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Bukowski A, Smith JS, Wheeler SB, Sanusi B, McGuire FH, Zeno E, Des Marais AC, Barclay L, Hudgens MG, Jackson S, Brewer NT. Cervical Cancer Screening Knowledge, Perceptions, and Behaviors in a Multiracial Cohort of Low-Income, Underscreened Women in North Carolina. J Womens Health (Larchmt) 2023; 32:970-981. [PMID: 37327372 PMCID: PMC10510685 DOI: 10.1089/jwh.2022.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
Background: Underscreened, low-income, and uninsured or publicly insured women in the United States bear a greater burden of cervical cancer morbidity and mortality and may face unique barriers that preclude screening adherence. Methods: Participants were 710 My Body My Test-3 clinical trial participants who were publicly insured or uninsured with incomes ≤250% of the U.S. Federal Poverty Level, aged 25-64 years, and not up to date on cervical cancer screening as per national guidelines. Using Health Belief Model constructs, we assessed screening-related knowledge, perceptions, and behaviors-overall and stratified by race and ethnicity-and estimated associations with past-year attempted screening using multivariable regression models. Results: Overall, knowledge was low about the human papillomavirus, purpose of a Pap test, and recommended screening interval. Perceived severity of cervical cancer was high (3.63 on a 4-point scale). Black and Latina/Hispanic women were more likely to perceive screening as lowering their risk of cervical cancer than White women. Black women reported lower perceived risk of cervical cancer compared with White women (p = 0.03), but Black women were more likely to have sought screening in the past year (p = 0.01). Having at least three doctor visits in the past year was associated with a screening attempt. Greater perceived risk of cervical cancer, more positive perceptions of screening, and feeling more nervousness about screening were also associated with a screening attempt (all p < 0.05). Conclusions: Addressing knowledge gaps and misconceptions about cervical cancer screening and leveraging positive perceptions of screening may improve screening uptake and adherence among diverse underscreened U.S. women. Clinical Trial Registration Number: NCT02651883.
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Affiliation(s)
- Alexandra Bukowski
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer S. Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stephanie B. Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Busola Sanusi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - F. Hunter McGuire
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erica Zeno
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrea C. Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lynn Barclay
- American Sexual Health Association, Research Triangle Park, North Carolina, USA
| | - Michael G. Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sarah Jackson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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2
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Kulkarni A, Chen L, Gockley A, Khoury-Collado F, Hou J, Clair CST, Melamed A, Hershman DL, Wright JD. Patterns of cervical cancer screening follow-up in the era of prolonged screening intervals. Gynecol Oncol 2023; 175:53-59. [PMID: 37327539 DOI: 10.1016/j.ygyno.2023.06.007] [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: 06/17/2022] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Little is known as to how prolonged screening recommendations for cervical cancer have affected compliance. OBJECTIVE We examined compliance with repeat cervical cancer screening among U.S. women aged 30-64 who underwent index screening between 2013 and 2019. STUDY DESIGN The IBM Watson Health MarketScan Database was used to identify commercially-insured women 30-64 years old who underwent cervical cancer screening from 2013 to 2019. The cohort was limited to women with continuous insurance 12 months before and ≥ 2 months after index testing. Patients with prior hysterectomy, more frequent surveillance needs, or a history of abnormal cytology, histology, or HPV test were excluded. Index screening included cytology, co-testing, or primary HPV testing. Cumulative incidence curves described screening intervals. Compliance was considered if repeat screening occurred 2.5-4 years after index cytology and 4.5-6 years after index co-testing. Cause-specific hazard models examined factors associated with compliance. RESULTS Of 5,368,713 patients identified, co-testing was performed in 2,873,070 (53.5%), cytology in 2,422,480 (45.1%), and primary HPV testing in 73,163 (1.4%). The cumulative incidence of repeat screening among all women by seven years was 81.9%. Of those who underwent repeat screening, 85.7% with index cytology and 96.6% with index co-testing were rescreened early. Only, 12.2% with index cytology had appropriate rescreening and 2.1% had delayed rescreening. Among the index co-testing group, 3.2% had appropriate rescreening and 0.3% had delayed rescreening. CONCLUSION Appropriate cervical cancer follow-up screening is highly variable. The cumulative incidence rate of repeat screening was 81.9% and among women rescreened, the vast majority are tested earlier than recommended by current guidelines.
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Affiliation(s)
- Amita Kulkarni
- Columbia University College of Physicians and Surgeons, USA
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, USA
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - June Hou
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Caryn S T Clair
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA; Joseph L. Mailman School of Public Health, Columbia University, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA.
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3
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Rickford R, Rogers M, Halliday A, Lamptey P, Kola-Palmer S. Attitudes to reducing cervical screening frequency among UK women: A qualitative analysis. Psychooncology 2023; 32:721-729. [PMID: 36855835 DOI: 10.1002/pon.6117] [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: 11/01/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Cervical cancer remains a significant health threat amongst women globally despite most cervical cancers being preventable through screening and Human Papilloma Virus (HPV) vaccination. With the introduction of HPV testing and vaccination, evidence suggests that the frequency of cervical screening for women can be reduced. However, there is limited evidence on women's attitudes to possible changes to the cervical screening programme. This study explored attitudes, perceptions and beliefs of women in the United Kingdom (UK) regarding potential changes to the National Cervical Screening Programme. METHOD Forty-four women were interviewed between November 2018 and March 2019. Reflexive thematic analysis was used to identify key themes. RESULTS Most participants were opposed to any reduction in cervical screening frequency. Reasons included perceptions that disease would develop undetected, disempowerment, increased anxiety, reduced motivation to attend, and inefficient use of health care resources. Women perceived that they were ill-informed about the reasons for the proposed change, and that access to evidence for the basis of proposed changes may persuade them to accept reduced screening frequency. Women believed that cervical screening is a test for cancer and that HPV vaccination does not provide reliable protection against cervical cancer. These beliefs suggest that women's perception that they require more information about the basis for reduced screening frequency is correct. CONCLUSION Any changes to cervical screening frequency need to ensure public support and trust through a robust public health initiative clearly identifying the rationale for any changes.
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Affiliation(s)
- Rose Rickford
- Department of Sociology, University of York, York, UK
| | - Melanie Rogers
- Department of Nursing, University of Huddersfield, Huddersfield, UK
| | - Abigail Halliday
- Department of Psychology, University of Huddersfield, Huddersfield, UK
| | - Pearl Lamptey
- Department of Psychology, University of Huddersfield, Huddersfield, UK
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4
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Peterson CE, Dykens JA, Weine SM, Holt HK, Fleurimont J, Hutten CG, Wieser J, Abuisneineh F, Awadalla S, Ongtengco NP, Gastala N, Jasenof IG. Assessing the interrelationship between stigma, social influence, and cervical cancer prevention in an urban underserved setting: An exploratory study. PLoS One 2022; 17:e0278538. [PMID: 36454990 PMCID: PMC9714950 DOI: 10.1371/journal.pone.0278538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
In the US, incidence and mortality from cervical cancer disproportionately affects racial/ethnic minorities and low-income women. Despite affordable access to primary and secondary prevention measures at Federally Qualified Health Centers (FQHCs), Human Papillomavirus (HPV) vaccination and screening rates are low, suggesting the presence of non-financial barriers to uptake in this population. This explanatory sequential mixed-methods study sought to explore factors that influence the acceptability of cervical cancer prevention services among parents and legal guardians of vaccine-eligible girls attending an urban FQHC and to assess social influences related to cervical cancer prevention. Participants included eight mothers, one father, and two grandparents/legal guardians. Nine participants self-identified as Black/Afro-Caribbean, or African American, two as Latinx, and one as Native American. The quantitative data suggested discordance between participants' cervical cancer prevention knowledge and their practices. Most indicated that their daughters had received the HPV vaccine but were unsure about HPV transmission modes. Qualitative data revealed that participants were comfortable disclosing information on HPV infection and vaccination status, and most women were likely to share information related to cervical cancer testing and diagnosis. Few comments indicated personal stigma on the part of participants, but there was frequent expression of perceived public stigma (shaming and blaming women), gender differences (men are indifferent to risk), and distrust of the healthcare system. Findings highlight several concepts including the disharmony between knowledge and practice, prevalent perceived public stigma, cumbersome attitudes on the part of men regarding HPV and cervical cancer, and distrust of the healthcare system.
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Affiliation(s)
- Caryn E. Peterson
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - J. Andrew Dykens
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Stevan M. Weine
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Hunter K. Holt
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Judes Fleurimont
- Mile Square Health Center, UI Health, Chicago, Illinois, United States of America
| | - Christina G. Hutten
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - John Wieser
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Fida Abuisneineh
- Mile Square Health Center, UI Health, Chicago, Illinois, United States of America
| | - Saria Awadalla
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | | | - Nicole Gastala
- Mile Square Health Center, UI Health, Chicago, Illinois, United States of America
| | - Ian G. Jasenof
- Mile Square Health Center, UI Health, Chicago, Illinois, United States of America
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5
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Lee YW, Morgan JR, Fiascone S, Perkins RB. Underscreening, overscreening, and guideline-adherent cervical cancer screening in a national cohort. Gynecol Oncol 2022; 167:181-188. [PMID: 36150914 DOI: 10.1016/j.ygyno.2022.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore rates of under- and overscreening for cervical cancer among a national cohort. METHODS The MarketScan database, a national administrative database of employee-sponsored insurance, was queried for elements relevant to cervical cancer screening among women aged 21-65 with 6 years of continuous enrollment (2015-2019). Average-risk women were defined as those without high-risk medical conditions or abnormal screening histories, and without evidence of hysterectomy with removal of the cervix for benign indications. Average-risk women were considered adequately screened if they had Pap tests alone at 2.5-3.5 year intervals, or HPV tests or co-tests at 4.5-5.5 year intervals. Logistic regressions were used to predict the odds of receiving guideline-adherent screening, underscreening, and overscreening. RESULTS Among 1,872,809 eligible patients, 1,471,063 (78.5%) qualified for routine screening. Of these, only 18.1% received guideline-adherent screening, and 25.4% were unscreened during the 6-year period. Younger women (aged 21-39) were more likely to be overscreened [OR 1.46]. Older women (aged 50-64) were more likely to be underscreened or unscreened during the study period [OR 2.54]. Guideline-adherent screening was highest with HPV testing alone (80%) followed by co-testing (44%), and lowest with cytology alone (15%). A total of 329,062 women in this general population sample (18%) met high-risk criteria that required increased frequency of screening. CONCLUSIONS High rates of both underscreening and overscreening indicate a need for additional strategies to improve guideline-adherent care. CLINICAL TRIAL REGISTRATION N/A.
