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  • The final issue identified by our review is that

    2019-08-16

    The final issue identified by our review is that the central reason for the limited availability of official cervical cancer mortality data noted by IARC for the most recent reported HCMC cancer registry (2009–2012), is that death certificates have not been used to identify the cause of death in Vietnam. Rao et al., 2010, found that the mortality registration system in Vietnam has not complied with international standards for recording and reporting death cases by age, sex and cause [83]. According to the international recommendations for statistical classification of diseases and health related problems, the cause of death should be verified by a trained medical doctor and the diseases need to be coded in ICD-10 [84]. In Vietnam, for deaths that occurred outside health facilities, the cause of death is not ascertained by medical certification. Consequently, this could result in the misclassification of cause of death. The issues this review identified in Vietnam regarding limitations in the availability of cancer data, the quality of cancer registry data, the lack of death certification in cause-of-death ascertainment, and the variation in the burden of disease among regions are likely to be similar in many other LMICs. Curado et al. (2009), by reviewing population-based cancer registry data that reported to IARC, CI5-IX for the SCH 58261 1998–2002, found that there were only a limited number of cancer registries from Africa and Asia included, which covered only 1% and 4% of the total population in each continent, respectively [85]. In Africa, among a total of 16 submitted cancer registries, only 5 cancer registries were included in CIV-IX. In Asia, only 44 cancer registries were reported among a total of 77 submitted cancer registries [85]. The issue of low-quality-cancer-registry data does not necessarily involve the registries per se, but it might be caused SCH 58261 by gaps in the existing civil and health information registration system in LMICs [85]. Examples of these gaps could be not using a medical certificate to verify a cause of death, or lack of collaboration between different reporting sources. Only when these gaps are filled will cancer registry data from LMICs meet the criteria of completeness, validity, comparability, and timeliness required to be continuously certified and reported by IARC [86]. As a result, the improvement of civil and health information registration systems and cancer registry data will make high quality cancer data more available for disease monitoring and surveillance, as well as provide detailed information for the planning stages of future interventions in these countries [87]. The WHO Director-General has called for action towards the elimination of cervical cancer as a public health problem [88]. The completeness of data from LMICs will be a critical issue in future for evaluating the burden of disease and monitoring of the effectiveness of cervical cancer control interventions. Our projections indicate that in the absence of a comprehensive national prevention strategy, the number of new cervical cancer cases diagnosed in Vietnam is expected to increase by 20% (range 0–50%) from 2012 to 2050, indicating that the implementation of cervical cancer preventive strategies is crucial. The WHO guidelines for cervical cancer prevention (2014) and more recently the American Society of Clinical Oncology (ASCO) resource-stratified guidelines for cervical screening (2016) have proposed a range of possible cervical screening strategies which could be affordable and accessible for LMICs like Vietnam, including possibilities for testing women once or a few times in their lifetime with HPV DNA-based screening [89,90]. Over the longer term, the widespread implementation of HPV vaccination also holds potential to substantially reduce the burden of cervical cancer in Vietnamese women. Our future work will use the findings of the current study to evaluate the most effective and cost-effective options for cervical cancer screening combined with HPV vaccination in Vietnam, as we have previously done for China and other countries [91].