<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2 20190208//EN" "http://jats.nlm.nih.gov/publishing/1.2/JATS-journalpublishing1.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="other" dtd-version="1.2" xml:lang="en">
    <front>
        <journal-meta>
            <journal-id journal-id-type="pmc">F1000Research</journal-id>
            <journal-title-group>
                <journal-title>F1000Research</journal-title>
            </journal-title-group>
            <issn pub-type="epub">2046-1402</issn>
            <publisher>
                <publisher-name>F1000 Research Limited</publisher-name>
                <publisher-loc>London, UK</publisher-loc>
            </publisher>
        </journal-meta>
        <article-meta>
            <article-id pub-id-type="doi">10.12688/f1000research.135180.1</article-id>
            <article-categories>
                <subj-group subj-group-type="heading">
                    <subject>Study Protocol</subject>
                </subj-group>
                <subj-group>
                    <subject>Articles</subject>
                </subj-group>
            </article-categories>
            <title-group>
                <article-title>Assessing the awareness regarding cervical cancer in Vidarbha: A Cross-Sectional Study</article-title>
                <fn-group content-type="pub-status">
                    <fn>
                        <p>[version 1; peer review: awaiting peer review]</p>
                    </fn>
                </fn-group>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author" corresp="yes">
                    <name>
                        <surname>joshi</surname>
                        <given-names>Dhanshree</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Validation</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Original Draft Preparation</role>
                    <uri content-type="orcid">https://orcid.org/0009-0001-7521-9096</uri>
                    <xref ref-type="corresp" rid="c1">a</xref>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Mude</surname>
                        <given-names>Gaurav</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Validation</role>
                    <role content-type="http://credit.niso.org/">Visualization</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Review &amp; Editing</role>
                    <xref ref-type="aff" rid="a2">2</xref>
                </contrib>
                <aff id="a1">
                    <label>1</label>Clinical Research, School Of Allied Health Sciences, Datta Meghe Institute Of Higher Education And Research, Wardha, Maharashtra, India</aff>
                <aff id="a2">
                    <label>2</label>Pharmacology, Datta Meghe College of Pharmacy, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India</aff>
            </contrib-group>
            <author-notes>
                <corresp id="c1">
                    <label>a</label>
                    <email xlink:href="mailto:joshidhanshree2@gmail.com">joshidhanshree2@gmail.com</email>
                </corresp>
                <fn fn-type="conflict">
                    <p>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>21</day>
                <month>8</month>
                <year>2023</year>
            </pub-date>
            <pub-date pub-type="collection">
                <year>2023</year>
            </pub-date>
            <volume>12</volume>
            <elocation-id>1015</elocation-id>
            <history>
                <date date-type="accepted">
                    <day>1</day>
                    <month>8</month>
                    <year>2023</year>
                </date>
            </history>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2023 joshi D and Mude G</copyright-statement>
                <copyright-year>2023</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <self-uri content-type="pdf" xlink:href="https://f1000research.com/articles/12-1015/pdf"/>
            <abstract>
                <p>Cervical cancer is a tangible disease nowadays, many people are unaware of the signs and symptoms of the same and thus it has a poor prognosis. Prior to cervical cancer developing, the tissue of the cervix goes through changes known as aplasia, during which the tissue starts to develop aberrant cells. The unusual cells could potentially turn into cancer cells, grow deeper into the cervix, and spread to neighboring tissue if unchecked or untreated. Every year, 5 lakh new instances of cervical cancer are identified worldwide. A 20- year-old woman at moderate chance has a 250/10,000 of adopting invasive cervical cancer throughout her lifetime and a 118/10,000 chance of dying from it in the absence of screening. Between the ages of 20 - 75, screening at least every three years will reduce these risks by roughly 215/10,000 and 107/10,000, respectively, which eventually prolongs the life expectancy of a woman in her 20s by around 96 days. According to the previous data, 26.1 percent of people are apprised of cervical cancer in the year 2020 in India. The cross-sectional study will be performed for assessing the awareness of cervical cancer through a digital questionnaire format in the year 2023 and expecting the result of awareness between 40% - 60% in the general population in Vidarbha.</p>
            </abstract>
            <kwd-group kwd-group-type="author">
                <kwd>Disease</kwd>
                <kwd>Awareness</kwd>
                <kwd>Symptoms</kwd>
                <kwd>Signs</kwd>
                <kwd>Screening</kwd>
                <kwd>Gender</kwd>
                <kwd>Life expectancy</kwd>
                <kwd>Spreading percentage</kwd>
            </kwd-group>
            <funding-group>
                <funding-statement>The author(s) declared that no grants were involved in supporting this work.</funding-statement>
            </funding-group>
        </article-meta>
    </front>
    <body>
        <sec id="sec1" sec-type="intro">
            <title>Introduction</title>
            <p>Cancer is one of the most neophobic disease of the 20th century and is still spreading today and becoming more common. Every fourth individual has a lifelong risk of developing cancer because of the dire condition.