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Affiliation(s)
- Yeon Woo Lee
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America.
| | - Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States of America.
| | - Stephen Fiascone
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America.
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America.
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6
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Kola‐Palmer S, Rogers M, Halliday A, Rickford R. "A lot can happen in five years": Women's attitudes to extending cervical screening intervals. Eur J Cancer Care (Engl) 2022; 31:e13655. [PMID: 35838304 PMCID: PMC9786642 DOI: 10.1111/ecc.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Evidence suggests that cervical screening intervals can be extended and lifetime cervical screening for human papillomavirus (HPV)-vaccinated women could be reduced. This study examines UK women's attitudes to extending screening intervals and assesses associations between knowledge, risk perception and HPV vaccination status, and acceptability of changes. METHODS Using a convenience sampling strategy, an anonymous mixed-methods online survey was used and data recorded from 647 women (mean age = 28.63, SD = 8.69). RESULTS Across the full sample, 46.1% of women indicated they would wait 5 years for their next cervical screening, while 60.2% of HPV-vaccinated women would be unwilling to have as few as three cervical screens in a lifetime. Multivariate analysis revealed those who are regular screened, those who intend to attend when invited, and those who perceive greater personal risk of cervical cancer are less likely to accept a 5-year screening interval. Qualitative findings relating to benefits of extending intervals included convenience of less tests, less physical discomfort, and psychological distress. Concerns identified included the likelihood of developing illness, increased psychological distress relating to what may be happening in the body, and worries about increased risk of cervical cancer. CONCLUSION Women need clear and specific information about HPV timelines, their relationship with cancer risk, and the rationale for extending screening intervals.
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Affiliation(s)
| | - Melanie Rogers
- Department of Nursing and MidwiferyUniversity of HuddersfieldHuddersfieldUK
| | - Abigail Halliday
- Department of PsychologyUniversity of HuddersfieldHuddersfieldUK
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7
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Schrier E, Holt HK, Kuppermann M, Sawaya GF. Changing Preferences for a Cervical Cancer Screening Strategy: Moving Away from Annual Testing. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:709-717. [PMID: 36147829 PMCID: PMC9436266 DOI: 10.1089/whr.2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/12/2022]
Abstract
Background While annual cytology has not been recommended for many years, it remains many patients' preferred screening strategy for cervical cancer. Patient education and provider recommendations have been found effective in aligning professional society guidelines with patient preferences. We assessed whether an educational video with value elicitation exercises (utility assessments) changed screening strategy preferences among patients who had an initial preference for annual screening. Materials and Methods We conducted an interventional study of English- or Spanish-speaking women 21-65 years of age, recruited from two women's health clinics in San Francisco, California (n = 262). Participants were asked about their preferred method of screening before viewing a 7-minute educational video and using a computerized tool that elicited values for 23 different health states related to cervical cancer screening. Directly afterward, they were again asked about their preferred screening strategy. Multivariable regression analysis was utilized to identify independent predictors of changing preferences. Results Of 246 enrollees, 62.6% (154/246) had an initial preference for annual cytology; after viewing the video and completing the values elicitation exercises, about half (72/154, 47%) preferred a strategy other than annual screening. Having attended college and being screened every 3 to 5 years in the recent past were independent predictors of changing preferences away from annual screening. In sensitivity analyses, 53.2% of average-risk participants changed preferences away from annual cytology (p < 0.01). Conclusions Viewing an educational video and conducting a series of value elicitation exercises were associated with a substantially decreased likelihood of preferring annual screening. These findings underscore the importance of patient-centered education to help support informed patient preferences.
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Affiliation(s)
- Elizabeth Schrier
- School of Medicine, University of California, San Francisco, San Francisco, California, USA.,Address correspondence to: Elizabeth Schrier, BA, School of Medicine, University of California, San Francisco, San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Hunter K. Holt
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA.,Department of Family and Community Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - George F. Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA.,Center for Healthcare Value, University of California, San Francisco, San Francisco, California, USA
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8
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Dillon J, Chen L, Melamed A, St Clair CM, Hou JY, Khoury-Collado F, Gockley A, Accordino M, Hershman DL, Wright JD. Patterns of cervical cancer screening among Medicaid beneficiaries. BJOG 2021; 129:1104-1111. [PMID: 34882962 DOI: 10.1111/1471-0528.17050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cervical cancer screening guidelines have evolved over time with the incorporation of human papillomavirus (HPV) testing along with cytology. Current screening guidelines recommend cytological screening every 3 years or HPV testing with or without cytology every 5 years in women age 30-65 years. We examined the use of cervical cancer screening among average-risk Medicaid beneficiaries. DESIGN Retrospective cohort study. POPULATION Women age 30-64 years at average risk for cervical cancer who underwent cervical cancer screening with cytology, co-testing or primary HPV testing from 2013 to 2016. METHODS The IBM Watson Health Multi-State Medicaid MarketScan Database was used. Subsequent screening rates within 3 years of the index test were examined. MAIN OUTCOME MEASURE The rate of repeat cervical cancer screening was analysed using a cumulative incidence function. RESULTS A total of 265 083 patients were identified. Overall, 43.1% (n = 114 312) had index co-testing, 55.2% (n = 146 309) had cytology and 1.7% (n = 4462) had primary HPV testing. The cumulative incidence of early, repeat cervical cancer screening was 3.9% at 12 months, 22.7% at 24 months and 33.3% at 36 months. During the period from 12 to 24 months after follow up, 20.9% of women underwent repeat screening while 19.4% underwent repeat screening 24-36 months after the index test. Among women who did not undergo repeat cervical cancer screening, a yearly gynaecological examination was performed in only 16 627 (10.7%) during year 2 and in 11 116 (8.8%) during year 3. CONCLUSION Among average-risk Medicaid beneficiaries, cervical cancer screening is frequently overused. Women who do not undergo cervical cancer screening are unlikely to undergo routine gynaecological examination. TWEETABLE ABSTRACT Among average-risk Medicaid beneficiaries, cervical cancer screening is frequently overused.
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Affiliation(s)
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Caryn M St Clair
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - June Y Hou
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Melissa Accordino
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
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9
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Peterson CE, Silva A, Goben AH, Ongtengco NP, Hu EZ, Khanna D, Nussbaum ER, Jasenof IG, Kim SJ, Dykens JA. Stigma and cervical cancer prevention: A scoping review of the U.S. literature. Prev Med 2021; 153:106849. [PMID: 34662598 DOI: 10.1016/j.ypmed.2021.106849] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/20/2021] [Accepted: 10/11/2021] [Indexed: 01/08/2023]
Abstract
Cervical cancer is preventable through HPV vaccination and screening however, uptake falls below national targets. A scoping review was conducted to describe stigmas related to HPV infection and vaccination and cervical cancer and screening in the US. Results were organized into the domains proposed by Stangl and colleagues' Health Stigma and Discrimination Framework. Common drivers of stigma were fear of social judgement and rejection, self-blame, and shame. Positive facilitators included social norms that provided motivation to receive HPV vaccination and screening. Gender and social norms were notable negative facilitators of stigma. HPV infection and cervical cancer resulted in stigma marking through the belief that both result from incautious behavior-either multiple sexual partners or failing to get screening. Stereotyping and prejudice were stigma practices attributed to HPV infection and cervical cancer through these same behaviors. Stigma experiences related to HPV infection, cervical cancer, and abnormal screening results included altered self-image based on perceived/anticipated stigma, as well as discrimination. This review advances understanding of the multiple dimensions of stigma associated with these outcomes in the US population. Three areas warrant additional consideration. Future studies should 1) assess how stigma dimensions affect uptake of cervical cancer preventions efforts; 2) focus on US women most affected by cervical cancer incidence and mortality to identify potential differences in these dimensions and tailor interventions accordingly; 3) include women from geographic areas of the US with high rates of cervical cancer to adapt interventions that address potential regional variations in resources and need.
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Affiliation(s)
- Caryn E Peterson
- School of Public Health, University of Illinois at Chicago, USA.
| | - Abigail Silva
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, USA
| | | | | | - Elise Z Hu
- University of Illinois College of Medicine, USA
| | | | | | - Ian G Jasenof
- University of Illinois Health, Mile Square Health Center, USA
| | - Sage J Kim
- School of Public Health, University of Illinois at Chicago, USA
| | - J Andrew Dykens
- University of Illinois College of Medicine, USA; Department of Family Medicine, College of Medicine, Center for Global Health, USA
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10
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Young B, Robb KA. Understanding patient factors to increase uptake of cancer screening: a review. Future Oncol 2021; 17:3757-3775. [PMID: 34378403 DOI: 10.2217/fon-2020-1078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Early detection of cancer through organized screening is a central component of population-level strategies to reduce cancer mortality. For screening programs to be effective, it is important that those invited to screening participate. However, uptake rates are suboptimal in many populations and vary between screening programs, indicating a complex combination of patient factors that require elucidation to develop evidence-based strategies to increase participation. In this review, the authors summarize individual-level (sociodemographic and psychosocial) factors associated with cancer screening uptake and evidence for the effectiveness of behavioral interventions to increase uptake. The authors reflect on current trends and future directions for behavioral cancer screening research to overcome challenges and address unmet needs in reducing cancer mortality.
