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## Meet the editor

Rajamanickam Rajkumar is a scientist at the forefront of cervical cancer and HPV prevention and control. He has an MD in Community Medicine and a Ph.D. in Cancer Epidemiology. He is a professor at Meenakshi Medical College, Kanchipuram, India, and a Ph.D. mentor at Indian medical universities. He was Principal Investigator for one of the largest cervical cancer screening programs in India with the International Agency for Research on

Cancer of the World Health Organization. Dr. Rajkumar is trained in cancer registry, cancer epidemiology, and colposcopy. He is also a consultant to The Ohio State University Medical Center in cervical cancer screening and an honorary member of the Society for Colposcopy & Cervical Pathology of Singapore.

Contents

**Section 1**

**Section 2**

**Section 3**

and Vaccination

*by Tariku Laelago Ersado*

**Preface XI**

Epidemiology **1**

**Chapter 1 3**

**Chapter 2 13**

Screening **19**

**Chapter 3 21**

**Chapter 4 29**

Prevention and Control **51**

**Chapter 5 53**

**Chapter 6 61**

Cervical Cancer Elimination by 2030: The "SMASH" Strategy

*by Bojana Turic, Xiaorong Sun, Jian Wang and Baochang Pang*

*by Sunardhi Widyaputra, Natallia Pranata, Ignatius Setiawan* 

The Presence of HPV in Dental Calculus: It's Role in Pathogenesis

Preventing Human Papilloma Virus through Community Education

of Raj © A Global Public Health Treatise

The Role of AI in Cervical Cancer Screening

*by Celeste Mulry Baldwin and Lisa Rinke*

Cervical Cancer Prevention and Control

*by Rajamanickam Rajkumar*

of Oral and Cervical Cancer

*and Jamas Ari Anggraini*

Global Burden of Cervical Cancer *by Alemnju Venceslas Tarnju*

### Contents



Preface

Cervical cancer is the fourth most common form of cancer among women worldwide. In 2020, there were 604,000 new cases and 342,000 deaths due to cervical cancer globally. More than 70% of these occurred in the limited-resource settings of developing countries. The causative factor is persistent infections by the high-risk, oncogenic strains of human papilloma virus (HPV) types 16 and 18.

Cervical cancer is preventable and treatable. It is the only cancer targeted for elimination by 2030 by the World Health Organization (WHO). More than 193 member countries are signatories to the WHO's Cervical Cancer Elimination

Achieving this lofty goal involves plans, programs, strategies, solutions, research, and revolutions, all of which this book, Cervical Cancer – A Global Public Health Treatise, discusses. According to the WHO, the three key pillars to eliminating cervical cancer are vaccinating 90% of girls by the age of 15 years, screening 70% of women by the age of 35 years and again by the age of 45 years, and treating 90% of women with precancer and managing 90% of women with invasive cancer.

The first chapter on epidemiology describes incidence rates and mortality rates of cervical cancer in many countries. It analyzes the sociodemographic factors responsible for the high number of cases in certain regions as well as prevalence rates of oncogenic HPV infections in different age groups and groups residing in different locations. Sex life, menstrual behavior and hygiene practices, age at which sexual activity began, number of sex partners, condom use, number of unhygienic abortions, intake of oral contraceptive pills, smoking, and family history of carcinoma of the cervix are all postulated risk factors for the high incidence of cervical cancer substantiated by case-control and cohort studies presented in this

The chapter on HPV vaccination addresses the protective value of the bivalent, quadrivalent, and nanovalent HPV vaccines and their cost-effectiveness. It also discusses problems in vaccinating teenage girls in different societies, cultures, and

The chapter on screening and treatment discusses different screening strategies, such as visual inspection methods, cytology screening, and HPV screening, and their protocols and recommendations. It also discusses treatments available for precancerous lesions, including cryotherapy, cold knife conization, loop electrosurgical excision procedure (LEEP), and laser ablation methods.

The chapter on prevention and control emphasizes HPV vaccination for all girls 9 to 14 years old and other eligible women up to 21 years old. "See and Treat" protocols, offered at least once in a woman's lifetime, help prevent cervical cancer, thus they

are advocated for limited-resource settings as a cost-effective strategy.

socioeconomic backgrounds, along with potential solutions.

Initiative.

chapter.
