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Mapping evidence on the distribution of human papillomavirus-related cancers in sub-Saharan Africa: scoping review protocol

  • Bridget K. M. Lekoane1,
  • Tivani P. Mashamba-Thompson1 and
  • Themba G. Ginindza1Email author
Systematic Reviews20176:229

https://doi.org/10.1186/s13643-017-0623-3

Received: 18 May 2017

Accepted: 7 November 2017

Published: 17 November 2017

Abstract

Background

Despite the introduction of HPV vaccines, the incidence of HPV-related cancers (cervical, penile, anal, vulvar, vagina, head, and neck) in sub-Saharan Africa has been rising. The increasing incidence of these HPV-related cancers has been attributed to changes in lifestyle-related risk factors, most notably sexual behavior. The main objective of this study is to map evidence on the distribution of HIV-related cancers in sub-Saharan Africa (SSA).

Methods and analysis

We will conduct a scoping review to explore, describe, and map literature on the distribution of HPV-related cancers in sub-Saharan Africa. The primary search will include peer-reviewed and review articles. The list of references from included studies will also be searched. The search will be performed using EBSCOhost platform by searching the following databases within the platform: Academic search complete, health source: nursing/academic edition, CINAHL with full text, PubMed, Science Direct, Google scholar and World Health Organization (WHO) library databases, and gray literature. The researcher will search the articles using keywords, from the included studies; abstract and full articles will be screened by two independent reviewers. The screening will be guided by the inclusion and exclusion criteria. A thematic content analysis will be used to present the narrative account of the reviews, using NVivo version 10.

Discussion

We anticipate finding relevant literature on the distribution of HPV-related cancers in sub-Saharan Africa. The study findings will help reveal research gaps to guide future research.

Systematic review registration

PROSPERO CRD42017062403.

Keywords

HPV-related cancersRisk factorsPrevalenceIncidenceMortalityTrendsHIV

Background

The International Agency for Research on Cancer (IARC) defined human papilloma virus (HPV)-associated cancers as a specific cellular type of cancers diagnosed in a part of the body where HPV DNA is found [1]. HPV-related cancers are found on the parts of the body such as cervix, vulva, vagina, anal, penile, and oropharynx [2]. Per worldwide estimates, HPV infection is responsible for 5.2% of all cancers [3, 4]. Cancers associated with HPV are more prevalent in developing countries as compared to developed countries [5]. HPV is implicated in 99.7% of cervical cancer, 85% of anal cancers, 20% of oropharyngeal cancers, and 50% of cancers of the vulva, vagina, and penis cases worldwide [6]. According to estimates, cervical cancer is the fourth most common cancer among women with 572,624 new cases worldwide, which around 85% occurred in less developed regions. Around 266,000 females died of cervical cancer, accounting for 7.5% of all female cancer deaths [7].

WHO developed guidelines for prevention and control of cervical cancer; the main elements in the guideline were to vaccinate 9–13-year-old girls with two doses of HPV vaccine, use HPV tests to screen women for cervical cancer prevention, and communicate more widely to reach a wider audience e (http://www.who.int/reproductivehealth/RHUpdate/en/index.html). HPV vaccines are now broadly used in the prevention of cervical cancer; quadrivalent and bivalent are the two HPV vaccines developed towards mitigating the burden of cervical cancer. They have been pre-qualified by the World Health Organization (WHO) and approved by national government in many counties [8]. Also, the adoption of Papanicolaou(Pap) smear screening programs became successful and resulted in declining cervical cancer rates in Canada and the USA, but the incidence of other HPV-related cancers has been increasing [9, 10]. These increasing incidences of HPV-related cancers have been attributed to changes in lifestyle-related risk factors, most notably sexual behavior [10].

A scoping review of the literature regarding the distribution of HPV-related cancers in sub-Saharan Africa (SSA) is to be conducted. Interventions aimed at preventing and controlling cervical cancer in high endemic regions such as SSA are encouraged. However, research studies aimed at helping improve the efficiency of implementing these interventions are required. The aim of the study is to map evidence on the distribution of HPV-related cancers in sub-Saharan Africa. It is anticipated that the results of this study will reveal research gaps to guide future primary research and scoping reviews on HPV-related cancers in sub-Saharan Africa.

Methods and materials

The current scoping review protocol is to be performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines [11] (Additional file 1: Figure S1), and the protocol is registered with PROSPERO under registration number CRD42017062403 and accessible via this link: https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017062403.

