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Heley K, Vanderpool RC, Vedham V. Global cancer stigma research: a U.S. National Cancer Institute workshop report. J Natl Cancer Inst Monogr 2024; 2024:4-10. [PMID: 38836530 DOI: 10.1093/jncimonographs/lgad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 06/06/2024] Open
Abstract
Stigma is a social process characterized by negative beliefs, attitudes, and stereotypes associated with a specific attribute or characteristic that leads to discrimination and social exclusion. Stigma manifests across the cancer control continuum and remains a key challenge for cancer prevention and control worldwide. In this commentary, we provide an overview of the U.S. National Cancer Institute's (NCI) Global Cancer Stigma Research Workshop, a multi-disciplinary international conference held virtually in September 2022, which focused on the intersection of cancer and stigma. The meeting was unique in its convening of researchers, advocates, clinicians, and non-governmental and governmental organizations, who-as a collective-provided overarching topics, cross-cutting considerations, and future directions for the cancer stigma research community to consider, which we describe herein. In summary, studying cancer stigma comprehensively requires a holistic, adaptive, and multifaceted approach-and should consider interrelated factors and their intersection within diverse cultural and social contexts worldwide. Collectively, there was a call for: an inclusive approach, encouraging researchers and practitioners to identify and measure cancer stigma as a driver for cancer health inequities globally; an expansion of existing research methodology to include diversity of experiences, contexts, and perspectives; and collaborations among diverse stakeholders to develop more effective strategies for reducing stigma and improving cancer outcomes. Such efforts are essential to cultivating effective and equitable approaches to preventing and treating cancer worldwide.
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Affiliation(s)
- Kathryn Heley
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Robin C Vanderpool
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Vidya Vedham
- Center for Global Health, Office of the Director, National Cancer Institute, Rockville, MD, USA
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Coman IA, Bazaa U, Guidry JPD, Miller CA. #EndtheSTIgma: An Exploratory Analysis of the 2019 HPV Awareness Day Conversation on Twitter & Instagram. HEALTH COMMUNICATION 2024; 39:927-936. [PMID: 37041687 DOI: 10.1080/10410236.2023.2196466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The current study explores the risk communication conversations on Twitter and Instagram in the context of the 2019 HPV Awareness Day, through the theoretical lenses of the stigma associated with HPV, HPV-related cancer, and the HPV vaccine. Our findings reveal that: 1) self and enacted stigma are present in these social media conversations, via nonprofits and official ambassadors, and via regular people; 2) other categories related to stigma, which can be seen as reactions to stigma and appeals to better individuals and society (i.e. stopping stereotypes) also emerged in these conversations, via official and not official sources, pro and against vaccine discourses; and 3) the same categories emerged from the data via both platforms, but differences exist in terms of narratives and messaging. Practical implications are discussed.
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Affiliation(s)
- Ioana A Coman
- College of Media and Communication, Texas Tech University
| | - Uyanga Bazaa
- Department of Communication, Mississippi State University
| | | | - Carrie A Miller
- Public Relations/STEM Translational Communication Center, College of Journalism and Communications, UF Health Cancer Center, University of Florida
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Kluitenberg Harris C, Wu HS, Lehto R, Wyatt G, Given B. Relationships Among Determinants of Health, Cancer Screening Participation, and Sexual Minority Identity: A Systematic Review. LGBT Health 2024. [PMID: 38557207 DOI: 10.1089/lgbt.2023.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Purpose: To address cancer screening disparities and reduce cancer risk among sexual minority (SM) groups, this review identifies individual, interpersonal, and community/societal determinants of cancer screening (non)participation among differing SM identities. Methods: Seven scientific databases were searched. Inclusion criteria were as follows: (1) used quantitative methods; (2) English language; (3) cancer screening focus; and (4) at least one SM group identified. Articles were excluded if: (1) analysis was not disaggregated by SM identity (n = 29) and (2) quantitative analysis excluded determinants of cancer screening (n = 19). The Sexual and Gender Minority Health Disparities Research Framework guided literature synthesis. Results: Twelve studies addressed cervical (n = 4), breast (n = 3), breast/cervical (n = 3), or multiple cancers (n = 2). Other cancers were excluded due to inclusion/exclusion criteria. The total sample was 20,622 (mean 1525), including lesbian (n = 13,409), bisexual (n = 4442), gay (n = 1386), mostly heterosexual (n = 1302), and queer (n = 83) identities. Studies analyzing individual-level determinants (n = 8) found that socioeconomic status affected cervical, but not breast, cancer screening among lesbian and bisexual participants (n = 2). At the interpersonal level (n = 7), provider-patient relationship was a determinant of cervical cancer screening among lesbian participants (n = 4); a relationship not studied for other groups. Studies analyzing community/societal determinants (n = 5) found that rurality potentially affected cervical cancer screening among lesbian, but not bisexual people (n = 3). Conclusions: This review identified socioeconomic status, provider-patient relationship, and rurality as determinants affecting cancer screening among SM people. While literature addresses diverse SM groups, inclusion/exclusion criteria identified studies addressing cisgender women. Addressing disparities in the identified determinants of cervical cancer screening may improve participation among SM women. Further research is needed to understand determinants of cancer screening unique to other SM groups.
