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Voidăzan S, Budianu AM, Francisc RF, Kovacs Z, Uzun CC, Apostol BE, Bodea R. Assessing the Level of Knowledge and Experience Regarding Cervical Cancer Prevention and Screening among Roma Women in Romania. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1885. [PMID: 37893602 PMCID: PMC10608646 DOI: 10.3390/medicina59101885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Romania ranks among the countries with a particularly high rate of mortality that can be prevented through prevention programs, screening, early detection, and prompt care. Cervical cancer (CC) is a major cause of these preventable deaths, affecting individuals from marginalized and rural regions, as well as the Roma population. The purpose of this article was to identify accurate and consistent information about the Roma population on the risk of CC, as well as the importance of understanding the causes of the disease and awareness of the available prevention methods. Materials and Methods: A cross-sectional study was conducted using a self-administered questionnaire applied only to Roma women in Romania. Results: We enrolled 759 patients in this study. These were divided into two groups: Group 1 comprised 289 (38.1%) women who had been tested for HPV infection, while Group 2 included 470 (61.9%) women who had never been tested for HPV infection. Characterization of women in Group 1: mostly aged between 25 and 54 years, with high school education, married, who started sexual activity under the age of 18 years, with only one sexual partner, and had over five pregnancies. Regarding contraceptive methods, 35.7% of women do not know or use any contraceptive method, and 32.2% use hormonal contraceptives. Two thirds of the women tested had heard of HPV, and 19.7% were vaccinated against HPV with at least 2-3 doses. A percentage of 8.7 had a diagnosis of CC, compared to those who were not tested (p-0.0001), whereas 63% of the tested women did not know much about CC, as opposed to 85.7% of the group of untested women. Conclusions: Cervical cancer (CC) continues to be a public health concern in Romania, particularly among vulnerable groups. Promoting campaigns to raise awareness for HPV vaccination and CC screening are necessary to reduce the associated mortality and morbidity.
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Affiliation(s)
- Septimiu Voidăzan
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (S.V.); (R.B.)
| | - Alexandra Mihaela Budianu
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (S.V.); (R.B.)
| | - Rozsnyai Florin Francisc
- Department of Obstetrics Gynecology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
| | - Zsolt Kovacs
- Department of Biochemistry and Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (Z.K.); (C.C.U.)
| | - Cosmina Cristina Uzun
- Department of Biochemistry and Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (Z.K.); (C.C.U.)
| | - Bianca Elena Apostol
- General Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
| | - Reka Bodea
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (S.V.); (R.B.)
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Simion L, Rotaru V, Cirimbei C, Gales L, Stefan DC, Ionescu SO, Luca D, Doran H, Chitoran E. Inequities in Screening and HPV Vaccination Programs and Their Impact on Cervical Cancer Statistics in Romania. Diagnostics (Basel) 2023; 13:2776. [PMID: 37685314 PMCID: PMC10486539 DOI: 10.3390/diagnostics13172776] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Introduction: A Romanian woman is diagnosed with cervical cancer every two hours; the country ranks second in Europe in terms of the mortality and incidence rate of this disease. This paper aims to identify the main reasons that have led to this situation, focusing on the measures taken by the Romanian Ministry of Health for the prevention of this type of cancer-national programs for cervical cancer screening and HPV vaccination. (2) Materials and methods: We performed a study based on the available secondary data from the National Statistics Institute, World Health Organization and Bucharest Institute of Oncology in order to assess the burden associated with cervical cancer and place it in the context of known global and European incidence and mortality rates, thus evaluating the importance of this health issue in Romania. The second component of our study was a cross-sectional study. Here, we used a 14-question questionnaire applied to the women participating in the National Screening Program for Cervical Cancer and aimed to evaluate the women's level of knowledge about screening and HPV vaccination and their access cervical-cancer-specific healthcare services. (3) Results: The results of this research show that a high percentage of women postpone routine checks due to a lack of time and financial resources and indicate that a low level of knowledge about the disease and the specific preventive methods determines the low participation in screening and HPV vaccination programs implemented in Romania, contributing to the country's cervical cancer situation. (4) Conclusions: The national programs have complicated procedures, are underfunded and do not motivate healthcare workers enough. This, combined with the lack of information for the eligible population, adds up to an extremely low number of women screened and vaccinated. Our conclusion is that the Romanian Ministry of Health must take immediate action by conducting major awareness campaigns, implementing measures to make the programs functional and ensuring coherent funding.
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Affiliation(s)
- Laurentiu Simion
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Vlad Rotaru
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Ciprian Cirimbei
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Laurentia Gales
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- Medical Oncology Department, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Daniela-Cristina Stefan
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
| | - Sinziana-Octavia Ionescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Dan Luca
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Horia Doran
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- Surgical Clinic I, Clinical Hospital Dr. I. Cantacuzino Bucharest, 030167 Bucharest, Romania
| | - Elena Chitoran
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
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Anjos EFD, Andrade KB, Martins PC, Paiva JAC, Prado NMDBL, Santos AMD. Atuação de profissionais de saúde e qualidade das ações no controle de câncer cervicouterino: um estudo transversal. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo avaliar o tempo de atuação de médicos e enfermeiros na Atenção Primária à Saúde (APS) e qualidade das ações desenvolvidas para controle do câncer cervicouterino (CC). Métodos estudo transversal, conduzido de janeiro a março de 2019 em região de saúde compreendida em 19 municípios localizada no estado da Bahia, Brasil. A amostra foi de 241 médicos e enfermeiros da APS. Utilizou-se a linha de cuidado do CC como condição traçadora. Elegeram-se o desfecho tempo de atuação na APS no mesmo município, categorizado em < 2 anos e ≥ 2 anos, e indicadores representativos da qualidade da APS. Os testes χ2 de Pearson e exato de Fisher foram empregados. Resultados a prevalência de tempo de atuação na APS foi 43,57% (IC95%: 37,40%; 49,94%) para < 2 anos e 56,43% (IC95%: 50,06%; 62,60%) para ≥ 2 anos. Observaram-se maiores prevalências, com diferença estatística significativa, dos indicadores de qualidade para o maior tempo de atuação. Conclusões e implicações para a prática a rotatividade profissional parece afetar o cuidado longitudinal de mulheres na linha de cuidado eleita. Sugere-se a ampliação do número e do papel dos enfermeiros, especialmente nos serviços de APS, para maior resolutividade e eficiência do sistema de saúde.
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Cervical Cancer Mortality in Romania: Trends, Regional and Rural–Urban Inequalities, and Policy Implications. Medicina (B Aires) 2021; 58:medicina58010018. [PMID: 35056326 PMCID: PMC8778365 DOI: 10.3390/medicina58010018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 12/18/2022] Open
Abstract
Background and Objectives: Despite being largely preventable, cervical cancer mortality still remains an important public health problem globally, in Europe, and in Romania. The European Union member states are urged to implement systematic, population-based screenings for cervical cancer, but the programs developed by the countries remain very heterogeneous. This study aimed to investigate the differences in cervix cancer mortality between Romania and EU and within Romania over the last two decades and to reveal the major sources of inequalities and the policy implications. Materials and Methods: We analyzed the number of deaths and the mortality rates by cervical cancer, standardized using the direct method, over two decades (2001–2016 for the EU, and 2001–2019 for the national and sub-national analyses). Trends, mortality reduction over the years, and mortality differences at the beginning and end of the time interval have been calculated for the EU and Romania, at national and sub-national levels (rural–urban and regions). Results: Our results revealed differences in cervical cancer mortality between Romania and EU and within Romania (among regions and rural–urban areas). These differences used to be very high in the past and are still persisting. Conclusions: The country should revisit its national cervical cancer screening program, which has been implemented for many years, but with a very limited participation rate. Due to the similar problems existing in Central-Eastern Europe, targeted support from the EU for the members from this geographical area could contribute to the minimization of differences in cervical cancer mortality among the EU members.