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Affiliation(s)
- Ben Young
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
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11
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Castle PE, Kinney WK, Chen L, Kim JJ, Jenison S, Rossi G, Kang H, Cuzick J, Wheeler CM. Adherence to National Guidelines on Cervical Screening: A Population-Based Evaluation from a Statewide Registry. J Natl Cancer Inst 2021; 114:djab173. [PMID: 34463763 PMCID: PMC9002271 DOI: 10.1093/jnci/djab173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 04/05/2021] [Accepted: 08/25/2021] [Indexed: 12/04/2022] Open
Abstract
In 2012, national recommendations for cervical-cancer screening of women aged 30-64 years were quinquennial human papillomavirus and cytology co-testing or triennial cytology. Data from a state-wide surveillance program in New Mexico demonstrated 65.2% (95% confidence interval [95%CI]= 64.6%% to 65.7%) of women screened in 2019 had negative co-test within the last 3 years. Percentages of women screened in 2013, 2016, and 2019 with a prior negative co-test more than 5 and up to 7 years ago were 2.6% (95% CI = 2.2% to 2.9%), 2.1% (95% CI = 1.9% to 2.2%), and 6.5% (95% CI = 6.2% to 6.8%), respectively (2-sided P trend<.001). Percentages of women screened in 2013, 2016, and 2019 with a prior negative cytology more than 5 and up to 7 years ago were 3.8% (95% CI = 3.7% to 3.9%), 9.0% (95% CI = 8.7% to 9.3%), and 14.9% (95% CI = 14.4% to 15.4%), respectively (2-sided P trend<.001). Thus, in 2019, only 12.7% (95% CI = 12.4% to 13.1%) of the 30,215 women aged 30-64 years underwent co-testing and 27.7% (95% CI = 27.1% to 28.3%) of the 18,733 underwent cytology at the recommended interval. The observed under- and over-screening could result in increases in cervical-cancer incidence and harms and costs, respectively.
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Affiliation(s)
- Philip E Castle
- Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Cancer Prevention and Division of Cancer Epidemiology and Genetics, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
- National Institutes of Health, National Cancer Institute, Division of Cancer Prevention and Division of Cancer Epidemiology and Genetics, Rockville, MD, USA
| | | | - Lu Chen
- Comprehensive Cancer Center, Biostatistics Shared Resource, University of New Mexico, Albuquerque, NM, USA
| | - Jane J Kim
- Harvard T.H. Chan, School of Public Health, Boston, MA, USA
| | - Steven Jenison
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | | | - Huining Kang
- Comprehensive Cancer Center, Biostatistics Shared Resource, University of New Mexico, Albuquerque, NM, USA
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Cosette M Wheeler
- Comprehensive Cancer Center, Center for HPV Prevention, University of New Mexico, Albuquerque, USA
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Wright JD, Chen L, Tergas AI, Melamed A, St. Clair CM, Hou JY, Khoury-Collado F, Gockley A, Accordino M, Hershman DL. Overuse of Cervical Cancer Screening Tests Among Women With Average Risk in the United States From 2013 to 2014. JAMA Netw Open 2021; 4:e218373. [PMID: 33914050 PMCID: PMC8085723 DOI: 10.1001/jamanetworkopen.2021.8373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE While cervical cancer screening with cytologic and human papillomavirus (HPV) testing has reduced mortality from cervical cancer, overuse of these tests is associated with downstream psychological and medical consequences, as well as significant costs. Guidelines now recommend less frequent testing, although adherence to these recommendations is uncertain. OBJECTIVE To determine the frequency of overuse of cervical cancer screening tests. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 2 299 177 women aged 30 to 65 years recorded in the MarketScan database who underwent cervical cancer screening with cervical cytologic testing, cotesting, or primary HPV testing in 2013 through 2014. Women were followed-up for 3 years, and use of repeat testing during this period was noted. Clinical and demographic characteristics associated with overuse of screening and the association between screening and performance of routine gynecologic examinations were recorded. Data were analyzed from June 15 to September 15, 2020. MAIN OUTCOMES AND MEASURES Cumulative performance of overuse of cervical cancer screening with repeat cytologic or HPV testing within 36 months of the index screening test. RESULTS A total of 2 299 177 women with a median (interquartile range) age of 47 (39-54) years were identified. Initial cervical cancer screening consisted of cytologic testing alone in 1 286 179 women (55.9%), cotesting in 991 583 women (43.1%) and HPV testing in 21 415 women (0.9%). The cumulative incidence of repeat cervical cancer screening was 17.7% (95% CI, 17.6%-17.7%) at 12 months, 51.1% (95% CI, 51.0%-51.2%) at 24 months and 65.8% (65.7%-65.8%) at 36 months. Repeat screening was less common in older women (32 198 women [60.2%] aged 60-64 years vs 194 665 women [67.8%] aged 30-39 years; P < .001), women with medical comorbidities (125 197 women [64.1%] with ≥2 comorbidities vs 423 012 women [64.7%] with no comorbidities; P < .001), women screened in 2014 (176 734 women [53.4%] in 2014 vs 555 767 women [69.4%] in 2013; P < .001), and those screened with cotesting (277 032 women [56.9%] for cotesting vs 450 438 [71.2%] for cytologic testing; P < .001). In contrast, overuse of testing was more common in the Northeastern US (143 916 women [68.1%] in the Northeast vs 81 552 women [51.6%] in the West; P < .001), in women with more frequent outpatient visits (238 510 women [71.1%] with ≥6 visits vs 279 412 [58.7%] with ≤2 visits; P < .001). Women with a sexually transmitted infection after their index testing were also more likely to undergo repeat testing (adjusted odds ratio, 1.42 [95% CI, 1.21-1.68]). Women who did not undergo repeat screening were significantly less likely to undergo a gynecological exam after the index screening test: during year 2 of follow-up, 657 749 women (96.7%) who underwent repeating screening had a gynecological examination compared with 203 566 women (26.2%) who did not undergo a gynecological examination. CONCLUSIONS AND RELEVANCE These findings suggest that among commercially insured women with average risk, cervical cancer screening tests were frequently overused.
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Affiliation(s)
- Jason D. Wright
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Ana I. Tergas
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
- Joseph L. Mailman School of Public Health, Columbia University, New York, New York
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Caryn M. St. Clair
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
| | - June Y. Hou
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
| | - Melissa Accordino
- Columbia University College of Physicians and Surgeons, New York, New York
- New York Presbyterian Hospital, New York, New York
- Joseph L. Mailman School of Public Health, Columbia University, New York, New York
| | - Dawn L. Hershman
- Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, New York, New York
- New York Presbyterian Hospital, New York, New York
- Joseph L. Mailman School of Public Health, Columbia University, New York, New York
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13
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Fuzzell LN, Perkins RB, Christy SM, Lake PW, Vadaparampil ST. Cervical cancer screening in the United States: Challenges and potential solutions for underscreened groups. Prev Med 2021; 144:106400. [PMID: 33388330 DOI: 10.1016/j.ypmed.2020.106400] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/09/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
Cervical cancer screening rates in the United States are generally high, yet certain groups demonstrate disparities in screening and surveillance. Individuals at greatest risk for cervical cancer are often from marginalized or underserved groups who do not participate in regular screening for a variety of reasons. Using the Population-based Research to Optimize the Screening Process (PROSPR) Trans-Organ Conceptual Model, including concepts of individual-, provider-, facility-, system-, or policy-level factors, we provide a commentary to highlight reasons for low screening participation among subgroups in the U.S. These include racial and ethnic minorities, rural residents, sexual and gender minorities, those with limited English proficiency, those with particular religious beliefs, and various health conditions. We describe barriers and offer potential solutions for each group. In addition, we discuss cross-cutting barriers to screening including difficulty interacting with the healthcare system (limited knowledge and health literacy, lack of provider recommendation/contact), financial (cost, lack of insurance), and logistical barriers (e.g., lack of usual source of care, competing demands, scheduling issues). Solutions to address these barriers are needed to improve screening rates across all underscreened groups. Changes at state and national policy levels are needed to address health insurance coverage. Mobile screening, ensuring that interpreters are available for all visits, and targeted in reach at non-gynecological visits can further overcome barriers. Employing community outreach workers can increase community demand for screening, and patient navigators can improve adherence to both screening and follow-up diagnostic evaluation. HPV self-sampling can address multiple barriers to cervical cancer screening.
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Affiliation(s)
- Lindsay N Fuzzell
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America.
| | - Rebecca B Perkins
- Boston University School of Medicine, 85 E. Concord St., Boston, MA 02118, United States of America
| | - Shannon M Christy
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America
| | - Paige W Lake
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America
| | - Susan T Vadaparampil
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America.
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Nagendiram A, Bidgood R, Banks J, Heal C. Women's attitudes and understanding of cervical cancer and the new National Cervical Screening Program. Health Promot J Austr 2020; 32:372-377. [PMID: 32475013 DOI: 10.1002/hpja.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/26/2020] [Accepted: 05/19/2020] [Indexed: 01/21/2023] Open
Abstract
ISSUES ADDRESSED The new National Cervical Screening Program (NCSP) has recently been implemented. Little research is available on women's attitudes towards the program. This study aims to quantitatively assess Australian women's understanding and attitudes towards the new guidelines and their barriers to screening. METHOD Authors designed a cross-sectional survey which was piloted and distributed as a waiting room survey to eligible women who attended a private general practice in North Queensland. RESULTS Of the respondents, 53.8% had accurate knowledge of the new NCSP. Most participants (75.8%) believed they were not provided sufficient information about the NCSP and 60.2% wished to receive this information from their general practitioner. The screening test itself remains an issue, with embarrassment and discomfort listed as the most common barriers to screening. CONCLUSION Many women do not have accurate knowledge of the new NCSP. Further health promotion in this area is warranted, where the general practitioner may play a key role. SO WHAT?: While the new NCSP will lead to further reduction in cervical cancer mortality, it appears from the data that women did not fully understand cervical cancer and its screening. This suggests the need for further health education to women about updated screening guidelines.
