World Journal of Obstetrics and Gynecology

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World Journal of

Obstetrics and Gynecology

World J Obstet Gynecol 2013 February 10; 2(1): 1-7

ISSN 2218-6220 (online)

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World Journal of

W J O G

EDITOR-IN-CHIEF Bo Jacobsson, Gothenburg GUEST EDITORIAL BOARD MEMBERS

Wing P Chan, Taipei Chie-Pein Chen, Taipei Shi-Yann Cheng, Yulin Song-Nan Chow, Taipei Peng-Hui Wang, Taipei

MEMBERS OF THE EDITORIAL BOARD

Australia Ashwini Chand, Melbourne Steven D Fleming, Brisbane Ankit Jain, Coffs Harbour Marjan Khajehei, Como Gavin Sacks, Sydney Jing Sun, Brisbane

Austria Susanne Huber, Vienna Edgar Petru, Graz

Belgium Marc FD Baay, Antwerp Christophe Blockeel, Brussels Yves Jacquemyn, Edegem Ekaterine Tskitishvili, Liege Jan Baptist Vermorken, Edegem

Brazil

Carlos KB Ferrari, Barra do Garças Wellington P Martins, Ribeirão Preto Fernando M Reis, Belo Horizonte Maria Inês Rosa, Criciúma Cicero de Andrade Urban, Curitiba

Canada Emmanuel Bujold, Québec Paul James Hoskins, Vancouver

Chile Patricio E Donoso, Santiago

China Cherng-Jye Jeng, Nanjing Jian-Xin Li, Nanjing

Ernest Hung Yu Ng, Hong Kong Dan Xie, Guangzhou

Egypt

Hesham E Abdel-Hady, Mansoura Ahmed S El Hefnawy, Mansoura Ahmed Nasr, Assiut

Finland Johan O Fellman, Helsinki

Kari Juhani Syrjanen, Turku

France Cherif Y Akladios, Strasbourg Souhail Alouini, Orleans

Germany Safaa H Al-Hasani, Luebeck

Greece

Georgios P Artsinevelos, Athens Byron Asimakopoulos, Alexandroupolis Anastasios Athanasopoulos, Patra Panagiotis Christopoulos, Athens Christos R Iavazzo, Athens Ioannis E Messinis, Larissa Athanasios PG Papatsoris, Athens Kitty Pavlakis, Athens

Konstantinos A Toulis, Thessaloniki Panagiotis PT Tsikouras, Alexandroupolis Menelaos Zafrakas, Thessaloniki

Hungary Jozsef Gabor Joo, Budapest

India Chinmoy K Bose, Kolkata Pralhad Kushtagi, Mangalore

I

Editorial Board

2012-2016

The World Journal of Obstetrics and Gynecology Editorial Board consists of 178 members, representing a team of worldwide experts in obstetrics and gynecology. They are from 40 countries, including Australia (6), Austria (2), Belgium (5), Brazil (5), Canada (2), Chile (1), China (9), Egypt (3), Finland (2), France (2), Germany (1), Greece (11), Hungary (1), India (3), Iran (3), Israel (6), Italy (13), Japan (6), Jordan (2), Lithuania (1), Malaysia (1), Mexico (1), Moldova (1), Netherlands (3), Nigeria (1), Norway (2), Poland (1), Portugal (1), Qatar (1), Saudi Arabia (3), Serbia (1), Slovenia (1), South Korea (3), Spain (4), Sweden (2), Thailand (3), Turkey (8), United Kingdom (10), United States (46), and Venezuela (1).

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Niraj N Mahajan, Mumbai

Iran Hossein Fallahzadeh, Yazd Abbas A Ghaderi, Shiraz Ramesh Omranipour, Tehran

Israel Zeev Blumenfeld, Haifa

Sorina Grisaru-Granovsky, Jerusalem Alexander Ioscovich, Jerusalem Marwan Odeh, Nahariya Eyal Sheiner, Beer-Sheva Johnny S Younis, Tiberias

Italy

SML Chamayou, Sant’Agata Li Battiati Federico Coccolini, Bergamo

Erich Cosmi, Padua Vassilios Fanos, Cagliari Roberta Granese, Messina Anna Maria Marconi, Milano Filippo Murina, Milan Felice Petraglia, Siena Giuseppe Rizzo, Rome Emilio Sacco, Rome

Giulio Aniello Santoro, Treviso Andrea Tinelli, Lece

Emanuela Turillazzi, Foggia

Japan Madoka Furuhashi, Nagoya Takeshi Maruo, Kobe Kaei Nasu, Oita

Yuzuru Niibe, Sagamiahra Kenzo Sonoda, Fukuoka Yoshihito Yokoyama, Hirosaki

Jordan Moamar I Al-Jefout, Mutah Zouhair O Amarin, Irbid

Lithuania Linas Rovas, Klaipeda

Malaysia Geok Chin Tan, Kuala Lumpur

Mexico

Alfonso Dueñas-González, Mexico City

Moldova Fanuel Lampiao, Blantyre

Netherlands Marieke J Claas, Utrecht Wendy Koster, Utrecht Arnold-Jan Kruse, Maastricht

Nigeria Chibuike O Chigbu, Enugu

Norway Andrej M Grjibovski, Oslo Svein Rasmussen, Bergen

Poland Andrzej Wincewicz, Kielce

Portugal

Renato Manuel Natal Jorge, Porto

Qatar Sajjad ur Rahman, Doha

Saudi Arabia Ismail Al-Badawi, Riyadh Mamdoh Eskandar, Abha Hans-Juergen Schulten, Jeddah

Serbia

Miroslava G Gojnic Dugalic, Belgrade

Slovenia Spela Smrkolj, Ljubljana

South Korea Kwang-Hyun Baek, Seongnam Min Hyung Jung, Seoul Sue Kyung Park, Seoul

Spain

J de la Torre Fernandez de Vega, Tenerife Antonio Pinero Madrona, Murcia Santiago Palacios, Madrid

Faustino R Perez-Lopez, Zaragoza

Sweden

Eva Marie Wiberg-Itzel, Stockholm

Thailand

Pisake NA Lumbiganon, Khon Kaen Vorapong Phupong, Bangkok Viroj Wiwanitkit, Bangkok

Turkey Metin Akbulut, Denizli Cem Baykal, Istanbul Husnu Celik, Elazig Cem Dane, Istanbul Polat Dursun, Ankara Erdin İlter, İstanbul Mehmet Kefeli, Samsun Kamile Kukulu, Antalya

United Kingdom Mohamed Abdel-fattah, Aberdeen Suha Deen, Nottingham

Stergios K Doumouchtsis, London Mona A El-Bahrawy, London Alaa A El-Ghobashy, Wolverhampton Ayman AA Ewies, Birmingham Myra S Hunter, London Paul D Losty, Liverpool