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Todor RD, Bratucu G, Moga MA, Candrea AN, Marceanu LG, Anastasiu CV. Challenges in the Prevention of Cervical Cancer in Romania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1721. [PMID: 33578977 PMCID: PMC7916723 DOI: 10.3390/ijerph18041721] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
Abstract
Approximately every two hours, a Romanian woman is diagnosed with cervical cancer as the country ranks first in the EU in terms of its mortality rate. This paper aims to identify the main reasons that have led to this situation. First, a study based on secondary data was conducted in order to identify measures taken by the Romanian Ministry of Health for the prevention of this type of cancer. Second, a quantitative study was conducted to evaluate the impact that exposure to information and awareness campaigns has on women's behavior regarding cervical cancer prevention through screening. The results of the research show an increased percentage of the women understanding the importance of screening and the benefits of early diagnosis, but also shows that a high percentage of women postpone the routine checks due to lack of time and financial resources. The research results also indicate that the only free screening program implemented in Romania during 2012-2017 was a failure due to poor procedures, low number of women tested, underfunding and the lack of promotion. Our conclusion is that the Romanian Ministry of Health has to take immediate action by conducting major awareness campaigns and also by implementing functional screening programs.
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Affiliation(s)
- Raluca Dania Todor
- Faculty of Economic Sciences and Business Administration, Department of Marketing, Tourism Services and International Affairs, Transilvania University of Braşov, Colina Universității Street, no. 1, Building A, Braşov 500068, Romania; (R.D.T.); (G.B.)
| | - Gabriel Bratucu
- Faculty of Economic Sciences and Business Administration, Department of Marketing, Tourism Services and International Affairs, Transilvania University of Braşov, Colina Universității Street, no. 1, Building A, Braşov 500068, Romania; (R.D.T.); (G.B.)
| | - Marius Alexandru Moga
- Faculty of Medicine, Department of Medical and Surgical Specialties, Transilvania University of Braşov, B-dul Eroilor 29, 500036 Brașov, Romania; (L.G.M.); (C.V.A.)
| | - Adina Nicoleta Candrea
- Faculty of Economic Sciences and Business Administration, Department of Marketing, Tourism Services and International Affairs, Transilvania University of Braşov, Colina Universității Street, no. 1, Building A, Braşov 500068, Romania; (R.D.T.); (G.B.)
| | - Luigi Geo Marceanu
- Faculty of Medicine, Department of Medical and Surgical Specialties, Transilvania University of Braşov, B-dul Eroilor 29, 500036 Brașov, Romania; (L.G.M.); (C.V.A.)
| | - Costin Vlad Anastasiu
- Faculty of Medicine, Department of Medical and Surgical Specialties, Transilvania University of Braşov, B-dul Eroilor 29, 500036 Brașov, Romania; (L.G.M.); (C.V.A.)
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Byamugisha J, Munabi IG, Mubuuke AG, Mwaka AD, Kagawa M, Okullo I, Niyonzima N, Lusiba P, Ainembabazi P, Kankunda C, Muhumuza DD, Orem J, Atwine D, Ibingira C. A health care professionals training needs assessment for oncology in Uganda. HUMAN RESOURCES FOR HEALTH 2020; 18:62. [PMID: 32873293 PMCID: PMC7465387 DOI: 10.1186/s12960-020-00506-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/20/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Cancer incidence and mortality in sub-Saharan Africa are increasing and do account for significant premature death. The expertise of health care providers is critical to downstaging cancer at diagnosis and improving survival in low- and middle-income countries. We set out to determine the training needs of health care providers for a comprehensive oncology services package in selected hospitals in Uganda, in order to inform capacity development intervention to improve cancer outcomes in the East African region. METHODS This was a cross-sectional survey using the WHO Hennessey-Hicks questionnaire to identify the training needs of health workers involved in cancer care, across 22 hospitals in Uganda. Data were captured in real time using the Open Data Kit platform from which the data was exported to Stata version 15 for analysis using the Wilcoxon signed-rank test and Somers-Delta. RESULTS There were 199 respondent health professionals who were predominately female (146/199, 73.37%), with an average age of 38.97 years. There were 158/199 (79.40%) nurses, 24/199 (12.06%) medical doctors and 17/199 (8.54%) allied health professionals. Overall, the research and audit domain had the highest ranking for all the health workers (Somers-D = 0.60). The respondent's level of education had a significant effect on the observed ranking (P value = 0.03). Most of the continuing medical education (CME) topics suggested by the participants were in the clinical task-related category. CONCLUSION The "research and audit" domain was identified as the priority area for training interventions to improve oncology services in Uganda. There are opportunities for addressing the identified training needs with an expanded cancer CME programme content, peer support networks and tailored training for the individual health care provider.
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Affiliation(s)
- Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ian G. Munabi
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aloysius G. Mubuuke
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Amos D. Mwaka
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mike Kagawa
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Isaac Okullo
- Department of Dentistry, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Pastan Lusiba
- Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peruth Ainembabazi
- Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | - Caroline Kankunda
- Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | - Dennis D. Muhumuza
- Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Charles Ibingira
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
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Forsea AM. Melanoma Epidemiology and Early Detection in Europe: Diversity and Disparities. Dermatol Pract Concept 2020; 10:e2020033. [PMID: 32642304 DOI: 10.5826/dpc.1003a33] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
Melanoma claims annually more than 20,000 lives in Europe and is an important public health burden through its continuously increasing incidence and with its high mortality, costs, and complexity of care in advanced stages. Epidemiological surveillance is indispensable for the research into its causes, new prognostic markers, and innovative therapies, as well as for the building of efficient cancer control plans. However, important differences in the sources and availability of accurate epidemiological data exist among European countries and regions, contributing to a heterogeneous picture with 20-fold differences in the reported national melanoma incidence rates, divergent mortality trends, and solid disparities in survival across the Continent. Countries in the eastern half of Europe report the lowest incidence rates, but high case fatality, persisting and increasing mortality, a higher proportion of thicker tumors and late diagnosis, and lower survival rates. They are the least well equipped with quality cancer registration and reporting, and they lag behind in efficient cancer control plans implementation. This review highlights the main differences in melanoma epidemiology across Europe, together with an insight into their underlying causes in the areas of melanoma registration, early diagnosis, and prevention. These differences should be acknowledged and understood by physicians, researchers, and all stakeholders involved in improving melanoma care and outcomes, as no one-size-fits-all solution can tackle the melanoma problem in Europe. Instead, there is a need for nuanced strategies, adapted to the heterogeneous national and regional contexts, that would build on European diversity to eliminate the outcome disparities.
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Affiliation(s)
- Ana-Maria Forsea
- Oncologic Dermatology Department, Elias University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Collins A, L Moss E, Nieminen P, Leeson S, Redman CW. Identification of European-wide clinical priorities for guideline development in the management of pre-invasive cervical disease. Eur J Obstet Gynecol Reprod Biol 2020; 251:36-41. [PMID: 32480178 DOI: 10.1016/j.ejogrb.2020.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Addressing management controversies in the treatment of pre-invasive cervical disease is a key priority for the European Federation for Colposcopy/European Society of Gynaecologic Oncology who aim to develop a practical handbook of European centred guidelines to address areas where there is a lack of high-quality evidence or identifiable practice variation. Clinical opinion across the EFC network was sought to identify topics likely to have the most impact on clinical practice for systematic review and development of practice recommendations. STUDY DESIGN A scoping exercise comprising of a three-iteration modified Delphi with representation from each member society of the EFC was conducted in 2018. Round one identified 19 potential topics which were scored for importance using a five-point Likert scale by EFC members in round two and ranked. Results from round two were discussed at an open EFC satellite meeting resulting in exclusion of five topics. A third round of the 14 remaining topics was conducted to allow members to modify scores after viewing the second-round rankings. Responses were analysed and topics were allocated a weighted score. RESULTS Strategies for management of persistent HPV infection in the context of normal colposcopy and negative cytology was the highest overall weighted topic (4.40) followed by identification of appropriate length of follow up for ASCUS or LSIL prior to excisional treatment (3.95) and the impact of length of excision on patient outcomes (3.95). Topics to identify best practice for management of challenging topics scored highly including optimising follow up strategies for cervical stenosis (3.91) and management of HSIL in the under 25 year olds (3.64) or pregnancy (3.64). CONCLUSION A European wide systematic modified-Delphi has prioritised six topics for systematic review and generation of clinical practice recommendations aiming to assist management in areas of controversy in pre-invasive cervical disease.