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Affiliation(s)
- Archana Nagendiram
- Mackay Clinical School, College of Medicine and Dentistry, James Cook University, Mackay, QLD, Australia
| | | | - Jennifer Banks
- Mackay Clinical School, College of Medicine and Dentistry, James Cook University, Mackay, QLD, Australia
| | - Clare Heal
- Mackay Clinical School, College of Medicine and Dentistry, James Cook University, Mackay, QLD, Australia
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15
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Head KJ, Johnson NL, Scott SF, Zimet GD. Communicating Cervical Cancer Screening Results in Light of New Guidelines: Clinical Practices at Federally Qualified Health Centers. HEALTH COMMUNICATION 2020; 35:815-821. [PMID: 30945950 DOI: 10.1080/10410236.2019.1593079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
New guidelines for cervical cancer screening (CCS) incorporate both HPV and Pap tests, and there is a need to understand communication of these cotesting results to patients, especially in at-risk populations disproportionally affected by cervical cancer. This study used computer-assisted telephone interviews in 2017 at 51 federally qualified health centers (FQHCs) in Indiana to evaluate the characteristics of clinical communication CCS results to women. Results revealed that clinical communication practices varied on channel, timing, and content. Almost half of the clinics (n = 23, 45%) communicate results to patients by phone. Most clinics (n = 47, 92%) notify patients of results in two weeks or less. For cotesting, 70% (n = 36) always communicate Pap/HPV results at the same time. The majority of clinics (n = 42, 82%) explain the type of abnormal Pap test, while only 43% (n = 22) discuss the cervical cancer risk as indicated by the HPV test result. Even though 98% (n = 48) of participants rated their communication strategy as effective, qualitatively participants acknowledged difficulties in communicating cotesting results with their often transient and low health literate patients populations. These results indicate considerable variation and potential deficits in clinical communication of cotesting results in FQHCs, but several promising communication strategies were identified that may inform improved screening communication for other clinics.
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Affiliation(s)
- Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
| | - Nicole L Johnson
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
| | - Susanna Foxworthy Scott
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
- Division of Clinical Pharmacology, Indiana University School of Medicine
| | - Gregory D Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine
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16
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Effect of a school-based educational intervention on HPV and HPV vaccine knowledge and willingness to be vaccinated among Chinese adolescents : a multi-center intervention follow-up study. Vaccine 2020; 38:3665-3670. [DOI: 10.1016/j.vaccine.2020.03.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 12/22/2022]
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17
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Dodd RH, Obermair HM, McCaffery KJ. A Thematic Analysis of Attitudes Toward Changes to Cervical Screening in Australia. JMIR Cancer 2019; 5:e12307. [PMID: 30973340 PMCID: PMC6482401 DOI: 10.2196/12307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/05/2019] [Accepted: 02/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background In December 2017, the Australian National Cervical Screening Program (NCSP) was changed to encompass a 5-yearly human papillomavirus (HPV) primary test for women aged 25 to 74 years. Public concerns about changes to screening programs has been demonstrated in other countries previously. Objective The aim of the study was to explore in depth women’s understanding of and concerns about the specific changes to the Australian NCSP implemented in December 2017. Methods A Web-based petition (Change.org) opposing the changes received over 70,000 signatures and nearly 20,000 comments from February to March 2017. Of 19,633 comments, a random sample of 10% (2000/19,633) were analyzed using content analysis (reported elsewhere). Comments relating directly to the specific changes to the program were further analyzed using qualitative thematic analysis. Results Around one-third (34.55%; 691/2000) of the total comments were related to concerns about specific changes to the program. The greatest concern was that screening intervals would be too long and that cancer may not be detected in time for successful treatment. Missing cancer in younger women (aged <25 years) was also an important concern, perceiving younger women to remain at significant risk. Notably, concern was rarely expressed about the new test (the HPV test). Conclusions Gaps in knowledge and understanding about changes to the program and the rationale behind these have caused health concerns among women. Worry about the extended screening interval indicates little understanding of the slow progression of the HPV infection to cervical cancer or the high rates of regression. Identification of these knowledge gaps can inform both deintensification of other cancer screening programs and practitioners, so that they are able to address these concerns with their patients.
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Affiliation(s)
- Rachael H Dodd
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Helena M Obermair
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten J McCaffery
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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18
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Li S, Liu S, Ratcliffe J, Gray A, Chen G. Preferences for cervical cancer screening service attributes in rural China: a discrete choice experiment. Patient Prefer Adherence 2019; 13:881-889. [PMID: 31239646 PMCID: PMC6554707 DOI: 10.2147/ppa.s201913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/27/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives: Compared with other cancers, screening for cervical cancer is highly cost-effective. However, due to limited awareness about cervical cancer and many other factors, women's attendance rate in rural China for cervical cancer screening remains low. This study aimed to determine women's preferences for cervical cancer screening, to help enhance screening uptake. Methods: A discrete choice experiment (DCE) was conducted among a population-based random sample of 420 women (30-65 years old) in August 2015. Attributes included the percentage of cervical cancer-related death reduction, screening interval, screening location, screening pain, waiting time for screening results and out-of-pocket costs. Mixed logit models were used to analyze the relative importance of each screening attribute. Results: When considering a screening program, the screening cost, location and the percentage of cervical cancer-related death reduction were of most concern to women. Among the presented attributes, the pain associated with the process of screening was of the least concern. Conclusions: All six attributes in our study were found to have a large influence on the preference for cervical cancer screening, and significant preference heterogeneity existed among participants. The findings indicate that the maintenance of a free screening program is essential to increasing screening uptake in this vulnerable population.
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Affiliation(s)
- Shunping Li
- School of Health Care Management, Shandong University, Jinan250012, People’s Republic of China
- NHC Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, People’s Republic of China
| | - Shimeng Liu
- School of Health Care Management, Shandong University, Jinan250012, People’s Republic of China
- NHC Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, People’s Republic of China
| | - Julie Ratcliffe
- Health Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia5042, Australia
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gang Chen
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, South Australia5042, Australia
- Correspondence: Gang ChenFlinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, South Australia5042, AustraliaTel +61 42 581 1029Email
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Townsend JS, Puckett M, Gelb CA, Whiteside M, Thorsness J, Stewart SL. Improving Knowledge and Awareness of Human Papillomavirus-Associated Gynecologic Cancers: Results from the National Comprehensive Cancer Control Program/Inside Knowledge Collaboration. J Womens Health (Larchmt) 2018; 27:955-964. [PMID: 30129896 DOI: 10.1089/jwh.2018.7289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Over 16,000 women are diagnosed with a human papillomavirus (HPV)-associated gynecologic cancer every year. Because most of these cancers are preventable, correct and appropriate information about the HPV vaccine and cervical cancer screening can help reduce incidence. MATERIALS AND METHODS The Centers for Disease Control and Prevention created Inside Knowledge: Get the Facts About Gynecologic Cancer campaign materials, which were used by seven National Comprehensive Cancer Control Program recipients in tailored educational sessions on gynecologic cancer with women and healthcare providers in the community setting. Session participants completed presession and postsession questionnaires. Differences in knowledge and intentions were assessed using chi-square tests for women in the general public, obstetricians/gynecologists (OB/GYNs), primary care physicians (PCPs), and other healthcare providers. RESULTS Women's knowledge improved significantly presession to postsession that HPV causes vaginal (39%-65%, p < 0.001) and vulvar cancers (26%-60%, p < 0.001), but postsession few women correctly identified all HPV-associated gynecologic cancers (15%). From presession to postsession, more women were able to correctly identify recommended age groups for whom the HPV vaccine is recommended (15%-30%, p < 0.001), and that the Pap test only screens for cervical cancer (58%-73%, p < 0.001). Among providers, OB/GYNs had more baseline knowledge of HPV-associated gynecologic cancers than other providers. Postsession, PCPs and other providers increased their knowledge of HPV vaccine recommended age groups (33%-71% and 23%-61%, respectively), and the 3-year recommended screening interval for the Pap test (73%-91% and 63%-85%, respectively). HPV vaccine knowledge did not show significant improvement among OB/GYNs postsessions. CONCLUSIONS Women and healthcare providers who attended the Inside Knowledge sessions significantly improved their knowledge of HPV-associated gynecologic cancers. Additional educational activities during the sessions that support distinguishing between HPV-associated versus other gynecologic cancers and clarify HPV vaccine recommendations may help with further increases in knowledge.
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Affiliation(s)
- Julie S Townsend
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Mary Puckett
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Cynthia A Gelb
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Martin Whiteside
- 2 Office of Cancer Surveillance , Division of Policy, Planning and Assessment, Tennessee Department of Health, Nashville, Tennessee
| | - Julia Thorsness
- 3 Alaska Comprehensive Cancer Control Program , Chronic Disease Prevention Health Promotion, Division of Public Health, Alaska Department of Health and Human Services, Anchorage, Alaska
| | - Sherri L Stewart
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
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20
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Pratte MA, Griffin A, Ogazi C, Yurasevecz S, Blanks CA, McCooey L, Kaufman JS. Racial/Ethnic Disparities in Cervical Cancer Screening Services Among Contractors of the Connecticut Breast and Cervical Cancer Early Detection Program. Health Equity 2018; 2:30-36. [PMID: 29696243 PMCID: PMC5909280 DOI: 10.1089/heq.2017.0038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Racial/ethnic minority women are at increased risk for cervical cancer. The objective of this study is to use performance management data from the Connecticut Breast and Cervical Cancer Early Detection Program (CBCCEDP) to determine whether race/ethnicity disparities exist in human papillomavirus (HPV) co-testing uptake across CBCCEDP contractors. Methods: Secondary analysis of Connecticut's Minimum Data Elements data for 2013–2015 among 10 contractors participating in the CBCCEDP. Participants included women aged 30–64 years and eligible to receive routine cervical cancer screening services through the CBCCEDP (n=5,262). HPV co-testing uptake was compared across contractors and race/ethnicity groups within each contractor using chi-square and Fisher's exact tests as appropriate. Results: Overall, 62.9% of women received HPV co-testing services. Significant differences in co-testing rates were detected between racial/ethnic groups when data were examined across all contractors (p<0.001). Black women were least likely to receive co-testing (49.1%), while Hispanic women were most likely to receive co-testing (68.2%). When data were examined at the individual contractor level, significant differences between racial/ethnic groups were observed in 50% of the contractors. Conclusions: This study identified racial/ethnic disparities in uptake of HPV co-testing both overall and within individual contractors involved in the CBCCEDP. These findings will be used to guide program improvement with the goal of increasing quality and consistency of care for all women seeking screening services.