Tim Mark Reynolds, Burton-on-Trent Ariel Zosmer, London

United States Muktar H Aliyu, Nashville M Robyn Andersen, Seattle Priya R Bhosale, Houston Donald P Braun, Zion Chunxia Cao, Gainesville Wally A Carlo, Birmingham Linda R Chambliss, Phoenix Teresa P Diaz-Montes, Baltimore Steven M Donn, Ann Arbor Omar F Duenas, New York Marilyn B Escobedo, Oklahoma Robert Freedman, Detroit Sergio G Golombek, Valhall Michael P Goodman, Davis Diane M Harper, Kansas Matthew H Ho, Los Angeles Patricia B Hoyer, Tucson Mei-Hua Huang, Los Angeles William W Hurd, Cleveland Gabor B Huszar, New Haven Amer K Karam, Los Angeles Justin P Lavin, Akron Linda E May, Kansas Zaher Merhi, Bronx Nash S Moawad, Gainesville Lisa Eileen Moore, Albuquerque Robert D Moore, Atlanta

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David Gardner Mutch, St. Louis Nihar R Nayak, Palo Alto Anita L Nelson, Manhattan Beach Farr Nezhat, New York

Robert W Powers, Pittsburgh Werner Schaefer, Pittsburgh Gerald Phillip Schatten, Pittsburgh Danny Joseph Schust, Columbia

Hen Yitzhak Sela, New York Elizabeth S Ginsburg, New York Sherri Lynn Stewart, Atlanta Robert S Tan, Houston Ping Tang, Rochester

Ihab Mohammed Usta, New York Jian-Jun Wei, Chicago

Xiuquan Zhang, Salt Lake

Chengquan Zhao, Pittsburgh Yulian Zhao, Baltimore Wenxin Zheng, Tucson

Venezuela María E Aponte-Rueda, Caracas

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1 Burden of gynaecological cancers in developing countries Iyoke CA, Ugwu GO

© 2013 Baishideng. Articles published by this Open- Access journal are distributed under the terms of the Creative Commons Attribution Non-commercial Li- cense, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

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APPENDIX ABOUT COVER

AIM AND SCOPE

FLYLEAF

February 10, 2013|Volume 2|Issue 1|

NAME OF JOURNAL

World Journal of Obstetrics and Gynecology ISSN

ISSN 2218-6220 (online) LAUNCH DATE June 10, 2012 FREQUENCY Quarterly EDITOR-IN-CHIEF

Bo Jacobsson, MD, PhD, Professor, Department Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, SE-416 85 Gothenburg, Sweden EDITORIAL OFFICE

Jin-Lei Wang, Director Xiu-Xia Song, Vice Director

I-V Instructions to authors

World Journal of Obstetrics and Gynecology Editorial Board Member, Danny Joseph Schust, MD, Associate Professor, Center for Reproductive Medicine and Fertility, Department of Obstetrics, Gynecology and Women’s Health, University of Missouri School of Medicine, 500 North Keene Street, Suite 203, Columbia, MO 65201, United States

World Journal of Obstetrics and Gynecology (World J Obstet Gynecol, WJOG, online ISSN 2218-6220, DOI: 10.5317) is a peer-reviewed open access academic journal that aims to guide clinical practice and improve diagnostic and therapeutic skills of clinicians.

WJOG covers topics concerning pregnancy complications, obstetric surgical procedures, diagnostic imaging, endoscopy, reproductive endocrinology, tumors, pelvic diseases, evidence-based medicine, epidemiology and nursing.

We encourage authors to submit their manuscripts to WJOG. We will give priority to manuscripts that are supported by major national and international foundations and those that are of great basic and clinical significance.

World Journal of Obstetrics and Gynecology is now indexed in Digital Object Identifier.

I-III Editorial Board INDEXING/

ABSTRACTING

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Burden of gynaecological cancers in developing countries

Chukwuemeka Anthony Iyoke, George Onyemaechi Ugwu

Chukwuemeka Anthony Iyoke, Department of Obstetrics and Gynaecology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, United Kingdom

George Onyemaechi Ugwu, Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku- Ozalla, Enugu 4000001, Nigeria

Author contributions: Iyoke CA conducted the literature review and drafted the manuscript; Ugwu GO reviewed and added intellectual content to the manuscript.

Correspondence to: Dr. Chukwuemeka Anthony Iyoke, De- partment of Obstetrics and Gynaecology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN,

United Kingdom. [email protected]

Telephone: +44-117-9043422 Fax: +44-117-9043444 Received: June 22, 2012 Revised: November 7, 2012 Accepted: December 15, 2012

Published online: February 10, 2013

Abstract

Approximately 1:4 of all cancers in women in developing countries (excluding non-melanoma skin cancer) is a gynaecological cancer. The gynaecological cancer burden in developing countries is huge primarily due to the high incidence and mortality of cervical cancer.

Cervical cancer accounts for over 60% of the gynaecological cancer burden in developing countries despite being preventable by current technologies. This is due to the absence of effective nationally organized screening programmes in most developing countries.

Institution of such programmes, therefore, has the potential to dramatically reduce gynaecological cancer burden in these countries. Subsidized human papilloma virus (HPV) vaccine and HPV typing as well as cheap screening techniques such as visual inspection aided with acetic acid hold the key to effective prevention of cervical cancer in these countries. This is because a significant proportion of patients in developing countries are unable to access and avail themselves of the few available preventive, diagnostic and treatment services because of poverty. Although, advocacy and the political will to invest in the development of human resources and healthcare infrastructure appear criti-

cal to gynaecological cancer control and reducing the burden of disease in many developing countries, the proposition assumes that resources are truly available for this investment. This may not be true. Many developing countries rely on foreign aids for developmental programmes and these aids have dwindled significantly with the current global economic meltdown.

Key words: Gynaecological cancer; Cancer burden; Can- cer mortality; Cancer morbidity; Cancer prevention Iyoke CA, Ugwu GO. Burden of gynaecological cancers in developing countries. World J Obstet Gynecol 2013; 2(1): 1-7 Available from: URL: http://www.wjgnet.com/2218-6220/full/

v2/i1/1.htm DOI: http://dx.doi.org/10.5317/wjog.v2.i1.1

INTRODUCTION

Emerging global trend in the burden of cancer

Cancer is the second leading cause of death and disability worldwide, behind only heart disease

^[1]

. More people die from cancer every year than human immunodeficiency virus (HIV), tuberculosis and malaria combined

^[1-4]

. Con- trary to about three decades ago when cancer was more prevalent in the developed world, the burden is shifting significantly to the developing countries. According to estimates by the International Agency for Research on Cancer (IARC), in 2008, 53% of the 12.7 million new cases of cancer and 63% of the 7.6 million cancer deaths occurred in developing countries

^[3]

. Three decades earlier, developing countries accounted for a mere 15% of global cancer burden

^[4]

. A recent report based on the IARC/

GLOBOCAN 2002 world cancer statistics estimated that by the year 2020, about 10.25 million new cases of cancer would be diagnosed in the developing countries com- pared to 5.94 million in the developed countries

^[1]

. This trend is quite disturbing for many reasons including the fact that it will, no doubt, compound the already existing MINIREVIEWS

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formidable health and human developmental challenges posed by poverty, weak economies and high prevalences of communicable diseases in developing countries.