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Affiliation(s)
- Anna Collins
- Leicester Cancer Research Centre, University of Leicester, Clinical Sciences Building, Leicester, LE2 7LX, UK
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Clinical Sciences Building, Leicester, LE2 7LX, UK
| | - Pekka Nieminen
- Department of Gynaecology and Obstetrics, Helsinki University Hospital, University of Helsinki, 00029 HUS, Finland
| | - Simon Leeson
- Department of Obstetrics and Gynaecology, Betsi Cadwaladr University, Bangor, LL57 2PW, UK
| | - Charles We Redman
- Department of Gynaecological Oncology, University Hospitals of North Midlands, Newcastle Road, Stoke on Trent, ST4 6QG, UK.
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Priaulx J, de Koning HJ, de Kok IMCM, Széles G, McKee M. Identifying the barriers to effective breast, cervical and colorectal cancer screening in thirty one European countries using the Barriers to Effective Screening Tool (BEST). Health Policy 2018; 122:1190-1197. [PMID: 30177278 DOI: 10.1016/j.healthpol.2018.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/09/2018] [Accepted: 08/17/2018] [Indexed: 12/13/2022]
Abstract
The aim of this study was to identify barriers to effective breast, cervical and colorectal cancer screening programmes throughout the whole of the European region using the Barriers to Effective Screening Tool (BEST). The study was part of the scope of the EU-TOPIA (TOwards imProved screening for breast, cervical and colorectal cancer In All of Europe) project and respondents were European screening organisers, researchers and policymakers taking part in a workshop for the project in Budapest in September 2017. 67 respondents from 31 countries responded to the online survey. The study found that there are many barriers to effective screening throughout the system from identification of the eligible population to ensuring appropriate follow-up and treatment for the three cancers. The most common barriers were opportunistic screening, sub-optimal participation, limited capacity (including trained human resource), inadequate and/or disjointed information technology systems and complex administration procedures. Many of the barriers were reported consistently across different countries. This study identified the barriers that, in general, require further investment of resources.
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Affiliation(s)
| | - Harry J de Koning
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands
| | - Inge M C M de Kok
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK.
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Crăciun IC, Todorova I, Băban A. “Taking responsibility for my health”: Health system barriers and women’s attitudes toward cervical cancer screening in Romania and Bulgaria. J Health Psychol 2018; 25:2151-2163. [DOI: 10.1177/1359105318787616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The study used mixed-methods to illustrate the complexity of the interplay between the contexts in Bulgaria and Romania and women’s attitudes and behaviors related to screening. A secondary analysis of quantitative data from Romanian (n = 1053) and Bulgarian (n = 1099) women and qualitative interviews ( n = 30 Romanian, n = 35 Bulgarian) was performed. Low rates of screening attendance were found in both countries. Regression analysis illustrates that attitudes and social norms significantly predicted intentions and screening behavior in both countries. Thematic analysis revealed that systemic barriers and cultural meanings were relevant to women’s decisions to attend screening or avoid contact with the health-care system.
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Affiliation(s)
| | - Irina Todorova
- Health Psychology Research Center, Bulgaria
- Northeastern University, USA
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Petkeviciene J, Ivanauskiene R, Klumbiene J. Sociodemographic and lifestyle determinants of non-attendance for cervical cancer screening in Lithuania, 2006–2014. Public Health 2018; 156:79-86. [DOI: 10.1016/j.puhe.2017.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/29/2017] [Accepted: 12/16/2017] [Indexed: 01/21/2023]
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Performance indicators in a newly established organized cervical screening programme: registry-based analysis in the Czech Republic. Eur J Cancer Prev 2018; 26:232-239. [PMID: 26908155 DOI: 10.1097/cej.0000000000000236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 2008, the organized Czech National Cervical Cancer Screening Programme (CNCCSP) was initiated by transformation of the existing opportunistic efforts. The aim of our study was to examine recent cervical cancer burden trends and to assess the quality of the Czech National Cervical Cancer Screening Programme using a set of standard performance indicators. Our study utilized data from the national Cervical Cancer Screening Registry and the Czech National Cancer Registry. We computed internationally accepted indicators and assessed time trends and variability among screening centres. Between 1995 and 2011, the incidence of age-standardized cervical cancer decreased by 21% (1023 cases in 2011), and the mortality decreased by 35% (399 deaths in 2011). The annual coverage of the target population by cervical screening increased to 56% in 2013 (as compared with 35% in 2001). If we consider a 2-year interval (2012-2013), the estimated coverage was 77%. Over two million women underwent screening in 2013; 96% of them had a negative result. About 0.2% of smears showed cytological signs of a high-grade intraepithelial lesion or a malignancy, and the estimated positive predictive value for advanced intraepithelial neoplasia (cervical intraepithelial neoplasia grade 2+) was 79.6%. However, performance indicators show considerable heterogeneity between screening centres. The reported values of performance indicators are in line with the results of programmes that have previously been shown to be successful in terms of decreasing the cervical cancer burden, and are promising with respect to an even more pronounced decrease in cervical cancer mortality in the near future, provided that continuous quality improvement can be maintained. Linkage studies between screening, cancer and cause-of-death registers can provide further information on screening effectiveness and validity issues.
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Arbyn M, Antoine J, Valerianova Z, Mägi M, Stengrevics A, Smailyte G, Suteu O, Micheli A. Trends in Cervical Cancer Incidence and Mortality in Bulgaria, Estonia, Latvia, Lithuania and Romania. TUMORI JOURNAL 2018; 96:517-23. [DOI: 10.1177/030089161009600402] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The burden of cervical cancer varies considerably in the European Union. In this paper, we describe trends in incidence of and mortality from this cancer in the five most affected member states. Methods Data on number of deaths from uterine cancers and the size of the female population of Estonia, Latvia, Lithuania, Bulgaria and Romania were extracted from the WHO mortality database. Mortality rates were corrected for inaccuracies in the death certification of not otherwise specified uterine cancer. Incidence data were obtained from the national cancer registries. Joinpoint regression was used to study the annual variation of corrected and standardized incidence and mortality rates. Changes by birth cohort were assessed for specific age groups and subsequently synthesized by computing standardized cohort incidence/mortality ratios. Results Joinpoint regression revealed rising trends of incidence (in Lithuania, Bulgaria and Romania) and of mortality (in Latvia, Lithuania, Bulgaria and Romania). In Estonia, rates were rather stable. Women born between 1940 and 1960 were at continuously increasing risk of both incidence of and mortality from cervical cancer. Conclusions Rising trends of cervical cancer in the most affected EU member states reveal a worrying pattern that warrants urgent introduction of effective preventive actions as described in the European guidelines.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Jerome Antoine
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | | | | | | | | | - Ofelia Suteu
- I. Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Institute of Oncology, Cluj, Romania
| | - Andrea Micheli
- Descriptive Studies and Health Planning Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
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Sabol I, Milutin Gašperov N, Matovina M, Božinović K, Grubišić G, Fistonić I, Belci D, Alemany L, Džebro S, Dominis M, Šekerija M, Tous S, de Sanjosé S, Grce M. Cervical HPV type-specific pre-vaccination prevalence and age distribution in Croatia. PLoS One 2017; 12:e0180480. [PMID: 28692681 PMCID: PMC5503252 DOI: 10.1371/journal.pone.0180480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/15/2017] [Indexed: 11/18/2022] Open
Abstract
The main etiological factor of precancerous lesion and invasive cervical cancer are oncogenic human papillomaviruses types (HPVs). The objective of this study was to establish the distribution of the most common HPVs in different cervical lesions and cancer prior to the implementation of organized population-based cervical screening and HPV vaccination in Croatia. In this study, 4,432 cervical specimens, collected through a 16-year period, were tested for the presence of HPV-DNA by polymerase chain reaction (PCR) with three sets of broad-spectrum primers and type-specific primers for most common low-risk (LR) types (HPV-6, 11) and the most common high-risk (HR) types (HPV-16, 18, 31, 33, 45, 52, 58). Additional 35 archival formalin-fixed, paraffin embedded tissue of cervical cancer specimens were analyzed using LiPA25 assay. The highest age-specific HPV-prevalence was in the group 18-24 years, which decreased continuously with age (P<0.0001) regardless of the cytological diagnosis. The prevalence of HR-HPV types significantly increased (P<0.0001) with the severity of cervical lesions. HPV-16 was the most common type found with a prevalence (with or without another HPV-type) of 6.9% in normal cytology, 15.5% in atypical squamous cells of undetermined significance, 14.4% in low-grade squamous intraepithelial lesions, 33.3% in high-grade squamous intraepithelial lesions, and 60.9% in cervical cancer specimens (P<0.0001). This study provides comprehensive and extensive data on the distribution of the most common HPV types among Croatian women, which will enable to predict and to monitor the impact of HPV-vaccination and to design effective screening strategies in Croatia.