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Affiliation(s)
- Morgan A Pratte
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Amy Griffin
- Program and Service System Evaluation, The Consultation Center, New Haven, Connecticut.,Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Chioma Ogazi
- Comprehensive Cancer Program, Connecticut Department of Public Health, Hartford, Connecticut
| | - Susan Yurasevecz
- Comprehensive Cancer Program, Connecticut Department of Public Health, Hartford, Connecticut
| | - Carol A Blanks
- Comprehensive Cancer Program, Connecticut Department of Public Health, Hartford, Connecticut
| | - Lisa McCooey
- Comprehensive Cancer Program, Connecticut Department of Public Health, Hartford, Connecticut
| | - Joy S Kaufman
- Program and Service System Evaluation, The Consultation Center, New Haven, Connecticut.,Department of Psychiatry, Yale University, New Haven, Connecticut
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Rendle KA, Schiffman M, Cheung LC, Kinney WK, Fetterman B, Poitras NE, Lorey T, Castle PE. Adherence patterns to extended cervical screening intervals in women undergoing human papillomavirus (HPV) and cytology cotesting. Prev Med 2018; 109:44-50. [PMID: 29288782 DOI: 10.1016/j.ypmed.2017.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 02/03/2023]
Abstract
Although guidelines have recommended extended interval cervical screening using concurrent human papillomavirus (HPV) and cytology ("cotesting") for over a decade, little is known about its adoption into routine care. Using longitudinal medical record data (2003-2015) from Kaiser Permanente Northern California (KPNC), which adopted triennial cotesting in 2003, we examined adherence to extended interval screening. We analyzed predictors of screening intervals among 491,588 women undergoing routine screening, categorizing interval length into early (<2.5years), adherent (2.5<3.5years), or late (3.5<6.0years). We also examined repeated early screening in a subgroup of 50,691 women. Predictors examined included: cohort year (defined by baseline cotest, 2003-2009), race/ethnicity, and baseline age. Compared to the 2003 cohort, women in the 2009 cohort were significantly less likely to screen early (aOR=0.22, 95% CI=0.21, 0.23) or late (aOR=0.47, 95% CI=0.45, 0.49). African American (AA) and Hispanic women were less adherent overall than Non-Hispanic White women, with increased early [(AA: aOR=1.21, 95%CI=1.17, 1.25) (Hispanic: aOR=1.08, 95%CI=1.06, 1.11)] and late screening [(AA: aOR=1.23, 95%CI=1.19, 1.27) (Hispanic: aOR=1.06, 95%CI=1.03, 1.08)]. Asian women were slightly more likely to screen early (aOR=1.03, 95%CI=1.01, 1.05), and less likely to screen late (aOR=0.92, 95% CI=0.90, 0.94). Women aged 60-64years were most likely to screen early for two consecutive intervals (aOR=2.09, 95%CI=1.91, 2.29). Our study found that widespread and rapid adoption of extended interval cervical cancer screening is possible, at least in this managed care setting. Further research examining multilevel drivers promoting or restricting extended interval screening across diverse healthcare settings is needed.
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Affiliation(s)
- Katharine A Rendle
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States.
| | - Mark Schiffman
- Clinical Genetics Branch, Division of Clinical Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States.
| | - Li C Cheung
- Biostatistics Branch, Division of Clinical Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States.
| | - Walter K Kinney
- Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA, United States.
| | - Barbara Fetterman
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Nancy E Poitras
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Thomas Lorey
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Philip E Castle
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States.
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22
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Pedersen HN, Smith LW, Racey CS, Cook D, Krajden M, van Niekerk D, Ogilvie GS. Implementation considerations using HPV self-collection to reach women under-screened for cervical cancer in high-income settings. ACTA ACUST UNITED AC 2018; 25:e4-e7. [PMID: 29507489 DOI: 10.3747/co.25.3827] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The success of cytology (Pap screening) programs is undeniable and has drastically reduced cervical cancer rates in high-income settings where it has been implemented [...]
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Affiliation(s)
- H N Pedersen
- University of British Columbia, Vancouver, BC.,Women's Health Research Institute, Vancouver, BC
| | - L W Smith
- Women's Health Research Institute, Vancouver, BC.,BC Cancer Agency, Vancouver, BC; and
| | | | - D Cook
- BC Centre for Disease Control, Vancouver, BC
| | - M Krajden
- BC Centre for Disease Control, Vancouver, BC
| | | | - G S Ogilvie
- University of British Columbia, Vancouver, BC.,Women's Health Research Institute, Vancouver, BC
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23
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Tracy L, Colt R, Bradish S, Reilly T, Marshall-Aiyelawo K, Chiu L. Patient Knowledge of and Barriers to Breast, Colon, and Cervical Cancer Screenings: A Cross-Sectional Survey of TRICARE Beneficiaries. Fed Pract 2017; 34:S50-S56. [PMID: 31089322 PMCID: PMC6375581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
TRICARE Prime beneficiaries view cancer screening as important for overall health but may need more frequent scheduling reminders, education, and scheduling options to increase below-average screening rates.
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Affiliation(s)
- LaRee Tracy
- is a mathematical statistician at the FDA in Silver Spring, Maryland. is the medical director and chief of clinical operations, is chief of clinical quality, and is chief of case management, all at the TRICARE Regional Office West in San Diego, California. is a senior health care research analyst for the Defense Health Agency Decision Support Division in Falls Church, Virginia. is senior finance and health care data manager at University of California in Oakland
| | - Ross Colt
- is a mathematical statistician at the FDA in Silver Spring, Maryland. is the medical director and chief of clinical operations, is chief of clinical quality, and is chief of case management, all at the TRICARE Regional Office West in San Diego, California. is a senior health care research analyst for the Defense Health Agency Decision Support Division in Falls Church, Virginia. is senior finance and health care data manager at University of California in Oakland
| | - Shaina Bradish
- is a mathematical statistician at the FDA in Silver Spring, Maryland. is the medical director and chief of clinical operations, is chief of clinical quality, and is chief of case management, all at the TRICARE Regional Office West in San Diego, California. is a senior health care research analyst for the Defense Health Agency Decision Support Division in Falls Church, Virginia. is senior finance and health care data manager at University of California in Oakland
| | - Trish Reilly
- is a mathematical statistician at the FDA in Silver Spring, Maryland. is the medical director and chief of clinical operations, is chief of clinical quality, and is chief of case management, all at the TRICARE Regional Office West in San Diego, California. is a senior health care research analyst for the Defense Health Agency Decision Support Division in Falls Church, Virginia. is senior finance and health care data manager at University of California in Oakland
| | - Kimberley Marshall-Aiyelawo
- is a mathematical statistician at the FDA in Silver Spring, Maryland. is the medical director and chief of clinical operations, is chief of clinical quality, and is chief of case management, all at the TRICARE Regional Office West in San Diego, California. is a senior health care research analyst for the Defense Health Agency Decision Support Division in Falls Church, Virginia. is senior finance and health care data manager at University of California in Oakland
| | - Lisa Chiu
- is a mathematical statistician at the FDA in Silver Spring, Maryland. is the medical director and chief of clinical operations, is chief of clinical quality, and is chief of case management, all at the TRICARE Regional Office West in San Diego, California. is a senior health care research analyst for the Defense Health Agency Decision Support Division in Falls Church, Virginia. is senior finance and health care data manager at University of California in Oakland
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24
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Karimy M, Azarpira H, Araban M. Using Health Belief Model Constructs to Examine Differences
in Adherence to Pap Test Recommendations among Iranian
Women. Asian Pac J Cancer Prev 2017; 18:1389-1394. [PMID: 28612592 PMCID: PMC5555552 DOI: 10.22034/apjcp.2017.18.5.1389] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Despite documented successful Pap tests in routine care of women, screening levels are unfortunately often lower than recommended. This study aimed to assess differences in adherence to Pap test guidelines among a sample of Iranian women using the Health Belief Model (HBM). In this descriptive and analytical study, information was collected from a total of 305 women, (age range of 15-49) from Zarandieh health centers in Iran using a random multistage sampling method. The questionnaire covered demographic characteristics; health belief model constructs were gathered by a self-report method. The results were analyzed using the independent samples t test and logistic regression in SPSS-20. A total 32% of the subjects had a history of a Pap test and the score mean of the whole constructs model (knowledge, susceptibility, severity, benefits, barriers and self-efficacy) in these individuals was higher than those without a positive history. Among the predictive variables of HBM constructs, the highest weights were observed for perceived benefits ß)=0.36), perceived susceptibility =ß) 0.35) and self-efficacy ß)=0.29). Based on our finding of positive relationships for health belief model structures with performance of a pap smear test, designing educational interventions for changing the knowledge levels and beliefs of women is recommended.