Explanations given for the increasing burden of cancer currently observed in developing countries have been based largely on epidemiological data and empirical observations. Reasons often cited include a shift in developing countries to Western lifestyle and behaviors such as

cigarette smoking, low fiber/high fat diets and less physi-

cal activity

^[5]

; high prevalence of immunosuppressing conditions such as malnutrition, tuberculosis and HIV

^[6]

; high prevalence of oncogenic infections such as hepatitis B virus, HIV, hepatitis C virus, human papilloma virus (HPV), Helicobacter pylori

^[5]

. We observe that it is also possible that increasing health awareness in these countries has facilitated resort to orthodox medical care resulting in more persons with cancer reporting to hospitals for care, rather than seeking care from herbalists and other forms of alternative health care. Whether the increased documentation of cancer in developing countries is due to actual increase in disease incidence or reporting bias, cancer has become a new challenge to the health systems in developing countries.

Definition of operative concepts

Developing countries:

For the purpose of this review, the term developing countries refers to countries clas- sified by the World Bank as middle and low income

countries in their classification of economies in 2009^[7]

. These countries had gross national income per capita of USD 12 275 or below

^[7]

. Developing countries are by no means homogenous with respect to all indices of development. However, they are generally characterized by low standard of living (including poor access to health care, poor sanitation, poor access to safe drinking water and poor nutrition); underdeveloped industrial base and low human development index (including low level of literacy, low life expectancy, high infant and maternal mortality)

^[8]

. They include most countries of sub-Saharan Africa, South and South East Asia, Latin and South America.

Burden of cancer:

For the burden of cancer, the epide-

miological definition of the burden of cancer as described

by Sankaranarayanan et al

^[9]

was used in this review. For economic burden, the economic definition described by Kim et al

^[10]

was adopted. Accordingly, the epidemiological indices of burden of gynaecological cancer used in this review include cancer incidence, mortality and case fatality

while the economic definition involves the economic cost

of the cancer (including medical costs, nonmedical costs and the cost due to loss of productivity)

^[9,10]

.

Sources of data

The information contained in this review were obtained through electronic literature search conducted in major data bases including PubMed, Medline, EMBASE, Sco- pus, Cochrane database and central register of controlled

trials using the following search terms individually and in combination: gynaecological cancer, cancer in developing countries, burden of gynaecological cancer, cancer, cancer burden, cancer in sub-Saharan Africa, South Asia, Latin America, South America, the Caribbean, economic burden of cancer, cervical cancer, ovarian cancer, corpus cancer, vulval cancer, vaginal cancer, choriocarcinoma.

All relevant peer-reviewed English language articles and

publications were identified, retrieved and reviewed. We

also obtained further articles by reviewing the bibliogra- phies of the relevant published documents obtained in the primary search of databases. In addition to these, we consulted the website of the IARC for the current ver- sion of the GLOBOCAN world cancer statistics.

Aetiology of gynaecological cancers

In view of the importance of causative factors to any disease burden, it is appropriate to review the aetiological basis of gynaecological cancers. Gynaecological cancers include cancers of the ovary, fallopian tube, uterine body, cervix, vagina and vulva as well as choriocarcinoma which primarily come under the care of gynaecologists and gynaecological oncologists. This review excludes breast cancer because it comes under the specialty of general surgery in most developing countries.

Gynaecological cancers can be epidemiologically grouped into two with respect to aetiology. On the one hand are cervical, vaginal and vulvar cancers which share similarities, first in having known premalignant stages before the development of invasive cancer and secondly in their link with high risk human papilloma virus infection. Chronic infection with this virus is now known to induce premalignant changes in epithelial cells ultimately leading to cancer after several years

^[11-13]

. Human papilloma virus is a sexually transmitted disease. For cervical cancer, the relationship to HPV and the presence of a recognizable premalignant stage of the disease called cervical intraepithelial neoplasia (CIN) provide multiple planks for preventive efforts

^[14-17]

. Several co- factors are known to modify the effect of chronic HPV infection in the causation of cervical cancer and these include high parity, prolonged use of oral contraceptive pills, multiple sexual partners, cigarette smoking and early age at sexual debut

^[11]

. Vaginal and vulvar cancers are also known to evolve through premalignant phases called vaginal intraepithelial neoplasia and vulvar intraepithelial neoplasia respectively, but screening for these stages in the population is not currently recommended

^[18-20]

.

On the other hand are ovarian, Fallopian tube and corpus cancers which do not have any known infective aetiology. Most cases of ovarian cancer occur sponta- neously although genetic predisposition is responsible for ovarian cancer in 10% of cases

^[21]

. These hereditary ovarian cancers are associated with inherited germ line mutations in the BRCA-1 and

BRCA-2 genes as well as

the Lynch type 2 gene associated with hereditary non- polyposis colorectal cancer

^[21]

. Epithelial ovarian cancer is associated with a number of risk factors including a

Iyoke CA et al. Gynaecological cancer in developing countries

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family history of ovarian cancer, old age, postmenopausal status and use of hormone replacement therapy

^[21]

. Ovar- ian cancer has been traditionally thought to occur more in developed countries due to the higher prevalence of these epidemiological risk factors

^[22]

. However, it would appear that with recent global cancer estimates, the trend may be reversing

^[1]

.

On its part, corpus cancer refers to cancer of the uterine body and is mainly endometrial cancer although rarely uterine sarcoma (leiomyosarcoma) may occur. Endome- trial cancer is the third commonest gynaecological cancer in developing countries

^[1,2]

. It is a hormone-dependent cancer and is associated with several epidemiological risk

factors, the most significant of which include unopposed

estrogen, sedentary lifestyle and obesity

^[23,24]

. Endometrial cancer is thought to evolve through a premalignant stage called endometrial hyperplasia but the natural course of progression from endometrial hyperplasia to endometrial cancer is not clearly understood.

