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Purpose – To provide an overview of racial/ethnic disparities in human papillomavirus (HPV) infection, HPV vaccination, and cervical cancer on domestic and international levels.

Design/methodology/approach – The literature, cervical cancer prevention guidelines, and Centers for Disease Control and Prevention resources were culled to aggregate information on epidemiology, racial/ethnic disparities, and knowledge and attitudes related to HPV, HPV vaccination, and cervical cancer. Original data supplement information about HPV and HPV vaccination knowledge and attitudes.

Findings – Cervical cancer is among the leading causes of female death worldwide, with substantial racial/ethnic and geographic disparities. In the United States, African American and Hispanic women suffer disproportionate cervical cancer incidence and mortality compared to their Caucasian counterparts. Globally, the greatest burden of cervical cancer (and HPV infection) is shouldered by developing regions. Prevention efforts, such as HPV vaccination and adaption of screening programs to resource-poor areas, have the potential to reduce such disparities, but cultural context is critical to successful development and implementation of such interventions.

Research limitations/implications – As this is not a systematic review, but rather a viewpoint on issues related to disparities in cervical cancer, the literature review is not exhaustive.

Practical implications – This chapter provides a context for examining cervical cancer disparities domestically and globally and serves as a starting point for formulating future research.

Originality – This perspective on HPV and cervical cancer presents disparities both within the United States and worldwide. The chapter supplements the literature with new data that provide additional insight into knowledge and attitudes about these health issues.

To investigate the factors associated with the use of screening mammography for breast cancer and cervical smear tests for cervical cancer, a theoretical framework was used comprising elements from the Health Belief Model, the Theory of Reasoned Action, and illness representations from the self‐regulatory model. Items reflecting older women’s illness representations about cancer and cancer screening were derived from an earlier qualitative study. Using a highly structured interview schedule, telephone interviews were conducted with 1,200 women aged 50‐70 years. There were considerable similarities between the factors associated with both mammography and cervical smear test behaviours. The factors associated with screening mammography behaviour were: perceived barriers, perceived benefits, social influence, the illness representations, and marital status. The factors associated with cervical smear test behaviour were: perceived barriers, perceived benefits, emotions as a cause of cancer, feeling frightened of cancer, the illness representations, having a usual general practitioner, and being younger.

The purpose of the study is to assess the differential impact of gender and cancer sites on mental burden across different types of cancer and control patients.

The paper is based on a primary survey undertaken in 2015–2016 of 600 cancer and 200 control patients across five hospitals of Nepal. The data was analyzed using propensity score matching methods and treatment effect weighting estimators.

The authors find that of all the types of patients covered under this study, cervical cancer patients suffered from a greater intensity of anxiety and lack of functional wellbeing. On an average, all other female, male cancer patients, and control patients experience significantly lower intensity of mental burden in the range of 1.83, 2.63 and 3.31, respectively when compared to patients of cervical cancer. The results are robust across all the four treatment effect estimators and through all the measures of mental burden. The implications of suffering from cervical cancer, as a unique gynecological cancer was studied in-depth. An effect size analysis pointed out to the dysfunctional familial relationship as additional causes of concern for cervical cancer patients.

An important finding that emerged is that female cancer patients especially those who have cervical cancer should be given special attention because they appear to be the most vulnerable group. Further work is needed to delineate the reasons behind a cervical cancer patient facing higher amount of stress.

While there is literature that examines factors associated with low participation in cancer screening among Canadian ethnic groups, there is limited understanding of black visible minorities, particularly Somalis. Thus, the purpose of this study is to synthesize knowledge pertaining to the perceptions, beliefs and barriers of Somali women and men toward screening for breast, cervical and colorectal cancers in countries such as Canada.