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Affiliation(s)
- Ivan Sabol
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | | | - Mihaela Matovina
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Ksenija Božinović
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Goran Grubišić
- University Hospital Sisters of Mercy, Clinic of Obstetrics and Gynaecology, Zagreb, Croatia
| | - Ivan Fistonić
- Obstetrics, Gynecology and Menopause Clinic, Zagreb, Croatia
| | - Dragan Belci
- Department of Gynecology and Obstetrics, General Hospital Pula, Pula, Croatia
| | - Laia Alemany
- Cancer Epidemiology Research Program, Unit of Infections and Cancer, Catalan Institute of Oncology, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Sonja Džebro
- Department of Pathology and Cytology, University of Zagreb, School of Medicine, University Hospital Merkur, Zagreb, Croatia
| | - Mara Dominis
- Department of Pathology and Cytology, University of Zagreb, School of Medicine, University Hospital Merkur, Zagreb, Croatia
| | - Mario Šekerija
- Croatian National Cancer Registry, Croatian Institute of Public Health, Zagreb, Croatia
- School of Medicine, Andrija Štampar School of Public Health, University of Zagreb, Zagreb, Croatia
| | - Sara Tous
- Cancer Epidemiology Research Program, Unit of Infections and Cancer, Catalan Institute of Oncology, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Program, Unit of Infections and Cancer, Catalan Institute of Oncology, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Magdalena Grce
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
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Trapero-Bertran M, Acera Pérez A, de Sanjosé S, Manresa Domínguez JM, Rodríguez Capriles D, Rodriguez Martinez A, Bonet Simó JM, Sanchez Sanchez N, Hidalgo Valls P, Díaz Sanchis M. Cost-effectiveness of strategies to increase screening coverage for cervical cancer in Spain: the CRIVERVA study. BMC Public Health 2017; 17:194. [PMID: 28196467 PMCID: PMC5309977 DOI: 10.1186/s12889-017-4115-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 02/06/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of the study is to carry out a cost-effectiveness analysis of three different interventions to promote the uptake of screening for cervical cancer in general practice in the county of Valles Occidental, Barcelona, Spain. METHODS Women aged from 30 to 70 years (n = 15,965) were asked to attend a general practice to be screened. They were randomly allocated to one of four groups: no intervention group (NIG); one group where women received an invitation letter to participate in the screening (IG1); one group where women received an invitation letter and informative leaflet (IG2); and one group where women received an invitation letter, an informative leaflet and a phone call reminder (IG3). Clinical effectiveness was measured as the percentage increase in screening coverage. A cost-effectiveness analysis was performed from the perspective of the public health system with a time horizon of three to five years - the duration of the randomised controlled clinical trial. In addition, a deterministic sensitivity analysis was performed. Results are presented according to different age groups. RESULTS The incremental cost-effectiveness ratio (ICER) for the most cost-effective intervention, IG1, compared with opportunistic screening was € 2.78 per 1% increase in the screening coverage. The age interval with the worst results in terms of efficiency was women aged < 40 years. CONCLUSIONS In a population like Catalonia, with around 2 million women aged 30 to 70 years and assuming that 40% of these women were not attending general practice to be screened for cervical cancer, the implementation of an intervention to increase screening coverage which consists of sending a letter would cost on average less than € 490 for every 1000 women. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01373723 .
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Affiliation(s)
- Marta Trapero-Bertran
- Economy and Business Organisation Department, Faculty of Economics and Social Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
- Centre for Research in Economics and Health (CRES), University Pompeu Fabra, c/Immaculada 22, 08017 Barcelona, Spain
| | - Amelia Acera Pérez
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol. Sabadell, Barcelona, Spain
- Grup de Recerca GRASSIR reconegut per la Generalitat de Catalunya SGR 2014-2016, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBERESP), Barcelona, Spain
| | - Josep Maria Manresa Domínguez
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol. Sabadell, Barcelona, Spain
- Departament de Infermeria, Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Diego Rodríguez Capriles
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain
| | - Ana Rodriguez Martinez
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain
| | | | - Norman Sanchez Sanchez
- Sistemes d’Informació Sanitària, SAP Vallés Occidental, Institut Catala de la Salut, Sabadell, Barcelona, Spain
| | - Pablo Hidalgo Valls
- SAP Vallés Occidental, Institut Català de la Salut, Sabadell, Barcelona, Spain
| | - Mireia Díaz Sanchis
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBERESP), Barcelona, Spain
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Leinonen MK, Campbell S, Klungsøyr O, Lönnberg S, Hansen BT, Nygård M. Personal and provider level factors influence participation to cervical cancer screening: A retrospective register-based study of 1.3 million women in Norway. Prev Med 2017; 94:31-39. [PMID: 27894911 DOI: 10.1016/j.ypmed.2016.11.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/14/2016] [Accepted: 11/24/2016] [Indexed: 11/24/2022]
Abstract
High coverage is essential for an effective screening programme. Here we present screening barriers and facilitators among 1.3 million women aged 25-69years eligible for screening within the Norwegian Cervical Cancer Screening Program (NCCSP). We defined non-adherence as no screening test in 2008-2012. We divided adherent women into those screened spontaneously, and those who had a smear after receiving a reminder from the NCCSP. Explanatory variables were extracted from several nationwide registers, and modelled by modified Poisson regression. In total, 34% of women were non-adherent. 31% of native Norwegians were non-adherent, compared to 50% of immigrants. Immigrant status was a strong predictor of non-adherence, but the vast majority of non-adherent women were still native Norwegians. Higher non-adherence rates were associated with having a male general practitioner (GP), a foreign GP, a young GP, and distance to the screening site. Being unmarried, having no children, having lower socioeconomic position and region of residence predicted non-adherence and, to a smaller extent, reminded adherence to screening. In contrast, previous experience with cervical abnormalities substantially increased adherence to screening. The population-based screening programme promotes equity by recruiting women who are less likely to participate spontaneously. However, socioeconomic disparities were evident in a country with a nationwide programme and a policy of equal access to health care. Initiatives aimed at removing practical and financial barriers to equitable screening delivery and at reducing the effect of sociodemographic attributes on screening participation are needed.
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Affiliation(s)
- Maarit K Leinonen
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway.
| | - Suzanne Campbell
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
| | - Ole Klungsøyr
- Department of Treatment Research, Division of Mental Health and Addiction, Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, 0424 Oslo, Norway
| | - Stefan Lönnberg
- Department of Cervical Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway
| | - Bo T Hansen
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
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17
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Azzopardi-Muscat N, Funk T, Buttigieg SC, Grech KE, Brand H. Policy challenges and reforms in small EU member state health systems: a narrative literature review. Eur J Public Health 2016; 26:916-922. [PMID: 27335326 DOI: 10.1093/eurpub/ckw091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The EU directive on patients' rights and cross-border care is of particular interest to small states as it reinforces the concept of health system cooperation. An analysis of the challenges faced by small states, as well as a deep evaluation of their health system reform characteristics is timely and justified. This paper identifies areas in which EU level cooperation may bring added value to these countries' health systems. METHOD Literature search is based primarily on PUBMED and is limited to English-language papers published between January 2000 and September 2014. Results of 76 original research papers appearing in peer-reviewed journals are summarised in a literature map and narrative review. RESULTS Primary care, health workforce and medicines emerge as the salient themes in the review. Lack of capacity and small market size are found to be the frequently encountered challenges in governance and delivery of services. These constraints appear to also impinge on the ability of small states to effectively implement health system reforms. The EU appears to play a marginal role in supporting small state health systems, albeit the stimulus for reform associated with EU accession. CONCLUSIONS Small states face common health system challenges which could potentially be addressed through enhanced health system cooperation at EU level. The lessons learned from research on small states may be of relevance to health systems organized at regional level in larger European states.