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Affiliation(s)
- Mahmood Karimy
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
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25
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Gerend MA, Shepherd MA, Kaltz EA, Davis WJ, Shepherd JE. Understanding women's hesitancy to undergo less frequent cervical cancer screening. Prev Med 2017; 95:96-102. [PMID: 27932055 DOI: 10.1016/j.ypmed.2016.11.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 11/23/2016] [Accepted: 11/26/2016] [Indexed: 11/20/2022]
Abstract
Inappropriate cervical cancer screening (e.g., screening too often) can result in unnecessary medical procedures, treatment, and psychological distress. To balance the benefits and harms, cervical cancer screening guidelines were recently modified in favor of less frequent screening (i.e., every 3 to 5 years). This study investigated women's acceptance of less frequent cervical cancer screening and their primary concerns about extending the screening interval beyond one year. A national sample of 376 U.S. women ages 21-65 completed an online survey in 2014. Predictors of willingness to get a Pap test every 3 to 5 years were identified using logistic regression. We also examined perceived consequences of less frequent screening. Over two thirds were willing to undergo less frequent screening if it was recommended by their healthcare provider. Nevertheless, nearly 20% expressed discomfort with less frequent screening and 45% were either in opposition or unsure whether they would be comfortable replacing Pap testing with primary HPV testing. Women whose most recent Pap test was (vs. was not) within the past year and women who ever (vs. never) had an abnormal Pap test were less willing to extend the screening interval. Additionally, women who typically saw an obstetrician/gynecologist or nurse practitioner for their Pap test (vs. a family physician) were less accepting of the guidelines. Hesitancy about the longer screening interval appears to stem from concern about developing cancer between screenings. Findings contribute to the growing body of research on cancer overscreening and may inform interventions for improving adherence to cancer screening guidelines.
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Affiliation(s)
- Mary A Gerend
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences, 633 N St. Clair Street, Suite 1900, Chicago, IL 60611, USA; Northwestern University, Weinberg College of Arts and Sciences, Department of Psychology, 2029 Sheridan Road, Evanston, IL 60208, USA.
| | - Melissa A Shepherd
- Florida State University, Department of Psychology, 1107 W Call Street, Tallahassee, FL 32306, USA.
| | - Emily A Kaltz
- Florida State University, College of Medicine, 1115 W Call Street, Tallahassee, FL 32306, USA.
| | - Whitney J Davis
- Florida State University, Department of Psychology, 1107 W Call Street, Tallahassee, FL 32306, USA.
| | - Janet E Shepherd
- Florida State University, College of Medicine, 1115 W Call Street, Tallahassee, FL 32306, USA.
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26
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Cervical Cancer Screening Guideline Adherence Before and After Guideline Changes in Pennsylvania Medicaid. Obstet Gynecol 2017; 129:66-75. [DOI: 10.1097/aog.0000000000001804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Inglehart RC, Taberna M, Pickard RKL, Hoff M, Fakhry C, Ozer E, Katz M, Gillison ML. HPV knowledge gaps and information seeking by oral cancer patients. Oral Oncol 2016; 63:23-29. [PMID: 27938996 DOI: 10.1016/j.oraloncology.2016.10.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/29/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The incidence of human papillomavirus (HPV) positive oral squamous cell carcinoma (OSCC) continues to increase over time, challenging healthcare providers to address their patients' HPV-related concerns. MATERIALS AND METHODS This prospective study assessed health literacy, HPV knowledge, utilization and trust in information sources among patients with incident HPV-positive or HPV-negative OSCC diagnosed at the Ohio State University from 2011 to 2015. Health literacy was assessed with a standardized scale. Additional questions evaluated HPV knowledge (including transmission, prevalence, health consequences and treatment), the frequency and type of information sources sought, and trust in those sources. RESULTS Surveys were collected from 372 OSCC cases (HPV-positive, n=188; HPV-negative, n=184). Despite high mean health literacy scores, only 45.2% of HPV-related knowledge questions were answered correctly. HPV was known to be a sexually transmitted infection and a cause of cervical and anal cancer by 66.0%, 56.5% and 15.2%, respectively. In all domains, cases with HPV-positive OSCC were significantly more informed than HPV-negative cases (for all, p<0.01). Only 52.7% and 56.2% of patients with HPV-positive OSCC felt they knew enough to be comfortable discussing HPV with their doctor or sexual partner, respectively. The most frequently used information source was the internet (80.9%), which ranked 8th in trust of 15 possible sources. Although most (95.5%) patients trusted information from their doctors, only 37.9% used doctors as an information source. CONCLUSIONS Doctors are a highly trusted, but infrequent utilized, information source and should facilitate patient access to high-quality HPV information sources.
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Affiliation(s)
- R C Inglehart
- MSTP Program, The Ohio State University College of Medicine, Columbus, OH, United States
| | - M Taberna
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), IDIBELL. L'Hospitalet de Llobregar, Barcelona, Spain; Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Spain
| | - R K L Pickard
- Department of Medicine, The Ohio State University, Columbus, OH, United States
| | - M Hoff
- Department of Medicine, The Ohio State University, Columbus, OH, United States
| | - C Fakhry
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins School of Medicine, Johns Hopkins Outpatient Center, Baltimore, MD, United States
| | - E Ozer
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, Columbus, OH, United States
| | - M Katz
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States; Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - M L Gillison
- Department of Medicine, The Ohio State University, Columbus, OH, United States.
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28
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Benard VB, Greek A, Roland KB, Hawkins NA, Lin L, Saraiya M. Change in Provider Beliefs Regarding Cervical Cancer Screening Intervals After an Educational Intervention. J Womens Health (Larchmt) 2016; 25:422-7. [DOI: 10.1089/jwh.2015.5706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vicki B. Benard
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - April Greek
- Division of Health and Analytics, Battelle, Seattle, Washington
| | - Katherine B. Roland
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nikki A. Hawkins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lavinia Lin
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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29
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Ogilvie GS, Smith LW, van Niekerk D, Khurshed F, Pedersen HN, Taylor D, Thomson K, Greene SB, Babich SM, Franco EL, Coldman AJ. Correlates of women's intentions to be screened for human papillomavirus for cervical cancer screening with an extended interval. BMC Public Health 2016; 16:213. [PMID: 26935960 PMCID: PMC4776398 DOI: 10.1186/s12889-016-2865-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 02/12/2016] [Indexed: 11/24/2022] Open
Abstract
Background High-risk HPV DNA testing has been proposed as a primary tool for cervical cancer screening (HPV-CCS) as an alternative to the Papanicolaou cytology- method. This study describes factors associated with women’s intentions to attend cervical cancer screening if high-risk HPV DNA testing (HPV-CCS) was implemented as a primary screening tool, and if screening were conducted every 4 years starting after age 25. Methods This online survey was designed using the Theory of Planned Behaviour to assess factors that impact women’s intentions to attend HPV-CCS among women aged 25–69 upon exit of the HPV FOCAL trial. Univariate and regression analyses were performed to compare the demographic, sexual history, and smoking characteristics between women willing and unwilling to screen, and scales for intention to attend HPV-CCS. A qualitative analysis was performed by compiling and coding the comments section of the survey. Results Of the 981 women who completed the survey in full, only 51.4 % responded that they intended to attend HPV-CCS with a delayed start age and extended screening interval. Women who intended to screen were more likely to have higher education (AOR 0.59, 95 % CI [0.37, 0.93]), while both positive attitudes (AOR 1.26, 95 % CI [1.23, 1.30]) and perceived behavior control (AOR 1.06, 95 % CI [1.02, 1.10]) were significant predictors of intention to screen. Among women who provided comments in the survey, a large number of women expressed fears about not being checked more than every 4 years, but 12 % stated that these fears may be alleviated by having more information. Conclusions Acceptability of increased screening intervals and starting age could be improved through enhanced education of benefits. Program planners should consider measures to assess and improve women’s knowledge, attitudes and beliefs prior to the implementation of new screening programs to avoid unintended consequences.
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Affiliation(s)
- Gina S Ogilvie
- University of British Columbia, Vancouver, BC, Canada. .,Women's Health Research Institute, Vancouver, BC, Canada. .,BC Women's Hospital and Health Centre, Room H203G, 4500 Oak Street, Vancouver, BC, V6H 3 N1, Canada.
| | | | | | | | | | - Darlene Taylor
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.
| | | | - Sandra B Greene
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | - Suzanne M Babich
- Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
| | | | - Andrew J Coldman
- University of British Columbia, Vancouver, BC, Canada. .,British Columbia Centre for Disease Control, Vancouver, BC, Canada.
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30
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Roland KB, Benard VB, Greek A, Hawkins NA, Lin L. Changes in Knowledge and Beliefs About Human Papillomavirus and Cervical Cancer Screening Intervals in Low-Income Women After an Educational Intervention. J Prim Care Community Health 2016; 7:88-95. [PMID: 26763304 DOI: 10.1177/2150131915624869] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Women have been reluctant to adopt longer than annual intervals for cervical cancer screening, despite guidelines recommending screening every 3 to 5 years. Our study assessed patient knowledge and beliefs about human papillomavirus (HPV) and cervical cancer screening after exposure to an educational intervention, and whether there was a change in time regarding knowledge and beliefs among all study participants in an underserved population. METHOD The study was conducted in 15 clinics associated with 6 Federally Qualified Health Centers in Illinois, USA. Cervical cancer screening patients (n = 644) completed a baseline and postintervention follow-up survey. The intervention included an HPV test and an educational pamphlet. Significance testing of changes in knowledge and beliefs was conducted with multilevel, mixed-effects models adjusting for repeated measures of patients and clustering within clinics. RESULTS No significant differences in study outcomes were found between the intervention and control groups. Among all women, knowledge of HPV significantly improved over time. At follow-up, fewer women reported that having a co-test is good, wise, will give you peace of mind, will tell you whether you need to worry if Pap is abnormal, is something your doctor thinks you should have, and will give you the best care available. More women said it would be bad, useless, or worrying to wait 3 years for a Pap test at follow-up. CONCLUSION HPV knowledge improved over time, but the educational intervention utilized in this study was not successful in improving attitudes and beliefs about co-testing and longer screening intervals, and beliefs about HPV co-testing and 3-year screening intervals were less favorable. Having health care providers discuss the consequences of overscreening and the natural history of HPV and cervical cancer with their patients may help increase adherence to longer screening intervals. Further examination of the essential components for educational intervention in this population is warranted.