BURDEN OF GYNAECOLOGICAL CANCERS

General overview

The burden of gynaecological cancers in developing countries appears huge. In these countries, gynaecologi- cal cancers account for 25% of all new cancers diag- nosed among women aged up to 65 years compared to 16% in the developed world

^[25]

. According to a recent report, developing countries accounted for 820 265 cases (77.7%) of global estimates for new cases of the commonest gynaecological cancers including cervical, corpus and ovarian cancer in 2009

^[1]

. This constituted 12.1% of the 6.8 million cases of cancer in developing countries

^[1]

. This review intends to explore the pattern, magnitude

and significance of the current burden of gynaecological

cancers in developing countries.

Specific gynaecological cancers

Cervical cancer:

Cervical cancer is the commonest gyn- aecological malignancy in developing countries where or- ganized screening programmes do not exist

^[1,3]

. According to the IARC, there were 453 531 cases of cervical cancer in developing countries in 2008 representing 89% of global estimates

^[3]

. Also 273 000 deaths occur worldwide every year due to cervical cancer out of which 83% occur in developing countries

^[26]

. Case fatality rates of cervical cancer are quite high in these countries with case fatalities up to 60% reported

^[1]

. Conversely in developed countries where nationally organized screening programmes exist, cervical cancer is not as common and case fatality rates are as low as 32%

^[1]

. About 80%-95% of cervical cancers are squamous cell carcinoma

^[9]

.

Across different regions of the world, developing countries individually report heavy burdens of high incidences and mortality from cervical cancer. The highest incidence rates are found in Sub Saharan Africa, Latin America and the Caribbean, South Central and South

East Asia

^[9]

. A report from Nigeria gave the incidence of cervical cancer as 25/100 000 per year which translates to a disease burden for an estimated 32 million women in 2005 to about 8000 cases per year

^[27]

. A recent hospital based study in Lagos Nigeria showed that, overall, cancer was the leading cause of death among gynaecological inpatients and that cervical cancer contributed over 44%

to all gynaecological mortality

^[28]

. South and South East Asia are thought to experience over 200 000 new cases of cervical cancer yearly (more than one-third of the global burden)

^[26]

. Age-adjusted cervical cancer mortality rates exceed 15 per 100 000 in most developing countries, with rates as high as 35/100 000 in East Africa

^[9]

. A na- tionwide survey in India published recently evaluated the cause of 122 429 deaths in 1.1 million randomly selected homes across the country between 2001 and 2003: cervical cancer made the highest contribution to cancer deaths among women at 17.5%

^[29]

. In Latin America and the Caribbean, Haiti, Nicaragua and Bolivia had the highest mortality due to cervical cancer with rates of 40, 28 and 22 percent respectively

^[26]

. The very high mortality rates of cervical cancer in developing countries are due to the fact that most patients present at advanced clinical stages

of the disease, and to the fact that a significant propor-

tion of patients do not receive or complete prescribed courses of treatment due to deficiencies in treatment availability, accessibility, and affordability

^[9]

.

Ovarian and adnexal cancers:

Fallopian tube cancers and extra ovarian primary peritoneal cancers are con- sidered along with ovarian cancer because their biology and clinical characteristics are similar to ovarian cancer

^[9]

. Over 80% of cases of ovarian cancer are epithelial in ori-

gin

^[22,30,31]

. Ovarian cancer is the second commonest gyn-

aecological cancer in developing countries

^[9]

. It accounts for 18.8% of all gynaecological cancers in developing countries and 28.7% in developed countries

^[9]

. Recent estimates indicated that of 240 476 cases of ovarian cancer in 2009, 155 835 (64.8%) occurred in developing countries compared to 84 641 in developed countries

^[1]

. Accounts that ovarian cancer is commoner in developed countries than in developing countries may not, therefore, be sup- ported by the most current estimates. Ovarian cancer has a case-fatality rate of 59.2% in developing countries which is similar to the 54.8% in developed countries

^[1]

. The high case fatality rate of ovarian cancer is primarily due to the fact that the disease only becomes manifest in advanced stages of the disease

^[30,31]

.

Corpus cancer:

Corpus cancer is commoner in devel- oped countries than in developing countries

^[23]

. In 2009, there were 236 643 cases worldwide out of which 113 486 occurred in developing countries representing approximately 48% of the global burden

^[3]

. Low incidences less than 4/100 000 are found in South Asia and Africa

^[9]

. More than 90% occur in women aged 50 years and above

^[9]

. It has a more favorable prognosis than Ovarian and Cervical cancers with 5-year survival rates around

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global population contributes 6.4% of new cancer cases and accounts for a mere 0.3% global cancer costs

^[1]

.

DISCUSSION

From the foregoing, it is clear than the burden of gynaecological cancer in developing countries is huge. Con- tending with this challenge demands two vital planks of intervention: generation of representative and accurate data on cancer and the introduction or scaling up of preventive programmes and early detection of cancer through increased funding by all stakeholders.

Population data on cancer from developing countries are prone to inaccuracies. For instance the IARC relies on data from population-based cancer registries to estimate cancer incidences and mortality globally. Such registries are available in only 5% of developing countries - in parts of the developing world where cancer registries exist, they are either regional or hospital registries

^[9]

. In many countries of the developing world, data do not exist at all

^[9]

. For such countries, estimates are usually made from neighbouring countries. Variations in validity and extent of data from different countries are therefore unavoid- able and the actual burden of cancers may be more or

less than current quoted figures. Inaccurate data militates

against accurate planning of policies and programmes for cancer care and control. It is therefore advocated that the establishment of population based cancer registries be made a priority policy for cancer control in developing countries.

Gynaecological cancer incidences are either be expressed as an absolute number of cases per year which reflects the load of new patients diagnosed in a region or group, or as a rate in terms of number of new cases per 100 000 per year which represents the average risk of developing the disease in a population. Whichever way it is expressed, recent estimates of gynaecological cancer incidences in developing countries show that as much as 64% of the gynaecological cancer burden is due to cervical cancer

^[3]

. Cervical cancer control, therefore, holds the key to the reduction in overall gynaecological cancer burden in developing countries. With an estimated case- fatality rate of 55.1%

^[1]

, cervical cancer is also the major contributor to gynaecological cancer mortality in devel- oping countries.

Cervical cancer is preventable and curable in the very early stages of the disease. Fortunately, it has a very well known natural history characterized by a long premalignant phase which provides a good opportunity for preventive interventions. And among all gynaecological cancers, cervical cancer offers the greatest potential for prevention, early detection and cure

^[9]

. Evidence from the developed world shows that the high incidences of cervical cancer in developing countries are due to lack of or

inadequate/inefficient existing screening programmes^[34,35]

.

The central role of HPV infection in the etiology of cervical cancer has led to the introduction of the HPV vaccine and HPV detection and typing in cervical screen- 70% in developing countries

^[9]

.