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Affiliation(s)
| | - Horng-Shiuann Wu
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Rebecca Lehto
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Gwen Wyatt
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Barbara Given
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
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Gosse RA, Msengi EA, Chona EZ, Ambikile JS. Experiences of caring for women with cervical cancer: A qualitative study among male partners in Dar es Salaam, Tanzania. Health Expect 2024; 27:e14038. [PMID: 38561909 PMCID: PMC10985225 DOI: 10.1111/hex.14038] [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] [Received: 09/30/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND More than three-fourths of cervical cancer cases occur in low- and middle-income countries, with sub-Saharan Africa (SSA) accounting for approximately 25% of global mortality. The significant rise in the prevalence of cervical cancer in SSA amplifies the burden on caregivers, contributing to elevated rates of mental illness, particularly among spouses who provide care. Men who assume the role of caregivers for their partners with cervical cancer encounter unique challenges and substantial adjustments across multiple facets of life, impacting both their own quality of life and that of their partners. Despite this, there is a notable lack of extensive research on the experiences of male partners in caregiving roles, particularly within SSA countries like Tanzania. Therefore, this study aimed to explore the experiences of male partners providing care for women with cervical cancer in Dar es Salaam, Tanzania. METHODS An exploratory qualitative study was undertaken to explore the experiences of 13 male partners, selected purposively and guided by the principle of saturation. Data gathering employed in-depth interviews utilizing a semistructured interview guide, with subsequent analysis conducted via a thematic analysis approach. RESULTS Five themes and 13 subthemes were generated, encompassing psychosocial distress, attitudes towards cervical cancer, unity in the provision of care, economic burden, and altered sexual relationships. Participants reported experiencing emotional distress, shifts in social responsibilities, financial challenges, and unfulfilled sexual needs. Moreover, they expressed the need for social, psychological, financial, and sexual and reproductive support. CONCLUSION This study underscores the numerous challenges encountered by male partners caring for women with cervical cancer, encompassing emotional distress, financial strain, and shifts in social and sexual dynamics. The identified themes and subthemes highlight the intricate interplay of these difficulties and stress the necessity for holistic support systems addressing the social, psychological, financial, and sexual aspects of male partners' experiences. The findings emphasize the importance of designing and implementing comprehensive support programmes tailored to the diverse needs of male partners, ultimately enhancing their quality of life and overall well-being. PATIENT OR PUBLIC CONTRIBUTION Before the study, the nursing manager assisted in selecting three male partners randomly. These partners were involved in the design of the participants' information sheet, the evaluation of the interview schedule and rooms, and the dissemination of information about the study's purpose to the target population. Their valuable input contributed to improving the participant information sheet, refining data collection procedures and addressing ethical considerations. However, these individuals were not considered study participants. Throughout the study, in-charge nurses in the hospital were informed about the study's goals and helped organize appointments with participants and manage the interview schedule.