Scoping review framework

The framework proposed review by Arksey H and O’Malley will be influential in conducting the scoping review [12]. The framework involves (I) identifying the research question, (II) identifying relevant studies, (III) study selection, (IV) charting the data, and (V) collating, summarizing, and reporting the results.

I. Identifying the research question

The major research question is “What is the evidence on the burden of HPV-related cancers in Sub-Saharan Africa?”

Research sub-questions are as follows:
  • What is the burden of HPV-related cancers in sub-Saharan Africa with estimation on the prevalence, incidence, and mortality?

  • What are the risk factors associated with HPV-related cancers?

  • What are the trends of HPV-related cancers?

  • What is the association of HIV and HPV-related cancers?

Eligibility criteria

Studies will be selected according to the PEO (population, exposure, and outcomes) framework outlined below (Table 1).
Table 1

PEO framework for eligibility of research question

Criteria

Determinants

Population and their problem

Individuals with HPV-related cancers in Sub-Saharan Africa

Exposure

HPV-related cancers

Outcome

1. Mortality

 

2. Incidence

 

3. Prevalence

 

4. Risk factors(cervical cancer, anal cancer, penile cancer, vulva cancer, and head and neck cancers)

 

5. Interplay with HIV

6. Trends

II. Identifying relevant studies

There will be no date and language restrictions applied on literature search. We will perform a keyword search from the following electronic databases: PubMed; World Health Organization (WHO) library; Science Direct; Google scholar; EBSCOhost platform for the following databases: Academic search complete, Health Source: Nursing/Academic Edition, and CINAHL with full text. We will use the following keywords while searching the above databases: HPV-related cancers, risk factors, prevalence, incidence, trends, HIV, and sub-Saharan Africa. Boolean terms AND and OR will be used to separate the keywords during the search. Mesh terms (Medical Subject Headings) will also be included in the search. The researcher will do a hand search of eligible studies from the list of references of included studies.

III. Study selection and eligibility

Following title screening from the above databases, articles with relevant title to the subject of the research will be uploaded on the Endnote X7 X7.7.1 software. Search results from different electronic databases will be combined in a single EndNote library (Appendix 1). Studies which do not address the research question and the duplicates of the same records will be excluded. From the included studies, abstract and full articles will be screened by two independent reviewers. An abstract screening form with questions will be developed based on the review eligibility criteria. The screening will be guided by the eligibility criteria. Discrepancies between reviewers at the abstract stage will be resolved through consensus and will involve a third reviewer. Discrepancies between reviewers at full article stage will be resolved by involving a third screener.

The relevant studies will be identified with guidance from the inclusion and exclusion criteria which were formulated according to the research questions.

Eligibility criteria

Inclusion criteria
  • Study will include individuals with HPV-related cancers

  • All study designs with relevant intervention

  • Studies that focus on HPV-related cancers; prevalence, incidence, mortality, risk factors, and trends

  • Studies that focus on HIV and HPV-related cancers.

Exclusion criteria
  • Studies that do not focus on HPV-related cancers

  • Studies that do not focus on humans

  • Qualitative studies will also be excluded

PRISMA flow chart will be used to report the screening results.

Table 2 will be used to show the results of the titles searched from different databases.
Table 2

Database search record

Date of search

Search engine

Keyword searched

Number of articles found

Number articles eligible

PRISMA flow chart (Additional file 1: Figure S1) will be used to summarize the inclusion and exclusion criteria.

IV. Charting the data

Data from included studies will be extracted using an extraction form (Appendix 2). A data charting form will be developed and will be used to determine which variables to extract that will help to answer the research question. The extraction form will continually be updated. The form will include the following: author with date, study title, study design, study setting, population, study aim, intervention, percentages, outcomes of the study, key findings, and comments (Table 3).
Table 3

Data charting form

Author and date

 

Study design

 

Study setting

 

Population

 

- Average age

 

- Sample size

 

Aims

 

Intervention

 

Outcome

 

Key findings

 

Conclusion

 

Comment

 

V. Collating, summarizing, and reporting the results.

The aim of this study is to map the existing evidence and to summarize the findings as presented in articles. A narrative account of findings from existing literature will be presented through thematic content analysis. Literature will be extracted and structured around the following outcomes: prevalence, incidence, mortality, risk factors, trends, and HIV. The resulting themes will be analyzed and results will inspect the relationship between the findings and the research question. The meaning of the findings will be considered as they relate to the overall study purpose and the implications of these findings for future research, policy, and practice.