Vaginal cancer:

Vaginal cancer is rare and constitutes less than 2% of gynaecological cancers worldwide

^[9]

. Of 13 200 cases globally in 2002, 9000 (68%) occurred in developing countries

^[9]

. Incidence rates do not exceed 0.8/100 000 in any region of the world

^[9]

. Case fatality rate in developing countries is 44.7% compared to 15.4%

in the developed world

^[1]

. More than 75% of cases occur in women older than 60 years

^[9]

.

Vulva cancer:

This constitutes 3% of gynaecological can- cers worldwide

^[9]

. In 2002, there were 26 800 cases out of which 11 100 (41.4%) occurred in developing countries

^[9]

. Incidence rate is less than 1/100 000 in developing countries

^[9]

. More than 50% are seen in women over 70 years and more than two-thirds occur in the labia majora

^[9]

.

Choriocarcinoma:

This represents 0.6% of all gynaecological cancers

^[9]

. Approximately 5800 cases occurred worldwide in 2002 out of which 5400 (96.4%) occurred in developing countries

^[9]

. Incidence rates are highest in South East Asia where rates of (0.43-1.7)/100 000 are quoted compared to 0.04/100 000 in Africa and Europe

^[9]

.

ECONOMIC BURDEN OF GYNAECOLOGICAL CANCERS

The economic burden of gynaecological cancers can be discussed at the level of individual patients and their families as well as the level of health systems and government. Accurate estimation of the actual economic burden of gynecological cancers in developing countries is difficult because studies on the economic burden of gynaecological cancers in these countries are scanty. A few cross-sectional studies document the socio-economic impact of cervical cancer on individuals and families in some developing countries. Arrossi et al

^[32]

in Argentina and Ohaeri et al

^[33]

in Nigeria studied the socioeconomic and psychological impact of cervical cancer. The study in Argentina found that the socioeconomic impact of cervical cancer was considerable and that it had negative con- sequences on treatment compliance

^[32]

. It found that “in addition to facing pain, disability and fear of death, cervical cancer patients had to deal with increased treatment related expenses, loss of employment and consequent income, and changes in household responsibilities”

^[32]

.

At the level of government and health systems, studies on the cost of cancer care and control are also scanty. A report based on calculations extrapolated from a study in Korea suggests a huge unmet need for funding of cancer care in developing countries. According to the report, the cost of new gynaecological cancers in developing countries in 2009 totalled USD 1.087 billion

^[1]

. This pales into

insignificance when compared to the USD 11.913 billion

spent in developed countries

^[1]

. The report clearly shows a huge funding gap in developing countries compared to developed countries

^[1]

. Africa which represents 15% of

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ing

^[36,37]

. Already HPV vaccine is licensed for use in many developing countries, although the cost of the vaccine makes it generally unaffordable. In Nigeria, for instance, it costs the equivalent of USD 100.00 for a course of trivalent HPV vaccine - a country where over 70% of the population live on less than USD 1.0 per day. On its part, HPV detection and typing also require expensive equip- ment and highly skilled manpower that are not generally available in developing countries. Thus like cytology screening which requires a great input of human and ma- terial resources to sustain, nationally organized preventive programmes using HPV vaccine and detection may prove just too expensive for developing countries

^[38]

.

It would appear therefore, that cervical cancer control in developing countries will require active scaling up of cheaper screening techniques such as visual inspection with acetic acid which has similar CIN detection rates compared to HPV testing and cervical cytology

^[3]

. Subsi- dizing the cost of HPV vaccine and HPV DNA testing by governments of these countries will go a long way to make them affordable to individuals. It has been suggested that linking testing or screening to treatment (screen and treat) without recourse to colposcopy or sophisticated laboratories would potentially prevent cervical cancer in large numbers of women in developing countries

^[15,39,40]

.

In the case of ovarian cancer, the burden in developing countries appears to be rapidly evolving with recent estimates suggesting a greater burden than in developed countries

^[1]

. Except in about 10% of cases, ovarian cancer tends to occur spontaneously. The key to control of ovarian cancer appears to be early detection and treatment at the very early stages when cure may be theoreti- cally possible

^[13]

.

Screening for ovarian cancer has been evaluated re- cently by several large randomized controlled trials using assay of CA125 and transvaginal ultrasound

^[41-43]

. Results of the prostate, lung, colorectal, and ovarian cancer screening trial in the United States already published in 2011 suggest that whereas screening may decreases the stage at detection

^[44]

and thereby decrease case - specific

mortality; it may not decrease disease specific mortality^[45]

.

The methodological flaws in these conclusions have how-

ever, been raised in a recent publication

^[46]

and the world awaits the publishing of the final results of the UKC- TOCS trial in 2015 to draw a conclusion as to whether ovarian cancer screening decreases mortality from the disease.

Endometrial cancer is the third commonest gynaecological cancer in developing countries. In order to be pro- active in addressing the current and future burden of this cancer in developing countries, the risk factors that are

modifiable such as obesity, sedentary lifestyles and use of

unopposed estrogen/estrogen agonists have to be active- ly discouraged

^[47,48]

. Population screening for endometrial cancer is not yet recommended

^[24]

although early detection with transvaginal ultrasound scan using measure- ment of endometrial thickness in symptomatic women is practised in developed countries

^[49]

. Such practice requires

provision of ultrasonography and hysteroscopic facilities and manpower which are not yet freely available in developing countries.

The burden of vaginal and vulval cancers is small.

Currently no evidence exists to support any screening tests

^[50]

although their association with HPV provides a window of opportunity for preventive interventions through HPV vaccination or typing. The task for developing countries in mounting early treatment or primary preventive interventions will be similar to the challenges faced with cervical cancer.

In conclusion, there is a high incidence and mortality from gynaecological cancers in developing countries due primarily to the failure of these countries to mount effec- tive nationally organized screening programmes for cervi- cal cancer. A huge unmet need for funding for cancer care and control exists in these countries. “The human right to life, to prevention of suffering, and to education are all key rights linked to improving the control of cervical can- cer in resource poor parts of the world”

^[51]

. The resources needed to provide adequately for gynaecological cancer care in many developing countries demands that increased funding is critically needed

^[52]

. Scaling up of cheap sustain- able and effective preventive interventions against cervical cancer will potentially decrease the burden of gynaecological cancer in developing countries. Nationally organized HPV vaccination and low cost screening programmes subsidized by funding from governments and donor agen- cies are key to this intervention.