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Affiliation(s)
- Rashid A. Gosse
- School of NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Emanueli Amosi Msengi
- School of NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Emmanuel Z. Chona
- School of NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Joel S. Ambikile
- Department of Clinical NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
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Baeker Bispo JA, Goo I, Ashad-Bishop K, Kobetz E, Bailey Z. Does Neighborhood Social Cohesion Influence Participation in Routine Cancer Screening? Findings From a Representative Sample of Adults in South Florida. FAMILY & COMMUNITY HEALTH 2024; 47:130-140. [PMID: 38372330 DOI: 10.1097/fch.0000000000000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND AND OBJECTIVES Neighborhood social cohesion (NSC) has been associated with a variety of health outcomes, but limited research has examined its impact on behaviors that support cancer control. The purpose of this study was to examine associations between NSC and guideline-concordant breast, cervical and colorectal cancer screening. METHODS Data are from a cross-sectional survey administered to 716 adults in South Florida from 2019 to 2020. The analytic samples included adults eligible for breast (n = 134), cervical (n = 195), and colorectal cancer (n = 265) screening. NSC was measured using a validated 5-item instrument. Associations between NSC and guideline-concordant screening were examined using multivariable logistic regression. RESULTS In fully adjusted analyses, the odds of guideline-concordant breast cancer screening increased by 86% for every unit increase in NSC (aOR = 1.86; 95% CI, 1.03-3.36). NSC was not statistically significantly associated with guideline-concordant cervical cancer screening (aOR = 0.86; 95% CI, 0.54-1.38) or colorectal cancer screening (aOR = 1.29; 95% CI, 0.81-2.04). CONCLUSIONS These findings suggest that NSC supports some screening behaviors, namely, mammography use. To better understand heterogeneous relationships between NSC and utilization of preventive care services such as cancer screening, more research is needed that disaggregates effects by sex, age, race/ethnicity, and socioeconomic status.
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Affiliation(s)
- Jordan A Baeker Bispo
- American Cancer Society, Surveillance and Health Equity Science, Atlanta, Georgia (Drs Baeker Bispo and Ashad-Bishop); Miller School of Medicine, University of Miami, Miami, Florida (Drs Goo and Kobetz); Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida (Dr Kobetz); Keck School of Medicine, University of Southern California, Los Angeles, California (Dr Goo); and University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Bailey)
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Kavousi S, Maharlouei N, Rezvani A, Akbari Aliabad H, Molavi Vardanjani H. Worldwide association of the gender inequality with the incidence and mortality of cervical, ovarian, endometrial, and breast cancers. SSM Popul Health 2024; 25:101613. [PMID: 38322785 PMCID: PMC10844666 DOI: 10.1016/j.ssmph.2024.101613] [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: 10/29/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
Background There is a huge disparity in cancer incidence and mortality around the globe. A considerable share of this disparity can be explained by human development. Particularly in many less developed countries, women have been hindered in their human development. In this ecological study, we hypothesize that, notwithstanding acceptable overall development in countries, gender inequalities might affect the incidence and mortality of women's malignancies, and there is a distinct association between them. Method The data on the incidence and mortality of gynecologic and female breast cancers were retrieved from the GLOBOCAN database, and the data on the Human Development Index (HDI), Gender Development Index (GDI), and Gender Inequality Index (GII) were obtained from the United Nations Human Development Report. The Poisson regression modeling was then used to fit four models for each cancer. Result GII and GDI are both significantly associated with incidences of women's cancers, except for the insignificant association between GDI and the incidence of ovarian cancer. However, the association between GDI and the mortality of women's cancer is not strong. At the same time, there are significant direct relationships between GII and the mortality of breast, cervical, and endometrial cancer. Conclusion The incidence and mortality of women's cancers are ecologically associated with the country-level gender inequality captured with GDI and GII.
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Affiliation(s)
- Shahin Kavousi
- MD-MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Maharlouei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rezvani
- Department of Internal Medicine, School of Medicine, Hematology Research Center, Stem Cells Research Institute, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Akbari Aliabad
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences and Health Services, Shiraz, Iran
| | - Hossein Molavi Vardanjani
- MD-MPH Department, School of Medicine, Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Minchew LA. Self-Blame Attribution: Concept Analysis and Application to HPV-Related Cancers. J Christ Nurs 2024:00005217-990000000-00018. [PMID: 38319227 DOI: 10.1097/cnj.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
ABSTRACT The attribution of self-blame for a negative physical health outcome can lead to further deterioration of one's mental and spiritual state. Using Walker and Avant's eight-step model for concept analysis, self-blame attribution is explored following the diagnosis of a human papillomavirus-related cancer in women. Conceptual case examples provide application of the concept to patient situations. Spiritual assessment tools for nurses caring for those who evidence self-blame are provided.