Quality assessment

The quality of the evidence obtained from the studies will be assessed to make sure the study design is appropriate for the research objectives and the studies are reported well and to eliminate risk of bias. A quality appraisal tool which focuses on the study methods, the Mixed Method Quality Appraisal Tool (MMAT) Version 2011, will be used [13]. The tool will be used to examine the quality of an article looking at the following aspects: the appropriateness of the aim of the study, adequacy and methodology, study design, participant recruitment, data collection, data analysis, presentation of findings, authors’ discussions, and conclusions.

Discussion

The current scoping review aims to map available evidence regarding the distribution of HPV-related cancers, the risk factors, and its association with HIV and AIDS in sub-Saharan Africa in order to reveal research gaps in this area. High-risk HPV types are the cause of all cervical cancers, anogenital cancers including the vulva, and anal and penile cancers [14, 15], as well as head and neck cancers [16]. Sub-Saharan Africa has the highest incidence of HPV and cervical cancer in the world [17]. HPV-related cancers are rising and they are a major public health concern exacerbating current disease burden in sub-Saharan Africa [18]. The burden of HPV-associated diseases is substantially increased where there is a HIV-1 co-infection [19], and with diverse HIV/AIDS epidemic in sub-Saharan Africa, the burden of HPV-related cancers might still rise. The Sustainable Development Goals (SDG) include targets relevant to women’s cancers, including a one-third reduction in premature mortality from non-communicable diseases through prevention and treatment by 2030 and achievement of universal health coverage, with access to quality essential health-care services and access to safe, effective, quality, and affordable essential medicines and vaccines for all [20].

The focus of this review is on HPV-related cancers, hence excluding studies that do no focus on HPV-related cancers and humans as the data will be irrelevant and will not report according to the set research questions. The study will focus on all individuals with HPV-related cancers regardless of gender. There is a latency period of 10 years or more between the initial high-risk HPV infection and the development of cancer; hence, there are no date restrictions on the literature search. Since the study is aimed on mapping the distribution of the HPV-related cancer, qualitative studies will be excluded in this review.

Despite information about HPV vaccine and testing within cervical cancer screening programs, it has been shown that patients’ and public’s knowledge of HPV-related cancers is still very little [21, 22]. Therefore, the results of this study will help address this knowledge gap. It is anticipated that our study findings will help to strengthen a need for policy implementation for prevention of HPV-related cancers and raise more awareness of HPV-related cancers. Also, government and stakeholders can be able to ensure that HPV vaccines are introduced everywhere as part of a coordinated and comprehensive strategy to prevent cervical cancer and other diseases caused by HPV. There will also be proper implementation of education on reducing behaviors that increase the risk of acquiring HPV infection, training of health workers and information to women about screening, diagnosis, and treatment of precancerous lesions and cancer especially in underdeveloped and financially constrained countries in sub-Saharan Africa. The finding will also help strengthen the need of HPV vaccines to be included in national immunization programs in the whole of sub-Saharan Africa.

Abbreviations

AIDS: 

Acquired immunodeficiency syndrome

DNA: 

Deoxyribonucleic acid

HIV: 

Human immunodeficiency virus

HPV: 

Human papilloma virus

IARC: 

International Agency for Research on Cancer

MMAT: 

Mixed Methods Appraisal Tool

PRISMA-P: 

Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols

SDG: 

Sustainable Development Goals

SSA: 

Sub-Saharan Africa

WHO: 

World Health Organization

Declarations

Acknowledgements

The authors would like to thank the University of KwaZulu-Natal (UKZN) for the provision of resources towards this review and the UKZN Systematic Review Unit for the training and technical support.

Funding

Not applicable

Availability of data and materials

All data generated or analyzed during this study will be included in the published systematic review article.

Authors’ contributions

BL conceptualized the study under the supervision of TG and TPM-T and designed data collection methods. BL, TG, and TPM-T contributed to writing the first draft of the manuscript. All authors critically reviewed and approved of the final manuscript.