                <sup>
                    <xref ref-type="bibr" rid="ref1">1</xref>
                </sup> It&#x2019;s predicted that nearly 4 thousand new cases in 2020, were recorded, and due to that cervical cancer will become the 4
                <sup>th</sup> most frequent malignancy among females worldwide. It&#x2019;s predicted that around 3 lakh 42 thousand cervical cancer fatalities will occur in low and middle-income countries in the year 2020.
                <sup>
                    <xref ref-type="bibr" rid="ref2">2</xref>
                </sup> Destruction of cancer cells are living cells that have been partially transformed into pathogenic organisms or the building blocks of tumors. Understanding cancers leads to challenging philosophical issues because they both undermine and make use of multicellular organization mechanisms.
                <sup>
                    <xref ref-type="bibr" rid="ref3">3</xref>
                </sup> The predominant cell type inside the reactive stroma of several tumor forms is cancer-associated fibroblasts (CAFs). Numerous earlier investigations have demonstrated that CAFs play a pro-tumorigenic role by secreting different growth factors such as; cytokines, and chemokines as well as by degrading extracellular matrix.
                <sup>
                    <xref ref-type="bibr" rid="ref4">4</xref>
                </sup>
            </p>
            <p>The emphasis has been on biological investigations and coding for cancer for a very long time and has been changing quickly. Despite the huge effort being made to comprehend the development of cancer cells are the source of the malignant tissues and the method by which they spread and relapse.
                <sup>
                    <xref ref-type="bibr" rid="ref5">5</xref>
                </sup> Just a few of the several cellular processes in which receptor tyrosine kinases (RTKs) are active include growth, motility, differentiation, and metabolism. As a result, aberrant RTK signalling plays a role in many human diseases, most notably cancer.
                <sup>
                    <xref ref-type="bibr" rid="ref6">6</xref>
                </sup> Cancerous processes modify protooncogenes and tumor suppressor genes, which encode proteins for signal transduction. The absence of both repressive signals for cell proliferation and the susceptibility of cells to repressive signals may be the cause of many of the damages that result in carcinogenesis. The cell has systems for both receiving apoptotic-antitumor signals and carrying out these commands.
                <sup>
                    <xref ref-type="bibr" rid="ref7">7</xref>
                </sup>
            </p>
            <p>There are mostly 12 types of known cancers among all that, the most often cancers in females are &#x2013; breast carcinoma, endometrial carcinoma, lung carcinoma, cervical carcinoma, colorectal carcinoma, ovarian carcinoma, skin carcinoma; whereas the most often occurred cancers in males are &#x2013; colorectal carcinoma, bladder carcinoma, prostate carcinoma, lung carcinoma.