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Affiliation(s)
- Leigh Anne Minchew
- Leigh Anne Minchew, PhD, DNP, RN, WHNP-BC, PMHNP-BC, a dual-certified women's health and psychiatric nurse practitioner, provides supportive care to patients with gynecologic cancers. Her practice is devoted to addressing women's psychological and spiritual health needs
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Baeker Bispo J, Lee H, Pal Choudhury P, Bailey Z, Jemal A, Islami F. Government Housing Assistance and Cancer Screening Among Adults With Low Income. Am J Prev Med 2024; 66:205-215. [PMID: 37943202 DOI: 10.1016/j.amepre.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Access to affordable housing may support cancer control for adults with low income by alleviating financial barriers to preventive care. This study examines relationships between cancer screening and receipt of government housing assistance among adults with low income. METHODS Data are from the 2019 and 2021 National Health Interview Survey. Eligible respondents were classified as up-to-date or not with breast cancer (BC), cervical cancer (CVC) and colorectal cancer (CRC) screening guidelines. Multivariable logistic regression was used to model guideline-concordant screening by receipt of government housing assistance, overall and stratified by urban-rural status, race/ethnicity, and age. Analyses were performed in 2023. RESULTS Analyses for BC, CVC and CRC screening included 2,258, 3,132, and 3,233 respondents, respectively. There was no difference in CVC screening by housing assistance status, but screening for BC and CRC was higher among those who received assistance compared to those who did not (59.7% vs. 50.8%, p<0.01 for BC; 57.1% vs. 44.1%, p<0.01 for CRC). In models adjusted for sociodemographic characteristics, health status and insurance, these differences were not statistically significant for either BC or CRC screening. In stratified adjusted models, housing assistance was statistically significantly associated with increased BC screening in urban areas (aOR=1.35, 95% CI=1.00-1.82) and among Hispanic women (aOR=2.20, 95% CI=1.01-4.78) and women 45-54 years of age (aOR=2.10, 95% CI=1.17-3.75). CONCLUSIONS Policies that address housing affordability may enhance access to BC screening for some subgroups, including women in urban areas, Hispanic women, and younger women. More research on the mechanisms that link housing assistance to BC screening is needed.
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Affiliation(s)
- Jordan Baeker Bispo
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia.
| | - Hyunjung Lee
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Parichoy Pal Choudhury
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Zinzi Bailey
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Farhad Islami
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Szamreta EA, Mulvihill E, Aguinaga K, Amos K, Zannit H, Salani R. Information needs during cancer care: Qualitative research with locally advanced cervical cancer patients in Brazil, China, Germany, & the US. Gynecol Oncol Rep 2024; 51:101321. [PMID: 38273935 PMCID: PMC10809109 DOI: 10.1016/j.gore.2023.101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/27/2024] Open
Abstract
Objective This study aimed to identify the information needs and factors for making informed treatment decisions among a diverse group of locally advanced cervical cancer (LACC) patients. Methods Semi-structured interviews were conducted with LACC patients of diverse demographic and socioeconomic backgrounds within two years of their cancer diagnosis. Trained moderators asked open-ended questions about patients' cancer journeys. Transcripts were analyzed using NVivo software to identify emergent themes. Results In 2022, 92 LACC patients in the United States (n = 26), Brazil (n = 25), China (n = 25), and Germany (n = 16) participated in the study. Physicians were valued sources of information, providing patients with details on prognosis, treatment options, and side effects. While most patients trusted their physicians, one-third sought a second opinion to validate their diagnosis or find a more trusted physician.Most patients conducted their own research on treatment options, side effects, causes of LACC, symptoms, and others' experiences. Challenges to information searches included understanding medical terms, finding relevant information, and evaluating source credibility.Overall, patients felt knowledgeable enough to participate in treatment decisions, either by accepting the recommended treatment or collaborating with their physicians. Nearly one-third of patients desired a more significant role in the decision-making process. Conclusion This study highlights the importance of physicians providing LACC patients comprehensive and understandable information, while involving them in the decision-making process. Understanding LACC patients' motivations to seek information and their willingness to actively engage in treatment decisions can lead to improved patient satisfaction in their cancer care.