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Affiliation(s)
| | - Vicki B Benard
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - April Greek
- Battelle, Health & Analytics, Seattle, WA, USA
| | - Nikki A Hawkins
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lavinia Lin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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31
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Lin L, Benard VB, Greek A, Hawkins NA, Roland KB, Saraiya M. Racial and ethnic differences in human papillomavirus positivity and risk factors among low-income women in Federally Qualified Health Centers in the United States. Prev Med 2015; 81:258-61. [PMID: 26361751 PMCID: PMC4751981 DOI: 10.1016/j.ypmed.2015.08.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/17/2015] [Accepted: 08/31/2015] [Indexed: 11/18/2022]
Abstract
Reasons for racial/ethnic disparities in HPV infection are unclear. This study assessed racial/ethnic differences in and risk factors for HPV positivity among low-income women. Data were collected from 984 low-income women visiting Federally Qualified Health Centers across Illinois (2009-2011). Pearson chi square and Logistic regression analyses were used to examine associations with HPV positivity. Our results showed Mexican-born Hispanics had the lowest HPV positivity (16%), followed by non-Hispanic whites (29%), US-born Hispanics (35%), and non-Hispanic blacks (39%). Mexican-born Hispanics reported fewer risk behaviors for HPV positivity, including first sexual intercourse before age 16 years (9% versus 27%), multiple sexual partners in lifetime (48% versus 90%), and current cigarette smoking status (10% versus 35%) when compared to non-Hispanic whites (p<0.001). In multivariate-adjusted logistic regression, being non-Hispanic black, first sexual intercourse before age 16 years, increasing numbers of recent or lifetime sexual partners and current cigarette smoking status were associated with a higher likelihood of HPV positivity. Our findings highlight racial/ethnic differences in HPV positivity and risk factors in a population of women with similar socioeconomic characteristics. When measuring HPV risk factors within the Hispanic population, foreign-born status and other mediating factors, such as social norms and cultural characteristics, may be relevant to assess the intragroup heterogeneity.
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Affiliation(s)
- Lavinia Lin
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Vicki B Benard
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - April Greek
- Division of Health and Analytics, Battelle Memorial Institute, Seattle, WA, United States
| | - Nikki A Hawkins
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Katherine B Roland
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
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32
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Cooper CP, Saraiya M, Sawaya GF. Acceptable and Preferred Cervical Cancer Screening Intervals Among U.S. Women. Am J Prev Med 2015; 49:e99-107. [PMID: 26141914 PMCID: PMC4656074 DOI: 10.1016/j.amepre.2015.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/02/2015] [Accepted: 04/23/2015] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Current U.S. cervical cancer screening guidelines recommend a 3- or 5-year screening interval depending on age and screening modality. However, many women continue to be screened annually. The purpose of this study is to investigate U.S. women's self-reported frequency of cervical cancer screening, acceptance of an extended screening interval (once every 3-5 years), and preferred screening options. METHODS Data from a 2012 web-based survey of U.S. women aged ≥18 years who had not undergone a hysterectomy or been diagnosed with cervical cancer (N=1,380) were analyzed in 2014. Logistic regression models of extended screening interval use, acceptance, and preference were developed. RESULTS Annual Pap testing was the most widely used (48.5%), accepted (61.0%), and preferred (51.1%) screening option. More than one third of respondents (34.4%) indicated that an extended screening interval would be acceptable, but only 6.3% reported that they were currently screened on an extended interval. Women who preferred an extended screening interval (32.9% of those willing to accept regular screening) were more likely to report no primary care visits during the last 12 months (AOR=2.05, p<0.003), no history of abnormal Pap test results (AOR=1.71, p=0.013), and that their last Pap test was performed by an internist/family practitioner rather than an obstetrician-gynecologist (AOR=2.03, p<0.001). CONCLUSIONS U.S. women's acceptance of and preference for an extended cervical cancer screening interval appears to be more widespread than utilization. Strategies to educate women about the reasoning behind recommendations for less-than-annual testing and to foster informed preferences should be devised and evaluated.
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Affiliation(s)
| | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - George F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Epidemiology and Biostatistics, University of California, San Francisco, California
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33
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Dehkordy SF, Hall KS, Roach AL, Rothman ED, Dalton VK, Carlos RC. Trends in Breast Cancer Screening: Impact of U.S. Preventive Services Task Force Recommendations. Am J Prev Med 2015; 49:419-22. [PMID: 25841980 PMCID: PMC4546897 DOI: 10.1016/j.amepre.2015.02.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/12/2015] [Accepted: 02/24/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Although there is general agreement among various guidelines on benefits of routine screening mammography, the age of screening initiation and the optimal frequency of the test remain controversial. In 2009, the U.S. Preventive Services Task Force (USPSTF) recommended against routine breast cancer screening in women aged younger than 50 years. In this study, screening mammography guideline adherence among U.S. women is explored by examining patterns in rates of mammography age of initiation and utilization in years prior to and following the 2009 USPSTF guideline implementation. METHODS U.S. population-based data from the 2007, 2008, 2010, and 2012 Behavioral Risk Factor Surveillance System surveys were used to measure the overall proportion and rate of change in the proportion of women who underwent screening mammography within the last year, by age and survey year. Data were accessed and analyzed in July 2014. RESULTS Rates of mammography screening were lower in 2010 and 2012 compared with 2007 and 2008 (p<0.0001). The rate of screening initiation at age 40 years increased over time and was the highest in the years following USPSTF guideline changes (p=0.012). CONCLUSIONS These data support no perceptible change in U.S. women's patterns of screening mammography age at initiation within 3 years of the USPSTF guideline revision. Whether this finding reflects a delayed effect of guideline revision in population trends or rather health provider practice and patient preference for more frequent screening is unclear and requires further investigation.
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Affiliation(s)
| | - Kelli S Hall
- Department of Obstetrics and Gynecology, University of Michigan School of Medicine; Institute for Social Research, Population Studies Center
| | - Allison L Roach
- Department of Statistics ,University of Michigan, Ann Arbor, Michigan
| | - Edward D Rothman
- Department of Statistics ,University of Michigan, Ann Arbor, Michigan
| | - Vanessa K Dalton
- Department of Obstetrics and Gynecology, University of Michigan School of Medicine; University of Michigan Institute for Healthcare Policy and Innovation
| | - Ruth C Carlos
- Department of Radiology, University of Michigan School of Medicine; University of Michigan Institute for Healthcare Policy and Innovation; University of Michigan Program for Imaging Comparative Effectiveness and Health Services Research
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Whitham HK, Kulasingam SL. The significantly lower risk of cervical cancer at and after the recommended age to begin and end screening compared to breast and colorectal cancer. Prev Med 2015; 76:135-40. [PMID: 25937628 DOI: 10.1016/j.ypmed.2015.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/06/2015] [Accepted: 01/10/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We compare risk of cervical, colorectal, and breast cancer (and two pre-cancers: cervical intraepithelial neoplasia (CIN) grade 2-3 and colorectal adenomas) at and after the recommended ages to begin and end screening in the United States. METHODS Surveillance, Epidemiology, and End Results data were used with Monte Carlo simulations to estimate risk at and after the ages to screen. RESULTS At the age to begin screening, absolute risk of breast and colorectal cancer was 381 and 53 times higher, respectively, than cervical cancer (0.0122, 95% CI: 0.0089-0.0162 and 0.0017, 95% CI: 0.0012-0.0023 vs. 3.2e(-5), 95% CI: 2.3e(-5)-4.3e(-5)). Risk of colorectal adenomas and breast cancer was 45 and 2.4 times higher than CIN 2-3 (0.2319, 95% CI: 0.1287-0.3624 and 0.0122, 95% CI: 0.0089-0.0017 vs. 0.0051, 95% CI: 0.0029-0.0081). After the age to end screening, breast and colorectal cancer risk was 17 and 11 times higher, respectively, than cervical cancer. CONCLUSIONS Risk of cervical cancer at and after the recommended ages for screening is significantly lower than that of breast and colorectal cancer. Differences may become more pronounced in the era of HPV vaccines. Comparison of risk between cancers provides a novel perspective to inform future guideline development.
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Affiliation(s)
- Hilary K Whitham
- University of Minnesota, Division of Epidemiology & Community Health, USA.
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Silver MI, Rositch AF, Burke AE, Chang K, Viscidi R, Gravitt PE. Patient concerns about human papillomavirus testing and 5-year intervals in routine cervical cancer screening. Obstet Gynecol 2015; 125:317-329. [PMID: 25568994 DOI: 10.1097/aog.0000000000000638] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To explore attitudes toward new cervical cancer screening options and understand factors associated with those beliefs among women in routine gynecologic care. METHODS We used an interviewer-administered survey of 551 women aged 36-62 years enrolled in the HPV in Perimenopause Study. Poisson regression with robust error variance was used to estimate prevalence ratios and 95% confidence intervals (CIs) to compare women's preferences for cervical cancer screening methods and frequency. RESULTS A majority of women (55.6%, 95% CI 51.4-59.8%) were aware that screening recommendations had changed, yet 74.1% (95% CI 70.3-77.7%) still believed women should be screened annually. If recommended by their doctor, 68.4% (95% CI 64.4-72.2%) were willing to extend screening to every 3 years, but only 25.2% (95% CI 21.9-29.2%) would extend screening to 5 years. Most women (60.7%, 95% CI 56.5-65.7%) expressed a strong preference for Pap testing, and 41.4% (95% CI 37.4-45.6%) expressed at least moderate concern over having a human papillomavirus (HPV) test without a Pap test. A desire for more frequent care, higher degree of worry and perceived risk, and abnormal screening history were all associated with reduced willingness to accept HPV testing and longer screening intervals. CONCLUSION A majority of routinely screened women indicated a willingness to adopt a cervical cancer screening strategy of cytology alone or Pap-HPV cotesting every 3 years if recommended by their physician. However, they remain concerned about HPV testing and extension of screening intervals to once every 5 years. Our results suggest continued reticence to accepting newer HPV-based screening algorithms among routinely screened women older than age 35 years.