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Affiliation(s)
- Natasha Azzopardi-Muscat
- Department of Health Services Management, Faculty of Health Sciences, University of Malta c/o/Mater Dei Hospital MSD 2080 Msida, Malta .,Department of International Health, CAPHRI School for Public Health and Primary Care, Maastricht University, 30 Duboisdomein Maastricht, The Netherlands.,Directorate for Health Information and Research, Ministry for Energy and Health, 95 G'Mangia Hill Pieta', Malta
| | - Tjede Funk
- Department of International Health, CAPHRI School for Public Health and Primary Care, Maastricht University, 30 Duboisdomein Maastricht, The Netherlands.,Directorate for Health Information and Research, Ministry for Energy and Health, 95 G'Mangia Hill Pieta', Malta
| | - Sandra C Buttigieg
- Department of Health Services Management, Faculty of Health Sciences, University of Malta c/o/Mater Dei Hospital MSD 2080 Msida, Malta
| | - Kenneth E Grech
- Department of Health Services Management, Faculty of Health Sciences, University of Malta c/o/Mater Dei Hospital MSD 2080 Msida, Malta
| | - Helmut Brand
- Department of International Health, CAPHRI School for Public Health and Primary Care, Maastricht University, 30 Duboisdomein Maastricht, The Netherlands
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18
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Ribeiro JC, Andrade SRD. HEALTH SURVEILLANCE AND PAP TEST COVERAGE: INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2016. [DOI: 10.1590/0104-07072016005320015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This integrative review aimed to evidence in the literature health surveillance activities that contribute to the increased coverage of the cervical Pap smear. The search was undertaken between April and May 2014 in the databases LILACS, CINAHL, MEDLINE and Scopus, using the keywords health surveillance, cervix neoplasm prevention, and Papanicolaou test, in Portuguese, English and Spanish. We selected 341 articles, of which 33 met the inclusion criteria. In studies, the actions have been identified and grouped according to two main control practices of cervical cancer adopted in Brazil: primary prevention and secondary prevention, with emphasis on health promotion and prevention actions that contributed to the increased coverage of the cervical Pap smear.
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Penţa MA, Băban A. Mass media coverage of HPV vaccination in Romania: a content analysis. HEALTH EDUCATION RESEARCH 2014; 29:977-992. [PMID: 24890190 DOI: 10.1093/her/cyu027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Romania has the highest cervical cancer burden in Europe. Despite the implementation of two human papillomavirus (HPV) vaccination programmes, the uptake remained extremely low and the programmes were discontinued. Given that media are a common source of information for the public and may influence vaccination decisions, this article sought to explore the content and quality of HPV vaccine media coverage in Romania. We conducted a content analysis of 271 media reports (from newspapers, magazines, videos and informational websites) published online between November 2007 and January 2012. Overall, results indicated that 31.4% of the materials were neutral, 28% were negative or extremely negative, 17% were mixed, while 23.6% were positive towards the vaccine. The most dominant vaccine-related concerns were side effects and insufficient testing. Elementary information about the vaccine and HPV was constantly left out and sometimes inaccuracies were found. Negatively disposed reports were more likely to contain incorrect data about vaccine efficacy and less likely to provide comprehensive information about the vaccine and HPV-related diseases. Some dimensions of media coverage varied across time and media outlets. The present findings suggest that educational interventions are greatly needed as a response to suboptimal and incomplete media coverage of HPV vaccination.
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Affiliation(s)
- Marcela A Penţa
- Department of Psychology, Babes-Bolyai University, 37 Republicii Street, Cluj-Napoca, CJ 400015, Romania
| | - Adriana Băban
- Department of Psychology, Babes-Bolyai University, 37 Republicii Street, Cluj-Napoca, CJ 400015, Romania
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20
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Simões PW, Izumi NB, Casagrande RS, Venson R, Veronezi CD, Moretti GP, da Rocha EL, Cechinel C, Ceretta LB, Comunello E, Martins PJ, Casagrande RA, Snoeyer ML, Manenti SA. Classification of images acquired with colposcopy using artificial neural networks. Cancer Inform 2014; 13:119-24. [PMID: 25374454 PMCID: PMC4213185 DOI: 10.4137/cin.s17948] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/09/2014] [Accepted: 09/15/2014] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To explore the advantages of using artificial neural networks (ANNs) to recognize patterns in colposcopy to classify images in colposcopy. PURPOSE Transversal, descriptive, and analytical study of a quantitative approach with an emphasis on diagnosis. The training test e validation set was composed of images collected from patients who underwent colposcopy. These images were provided by a gynecology clinic located in the city of Criciúma (Brazil). The image database (n = 170) was divided; 48 images were used for the training process, 58 images were used for the tests, and 64 images were used for the validation. A hybrid neural network based on Kohonen self-organizing maps and multilayer perceptron (MLP) networks was used. RESULTS After 126 cycles, the validation was performed. The best results reached an accuracy of 72.15%, a sensibility of 69.78%, and a specificity of 68%. CONCLUSION Although the preliminary results still exhibit an average efficiency, the present approach is an innovative and promising technique that should be deeply explored in the context of the present study.
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Affiliation(s)
- Priscyla W Simões
- Curso de Medicina, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
- Research Group of Tecnologia da Informação e Comunicação na Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
| | - Narjara B Izumi
- Curso de Medicina, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
- Research Group of Tecnologia da Informação e Comunicação na Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
| | - Ramon S Casagrande
- Research Group of Tecnologia da Informação e Comunicação na Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
| | - Ramon Venson
- Research Group of Tecnologia da Informação e Comunicação na Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
| | - Carlos D Veronezi
- Curso de Medicina, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
- Research Group of Tecnologia da Informação e Comunicação na Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
| | - Gustavo P Moretti
- Research Group of Tecnologia da Informação e Comunicação na Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
| | - Edroaldo L da Rocha
- Graduate Program in Materials Science and Engineering, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Luciane B Ceretta
- Research Group of Gestão do Cuidado, Integralidade e Educação na Saúde, Laboratory of Direito Sanitário e Saúde Coletiva, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
| | - Eros Comunello
- INCoD – National Institute for Digital Convergence, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Paulo J Martins
- Research Group of Tecnologia da Informação e Comunicação na Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
| | - Rogério A Casagrande
- Research Group of Tecnologia da Informação e Comunicação na Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
| | - Maria L Snoeyer
- Curso de Medicina, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
| | - Sandra A Manenti
- Curso de Medicina, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
- Research Group of Tecnologia da Informação e Comunicação na Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Brazil
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Williams JH, Carter SM, Rychetnik L. 'Organised' cervical screening 45 years on: How consistent are organised screening practices? Eur J Cancer 2014; 50:3029-38. [PMID: 25282406 DOI: 10.1016/j.ejca.2014.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
Abstract
Organised screening programmes have been remarkably successful in reducing incidence and mortality from cervical cancer, while opportunistic screening varies in its effectiveness. Experts recommend that cervical screening or HPV testing be carried out only in the context of an organised programme. We sought to answer the following study questions: What does it mean for a cervical screening programme to be organised? Is there a place for opportunistic screening (in an organised programme)? We reviewed 154 peer-reviewed papers on organised and opportunistic approaches to cervical screening published between 1970 and 2014 to understand how the term 'organised' is used, formally and in practice. We found that despite broad recognition of a prescriptive definition of organisation, in practice the meaning of organisation is much less clear. Our review revealed descriptions of organised programmes that differ significantly from prescribed norms and from each other, and a variety of ways that opportunistic and organised programmes intersect. We describe the breadth of the variation in cervical cancer screening programmes and examine the relationships and overlaps between organised and opportunistic screening. Implications emerging from the review include the need to better understand the breadth of organisation in practice, the drivers and impacts of opportunistic screening and the impact of opportunistic screening on population programme outcomes. Appreciation of the complexity of cervical screening programmes will benefit both screeners and women as programmes are changed to reflect a partially vaccinated population, new evidence and new technologies.
