern and need further attention for optimal care. Quality of life, problems, and needs in such patients need to be assessed, and provisions should be made for delivery of adequate services.

Background:The uterine cervix is the second most common site of cancer among Indian women.Though the human papillomavirus has been demonstrated to be a causative agent for this cancer, a variety of other risk factors are in play, such as sexual and reproductive patterns, socioeconomic, hygienic practices, and diet. The accumulated evidence suggests that cervical cancer is preventable and is highly suitable for primary prevention. The dietary intake of antioxidants and vitamins like vitamin A, carotenoids, vitamin C, folacin and tocopherol is found to have protective effects against cancer of the cervix. Dietary data regarding cervical cancer are still scanty.Objective:The present study was therefore undertaken to study the dietary pattern among uterine cervical cancer patients and normal controls.Materials and Methods:A total of 60 consecutive patients and 60 controls were enrolled from a referral hospital during the year 2004. A schedule inclusive of the food frequency pattern and 24-h dietary recall along with the general information was administered to all the enrolled subjects to describe findings on the food consumption pattern along with other important factors.Results:The mean intake of energy, protein, vitamins, etc., between the cases and controls was not significantly different except for the vitamin C level. Serum vitamin E was found to have lower average in patients as compared to controls. The nutrient intake of cervical cancer patients and controls was grossly deficient in the socioeconomic group studied. With regard to the macronutrient intake, calorie and protein intakes showed a deficit of around 50% when compared to RDA.Conclusion:The food consumption profile was not significantly different between cervical cancer patients and normal controls.

Background: Breast and cervical cancers are two major cancers among Indian women. Analysis of trends would help in planning and organization of programs for control of these cancers. Objective: The objective of the following study is to compute risk of breast and cervical cancers using updated data from different cancer registries of India and study of its trends. Materials and Methods: Data on incidence rates of breast and cervical cancers were obtained from six major cancer registries of India for the years 1982-2008 and from the recently initiated cancer registries, North Eastern Registries of India with a total of 21 registries. Annual percent change in incidence and risk in terms of one in number of women likely to develop cancer was estimated for both the cancers in various registries. Results: The annual percentage change in incidence ranged from 0.46 to 2.56 and −1.14 to −3.4 for breast and cervical cancers respectively. Trends were significant for both cancers in the registries of Chennai, Bangalore, Mumbai and Delhi except Barshi and Bhopal. North East region showed decrease in risk for breast and cervical cancers whereas increasing trend was observed in Imphal (West) and for cervical cancer in Silchar. Conclusion: North Eastern region recorded decline in the incidence of breast cancer which is contrary to the observation in other registries, which showed increase in breast cancer and decline in cervical cancer incidences.

Ovarian carcinoma is one of the leading causes of morbidity and mortality associated with carcinomas affecting women. It comprises a heterogeneous group of neoplasms that represents the seventh most lethal malignancy in women worldwide, and is a major cause of death from gynecological carcinoma. Specific to different geographical locations all over the globe, there are variations in the magnitude and trends of ovarian carcinoma, and the scenario of the disease keeps changing. As such, it is necessary to update and review the existing study on ovarian carcinoma. Reviews on ovarian cancer from 2000 to 2015 were extracted from PubMed and Google Scholar, and a few selected landmark studies that incorporated old data were also included. The focus of the present study is to consolidate an updated global view on epithelial ovarian carcinoma, the most prevalent type of ovarian carcinoma. This article covers the epidemiology, types, diagnosis, prognosis, and treatment of epithelial ovarian carcinoma.