The scoping review methodology was used to search for peer-reviewed articles that explicitly examined perceptions, beliefs and barriers among Somalis toward screening for breast, cervical and colorectal cancers in developed countries. The following electronic databases were searched without time frame restrictions, namely, OVID Medline, Embase, CINHAL, PubMed, Scopes and ProQuest. A total of 402 peer-reviewed articles were identified and screened. Three articles were identified through reference list screening (one eligible) and consultation with experts in the networks (two eligible). In total, 12 studies met the inclusion criteria for synthesis. Thematic analysis was used to analyze the selected articles for key themes and the synthesis was informed by the socio-ecological model.

The majority of studies originated from the USA and focused primarily on Somali women and cervical cancer screening. Themes that emerged from the literature include individual-level negative experiences and socio-cultural perceptions/beliefs; community-level barriers in cancer screening; and systemic challenges in navigating the health-care system. Many of the studies focused on individual and community-level determinants of cancer screening, with little attention to systemic level determinants. Other gaps identified include factors influencing Somali men’s low participation in cancer screening; limited studies on colorectal cancer and Somali women; and specific cancer-screening barriers faced by Somalis within the Canadian context.

The findings of the review reveal multiple cancer screening challenges for Somali communities and the gained insights should inform both health and social care practitioners and policymakers.

Mortality rates of cervical cancer are high amongst Filipino women; however, uptake of cervical screening is low. The purpose of this paper is to identify known barriers and facilitators to cervical screening for Filipino migrant women.

A systematic approach was adopted for the search, data extraction, critical appraisal and synthesis processes of this review. Eight electronic databases were searched. Studies published in peer review journals in English between 1995 and 2019 were reviewed.

In total, 20 relevant studies were identified. Studies were heterogeneous in design and focus and mostly conducted in the USA. A complex multifactorial picture of barriers to cervical screening was identified, which included: demographic, cognitive, access, health-care provider and cultural factors. None of the studies incorporated all factors.

This review demonstrates the complexity and multifactorial characteristic of cervical screening for Filipino migrant women. To increase uptake of screening, barriers to cervical screening for Filipino migrant women need to be fully understood. Future research should be conducted in different locations, focussing on multiple factors.

Aggregation of barriers and facilitators for Asian women combined tends to ignore cultural differences between groups. This review synthesises the existing but scarce literature to identify known barriers and facilitators to cervical screening for this specific population of Filipino migrant women.

To identify women's sources of information about cervical cancer screening, information which women report receiving during Pap consultations, information they would like to receive, and the relationships between perceived information needs, personal characteristics and information sources.

Logistic regression analysis of questionnaire data obtained from 408 screen‐eligible women resident in east central UK.

Programme documentation and the Pap consultation represent the main sources of information, although a sizeable proportion rely on other sources (e.g. mass media). The range and frequency of information services which women report receiving during their Pap consultations are variable, and around one‐sixth of women report never receiving information. “Always wanting information” is predictable from subject characteristics, which do not map precisely, owing to the variation in frequency of information being supplied. Age and women's main sources of information are significant predictors of perceived information shortfall, and such shortfalls are associated with dissatisfaction with the screening programme.

Covers all aspects of women's attitudes towards satisfactory or unsatisfactory availability of external information in the matter of screening for cervical cancer in the UK.

The study aimed to disclose the anti-cancer activity of Pluchea indica tea leaves by evaluating the cytotoxicity on breast and cervical cancer cells, compared with non-cancer cells.

Two P. indica extracts were prepared using two solvents, namely hot water (PA) and ethanol (PE). MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) and clonogenic assays were applied to determine cytotoxic effect of both extracts toward cancer cells from human breast (MDA-MB-231 and MCF7) and cervix (SiHa, HeLa and C-33A) and also non-cancer Vero cells. Dichlorofluorescein diacetate (DCFDA)-staining assay was used to quantify the intracellular level of the reactive oxygen species (ROS). Correlation between the quantity of compounds present and the cytotoxicity of the extracts was analyzed by Pearson's method and a possible class of bioactive compounds was proposed based on the highest correlation coefficient (r).

