Cervical cancer is the leading cause of cancer related deaths and the second most common cancer amongst South African women. The key cause for cervical cancer development is sexual transmission and persistent infection with high-risk Human Papillomavirus (HPV). However, it takes several years from infection to cervical cancer development, suggesting that other factors contribute to the disease. Exposure of neoplastic epithelial cells to Seminal Fluid (SF) has been shown to promote cell proliferation in culture and growth of explants in mice injected with HeLa cervical adenocarcinoma cells. Since the majority of cervical cancer cases are squamous cell carcinoma, in this study, we examined the effect of SF on cancer cell proliferation, EMT, motility and gene expression using two squamous cell carcinoma cell line model systems, SiHa and Me180. This study shows that SF significantly enhanced cell proliferation in both cell lines. Using confocal microscopy and phalloidin staining, it was further shown that SF caused morphological changes and induced stress fibre formation. SF upregulated the expression of EMT transcription factors Snail, Twist and ZEB1. EMT induction was confirmed by the increase of N-cadherin and a decrease in E-cadherin protein expression. Additionally, results showed that the induction of EMT transcription factors Snail, Twist and ZEB1 by SF occurs via EP4 receptor, ERK1/2 and COX signaling pathways. To investigate the effect of SF on migration and invasion, transwell migration assays were used. SF significantly enhanced directional cell migration and invasion of SiHa and Me180 cells. Cell invasion was associated with an increase in MMP-2 and MMP-9. SF also induced proinflammatory and angiogenic gene expression in cervical squamous carcinoma cells. SF mediated induction of inflammatory and angiogenic genes was shown to be associated with AP-1 and NFkB transcription factors. A small molecule inhibitor of nuclear import, INI-43 inhibited the nuclear localization and activity of SF activated NF-kB as well as the expression of SF induced inflammatory and angiogenic genes. Employing ectocervical tissue biopsies, SF caused the upregulation of EMT transcription factors, MMPs, inflammatory and angiogenic genes. Taken together, these results suggest that SF may play a role in promoting EMT and enhances the migratory and invasive potential of cervical squamous cell carcinoma. These findings together implicate SF as a possible factor that may promote cervical cancer progression.

Thesis (MPH.) -- University of Limpopo, 2015 / Cervical cancer is a serious public health problem in both developed and developing countries. It is said to be the leading cause of death for women from developing countries as compared to other types of cancers. The aim of the study was to determine the initial clinical presentation of cervical cancer patients at the Pietersburg Hospital, Limpopo Province in South Africa. The objectives were to establish the demographic profile of cervical cancer patients, to identify the stage at initial clinical presentation, and to describe the factors that led to initial clinical presentation of cervical cancer patients at the Pietersburg Hospital in Limpopo Province, South Africa.The researcher conducted a quantitative retrospective cross-sectional survey by examining the records of cervical cancer patients seen for a period of three years from January 2012 to December 2014 at the Pietersburg. The results indicated that most patients, particularly the elderly, presented for the first time at the hospital with advanced stages of cervical cancer. Factors, such as age and place of residence contributed to this late presentation. There is a need for improved data capturing of information about marital status and parity to further assess the influence these two elements might have on the clinical presentation of cervical cancer. Furthermore, availability and facilities for screening should be improved because early detection of cervical cancer prevents progression to advanced stage of the disease. More awareness campaigns about risk factors of cervical cancer have to be implemented and a study is needed to establish why most patients with advanced stage cervical cancer are from Sekhukhune and Vhembe Districts, particularly the former Venda and Gazankulu Regions.