                <sup>
                    <xref ref-type="bibr" rid="ref8">8</xref>
                </sup>
            </p>
        </sec>
        <sec id="sec2">
            <title>Objectives</title>
            <p>
                <list list-type="bullet">
                    <list-item>
                        <label>&#x2022;</label>
                        <p>To assess the awareness regarding cervical cancer among common people and to create more awareness among them regarding it.</p>
                    </list-item>
                    <list-item>
                        <label>&#x2022;</label>
                        <p>To compare the knowledge levels and attitudes based on age, gender, and education.</p>
                    </list-item>
                </list>
            </p>
        </sec>
        <sec id="sec3">
            <title>Protocol</title>
            <sec id="sec4">
                <title>Methodology</title>
                <p>Type of Study: Cross-Sectional study (observational study)</p>
                <p>Study duration: 3 months
                    <list list-type="bullet">
                        <list-item>
                            <label>&#x2022;</label>
                            <p>Conceptual research on cervical cancer will be done.</p>
                        </list-item>
                        <list-item>
                            <label>&#x2022;</label>
                            <p>The recruitment of people will be independently done.</p>
                        </list-item>
                        <list-item>
                            <label>&#x2022;</label>
                            <p>The awareness research will be done through the standardized digital questionnaire tool with a consent form.</p>
                        </list-item>
                        <list-item>
                            <label>&#x2022;</label>
                            <p>The link will be generated and formulated among the people.</p>
                        </list-item>
                    </list>
                </p>
            </sec>
            <sec id="sec5">
                <title>Study design</title>
                <p>The study is conducted among the common population of the Vidarbha district. The study is about the awareness of cervical cancer among people. The conceptual research on cervical cancer will be done. The recruitment of the people is independently done and the awareness will be observed through a standardized digital questionnaire tool with a generated link.</p>
            </sec>
            <sec id="sec6">
                <title>Sample size</title>
                <p>
                    <list list-type="bullet">
                        <list-item>
                            <label>&#x2022;</label>
                            <p>The minimum sample size required: 
                                <disp-formula id="e1">
                                    <mml:math display="block">
                                        <mml:mi>N</mml:mi>
                                        <mml:mo>=</mml:mo>
                                        <mml:mfrac>
                                            <mml:mrow>
                                                <mml:msubsup>
                                                    <mml:mi>Z</mml:mi>
                                                    <mml:mrow>
                                                        <mml:mn>1</mml:mn>
                                                        <mml:mo>&#x2212;</mml:mo>
                                                        <mml:mi>&#x03b1;</mml:mi>
                                                        <mml:mo>/</mml:mo>
                                                        <mml:mn>2</mml:mn>
                                                    </mml:mrow>
                                                    <mml:mn>2</mml:mn>
                                                </mml:msubsup>
                                                <mml:mo>&#x2217;</mml:mo>
                                                <mml:mi>p</mml:mi>
                                                <mml:mo>&#x2217;</mml:mo>
                                                <mml:mfenced close=")" open="(">
                                                    <mml:mrow>
                                                        <mml:mn>1</mml:mn>
                                                        <mml:mo>&#x2212;</mml:mo>
                                                        <mml:mi>p</mml:mi>
                                                    </mml:mrow>
                                                </mml:mfenced>
                                            </mml:mrow>
                                            <mml:msup>
                                                <mml:mi>E</mml:mi>
                                                <mml:mn>2</mml:mn>
                                            </mml:msup>
                                        </mml:mfrac>
                                    </mml:math>
                                </disp-formula>
                            </p>
                        </list-item>
                    </list>
                </p>
                <p>Where;</p>
                <p>
                    <italic toggle="yes">Z</italic>
                    <sub>1</sub>
                    <sup>2</sup> &#x2013; 
                    <italic toggle="yes">&#x03b1;</italic>/2 = Its level of significance at 5% i.e., 95%</p>
                <p>Confidence Interval = 1.96
                    <disp-formula id="e2">
                        <mml:math display="block">
                            <mml:mi>P</mml:mi>
                            <mml:mo>=</mml:mo>
                            <mml:mtext>Proportion&#x2009;of&#x2009;Awareness&#x2009;about&#x2009;Cervical&#x2009;Cancer</mml:mtext>
                            <mml:mo>=</mml:mo>
                            <mml:mn>26.1</mml:mn>
                            <mml:mo>%</mml:mo>
                            <mml:mo>=</mml:mo>