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Affiliation(s)
- Jane H Williams
- Centre for Values, Ethics and the Law in Medicine (VELiM), K25, School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine (VELiM), K25, School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Lucie Rychetnik
- School of Medicine, University of Notre Dame, NSW 2010, Australia; Centre for Values, Ethics and the Law in Medicine (VELiM), K25, School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia.
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22
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Poljak M, Seme K, Maver PJ, Kocjan BJ, Cuschieri KS, Rogovskaya SI, Arbyn M, Syrjänen S. Human papillomavirus prevalence and type-distribution, cervical cancer screening practices and current status of vaccination implementation in Central and Eastern Europe. Vaccine 2014; 31 Suppl 7:H59-70. [PMID: 24332298 DOI: 10.1016/j.vaccine.2013.03.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 02/28/2013] [Accepted: 03/05/2013] [Indexed: 11/17/2022]
Abstract
We present a review of current cervical cancer screening practices, the implementation status of vaccination against human papillomaviruses (HPV) and available data concerning the burden of HPV infection and HPV type-specific distribution in 16 Central and Eastern European countries: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Montenegro, Poland, Romania, Serbia, Slovakia, Slovenia and the Former Yugoslav Republic (FYR) of Macedonia. Since published data were relatively scarce, two detailed surveys were conducted during August-October 2011 and in January 2013 to obtain relevant and updated information. The mean prevalence of HPV infection in 8610 women with normal cervical cytology from the region was 12.6%, with HPV16 being the most frequent HPV type. The overall HPV DNA prevalence in women with high-grade cervical lesions was 78.1%. HPV DNA was found in 86.6% of cervical cancers; the combined prevalence of HPV16/18 among HPV positive cases was 87.5%. The overall HPV DNA prevalence in genital warts and laryngeal papillomas was 94.8% and 95.2%, respectively, with HPV6 and HPV11 being the most frequent types. Opportunistic and organized cervical screening, mainly based on conventional cytology, is performed in nine and seven countries in the region, respectively, with the proposed age of the start of screening ranging from 20 to 30 years and the estimated coverage ranging from a few percent to over 70%. At least one of the current HPV prophylactic vaccines is registered in all Central and Eastern European countries except Montenegro. Only Bulgaria, Czech Republic, FYR Macedonia, Latvia, Romania and Slovenia have actually integrated HPV vaccination into their national immunization programme and currently provide routine vaccination free of charge to the primary target population. The key reasons for lack of implementation of HPV vaccination into the national immunization programme are high vaccine cost and negative public perception. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Central and Eastern Europe and Central Asia Region" Vaccine Volume 31, Supplement 7, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Affiliation(s)
- Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Katja Seme
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Polona J Maver
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Boštjan J Kocjan
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kate S Cuschieri
- Specialist Virology Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Svetlana I Rogovskaya
- Department of Obstetrics and Gynecology, Russian Medical Academy of Post-Graduate Education, Moscow, Russia
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium; Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
| | - Stina Syrjänen
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry and Medicine Research Laboratory, University of Turku, Turku, Finland
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Forsea A, del Marmol V, Stratigos A, Geller A. Melanoma prognosis in Europe: far from equal. Br J Dermatol 2014; 171:179-82. [DOI: 10.1111/bjd.12923] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2014] [Indexed: 12/21/2022]
Affiliation(s)
- A.M. Forsea
- Dermatology Department; Elias University Hospital; Carol Davila University of Medicine and Pharmacy Bucharest; 17, Marasti Blvd Sector 1 Bucharest Romania
| | - V. del Marmol
- Department of Dermatology; Erasme Hospital; Université Libre de Bruxelles; 1070 Bruxelles Belgium
| | - A. Stratigos
- Department of Dermatology; University of Athens Medical School; Andreas Sygros Hospital; Dragoumi 5 161 21 Athens Greece
| | - A.C. Geller
- Department of Social and Behavioral Sciences; Harvard School of Public Health; Kresge Building, 677 Huntington Ave. Boston MA 02115 U.S.A
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Kesic V. Prevention of Cervical Cancer in Central and Eastern Europe and Central Asia: A Challenge for the Future. Vaccine 2013; 31 Suppl 7:vii-ix. [DOI: 10.1016/j.vaccine.2012.11.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 10/29/2012] [Accepted: 11/22/2012] [Indexed: 11/17/2022]
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Evaluation of a worksite cervical screening initiative to increase Pap smear uptake in Malaysia: a cluster randomized controlled trial. BIOMED RESEARCH INTERNATIONAL 2013; 2013:572126. [PMID: 24073411 PMCID: PMC3773923 DOI: 10.1155/2013/572126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 06/26/2013] [Indexed: 11/20/2022]
Abstract
Background. Despite the significant burden of cervical cancer, Malaysia like many middle-income countries relies on opportunistic cervical screening as opposed to a more organized population-based program. The aim of this study was to ascertain the effectiveness of a worksite screening initiative upon Papanicolaou smear test (Pap test) uptake among educated working women in Malaysia. Methods. 403 female teachers who never or infrequently attended for a Pap test from 40 public secondary schools in Kuala Lumpur were recruited into a cluster randomized trial conducted between January and November 2010. The intervention group participated in a worksite cervical screening initiative whilst the control group received usual care from the existing cervical screening program. Multivariate logistic regression was performed to determine the impact of the intervention program on Pap smear uptake after 24 weeks of followup. Results. The proportion of women attending for a Pap test was significantly higher in the intervention than in the control group (18.1% versus 10.1%, P value < 0.05) with the worksite screening initiative doubling the Pap smear uptake, adjusted odds ratio 2.44 (95% CI: 1.29–4.62). Conclusion. Worksite health promotion interventions can effectively increase cervical smear uptake rates among eligible workers in middle-income countries. Policy makers and health care providers in these countries should include such interventions in strategies for reducing cervical cancer burden. This trial is registered with IRCT201103186088N1.
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Hoffmann K, Stein KV, Maier M, Rieder A, Dorner TE. Access points to the different levels of health care and demographic predictors in a country without a gatekeeping system. Results of a cross-sectional study from Austria. Eur J Public Health 2013; 23:933-9. [PMID: 23377140 DOI: 10.1093/eurpub/ckt008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The challenges for health care systems are evident both in terms of costs and of healthy life expectancy. It was the aim of this study to assess the access points towards the different levels of care and predictors for consulting a specialist without having consulted a general practitioner (GP), a common way of access to the Austrian health care system, a system without gatekeeping function. METHOD The database used for this analysis was the Austrian Health Interview Survey 2006-07, with data from 15 474 people. Statistical analyses included descriptive statistics as well as multivariate logistic regression models. RESULTS In the 12 months before the survey, 78.8% consulted a GP, 67.4% consulted a specialist, 18.6% visited an outpatient department and 22.8% had a hospital stay at least once. Overall, 15.1% visited a specialist, 8.5% an outpatient department and 8.1% a hospital without consulting a GP concomitantly. One of the main reasons for direct specialist use was a preventive check-up visit. Tertiary education and migration background increased significantly the chance of having been to a specialist without GP contact for both sexes. CONCLUSION The overall access rates for specialists as well as the access rates for specialist without GP consultations were high. The findings point into the direction of a benefit through a structurally supported advocacy role for primary health care professionals. The knowledge gained could contribute to the health policy debate on the importance of coordination and continuity with special respect to demographic factors showing the importance of target-group-specific interventions.