Significant reduction in cell viability and proliferation capability was observed in all cancer cells after treatment with either PA or PE extract albeit PE was more effective. Lower toxicity was detected in Vero cells, indicating the selectivity and safety of extracts. The intracellular ROS level was augmented in treated cancer cells which were inversely correlated to cell viability, suggesting the cancer toxicity was likely induced by intracellular oxidative stress. As flavonoids were found abundantly in the extracts and flavonoids' content was the most related to the activity (r = 0.815), it was hypothesized that the flavonoids might play crucial roles in cancer cytotoxicity.

P. indica tea-leaf extracts can be a good source of promising anti-cancer agents with reduced side effects for breast and cervical cancer treatment.

Reports on two small‐scale qualitative studies evaluating video‐based health promotion programmes, one aiming to encourage testicular self‐examination (TSE) among adolescent boys, the other aiming to promote positive attitudes towards and intention to use cervical screening services. Studies were part of a larger investigation aimed at developing a health education programme to promote TSE. Reports that TSE significantly increased at six weeks following the programme. However, sections of both programmes caused extreme embarrassment. This resulted in clear negative effects, which were particularly evident on girls’ intentions to adopt future screening. Suggests that adolescents perceive video‐based health education programmes ambivalently and that such programmes may have detrimental effects on positive action in the long term. Boys and girls preferred different media for the presentation of sensitive issues of health care. Boys preferred private access to media such as interactive computing, written information and home videos, while girls had a preference for group talks from health‐care professionals. Describes lessons to be drawn from these studies which may be helpful when developing health promotion programmes to promote TSE, and discusses these in terms of an emotional framework of fear and embarrassment experienced by adolescents.

Every year, 311,000 women die of cervical cancer globally, a disease which is preventable and treatable. Pap-testing should be part of a comprehensive approach to tackling cervical cancer; however, barriers to pap-testing do exist and migration may present additional barriers. In 2018, 2.3 million overseas Filipino workers were recorded and uptake of pap-testing for this group is low. The study aims to understand barriers and enablers to screening for overseas Filipino workers, which is essential to improve uptake of pap-testing for this population.

Embedded in a mixed-methods study, an exploratory qualitative study was conducted with Web-based, in-depth interviews (N = 8) with female overseas Filipino workers, mostly domestic workers, based in Kuwait, Qatar, Singapore and Hong Kong. Results were analysed using thematic analysis. A socio-ecological conceptual framework was used to explore barriers to uptake of pap-testing.

Barriers to pap-testing were cognitive factors, such as limited knowledge and fear of the outcome of pap-testing, as well as cultural and structural barriers. Findings revealed structural contexts not conducive to pap-testing, including difficulty navigating the health-care system, poverty, difficult employment circumstances and the overriding need to provide financially for family and children in the Philippines.

This study explored barriers to pap-testing with a hard-to-reach group, who are underrepresented in the literature. Barriers to pap-testing were embedded in structural barriers, resulting in health inequalities. Host and sending countries benefit from overseas Filipino workers and have a responsibility to care for their health and well-being, and should strive to tackle these structural factors.

Allison Watkins, senior director of Merck's Vaccines Division, needed to decide on the pricing of Gardasil, Merck's newest vaccine and one of the company's most important product launches of the year. The outside consulting firm she had hired to recommend a price for Gardasil had suggested a price of $120 per dose (or $360 per person, as each person required three doses over six months to achieve adequate immunity). The Gardasil marketing team disagreed about this recommended price; some thought it was clearly too high, whereas others said it was too low. The latter group argued that Merck would be missing a major opportunity by setting the price at such a low level. Watkins now needed to decide whether to follow the consulting firm's recommendation or to set a different price.

The case highlights the complexity and issues around pricing in the pharmaceutical industry. To decide on the price of Merck's new vaccine, students will work through product economics and be introduced to the role of economic modeling in determining appropriate prices in the biomedical industry. The case is unique because it gives students an opportunity to calculate a cost per quality adjusted life year (cost per QALY), and in the process discover the power and limitations of such an analysis.