Cervical cancer in Armenia: Current situation and challenges.

Abstract

e17529 Background: In Armenia, cervical cancer (CC) is the fifth most common cancer among women. Among 15 to 44-year-old women, CC is the second most common cancer. Every year, approximately 250 new cases are diagnosed; of all cases, 43% are in stage III, and 19% are in stage IV. Methods: We collected statistics from Armenian oncology registers during the 2016 to 2024 period, GLOVOCAN, and WHO. Also Information about CC statistics was collected from published articles, the HPV international centers article. Treatment availability was assessed against international guidelines. Information about CC screening statistics is very low, and we collect information from a few articles. Results: Despite high prevention and early diagnosis opportunities, CC in Armenia was diagnosed in early stages in 27,5% of cases in the last 8 years. More cases were detected in the locally advanced and unresectable stage. Armenia started doing the PAP screening test in Jan 2015, targeting women aged 30 to 60 years. From 2007 to 2022 period the proportion of women undergoing PAP testing increased from 5.6 % to 31%. From 2015 to 2021, approximately 329.000 women were screened with coverage of the national program. From a cell-based survey examination among women aged 21 to 39, just 18% had any type of HPV, 11% had high-risk HPV, and 3.3% had HPV 16 and 18 types. In Armenia, because of cultural features, the median age of first sexual intercourse is 21 years among women in Armenia, which is late compared to many countries. The HPV vaccination coverage program in Armenia started in Dec 2017. In 2024, HPV vaccination coverage among, last dose, 15-year old girls was only 41%, and in 2020, just 2% was vaccinated. We compared three countries: Australia, Bulgaria, and Armenia, where HPV vaccination program coverage, last dose, among females in 2022 was 57%, 3%, and 14%, respectively. In 2022, in these three countries, age-standardized CC mortality rates per 100.000 women were 1.4, 6.2, and 4.0, respectively, which illustrated the impact of an effective vaccination program on CC. We don't have national guidelines in Armenia, and so we use international ones, which are not adapted for our country. Some medications, for example, Pembrolizumab is not registered in Armenia, and there is no governmental reimbursement. As a result, many patients refuse to receive immunotherapy because of the high cost and inaccessibility. Conclusions: In Armenia, CC is mostly diagnosed in the locally advanced stage, despite early, highly effective screening and prevention programs. We cannot collect how many cases were diagnosed in the precancer stage, such as CIN1, CIN2, and CIN3, because of the absence of national data. We can say that despite a higher median age of first sexual intercourse, the circulation of HPV remains sufficient to sustain CC. In Armenia, anti-vaccination campaigns are very active, but the number of vaccinated people in society is increasing year by year and not decreasing, striving to reach the WHO target.