Background and Objective: An overview of the update of cancer incidence summary findings will be of help to researchers and clinicians for quick reference of facts in cancer control. To present an overview of cancer incidence available from the recent population-based cancer registries (PBCRs) in India from 2009 to 2011. Materials and Methods: Data on age-adjusted incidence rates and cumulative risks of cancer at various sites were collected for both sexes for six major cancer sites from the first report of the National Cancer Registry Programme (NCRP) on 25 PBCRs in India for the years 2009-2011. Site-specific risks in terms of one out of the total number of persons who develop cancer were computed. The summaries, in the form of ranges, are presented in six regions of the country in which the 20 PBCRs are located. The range of age-adjusted rates (AARs) and one out of the number of persons who develop cancer as a lifetime risk in the age of 0-64 years is presented. Results: In different regions, the highest risks for males for developing cancer in the various major sites studied were as follows: One out of 67 for cancer in the lungs in the Northeast, one out of 27 for cancer in the esophagus in the Northeast, one out of 71 for cancer in the mouth in the western region, one out of 100 cancer in the tongue in the rural western region, one out of 333 for cancer in the prostate in the northern region, and one out of 33 for cancer in the stomach in the northeastern region. The highest risks for the various sites studied were as follows: one out of 36 for cancer in the breast in the south, one out of 59 for cancer in the cervix in the western region, one out of 125 for cancer in the ovary in the northern region, one out of 63 for cancer in the esophagus in the northeastern region, one out of 250 for cancer in the mouth in three regions, and one out of 125 for cancer in the gall bladder in the western and central regions. Overall, for all cancers there is a risk of one out of 8-27 persons and one out of 10-25 persons among males and females, respectively, in the Indian population who are likely to develop cancer of any site in their lifetime during the age of 0-64 years. Conclusion: Female breast cancer in the southern region and esophagus and stomach cancers among males in the northeast region were of the highest magnitudes.

Context: Pap smear testing as a conventional cervical screening approach has limitations for implementation and aided visual cervical testing has varying results in different regions. Aims: The aim of this study is to demonstrate the performance of aided visual cervical screening tests as against conventional Pap smear testing in a rural community setting of North India. Settings and Design: This was a rural community based cross-sectional study. Materials and Methods: All 7603 ever married women of age 30-59 years surveyed in a pocket of Dadri Tehsil, Uttar Pradesh, India were targeted for screening by Pap, visual inspection of cervix using acetic acid (VIA) and visual inspection of cervix using Lugol's iodine (VILI) methods. Screen positives were referred to colposcopy and confirmation by histology. Statistical Analysis Used: Detection of histological cervical intraepithelial neoplasia (CIN) II + and CIN III + assessed separately by sensitivity, specificity and likelihood ratio's and predictive values. Analysis of data was performed by using IBM SPSS statstics software version 16.0. Results: A total of 65.6%(4988/7604) eligible women of 30-59 years age group in the target population were screened. Out of 4988, further analysis was performed on 4148 after excluding those who did not complete all screenings, who lost to follow-up and had missing histology results. Screen positivity rates by Pap (ASCUS and above), VIA and VILI were 2.6%, 9.7% and 13.5% respectively. Sensitivity and specificity of detecting the CIN III+ lesions were 87.5 and 98.8% for Pap, 50.0% and 96.7% for VIA and 50.0% and 95.7% for VILI respectively. Conclusions: VIA screening demonstrated as a feasible primary screening test for detecting high grade CIN and as to perform better when the Pap test is not feasible.

Context: S trategies for implementation of cervical screening are the need of the hour while effective screening tests for early detection exist. Aim: To demonstrate the implementation of cervical cancer screening by aided visual tests in a North Indian rural community. Setting and Design: Cross-sectional study in a rural setting. Subjects and Methods: Baseline survey of community perspectives of screening and identification of eligible women of age 30-59 years was performed by Accredited Social Health Activists (ASHAs). Screening was targeted on 7604 women by the methods of visual inspection of cervix using acetic acid (VIA), by using lugol's iodine (VILI) tests and by Pap test. Screen positives were referred to colposcopy and further management. Data on evaluation parameters was collected. Statistical Analysis: Screening test performances were assessed by sensitivity, specificity and positive/negative predictive values (PPV/NPV) for detection of histological CIN II+. Results: Study showed coverage of 65.6% of total eligible women (7604). Extent of agreement of visual testes (VIA/VILI) between nurses and doctor was 77.3-100%. Screen positivity rates by VIA, VILI and Pap were 9.7%, 13.5% and 2.6%, respectively. Screen positives turned up for confirmatory diagnosis were 78%. Acceptance of treatment was 76%. Screen positivity of VIA and VILI declined (P < 0.001) with increase in age. Sensitivity, specificity, and PPV of VIA were 59.0%, 92.3% and 3.6% and of VILI were72.7%, 89.6% and 3.3% respectively. NPV was 99% in all the tests. Conclusion: Implementation of screening by aided visual tests was successfully demonstrated through utilization of ASHAs for motivation, achievement of good coverage and good response in clinical management of screen positives.