                            <mml:mn>0.261</mml:mn>
                        </mml:math>
                    </disp-formula>
                    <disp-formula id="e3">
                        <mml:math display="block">
                            <mml:mi>E</mml:mi>
                            <mml:mo>=</mml:mo>
                            <mml:mtext>Error&#x2009;of&#x2009;Margin</mml:mtext>
                            <mml:mo>=</mml:mo>
                            <mml:mn>5</mml:mn>
                            <mml:mo>%</mml:mo>
                            <mml:mo>=</mml:mo>
                            <mml:mn>0.05</mml:mn>
                        </mml:math>
                    </disp-formula>
                    <disp-formula id="e4">
                        <mml:math display="block">
                            <mml:mi>N</mml:mi>
                            <mml:mo>=</mml:mo>
                            <mml:mfrac>
                                <mml:mrow>
                                    <mml:msup>
                                        <mml:mfenced close=")" open="(">
                                            <mml:mn>1.96</mml:mn>
                                        </mml:mfenced>
                                        <mml:mrow>
                                            <mml:mn>2</mml:mn>
                                            <mml:mo>&#x2217;</mml:mo>
                                        </mml:mrow>
                                    </mml:msup>
                                    <mml:mfenced close=")" open="(">
                                        <mml:mn>0.261</mml:mn>
                                    </mml:mfenced>
                                    <mml:mo>&#x2217;</mml:mo>
                                    <mml:mfenced close=")" open="(">
                                        <mml:mrow>
                                            <mml:mn>1</mml:mn>
                                            <mml:mo>&#x2212;</mml:mo>
                                            <mml:mn>0.261</mml:mn>
                                        </mml:mrow>
                                    </mml:mfenced>
                                </mml:mrow>
                                <mml:msup>
                                    <mml:mfenced close=")" open="(">
                                        <mml:mn>0.05</mml:mn>
                                    </mml:mfenced>
                                    <mml:mn>2</mml:mn>
                                </mml:msup>
                            </mml:mfrac>
                        </mml:math>
                    </disp-formula>
                </p>
                <p>
                    <italic toggle="yes">N</italic> = 296</p>
                <p>
                    <italic toggle="yes">N</italic> = The study sample size is 296</p>
                <p>Ref. 
                    <xref ref-type="bibr" rid="ref9">9</xref>
                </p>
            </sec>
            <sec id="sec7">
                <title>Selection of subjects</title>
                <p>Inclusion criteria:</p>
                <p>Subjects of both sexes will be included.</p>
                <p>Subjects of age group 18 to 50 years.</p>
                <p>Exclusion criteria:</p>
                <p>The subject under the category of vulnerable personnel, patients in an emergency condition, ethnic minority groups, homeless people, nomads, refugees, minors, or other</p>
                <p>participants will not be willing to participate.</p>
            </sec>
            <sec id="sec8">
                <title>Method of data collection</title>
                <p>
                    <list list-type="bullet">
                        <list-item>
                            <label>&#x2022;</label>
                            <p>Sampling techniques: Simple random sampling</p>
                        </list-item>
                        <list-item>
                            <label>&#x2022;</label>
                            <p>Instrument: Researcher prepared a structured questionary consisting of MCQs</p>
                        </list-item>
                    </list>
                </p>
                <p>
                    <bold>Steps of data collection</bold>
                </p>
                <p>
                    <bold>Step 1:</bold> Prior to data collection permission will be obtained from the ethics committee.</p>
                <p>
                    <bold>Step 2</bold>: The digital questionnaire is circulated among people through a link</p>
                <p>
                    <bold>Step 3</bold>: The data collected will be tabulated and analyzed for the outcome</p>
                <p>The cumulative data will be analyzed using a relevant Chi-squared test statistical test for understanding the comparative difference between groups and among groups will be compared.</p>
                <p>
                    <bold>Dissemination</bold>
                </p>
                <p>It will be published in an Index Journal.</p>
                <p>
                    <bold>Study status</bold>
                </p>
                <p>The study is yet to start.</p>
            </sec>
        </sec>
        <sec id="sec9" sec-type="discussion">
            <title>Discussion</title>
            <p>Cervical cancer develops progressively over a certain amount of time.
                <sup>
                    <xref ref-type="bibr" rid="ref10">10</xref>
                </sup> Most cases take place in less developed countries where there are no reliable testing campaigns available. Some of the risk factors include acquired immunodeficiency syndrome, smoking, and human papillomavirus exposure. Treatment-related to extended morbidity is common, however, most women with initial-stage tumours can be cured. According to the outcomes of randomized clinical research, chemotherapy, and radiation therapy is considered a standard of care for cancer-developed patients and especially for women with locally advanced cancer, whereas its applicability to women in less developed nations is largely not tested.