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Affiliation(s)
- Elizabeth A. Szamreta
- Center for Observational and Real-World Evidence (CORE), Merck & Co. Inc, 126 E. Lincoln Ave, Rahway, NJ 07065, USA
| | - Emily Mulvihill
- Oracle Life Sciences, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA
| | - Katherine Aguinaga
- Oracle Life Sciences, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA
| | - Kaitlan Amos
- Oracle Life Sciences, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA
| | - Heather Zannit
- Oracle Life Sciences, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
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Morse RM, Brown J, Gage JC, Prieto BA, Jurczuk M, Matos A, Vásquez Vásquez J, Reátegui RR, Meza-Sanchez G, Córdova LAD, Gravitt PE, Tracy JK, Paz-Soldan VA. "Easy women get it": pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program. BMC Public Health 2023; 23:2396. [PMID: 38042779 PMCID: PMC10693157 DOI: 10.1186/s12889-023-17324-w] [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] [Received: 08/11/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Cervical cancer is preventable with vaccination and early detection and treatment programs. However, for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system and community of a low-resource setting prior to implementation of an HPV screen-and-treat program. METHODS This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. RESULTS We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. CONCLUSIONS Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system and community in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.
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Affiliation(s)
- Rachel M Morse
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Julia C Gage
- Center for Global Health, National Cancer Institute, Bethesda, MD, USA
| | - Bryn A Prieto
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Magdalena Jurczuk
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Andrea Matos
- Dirección de Prevención y Control de Cancer (DPCAN) of Peruvian Ministry of Health, Lima, Peru
| | | | | | | | | | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - J Kathleen Tracy
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Valerie A Paz-Soldan
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
- Asociación Benéfica PRISMA, Lima, Peru.
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Cartwright K, Kosich M, Gonya M, Kanda D, Leekity S, Sheche J, Edwardson N, Pankratz VS, Mishra SI. Cervical Cancer Knowledge and Screening Patterns in Zuni Pueblo Women in the Southwest United States. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1531-1538. [PMID: 37046142 PMCID: PMC10097513 DOI: 10.1007/s13187-023-02295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 05/27/2023]
Abstract
American Indian women experience cervical cancer disparities, including later-stage diagnosis and a higher cervical cancer mortality rate. These disparities are interconnected and linked to cervical cancer screening disparities. Cervical cancer when identified early is highly treatable. Individual- and health system-level factors often contribute to gaps in cervical cancer screening. To better understand the source of these inequities experienced by American Indian women, specifically Zuni women, this paper examines how knowledge about cervical cancer and related risk factors is linked to cervical cancer screening for Zuni women using primary data gathered by the Zuni Health Initiative in 2020 and 2021. We find that of the women who completed the survey (n = 171), women with greater cervical cancer knowledge are statistically significantly more likely to have received cervical cancer screening. Closer examination of knowledge on the specific risk factors for cervical cancer provides evidence upon which to develop a cervical cancer education intervention.
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Affiliation(s)
- Kate Cartwright
- School of Public Administration, University of New Mexico, Albuquerque, NM USA
| | - Mikaela Kosich
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Madison Gonya
- School of Public Administration, University of New Mexico, Albuquerque, NM USA
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM USA
| | - Deborah Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Samantha Leekity
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Judith Sheche
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Nicholas Edwardson
- School of Public Administration, University of New Mexico, Albuquerque, NM USA
| | - V. Shane Pankratz
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM USA
| | - Shiraz I. Mishra
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
- Departments of Pediatric and Family and Community Medicine, University of New Mexico, Albuquerque, NM USA
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Morse RM, Brown J, Gage JC, Prieto BA, Jurczuk M, Matos A, Vásquez JV, Reátegui RR, Meza-Sanchez G, Córdova LAD, Gravitt PE, Tracy JK, Paz-Soldan VA. "Easy women get it": Pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program. RESEARCH SQUARE 2023:rs.3.rs-3256535. [PMID: 37790338 PMCID: PMC10543436 DOI: 10.21203/rs.3.rs-3256535/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Cervical cancer is preventable with vaccination and early detection and treatment programs. However, in order for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system of a low-resource setting prior to implementation of an HPV screen-and-treat program. Methods This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. Results We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. Conclusions Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.