REFERENCES

The Economist Intelligence Unit. Breakaway: The global burden of cancer-challenges and opportunities. The Econo- mist, 2009

2 Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 7-08 [PMID: 576078 DOI: 0.3322/canjclin.55.2.7]

3 International Agency for Research on Cancer. GLOBO- CAN 2008 Fast stats. Available from: URL: http: //www.

globocan.iarc.fr/. Accessed: April 2, 202

Boyle P, Levin B. World cancer report 2008. Lyon: Interna- tional Agency for Research on Cancer, 2008

5 Wilson CM, Tobin S, Young RC. The exploding worldwide cancer burden: the impact of cancer on women. Int J Gynecol Cancer 200; 14: - [PMID: 7602 DOI: 0./j.08- 89x.200.78.x]

6 Price AJ, Ndom P, Atenguena E, Mambou Nouemssi JP, Ryder RW. Cancer care challenges in developing countries.

Cancer 202; 118: 3627-3635 [PMID: 22223050 DOI: 0.002/

cncr.2668]

7 World bank. World Development indicators. Available from:

URL: http: //data.worldbank.org/data-catalog/world- development-indicators?cid=GDP_WDI. Accessed: April 2, 8 202United Nations Statistics Division. Composition of macro- geographical (continental) regions, geographical sub regions and selected economies and other groupings (“Footnote c”).

United Nations, 2008

9 Sankaranarayanan R, Ferlay J. Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol 2006; 20: 207-225 [PMID: 6359925 DOI:

0.06/j.bpobgyn.2005.0.007]

0 Kim SG, Hahm MI, Choi KS, Seung NY, Shin HR, Park

WJOG|www.wjgnet.com

(12)

EC. The economic burden of cancer in Korea in 2002. Eur J Cancer Care (Engl) 2008; 17: 36- [PMID: 8302650 DOI:

0./j.365-235.2007.0088.x]

Bosch FX, Manos MM, Muñoz N, Sherman M, Jansen AM, Peto J, Schiffman MH, Moreno V, Kurman R, Shah KV.

Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst 995;

87: 796-802 [PMID: 779229 DOI: 0.093/jnci/87..796]

2 Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kum- mer JA, Shah KV, Snijders PJ, Peto J, Meijer CJ, Muñoz N.

Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 999; 189: 2-9 [PMID:

0582 DOI: 0.002/(SICI)096-9896(99909)89]

3 Bosch FX, Lorincz A, Muñoz N, Meijer CJ, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 2002; 55: 2-265 [PMID: 99208 DOI:

0.36/jcp.55..2]

Denny L. Cytological screening for cervical cancer prevention. Best Pract Res Clin Obstet Gynaecol 202; 26: 89-96 [PMID: 2207306 DOI: 0.06/j.bpobgyn.20.08.00]

5 Wright TC, Kuhn L. Alternative approaches to cervical cancer screening for developing countries. Best Pract Res Clin Obstet Gynaecol 202; 26: 97-208 [PMID: 22385539 DOI:

0.06/j.bpobgyn.20..00]

6 Bhatla N, Singla S, Awasthi D. Human papillomavirus deoxyribonucleic acid testing in developed countries. Best Pract Res Clin Obstet Gynaecol 202; 26: 209-220 [PMID:

225228 DOI: 0.06/j.bpobgyn.20..003]

7 Sankaranarayanan R, Nessa A, Esmy PO, Dangou JM.

Visual inspection methods for cervical cancer prevention.

Best Pract Res Clin Obstet Gynaecol 202; 26: 22-232 [PMID:

22075 DOI: 0.06/j.bpobgyn.20.08.003]

8 American College of Obstetrics and Gynecology. ACOG Committee Opinion No. 509: Management of vulvar intraepithelial neoplasia. Obstet Gynecol 20; 118: 92-9 [PMID: 2205906 DOI: 0.097/AOG.0b03e3823b7c2]

9 Jones RW, Rowan DM, Stewart AW. Vulvar intraepithelial neoplasia: aspects of the natural history and outcome in 05 women. Obstet Gynecol 2005; 106: 39-326 [PMID:

639258 DOI: 0.097/0.AOG.00008730.76283.7f]

20 Pearson JM, Feltman RS, Twiggs LB. Association of human papillomavirus with vulvar and vaginal intraepithelial disease: opportunities for prevention. Womens Health (Lond Engl) 2008; 4: 3-50 [PMID: 907256 DOI: 0.227/755 057..2.3]

2 Jelovac D, Armstrong DK. Recent progress in the diagnosis and treatment of ovarian cancer. CA Cancer J Clin 20; 61:

83-203 [PMID: 252830 DOI: 0.3322/caac.203]

22 Hennessy BT, Coleman RL, Markman M. Ovarian cancer.

Lancet 2009; 374: 37-382 [PMID: 979360 DOI: 0.06/

S00-6736(09)6338-6]

23 Fader AN, Arriba LN, Frasure HE, von Gruenigen VE.

Endometrial cancer and obesity: epidemiology, biomark- ers, prevention and survivorship. Gynecol Oncol 2009; 114:

2-27 [PMID: 90660 DOI: 0.06/j.ygyno.2009.03.039]

2 Van den Bosch T, Coosemans A, Morina M, Timmerman D, Amant F. Screening for uterine tumours. Best Pract Res Clin Obstet Gynaecol 202; 26: 257-266 [PMID: 2207879 DOI:

06/j.bpobgyn]

25 Ferlay J, Bray F, Norman D, Mathers C, Parkin DM. GLO- BOCAN 2008, Cancer incidence and mortality worldwide.

International Agency for Research on Cancer, 2008

26 Ferlay J, Bray F, Pisani P, Parkin DM. Cancer incidence, mortality and Prevalence worldwide. GLOBOCAN 2002, IARC Cancer base 5(2.0). Lyon: IARC Press, 200

27 Adewole IF, Benedet JL, Crain BT, Follen M. Evolving a strategic approach to cervical cancer control in Africa. Gyne- col Oncol 2005; 99: S209-S22 [PMID: 62025 DOI: 0.06/

j.ygyno.2005.07.086]

28 Anorlu RI, Obodo K, Makwe CC. Cancer mortality among patients admitted to gynecological wards at Lagos Universi- ty Teaching Hospital, Nigeria. Int J Gynaecol Obstet 200; 110:

268-269 [PMID: 20505 DOI: 0.06/j.ijgo.200.03.038]

29 Dikshit R, Gupta PC, Ramasundarahettige C, Gajalakshmi V, Aleksandrowicz L, Badwe R, Kumar R, Roy S, Suraweera W, Bray F, Mallath M, Singh PK, Sinha DN, Shet AS, Gelband H, Jha P. Cancer mortality in India: a nationally representative survey. Lancet 202; 379: 807-86 [PMID:

226036 DOI: 0.06/S00]

30 Bast RC, Hennessy B, Mills GB. The biology of ovarian cancer: new opportunities for translation. Nat Rev Cancer 2009; 9:

5-28 [PMID: 96667 DOI: 0.038/nrc26]

3 Gubbels JA, Claussen N, Kapur AK, Connor JP, Patankar MS. The detection, treatment, and biology of epithelial ovarian cancer. J Ovarian Res 200; 3: 8 [PMID: 2035033 DOI:

0.86/757-225-3-8]

32 Arrossi S, Matos E, Zengarini N, Roth B, Sankaranayananan R, Parkin M. The socio-economic impact of cervical cancer on patients and their families in Argentina, and its influence on radiotherapy compliance. Results from a cross-sectional study. Gynecol Oncol 2007; 105: 335-30 [PMID: 725880 DOI: 0.06/j.ygyno.2006.2.00]

33 Ohaeri JU, Campbell OB, Ilesanmi AO, Omigbodun AO.

The psychosocial burden of caring for some Nigerian women with breast cancer and cervical cancer. Soc Sci Med 999; 49:

5-59 [PMID: 055635 DOI: 0.06/S0277-9536(99) 00223-3]

3 Gustafsson L, Pontén J, Bergström R, Adami HO. Inter- national incidence rates of invasive cervical cancer before cytological screening. Int J Cancer 997; 71: 59-65 [PMID:

939836 DOI: 0.002/(SICI)097-025(99700)7]

35 Gustafsson L, Pontén J, Zack M, Adami HO. International incidence rates of invasive cervical cancer after introduction of cytological screening. Cancer Causes Control 997; 8:

755-763 [PMID: 932898]

36 Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Mu- wonge R, Budukh AM, Hingmire S, Malvi SG, Thorat R, Kothari A, Chinoy R, Kelkar R, Kane S, Desai S, Keskar VR, Rajeshwarkar R, Panse N, Dinshaw KA. HPV screening for cervical cancer in rural India. N Engl J Med 2009; 360:

385-39 [PMID: 933979 DOI: 0.056/NEJMoa080856]

37 Brown AJ, Trimble CL. New technologies for cervical cancer screening. Best Pract Res Clin Obstet Gynaecol 202; 26: 233-22 [PMID: 229058 DOI: 0.06/j.bpobgyn.20..00]

38 Kulasingam S, Havrilesky L. Health economics of screening for gynaecological cancers. Best Pract Res Clin Obstet Gynaecol 202; 26: 63-73 [PMID: 2238003 DOI: 0.06/

j.bpobgyn.20.0.03]

39 Armstrong EP. Prophylaxis of cervical cancer and related cervical disease: a review of the cost-effectiveness of vaccination against oncogenic HPV types. J Manag Care Pharm 200; 16: 27-230 [PMID: 2033326]

0 Goldie SJ, Gaffikin L, Goldhaber-Fiebert JD, Gordillo-Tobar A, Levin C, Mahé C, Wright TC. Cost-effectiveness of cervical-cancer screening in five developing countries. N Engl J Med 2005; 353: 258-268 [PMID: 629985]

Buys SS, Partridge E, Greene MH, Prorok PC, Reding D, Riley TL, Hartge P, Fagerstrom RM, Ragard LR, Chia D, Izmirlian G, Fouad M, Johnson CC, Gohagan JK. Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovar- ian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial. Am J Obstet Gynecol 2005; 193:

630-639 [PMID: 6260202 DOI: 0.06/j.ajog.2005.05.005]

2 Menon U, Gentry-Maharaj A, Hallett R, Ryan A, Burnell M, Sharma A, Lewis S, Davies S, Philpott S, Lopes A, God- frey K, Oram D, Herod J, Williamson K, Seif MW, Scott I, Mould T, Woolas R, Murdoch J, Dobbs S, Amso NN, Leeson S, Cruickshank D, McGuire A, Campbell S, Fallowfield L, Singh N, Dawnay A, Skates SJ, Parmar M, Jacobs I. Sensitiv-

WJOG|www.wjgnet.com

(13)

ity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collabora- tive Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol 2009; 10: 327-30 [PMID: 92822 DOI: 0.06/

S70-205(09)70026-9]

3 Kobayashi H, Yamada Y, Sado T, Sakata M, Yoshida S, Kawaguchi R, Kanayama S, Shigetomi H, Haruta S, Tsuji Y, Ueda S, Kitanaka T. A randomized study of screening for ovarian cancer: a multicenter study in Japan. Int J Gynecol Cancer 2008; 18: -20 [PMID: 765503 DOI: 0./

j.525-38.2007.0035.x]

Pavlik EJ, van Nagell JR. Ovarian cancer screening--what women want. Int J Gynecol Cancer 202; 22 Suppl : S2-S23 [PMID: 225395]

5 Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C, Reding DJ, Greenlee RT, Yokochi LA, Kessel B, Crawford ED, Church TR, Andriole GL, Weissfeld JL, Fouad MN, Chia D, O’Brien B, Ragard LR, Clapp JD, Rathmell JM, Riley TL, Hartge P, Pinsky PF, Zhu CS, Izmirlian G, Kramer BS, Miller AB, Xu JL, Prorok PC, Gohagan JK, Berg CD. Ef- fect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA 20; 305: 2295-2303 [PMID: 26268 DOI: 0.00/jama.20.766]

6 Menon U. Ovarian cancer screening has no effect on disease- specific mortality: commentary on the mortality results of

the PLCO trial. Evid Based Med 202; 17: 7-8 [DOI: 0.36/

ebm.20.0063]

7 Gehrig PA, Cantrell LA, Shafer A, Abaid LN, Mendivil A, Boggess JF. What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol 2008; 111: -5 [PMID: 869588]

8 Soliman PT, Oh JC, Schmeler KM, Sun CC, Slomovitz BM, Gershenson DM, Burke TW, Lu KH. Risk factors for young premenopausal women with endometrial cancer. Obstet Gy- necol 2005; 105: 575-580 [PMID: 5738027 DOI: 0.097/0.

AOG.000055.56.f7]

9 Havrilesky LJ, Maxwell GL, Myers ER. Cost-effectiveness analysis of annual screening strategies for endometrial cancer. Am J Obstet Gynecol 2009; 200: 60.e-60.e8 [PMID:

93802]

50 Eva LJ. Screening and follow up of vulval skin disorders.

Best Pract Res Clin Obstet Gynaecol 202; 26: 75-88 [PMID:

2289088 DOI: 0.06/J.BPOBGYN.20..005]

5 Basile S, Angioli R, Manci N, Palaia I, Plotti F, Benedetti Panici P. Gynecological cancers in developing countries:

the challenge of chemotherapy in low-resources setting. Int J Gynecol Cancer 2006; 16: 9-97 [PMID: 688356 DOI:

0./J.525-38.2006.0089.x]

52 Cain JM, Ngan H, Garland S, Wright T. Control of cervical cancer: women’s options and rights. Int J Gynaecol Obstet 2009;

106: -3 [PMID: 953507 DOI: 0.06/j.ijgo.2009.03.027]

P- Reviewer Schust DJ S- Editor Gou SX L- Editor A E- Editor Li JY

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GENERAL INFORMATION

World Journal of Obstetrics and Gynecology (World J Obstet Gynecol, WJOG, online ISSN 2218-6220, DOI: 10.5317) is a peer-reviewed open access (OA) academic journal that aims to guide clinical practice and improve diagnostic and therapeutic skills of clinicians.