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Affiliation(s)
- Michelle I Silver
- Departments of Epidemiology, Gynecology and Obstetrics, and Pediatrics and the Center for Immunization Research, Johns Hopkins School of Public Health, Baltimore, Maryland; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Lin L, Benard VB, Greek A, Roland KB, Hawkins NA, Saraiya M. Communication practices about HPV testing among providers in Federally Qualified Health Centers. Prev Med Rep 2015. [PMID: 26213683 PMCID: PMC4511727 DOI: 10.1016/j.pmedr.2015.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Little is known about the information providers share with patients when ordering a co-test, or combined human papillomavirus (HPV) and Papanicolaou (Pap) test, for cervical cancer screening. We assessed provider perceptions of such communication practices with female patients aged 30–60 years. Methods We analyzed data from 98 providers in 15 Federally Qualified Health Center clinics across Illinois (2009–2010). Results About 70% of the providers reported that when ordering a co-test, they would usually or always communicate information about the HPV test to their patients, explain the test detects a sexually transmitted infection, and discuss how the test results may determine their next screening interval. Most (> 85%) reported that they were comfortable discussing co-test results. Compared with concordant positive results (HPV positive/Pap positive), providers were more likely to perceive that discordant results (HPV positive/Pap negative) would be too complex for patients to understand (25% vs. 15%, p = 0.006), and make patients feel less assured that they were getting the best standard of care (67% vs. 88%, p < 0.001). Conclusion As HPV testing plays a more prominent role in cervical cancer screening, more attention should be given to communications between providers and patients about the benefits and harms of different screening options.
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Affiliation(s)
- Lavinia Lin
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Vicki B Benard
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - April Greek
- Battelle, Health & Analytics, Seattle, WA, USA
| | - Katherine B Roland
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Nikki A Hawkins
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Mona Saraiya
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
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Roland KB, Greek A, Hawkins NA, Lin L, Benard VB. Provider beliefs associated with cervical cancer screening interval recommendations: A pilot study in Federally Qualified Health Centers. Prev Med Rep 2015. [PMID: 26203428 PMCID: PMC4508246 DOI: 10.1016/j.pmedr.2015.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Among providers who serve low-income and uninsured women, resistance to extending the cervical cancer screening interval following normal Pap and co-test results has been documented. Our objective was to examine provider characteristics and beliefs associated with guideline-consistent screening interval recommendations. Method We collected cross-sectional survey data between 2009 and 2010 from 82 primary care providers in six Federally Qualified Health Centers in Illinois, USA. The relationships between characteristics, beliefs, and screening interval recommendations (1 year vs. 3 years) were tested with Pearson chi-square, negative binomial and ordered logistic regression. Results Compared to providers who recommended annual intervals after a normal co-test, providers who recommended a guideline-consistent (i.e., 3 years) screening interval were significantly more likely to report the goodness, ease, and benefit of their recommendation and perceived encouragement for a 3-year interval from professional organizations and journals (p < .05). Providers who recommended a 3-year interval were also less likely to report that longer intervals increase patient risk for cervical cancer (p < .05). Interval recommendations were not associated with provider specialty, gender, or years in practice. Conclusion Messages that promote the benefits of longer screening intervals after a normal co-test, the natural history of human papillomavirus and cervical cancer, and low risk of developing cancer with a longer interval may be useful to promote evidence-based screening in this population of Federally Qualified Health Center providers. Dissemination of targeted messages through professional journals and specialty organizations should be considered. Annual cervical cancer screening is common, but not recommended by guidelines. Pilot study assessed provider factors associated with screening recommendations. Screening recommendations are associated with positive beliefs about screening tests. Perceived risk of the patient developing cancer between screenings is significant. Professional journals and organizations can disseminate screening interval messages.
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Affiliation(s)
- Katherine B Roland
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - April Greek
- Battelle, Health & Analytics, Seattle, WA, USA
| | - Nikki A Hawkins
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Lavinia Lin
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Vicki B Benard
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
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Saraiya M, Benard VB, Greek AA, Steinau M, Patel S, Massad LS, Sawaya GF, Unger ER. Type-specific HPV and Pap test results among low-income, underserved women: providing insights into management strategies. Am J Obstet Gynecol 2014; 211:354.e1-6. [PMID: 24813971 DOI: 10.1016/j.ajog.2014.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 03/31/2014] [Accepted: 05/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The primary cervical cancer screening strategy for women over age 30 is high-risk human papillomavirus (HPV) testing combined with Papanicolaou (Pap) testing (cotesting) every 5 years. This combination strategy is a preventive service that is required by the Affordable Care Act to be covered with no cost-sharing by most health insurance plans. The cotesting recommendation was made based entirely on prospective data from an insured population that may have a lower proportion of women with HPV positive and Pap negative results (ie, discordant results). The discordant group represents a very difficult group to manage. If the frequency of discordant results among underserved women is higher, health care providers may perceive the cotesting strategy to be a less favorable screening strategy than traditional Pap testing every 3 years. STUDY DESIGN The Centers for Disease Control and Prevention's Cervical Cancer Study was conducted at 15 clinics in 6 federally qualified health centers across Illinois. Providers at these clinics were given the option of cotesting for routine cervical cancer screening. Type-specific HPV detection was performed on residual extracts using linear array. RESULTS Pap test results were abnormal in 6.0% and HPV was positive in 7.2% of the underserved women screened in this study (mean age, 45.1 years). HPV prevalence decreased with age, from 10.3% among 30- to 39-year-olds to 4.5% among 50- to 60-year-olds. About 5% of the women had a combination of a positive HPV test and normal Pap test results; HPV 16/18 was identified in 14% of discordant women. CONCLUSION The rate of discordant results among underserved women was similar to those reported throughout the US in a variety of populations. Typing for HPV 16/18 appears to assist in the management in a small proportion of women with discordant results.
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Affiliation(s)
- Mona Saraiya
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Vicki B Benard
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Martin Steinau
- Division of High-Consequence Pathogens and Pathology, Chronic Viral Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sonya Patel
- Division of High-Consequence Pathogens and Pathology, Chronic Viral Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - L Stewart Massad
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - George F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, Chronic Viral Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Tsui J, Hofstetter AM, Soren K. Cervical cytology screening among low-income, minority adolescents in New York City following the 2009 ACOG guidelines. Prev Med 2014; 63:81-6. [PMID: 24650625 PMCID: PMC4075324 DOI: 10.1016/j.ypmed.2014.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 03/04/2014] [Accepted: 03/10/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES In December 2009, the American College of Obstetricians and Gynecologists recommended that cervical cancer screening begin at age 21 for young women. In this study, we examine receipt of first lifetime Papanicolaou (Pap) test and predictors of over-screening among adolescents within a large urban ambulatory care network. METHODS We compared the proportion of first lifetime Pap test of adolescents aged 13-20years between June 2007 - November 2009 (n=7700) and December 2009-June 2012 (n=9637) using electronic health records. We employed multivariable regression models to identify demographic and health care factors associated with receiving a first lifetime Pap test at age <21years in the post-guideline period (over-screening). RESULTS The proportion of Pap tests declined from 19.3% to 4.2% (p<0.001) between the two periods. Multivariable logistic regression results showed receiving care from gynecologic/obstetric/family planning clinics compared to pediatric clinics, having more clinic encounters, and older age were associated with over-screening in the post-guideline period. CONCLUSIONS We found that guideline adherence differed by clinic type, insurance status, and health care encounters. In the quickly evolving field of cervical cancer control, it is important to monitor practice trends as they relate to shifts in population-based guidelines, especially in high-risk populations.
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Affiliation(s)
- Jennifer Tsui
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th St., New York, NY 10032, USA.
| | - Annika M Hofstetter
- Columbia University Medical Center, Division of Child and Adolescent Health, 622 West 168th St., New York, NY 10032, USA
| | - Karen Soren
- Columbia University Medical Center, Division of Child and Adolescent Health, 622 West 168th St., New York, NY 10032, USA; Columbia University, Mailman School of Public Health, Department of Population and Family Health, 722 West 168th St., New York, NY 10032, USA
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Benard VB, Saraiya M, Greek A, Hawkins NA, Roland KB, Manninen D, Ekwueme DU, Miller JW, Unger ER. Overview of the CDC Cervical Cancer (Cx3) Study: an educational intervention of HPV testing for cervical cancer screening. J Womens Health (Larchmt) 2014; 23:197-203. [PMID: 24380501 PMCID: PMC4386595 DOI: 10.1089/jwh.2013.4655] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The recommended screening interval when using the Papanicolaou (Pap) and human papillomavirus (HPV) test (co-testing) is 5 years. However because providers are reluctant to extend the screening interval, we launched a study to identify barriers to appropriate use of the co-test and to implement an educational intervention to promote evidence-based screening practices. This article provides an overview of the study including the multi-component intervention and participant demographics. METHODS The study was conducted in 15 clinics associated with 6 Federally Qualified Health Centers (FQHCs) in Illinois. Each clinic received HPV tests to administer with routine Pap tests among enrolled patients (n=2,246) and was assigned to a study arm: intervention arm (n=7) received a multi-component educational intervention (small media, academic detailing, and website) for providers and printed educational materials for patients, and control arm (n=8) received printed copies of general guidelines. Clinic coordinators (n=15), providers (n=98), and patients (n=984) completed baseline surveys to assess screening practices. RESULTS Providers reported an average age of 41.3 years and were predominately female, non-Hispanic, and white. Patients reported an average age of 45.0 years and nearly two-thirds were Hispanic or black. Of the 2,246 patients, 89% had a normal co-test. Lessons learned from the study included the importance of buy-in at a high level in the organization, a champion provider, and a clinical coordinator devoted to the study. CONCLUSION Materials from this study can be adapted to educate providers and patients on appropriate use of the co-test and encourage extended screening intervals as a safe and effective practice.
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Affiliation(s)
- Vicki B. Benard
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Saraiya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - April Greek
- Battelle, Health & Analytics, Seattle, Washington
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