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Research report to be submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Masters of Medicine in the branch of Obstetrics and Gynaecology Johannesburg, 2017 / Introduction Cervical carcinoma is the second most common malignancy worldwide after carcinoma of the breast and most common in the developing world1,2. In Africa, the population of women who are 15 years and older is estimated to be 267.9 million with approximately 78 897 diagnosed with invasive cervical carcinoma annually and a 78% mortality1. Aim The aim of the study was to ascertain whether HIV sero-positive women in South Africa present with a more advanced disease of invasive cervical carcinoma than their HIV sero-negative counter parts as well as to assess the degree of immuno-suppression and its effect on the stage of the disease at initial presentation. Is there a difference between the studies done then and what is presented now? Methods This was a descriptive retrospective record review. A total of 1300 cases of cervical carcinoma were seen at Charlotte Maxeke Johannesburg Academic Hospital, Combined Oncology Clinic from 2009 to 2010. Variables analyzed were patient age, HIV status, ARV standing, CD4 count, parity, race, papsmear result, cell type FIGO staging. This was done using the SPSS (Statistical Package for Social Sciences) version 13. RESULTS The mean age of the patients analyzed was 50.74 +- 13.08. There were 436 (37.1%) HIV seropositive patients, with a mean CD4 count of 357.59 +- 361.15. The mean age of presentation for HIV sero-positive patients was 55.4 +- 11.8 and for sero-negative patients 42.1+- 9.5 (p=0.000). A majority of the patients presented with stage IIIB disease. The HIV status had no bearing on the stage of the disease at presentation (p=0.363), nor the degree of immunosuppression (p=0.999). Due to the HIV pandemic, sero-positive patients presented with invasive cervical carcinoma 10 years earlier than their sero-negative counterparts. Black patients were mostly affected when compared to other races with a (p= 0.004). Antiretroviral seemed to make no difference on clinical staging at presentation (p=0.152) Conclusion HIV sero-positive patients presented with invasive cervical carcinoma 10 years earlier than their sero-negative counterparts. The degree of immunosuppression and HIV sero-positivity has no bearing on severity of the disease. / MT2017

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Objectives This dissertation had two overarching objectives: 1. To determine how stakeholders perceive women’s preferences for cervical screening modalities. 2. To understand methods to measure women’s cervical screening preferences, to inform the development and testing of a person-centered, evidence-informed approach to preference-elicitation. Methods The overarching conceptual framework was the Ottawa Decision Support Framework. The first objective was addressed by interview studies with (1) guideline developers and program managers and (2) health professionals and women considering screening. This was complemented by a systematic review of quantitative, qualitative and mixed-methods studies of women’s cervical screening preferences, using the Grading of Recommendations, Assessment, Development, and Evaluation approach to developing preference-based recommendations. This approach was also used in a systematic review of methods to elicit women’s preferences, addressing the second objective. These findings led to the development and field testing of a preference-elicitation tool using International Patient Decision Aid Standards criteria, and the development of a protocol for a population-based study of women’s preferences. iv Results Objective 1 Experts disagree about whether there is enough evidence to include alternative modalities in cervical screening programs. Women and health care professionals do not recognize that women face a choice to participate in cervical screening. A narrative synthesis of relevant literature presented challenges in aggregating preferences across diverse study objectives, designs, and contexts. Objective 2 Preference-elicitation approaches for cervical screening are heterogenous in design and rigour. I therefore developed and field tested a tool to elicit women’s preferences, which demonstrated that women found the tool helpful to identify their preferences. I then propose a study that uses multiple methods to apply the tool more broadly. Conclusions Synthesized preferences data might not be the optimal approach to incorporate preferences into cervical screening guidelines. A tool grounded in shared decision-making can help women identify their informed, values-based screening preferences.