                <sup>
                    <xref ref-type="bibr" rid="ref11">11</xref>
                </sup> According to circumstantial evidence, cervical cancer screening should result in a 90% depletion in the prevalence and mortality of invasive cervical cancer.
                <sup>
                    <xref ref-type="bibr" rid="ref12">12</xref>
                </sup> According to previous studies, the effectiveness is improved by less than 5% depending on the age at which the expurgating phase is started for instance age 17 or 20 years, if screening is done every 1 or 2 years rather than every 3 years there will be a decrease in the incidence rate of cancer. From roughly the age of 20 to roughly the age of 65, screening is advised at least every three years.
                <sup>
                    <xref ref-type="bibr" rid="ref12">12</xref>
                </sup>
            </p>
            <p>Cervical cancer (CC) continues to be the subsequent common malignancy among females in developing countries. Therefore, it is requisite to expand people understanding regarding the molecular pathogenesis of cervical cancer, as well as to suggest new treatment targets and procedures for the early detection of this illness. The anatomical status of normal cells and the changes brought on by the emergence of tumours can be ascertained through differential expression analysis employing high-throughput techniques applied to biological materials.
                <sup>
                    <xref ref-type="bibr" rid="ref13">13</xref>
                </sup> In the past 20 years, researchers have discovered an increasing number of head and neck squamous cell carcinoma (HNSCC) patients with tumours that are human papillomavirus (HPV) positive and develop in younger people
                <sup>
                    <xref ref-type="bibr" rid="ref14">14</xref>
                </sup> The human papillomavirus causes more than 95% of the manifestation of cervical cancer (HPV).
                <sup>
                    <xref ref-type="bibr" rid="ref15">15</xref>
                </sup> Contamination with (human papillomavirus) HPV is required for the evolution of cervical cancer and its precursors. HPV also causes cancers of the respiratory and gastrointestinal tracts, as well as precancerous lesions and cancers elsewhere in the female and male lower reproductive tract.
                <sup>
                    <xref ref-type="bibr" rid="ref2">2</xref>
                </sup> The HPV infection is also associated with the lung cancer, however there is no convincing evidence of the claim.
                <sup>
                    <xref ref-type="bibr" rid="ref16">16</xref>
                </sup> Infection usually occurs through intercourse with the virus that deposits in the basal lamina of the cervical epithelium. It is then taken up by basal cells and viral enhancement occurs in the outer layer of epithelium i.e. squamous epithelium matures. It avoids the host&#x2019;s immune system during this phase and frequently does not elicit a reaction from the immune system. Clinically detectable serum antibody levels are not present in about 50% of HPV-positive women. Therefore, there is a risk of reinfection with the same type of HPV.
                <sup>
                    <xref ref-type="bibr" rid="ref2">2</xref>
                </sup> The changes in the genes include dilation of oncogenes and variant of tumour suppressor gene.
                <sup>
                    <xref ref-type="bibr" rid="ref17">17</xref>
                </sup> HIF-1&#x03b1; i.e. hypoxia- inducible factor-1&#x03b1; enacts in enhancing a tumour ontogenesis, which is attested by its upregulation in many of the human cancers such as breast, cervix, lung and oral cavity.
                <sup>
                    <xref ref-type="bibr" rid="ref18">18</xref>
                </sup> Exosomes, which contain a variety of chemicals, are the source of hypoxic tumour cells that alter the immune system and encourage the growth of cancer.
                <sup>
                    <xref ref-type="bibr" rid="ref19">19</xref>
                </sup>
            </p>
            <sec id="sec10">
                <title>Ethical considerations</title>
                <p>Approved by the Institutional Ethics Committee Ref. No. DMIHER (DU)/IEC/2023/595Datta Meghe Institute Of Higher Education And Research Sawangi (M) Wardha- 442107 Maharashtra, India.</p>
            </sec>
        </sec>
    </body>
    <back>
        <sec id="sec13" sec-type="data-availability">
            <title>Data availability</title>
            <p>No data is associated with this article.</p>
        </sec>
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