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Affiliation(s)
- Kathryn Hoffmann
- 1 Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
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27
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Kesic V, Poljak M, Rogovskaya S. Cervical Cancer Burden and Prevention Activities in Europe. Cancer Epidemiol Biomarkers Prev 2012; 21:1423-33. [DOI: 10.1158/1055-9965.epi-12-0181] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Martin-Moreno JM, Anttila A, von Karsa L, Alfonso-Sanchez JL, Gorgojo L. Cancer screening and health system resilience: keys to protecting and bolstering preventive services during a financial crisis. Eur J Cancer 2012; 48:2212-8. [PMID: 22424881 DOI: 10.1016/j.ejca.2012.02.060] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 02/20/2012] [Indexed: 01/20/2023]
Abstract
The aim of this paper is to elucidate the rationale for sustaining and expanding cost-effective, population-based screening services for breast, cervical and colorectal cancers in the context of the current financial crisis. Our objective is not only to promote optimal delivery of high-quality secondary cancer prevention services, but also to underline the importance of strengthening comprehensive cancer control, and with it, health system response to the complex care challenges posed by all chronic diseases. We focus primarily on issues surrounding planning, organisation, implementation and resources, arguing that given the growing cancer burden, policymakers have ample justification for establishing and expanding population-based programmes that are well-organised, well-resourced and well-executed. In a broader economic context of rescue packages, deficits and cutbacks to government entitlements, health professionals must intensify their advocacy for the protection of vital preventive health services by fighting for quality services with clear benefits for population health outcomes.
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Affiliation(s)
- Jose M Martin-Moreno
- University of Valencia, Department of Preventive Medicine and Public Health, Av. Blasco Ibañez 15, 46010 Valencia, Spain.
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Jackowska M, von Wagner C, Wardle J, Juszczyk D, Luszczynska A, Waller J. Cervical screening among migrant women: a qualitative study of Polish, Slovak and Romanian women in London, UK. ACTA ACUST UNITED AC 2012; 38:229-38. [PMID: 22219504 PMCID: PMC3970719 DOI: 10.1136/jfprhc-2011-100144] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore awareness of and participation in cervical screening services in women from Poland, Slovakia and Romania living in London, UK. METHODS Three qualitative studies were carried out in London in 2008-2009: an interview study of professionals working with Central and Eastern European migrants (n=11); a focus group study including three Polish, one Slovak and one Romanian focus group; and an interview study of Polish (n=11), Slovak (n=7) and Romanian (n=2) women. RESULTS Awareness of the cervical screening programme was good, but understanding of the purpose of screening was sometimes limited. Some women were fully engaged with the UK screening programme; others used screening both in the UK and their countries of origin; and a third group only had screening in their home countries. Women welcomed the fact that screening is free and that reminders are sent, but some were concerned about the screening interval and the age of the first invitation. CONCLUSIONS Migrant women from Poland, Slovakia and Romania living in London vary in their level of participation in the National Health Service Cervical Screening Programme. More needs to be done to address concerns regarding screening services, and to ensure that language is not a barrier to participation.
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Affiliation(s)
- Marta Jackowska
- Department of Epidemiology and Public Health, University College London, UK
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Pre-vaccination prevalence and distribution of high-risk human papillomavirus (HPV) types in Slovenian women: A cervical cancer screening based study. Vaccine 2012; 30:116-20. [DOI: 10.1016/j.vaccine.2011.10.066] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 10/10/2011] [Accepted: 10/25/2011] [Indexed: 01/09/2023]
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31
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Ursu RG, Onofriescu M, Nemescu D, Iancu LS. HPV prevalence and type distribution in women with or without cervical lesions in the Northeast region of Romania. Virol J 2011; 8:558. [PMID: 22192090 PMCID: PMC3257212 DOI: 10.1186/1743-422x-8-558] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 12/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer is a major public health problem worldwide. While Romania has the highest incidence of cervical cancer in Europe, the prevalence of HPV has not been evaluated. We report the first data on HPV prevalence and type distribution in Northeast Romania. METHODS HPV prevalence and genotype distribution was investigated in 514 consecutively women with or without cervical lesions in Northeast Romania. Genotyping was performed with Linear Array Genotyping/Roche kit. RESULTS In our study group, 192/514 (37.4%) patients were positive for HPV (infected with single and with multiple HPV types). Most frequent types were: 16 (10.5%), 53 (5.44%), 51 (5.05%), 52 (4.08%) 18 (2.91%) and 31 (2.73%). CONCLUSIONS Infection with high risk types of HPV is common in Northeast Romania. Enhanced and systematic screening for cervical cancer is needed. Our results call for the implementation of a National HPV vaccine program in Romania.
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Affiliation(s)
- Ramona Gabriela Ursu
- Microbiology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii Str. NO 15, Iaşi 700115, Romania
| | - Mircea Onofriescu
- Gynecology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Universitatii Str. NO 15, Iaşi 700115, Romania
| | - Dragoş Nemescu
- Gynecology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Universitatii Str. NO 15, Iaşi 700115, Romania
| | - Luminiţa-Smaranda Iancu
- Microbiology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii Str. NO 15, Iaşi 700115, Romania
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Arbyn M, Antoine J, Mägi M, Smailyte G, Stengrevics A, Suteu O, Valerianova Z, Bray F, Weiderpass E. Trends in cervical cancer incidence and mortality in the Baltic countries, Bulgaria and Romania. Int J Cancer 2011; 128:1899-1907. [DOI: 10.1002/ijc.25525] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Matejic B, Vukovic D, Pekmezovic T, Kesic V, Markovic M. Determinants of preventive health behavior in relation to cervical cancer screening among the female population of Belgrade. HEALTH EDUCATION RESEARCH 2011; 26:201-211. [PMID: 21273186 DOI: 10.1093/her/cyq081] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Identifying the factors that deter or stimulate the women to participate in screening activities is very important in order to design effective education and motivation strategies, particularly in the countries without an organized system. The study employed a case-control design. The participants were recruited in four primary health care institutions in Belgrade over a month. The study group comprised all women aged 18-70 years, who demonstrated an initiative for a PAP- smear. The controls were women with no Pap smears within the last 4 years, matched by age (±2 years), education and marital status with the study group participants. The study instrument was the 62-item self-administered questionnaire. According to multivariate analysis, adherence to cervical cancer screening practices is significantly related to better financial status [odds ratio (OR) = 10.8, P = 0.001], no gender preference for a gynecologist (OR = 3.1, P = 0.015), consultations with a gynecologist (OR = 4.7, P = 0.029), conversation with the women with cervical cancer about that disease (OR = 2.8, P = 0.029) and higher media exposure to information about cervical cancer prevention (OR = 5.0, P = 0.004). Open communication, social networks and improving social-economic status of women in our society are the most prominent factors, most of which are mainly outside the health services' domain and require multisectoral collaboration to improve women's reproductive health.
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Affiliation(s)
- Bojana Matejic
- Institute of social medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Comparison of clinical and analytical performance of the Abbott Realtime High Risk HPV test to the performance of hybrid capture 2 in population-based cervical cancer screening. J Clin Microbiol 2011; 49:1721-9. [PMID: 21430098 DOI: 10.1128/jcm.00012-11] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The clinical performance of the Abbott RealTime High Risk HPV (human papillomavirus) test (RealTime) and that of the Hybrid Capture 2 HPV DNA test (hc2) were prospectively compared in the population-based cervical cancer screening setting. In women >30 years old (n = 3,129), the clinical sensitivity of RealTime for detection of cervical intraepithelial neoplasia of grade 2 (CIN2) or worse (38 cases) and its clinical specificity for lesions of less than CIN2 (3,091 controls) were 100% and 93.3%, respectively, and those of hc2 were 97.4% and 91.8%, respectively. A noninferiority score test showed that the clinical specificity (P < 0.0001) and clinical sensitivity (P = 0.011) of RealTime were noninferior to those of hc2 at the recommended thresholds of 98% and 90%. In the total study population (women 20 to 64 years old; n = 4,432; 57 cases, 4,375 controls), the clinical sensitivity and specificity of RealTime were 98.2% and 89.5%, and those of hc2 were 94.7% and 87.7%, respectively. The analytical sensitivity and analytical specificity of RealTime in detecting targeted HPV types evaluated with the largest sample collection to date (4,479 samples) were 94.8% and 99.8%, and those of hc2 were 93.4% and 97.8%, respectively. Excellent analytical agreement between the two assays was obtained (kappa value, 0.84), while the analytical accuracy of RealTime was significantly higher than that of hc2. RealTime demonstrated high intralaboratory reproducibility and interlaboratory agreement with 500 samples retested 61 to 226 days after initial testing in two different laboratories. RealTime can be considered to be a reliable and robust HPV assay clinically comparable to hc2 for the detection of CIN2+ lesions in a population-based cervical cancer screening setting.