Thesis (MPH)--University of Limpopo, 2009. / Cervical cancer is the second highest form of cancer among women in Botswana, with breast cancer being the commonest (Ferlay et al, 2002), and is currently the highest cause of cancer deaths in Botswana (Ferlay et al, 2002). Cervical cancer screening using Pap smear provides an appropriate way for early detection and prevention of cervical cancer if appropriately implemented. Cervical cancer screening was introduced in Botswana in 2003 free of charge to all women of age greater than 18 years attending government hospitals. Despite this step by the government to decrease the mortality and morbidity rates resulting from cervical cancer, the uptake of cervical cancer has remained low among women in Botswana (Botswana central statistic report, 2009). Aim of the study; The study was aimed at identifying and describing factors influencing cervical cancer screening uptake among women greater than 18 years attending Mahalapye District Hospital in Botswana using the Health Belief Model. Methodology; This study was a cross sectional survey in which a questionnaire was used to interview 300 participants in order to assess their perceived susceptibility to cervical cancer, their perceived severity of cervical cancer, their perceived benefits of doing cervical cancer screening and their perceived barriers of seeking cervical cancer screening. Descriptive statistics was used to identify and describe factors influencing cervical cancer screening uptake among women attending Mahalapye District Hospital, Botswana using the Health Belief Model construct. Each question in the questionnaire was scored using a 5-point Likert scale ranged from strongly agree (5) to disagree (1). Negatively worded questions had their scales reversed and scores for each construct of the Health Belief Model was added to get an average. Analysis compared women who had ever had „cervical cancer screening‟ with women who had never had „cervical cancer screening‟. Chi-square statistic was used to test for association of selected variables and binary logistic regression was used to measure the associations for the aggregate score of health belief model constructs. Results; Cervical cancer screening rates was 39%. Participants were aware of the perceived severity of cervical cancer (average response 2.58-3.60), perceived benefits of cervical cancer 6 screening (average response 3.10-4.33) and perceived barriers to seeking cervical cancer screening (average response 2.0-3.44) but these were not significantly associated with screening. The highest predictor of cervical cancer screening was perceived susceptibility and those with high perceived susceptibility were 3.2 times more likely to do cervical cancer screening than those with low perceived susceptibility. Main socio-demographic characteristics significantly associated with perceived susceptibility were employment, monthly income and residential area while perceived severity was significantly associated with monthly income and residential area. Conclusions; Perceived susceptibility to cervical cancer was significantly associated with cervical cancer screening. Educational programs geared towards increasing perceived susceptibility to cervical cancer can significantly improve the uptake of cervical cancer screening in Botswana as well as address issues of barriers and misconceptions associated with low uptake of cervical cancer screening.

Thesis (MPH)--University of Limpopo (Medunsa Campus), 2011. / BACKGROUND: In Botswana, cervical cancer is the most common cancer among women (18), and the Southern Africa regional prevalence rate of cervical cancer is 15.5% (25). In Nyangabgwe Referral Hospital, cervical cancer is the most common malignancy admitted in the gynecology ward, contributing 73% and 78% of all malignancy admissions in 2007 and 2008 respectively. It is estimated that 200,000 to 300,000 women die from cervical cancer every year, mostly in poor countries (1). The study intends to create more awareness on the importance cervical cancer screening in Nyangabgwe Referral Hospital and catchment areas. Purpose: The purpose of the study is to improve the uptake of cervical cancer screening by integrating a health promotion component to the standard program. Methods: The study was an interventional quantitative research. Two populations were selected for the study namely women attending Nyangabgwe Referral Hospital and the clinics in Francistown (the research group) and women attending Princess Marina Hospital (the control group). The population of women attending Nyangabgwe Referral Hospital was exposed to health promotion. The second population of women attending Princess Marina Hospital was unexposed to the health promotion intervention. A pre-test quantitative trend of cervical cancer screening patterns was collected from June to September 2009 in the health facilities before the intervention from October 2009 to January 2010. Intervention was conducted in the study sites and was followed by a post - test quantitative measure of cervical cancer screening trends in both the research group and the control groups. Instruments for the health promotion were; flyers with translations in English and Setswana given to participants, posters which were posted at various strategic positions in the hospital and as well as in female wards. The population of study was all women attending Nyangabgwe Referral Hospital and its catchment clinics (the study site). Interactive health education sessions were provided to the population. Questionnaires which had Setswana translation were administered to respondents who were screened for cervical cancer in the study and control sites. Results: The analysis of finding revealed that the total uptake of Pap smear test was higher during the period of intervention than in the pre-intervention period in all the sites and for all the age groups. Among the health promotion activities, the effect of health education talks in the hospital and clinics was greater (67%), than the effects of flyer or pamphlets (35%) and posters in hospitals and clinics (17%) in escalating uptakes of cervical cancer screening services. Conclusions: The standard cervical cancer screening program alone as designed and executed by health care workers is not enough to stimulate the desired response of increase access to cervical cancer screening services, because many women usually are left out. Recommendations: The study results call for the need of instituting a visible and accountable comprehensive health promotion component to the standard cervical cancer screening program in order to sustain a steady cervical cancer screening uptake that will result in the expected decline in morbidity and mortality due to cervical cancer disease.