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WJOG covers topics concerning pregnancy complications, obstetric surgical procedures, diagnostic imaging, endoscopy, reproductive endocrinology, tumors, pelvic diseases, evidence-based medicine, epidemiology and nursing.

We encourage authors to submit their manuscripts to WJOG. We will give priority to manuscripts that are supported by major national and international foundations and those that are of great basic and clinical significance.

WJOG is edited and published by Baishideng Publishing Group (BPG). BPG has a strong professional editorial team composed of science editors, language editors and electronic editors. BPG currently publishes 42 OA clinical medical journals, including 41 in English, has a total of 15 471 editorial board members or peer reviewers, and is a world first-class publisher.

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The columns in the issues of WJOG will include: (1) Editorial: The editorial board members are invited to make comments on an important topic in their field in terms of its current research status and future directions to lead the development of this discipline; (2) Frontier: The editorial board members are invited to select a highly cited cutting-edge original paper of his/her own to summarize major findings, the problems that have been resolved and remain to be resolved, and future research directions to help readers understand his/her important academic point of view and future research directions in the field; (3) Diagnostic Advances: The editorial board members are invited to write high-quality diagnostic advances in their field to improve the diagnostic skills of readers. The topic covers general clinical diagnosis, differential diagnosis, pathological diagnosis, laboratory diagnosis, imaging diagnosis, endoscopic diagnosis, bio- technological diagnosis, functional diagnosis, and physical diagnosis; (4) Therapeutics Advances: The editorial board members are invited to write high-quality therapeutic advances in their field to help improve the therapeutic skills of readers. The topic covers medication therapy, psychotherapy, physical therapy, replacement therapy, interventional therapy, minimally invasive therapy, endoscopic therapy, transplantation therapy, and surgical therapy; (5) Field of Vision: The editorial board members are invited to write commentaries on classic articles, hot topic articles, or latest articles to keep readers at the forefront of research and increase their levels of clinical research. Classic articles refer to papers that are included in Web of Knowledge and have received a large number of citations (ranking in the top 1%) after being published for more than years, reflecting the quality and impact of papers. Hot topic articles refer to papers that are included in Web of Knowledge and have received a large number of citations after being published for no more than 2 years, reflecting cuttingedge trends in scientific research. Latest articles refer to the latest published high- quality papers that are included in PubMed, reflecting the latest research trends. These commentary articles should focus on the status quo of research, the most important research topics, the problems

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World Journal of Obstetrics and Gynecology ISSNISSN 2218-6220 (online)

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Bo Jacobsson, MD, PhD, Professor, Department Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, SE-416 85 Gothenburg, Sweden

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Contents

APPENDIX ABOUT COVER

ABSTRACTING

Abstract

INTRODUCTION

Emerging global trend in the burden of cancer

Cancer is the second leading cause of death and disability worldwide, behind only heart disease

GLOBOCAN 2002 world cancer statistics estimated that by the year 2020, about 10.25 million new cases of cancer would be diagnosed in the developing countries com- pared to 5.94 million in the developed countries

World Journal of

cal activity

Definition of operative concepts

For the purpose of this review, the term developing countries refers to countries clas- sified by the World Bank as middle and low income

Burden of cancer:

For the burden of cancer, the epide-

Sources of data

The information contained in this review were obtained through electronic literature search conducted in major data bases including PubMed, Medline, EMBASE, Sco- pus, Cochrane database and central register of controlled

Aetiology of gynaecological cancers

On the other hand are ovarian, Fallopian tube and corpus cancers which do not have any known infective aetiology. Most cases of ovarian cancer occur sponta- neously although genetic predisposition is responsible for ovarian cancer in 10% of cases

family history of ovarian cancer, old age, postmenopausal status and use of hormone replacement therapy

. It is a hormone-dependent cancer and is associated with several epidemiological risk

General overview

The burden of gynaecological cancers in developing countries appears huge. In these countries, gynaecologi- cal cancers account for 25% of all new cancers diag- nosed among women aged up to 65 years compared to 16% in the developed world

Specific gynaecological cancers

Cervical cancer is the commonest gyn- aecological malignancy in developing countries where or- ganized screening programmes do not exist

. About 80%-95% of cervical cancers are squamous cell carcinoma

. A recent hospital based study in Lagos Nigeria showed that, overall, cancer was the leading cause of death among gynaecological inpatients and that cervical cancer contributed over 44%

. In Latin America and the Caribbean, Haiti, Nicaragua and Bolivia had the highest mortality due to cervical cancer with rates of 40, 28 and 22 percent respectively

Ovarian and adnexal cancers:

Fallopian tube cancers and extra ovarian primary peritoneal cancers are con- sidered along with ovarian cancer because their biology and clinical characteristics are similar to ovarian cancer

. Accounts that ovarian cancer is commoner in developed countries than in developing countries may not, therefore, be sup- ported by the most current estimates. Ovarian cancer has a case-fatality rate of 59.2% in developing countries which is similar to the 54.8% in developed countries

Corpus cancer:

Corpus cancer is commoner in devel- oped countries than in developing countries

global population contributes 6.4% of new cancer cases and accounts for a mere 0.3% global cancer costs

. In many countries of the developing world, data do not exist at all

, cervical cancer is also the major contributor to gynaecological cancer mortality in devel- oping countries.

Vaginal cancer:

Vaginal cancer is rare and constitutes less than 2% of gynaecological cancers worldwide

Vulva cancer:

This constitutes 3% of gynaecological can- cers worldwide

. Approximately 5800 cases occurred worldwide in 2002 out of which 5400 (96.4%) occurred in developing countries

in Argentina and Ohaeri et al

. This pales into

It would appear therefore, that cervical cancer control in developing countries will require active scaling up of cheaper screening techniques such as visual inspection with acetic acid which has similar CIN detection rates compared to HPV testing and cervical cytology

Screening for ovarian cancer has been evaluated re- cently by several large randomized controlled trials using assay of CA125 and transvaginal ultrasound

and the world awaits the publishing of the final results of the UKC- TOCS trial in 2015 to draw a conclusion as to whether ovarian cancer screening decreases mortality from the disease.

. Such practice requires

0582 DOI: 0.002/(SICI)096-9896(99909)89]

939836 DOI: 0.002/(SICI)097-025(99700)7]

2289088 DOI: 0.06/J.BPOBGYN.20..005]

GENERAL INFORMATION

Aim and scope

Name of journal

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Title page