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa

References

  1. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans. Volume 90: Human papillomaviruses. Lyon, France: International Agency for Research on Cancer, World Health Organization; 2007.Google Scholar
  2. Shiels MS, Kreimer AR, Coghill AE, Darragh TM, Devesa SS. Anal cancer incidence in the United States, 1977–2011: distinct patterns by histology and behavior. Cancer Epidemiol Biomarkers Prev. 2015;24:1548–56.View ArticlePubMedPubMed CentralGoogle Scholar
  3. Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118:3030–44.View ArticlePubMedGoogle Scholar
  4. Parkin DM, Bray F. Chapter 2: the burden of HPV-related cancers. Vaccine. 2006;24(Suppl 3):S3/11–25.Google Scholar
  5. Agosti JM, Goldie SJ. Introducing HPV vaccine in developing countries—key challenges and issues. N Engl J Med. 2007;356:1908–10. doi:10.1056/NEJMp078053 PMID:17494923.View ArticlePubMedGoogle Scholar
  6. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papilloma virus is a necessary cause of invasive cancer worldwide. J Pathol. 1999;189:12–9. doi:10.1002/(SICI)1096-9896(199909)189:1<12:AID-PATH431>3.0.CO;2-F PMID:10451482.View ArticlePubMedGoogle Scholar
  7. Ferlay, J., Soerjomataram, I., Ervik, M., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., Parkin, D.M., Forman, D., Bray, F.: GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 11 [online]. International Agency for Research on Cancer, Lyon (France) 2013. Available from WWW: http://globocan.iarc.fr.
  8. Schiffman M, Wacholder S. Success of HPV vaccination is now a matter of coverage. Lancet Oncol. 2012;13:10–2. doi:10.1016/S1470-2045(11)70324-2 PMID:22075169.View ArticlePubMedGoogle Scholar
  9. Hatcher J, ed. Cervical cancer: 2010 report on cancer statistics in Alberta Edmonton (AB): Cancer Care, Alberta Health Services; 2012. Available: www.albertahealthservices.ca/poph/hi-poph-surv-cancer-cervical-2010.pdf (accessed accessed 2013 Jun. 20).
  10. Chaturvedi AK. Beyond cervical cancer: burden of other HPV-related cancers among men and women. J Adolesc Health. 2010;46(Suppl):S20–6.View ArticlePubMedGoogle Scholar
  11. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.View ArticlePubMedPubMed CentralGoogle Scholar
  12. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodology. 2005;8(1):19–32.View ArticleGoogle Scholar
  13. Pluye P, Robert E, Cargo M, Bartlett G, O’Cathain A, Griffiths F, Boardman F, Gagnon M, Rousseau M. Proposal: A mixed methods appraisal tool for systematic mixed studies reviews in.2011.http://mixedmethodsappraisaltoolpublic.pbworks.com/w/page/24607821/ FrontPage. Accessed 12 Jan 2016.
  14. Crum CP, et al. Pathobiology of vulvar squamous neoplasia. Curr Opin Obstet Gynecol. 1997;9:63–9.View ArticlePubMedGoogle Scholar
  15. Kayes O, et al. Molecular and genetic pathways in penile cancer. Lancet Oncol. 2007;8:420–9.View ArticlePubMedGoogle Scholar
  16. Mannarini L, Kratochvil V, Calabrese L, et al. Human papillomavirus (HPV) in head and neck region: review of literature. ActaOtorhinolaryngol Ital. 2009;29:119–26.Google Scholar
  17. De Vuyst H, Alemany L, Lacey C, Chibwesha CJ, Sahasrabuddhe V, Banura C, Denny L, Parham GP. The burden of human papillomavirus infections and related diseases in sub-Saharan Africa. Vaccine. 2013;31(Suppl. S5):F32–46.View ArticlePubMedPubMed CentralGoogle Scholar
  18. Baxi SS, Shuman AG, Corner GW, et al. Sharing a diagnosis of HPV-related head and neck cancer: the emotions, the confusion, and what patients want to know. Head Neck. 2013;35:1534–41.View ArticlePubMedGoogle Scholar
  19. Pantanowitz L, Michelow P. Review of human immunodeficiency virus (HIV) and squamous lesions of the uterine cervix. Diagn Cytopathol. 2011;39:65–72.View ArticlePubMedGoogle Scholar
  20. UN. Sustainable Development Goals. 2015. https://sustainabledevelopment.un.org/sdg3 (Accessed Sept 30, 2016).
  21. Hendry M, Pasterfield D, Lewis R, et al. Are women ready for the new cervical screening protocol in England? A systematic review and qualitative synthesis of views about human papillomavirus testing. Br J Cancer. 2012;107:243–54.View ArticlePubMedPubMed CentralGoogle Scholar
  22. Hendry M, Lewis R, Clements A, et al. “HPV? Never heard of it!”: a systematic review of girls’ and parents’ information needs, views and preferences about human papillomavirus vaccination. Vaccine. 2013;31:5152–67.View ArticlePubMedGoogle Scholar

Copyright

© The Author(s). 2017

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