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Approaches to monitoring biological outcomes for HPV vaccination: Challenges of early adopter countries. Vaccine 2011; 29:878-85. [DOI: 10.1016/j.vaccine.2010.10.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 10/03/2010] [Accepted: 10/07/2010] [Indexed: 11/20/2022]
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Repše-Fokter A, Pogačnik A, Snoj V, Primic-Žakelj M, Fležar MS. Review of negative and low-grade cervical smears in women with invasive cervical cancer after the first 3 years of the national cervical screening programme in Slovenia. Cytopathology 2010; 23:23-9. [PMID: 20964743 DOI: 10.1111/j.1365-2303.2010.00816.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of the study was to perform a national review of negative, low-grade and inadequate smears reported during the latest screening period before cervical cancer diagnosis in 2006, after the first 3 years of the screening programme. METHODS Among 162 new cervical cancer cases there were 47 (29%) without previous cytology, 47 (29%) with one high-grade smear prior to diagnosis and 68 (42.0%) with at least one previous negative, low-grade, atypical or inadequate smear 1-40 months before diagnosis. Of the latter 68 cases, 37 patients with 59 smears (together with 118 control slides) were included in the review as 31 had smears reported at laboratories no longer operating. Findings were related to the last cytology report before diagnosis as well as to histological type and stage of the cancer. RESULTS In our study group, 19 (51%) of 37 patients had squamous cell carcinoma, 15 (41%) adenocarcinoma and 3 (8%) adenosquamous carcinoma, compared with 121 (75%), 26 (16%), 12 (7%), respectively, and 3 (2%) other types, for all carcinomas. Twenty-one of 37 women also had high-grade cytology prior to diagnosis of cancer. Women with previous cytology (with or without recent high-grade smears) were more likely to have stage I cancers than those without cytology (P < 0.0001). The expert group upgraded 17/33 smears in the patients with squamous carcinomas, which was more than in those with adeno- and adenosquamous carcinomas (5/24, P < 0.05). CONCLUSION As expected, a higher proportion of smears preceding adenocarcinomas were true negative. Under-diagnosed smears were not related to cancer stage or last cytology report before diagnosis.
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Affiliation(s)
- A Repše-Fokter
- Department of Pathology and Cytology, Celje Teaching Hospital, Celje, Slovenia
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Gutnik H, Flezar MS, Pizem J, Ellis K, Don O, Perunović B. Impact of different sectioning of excision biopsies of the cervical transformation zone for detection of invasive cervical cancer in 2 European centers related to national cervical screening programs. Int J Gynecol Cancer 2010; 20:593-6. [PMID: 20686379 DOI: 10.1111/igc.0b013e3181d6333b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The impact of the number of sections used in cervical excision biopsies of transformation zone on sensitivity of histological detection of cervical cancer is poorly documented. AIM To assess whether different techniques of sectioning cervical excision biopsies in 2 European laboratories influence the finding of cervical cancer by histopathological examination. MATERIALS AND METHODS The routine assessment at the Department of Histopathology and Cytology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (Sheffield), encompassed sectioning a cone in 3-mm tissue blocks and cutting 3 levels per block. At the Institute of Pathology, Faculty of Medicine, University of Ljubljana, Slovenia (Ljubljana), cones were cut in a 3- to 4-mm-thick tissue block, and 10 levels were cut per block, spaced every 100 microm. The number of blocks and levels per block were assessed for each cone. Histopathological detection of cervical carcinoma between the laboratories was compared. RESULTS Among 820 cones in the Sheffield laboratory, we detected 35 invasive carcinomas, whereas 6 invasive carcinomas were detected among 94 cones in the Ljubljana laboratory. Although the Slovenian laboratory examined a significantly larger number of levels per cone biopsy (64 vs 24 in Sheffield), this was not associated with a larger proportion of invasive cervical carcinoma, especially foci of stage IA1 or high-grade cervical intraepithelial neoplasia diagnosed on excision biopsies: 6.4% of invasive cervical carcinomas (5 [83.3%] of stage IA1) in Ljubljana and 4.3% (30 [85.7%] of stage IA1) in Sheffield laboratory (P > 0.05); 71.2% of high-grade cervical intraepithelial neoplasia in Ljubljana and 75.5% in Sheffield (P > 0.05). CONCLUSIONS Our assessment showed that a method with a large number of levels per cervical cone or large loop excision of the transformation zone biopsy did not increase sensitivity for the detection of cervical cancer. However, extensive sectioning substantially affects the pathologist's workload, and this may need to be reconsidered.
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Affiliation(s)
- Helena Gutnik
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Slovenia
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De Vuyst H, Clifford G, Li N, Franceschi S. HPV infection in Europe. Eur J Cancer 2009; 45:2632-9. [DOI: 10.1016/j.ejca.2009.07.019] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 05/29/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
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Ronco G, Anttila A. Cervical cancer screening in Europe – Changes over the last 9 years. Eur J Cancer 2009; 45:2629-31. [DOI: 10.1016/j.ejca.2009.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 07/22/2009] [Indexed: 12/13/2022]
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40
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Anttila A, von Karsa L, Aasmaa A, Fender M, Patnick J, Rebolj M, Nicula F, Vass L, Valerianova Z, Voti L, Sauvaget C, Ronco G. Cervical cancer screening policies and coverage in Europe. Eur J Cancer 2009; 45:2649-58. [DOI: 10.1016/j.ejca.2009.07.020] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 06/30/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
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41
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Anttila A, Ronco G. Description of the national situation of cervical cancer screening in the member states of the European Union. Eur J Cancer 2009; 45:2685-708. [DOI: 10.1016/j.ejca.2009.07.017] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 07/01/2009] [Accepted: 07/22/2009] [Indexed: 11/17/2022]
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Process performance of cervical screening programmes in Europe. Eur J Cancer 2009; 45:2659-70. [DOI: 10.1016/j.ejca.2009.07.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 06/15/2009] [Accepted: 07/22/2009] [Indexed: 11/22/2022]
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Nicula FA, Anttila A, Neamtiu L, Zakelj MP, Tachezy R, Chil A, Grce M, Kesić V. Challenges in starting organised screening programmes for cervical cancer in the new member states of the European Union. Eur J Cancer 2009; 45:2679-84. [PMID: 19699083 DOI: 10.1016/j.ejca.2009.07.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 07/02/2009] [Accepted: 07/22/2009] [Indexed: 11/27/2022]
Abstract
Following the 2003 Recommendation of the Council of the European Union on cancer screening, equal access to organised cervical cancer screening is supposed to be ensured for all women at risk in all member states. However, the first IARC report on the implementation of the Council Recommendation suggests that a remarkable proportion of women in the new member states are not yet covered with the free Pap tests offered either in organised or opportunistic manners. Cervical cancer incidence and mortality rates in most of these countries are among the highest in Europe. The purpose of this paper is to identify some common challenges and make further proposals in organising and implementing quality-assured cervical cancer screening programmes in these countries. Based on the responses to a corresponding questionnaire, a summary on cervical cancer prevention policies was established for the seven new European Union member states, Czech Republic, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia, and two candidate states, Croatia and Serbia. In most of these countries there are a lot of challenges to overcome before achieving the level of preventive services as seen in Finland and the Netherlands nowadays.
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Affiliation(s)
- Florian Al Nicula
- Epidemiology and Biostatistics, Oncological Institute I. Chiricuta, Cluj-Napoca, Romania.
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