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Affiliation(s)
- Rachel M Morse
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
| | | | - Julia C Gage
- Center for Global Health, National Cancer Institute
| | - Bryn A Prieto
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
| | - Magdalena Jurczuk
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
| | - Andrea Matos
- Dirección de Prevención y Control de Cancer (DPCAN) of Peruvian Ministry of Health
| | | | | | | | | | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine
| | - J Kathleen Tracy
- Department of Medicine, University of Vermont College of Medicine
| | - Valerie A Paz-Soldan
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
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Camara H, Nosi S, Munnull G, Badman SG, Bolgna J, Kuk J, Mola GD, Guy R, Vallely AJ, Kelly-Hanku A. "This is really something: same place, same day result, same day treatment" women's experiences of testing positive for HPV and receiving same-day treatment in Papua New Guinea: an interpretative phenomenological analysis. BMC Womens Health 2023; 23:438. [PMID: 37596636 PMCID: PMC10439555 DOI: 10.1186/s12905-023-02557-z] [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] [Received: 07/19/2022] [Accepted: 07/19/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) testing is transforming cervical screening globally. The World Health Organization (WHO) now recommends same-day HPV screen-and-treat for primary cervical screening in low- and middle-income countries (LMIC) but there is a lack of evidence on women's lived experience of testing positive for oncogenic HPV and receiving same-day treatment. This study aimed to address this knowledge gap among women participating in a same-day HPV screen-and-treat (HPV S&T) program in Papua New Guinea. METHODS As part of a larger qualitative study, this paper explores the lived experiences of 26 women who tested positive for oncogenic HPV and were treated the same day. We analysed the data using the interpretative phenomenological analysis method. All data were managed using Nvivo 12.5. RESULTS The interpretative phenomenological analysis led to three superordinate themes: 1) facing and alleviating initial worries, (2) transforming the disclosure process, and (3) connecting to their faith. Women's experiences of the same day HPV screen-and-treat were framed by initial emotional reactions to their positive HPV test result, and having access to treatment on the same day, which helped address their worries and fears, and transformed their experience of disclosing their test result and subsequent treatment to family and friends. CONCLUSION This study shows that, while women experience similar initial emotional reactions, undergoing same day treatment quickly resolved the women's worries, making this program highly acceptable. Overall, women's engagement in the program confirmed its high acceptability and cultural congruence, leaving women feeling empowered and hopeful about their future, and the future of all Papua New Guinea women.
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Affiliation(s)
- Hawa Camara
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia.
| | - Somu Nosi
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Gloria Munnull
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
- Department of Obstetrics & Gynaecology, Mt Hagen Provincial Hospital, WHP 281, PO Box 36, Mt Hagen, Papua New Guinea
| | - Steven G Badman
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
| | - John Bolgna
- Department of Obstetrics & Gynaecology, Modilon General Hospital, PO Box 1200, Madang, Papua New Guinea
| | - Joseph Kuk
- Department of Obstetrics & Gynaecology, Mt Hagen Provincial Hospital, WHP 281, PO Box 36, Mt Hagen, Papua New Guinea
| | - Glen Dl Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, NCD, PO Box 5623, Boroko, Papua New Guinea
| | - Rebecca Guy
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
| | - Andrew J Vallely
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Angela Kelly-Hanku
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
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14
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Bas S, Sijben J, Bischoff EWMA, Bekkers RLM, de Kok IMCM, Melchers WJG, Siebers AG, van der Waal D, Broeders MJM. Acceptability of risk-based triage in cervical cancer screening: A focus group study. PLoS One 2023; 18:e0289647. [PMID: 37585441 PMCID: PMC10431661 DOI: 10.1371/journal.pone.0289647] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/22/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Compared to the previous cytology-based program, the introduction of primary high-risk human papillomavirus (hrHPV) based screening in 2017 has led to an increased number of referrals. To counter this, triage of hrHPV-positive women in cervical cancer screening can potentially be optimized by taking sociodemographic and lifestyle risk factors for cervical abnormalities into account. Therefore, it is essential to gain knowledge of the views of women (30-60 years) eligible for cervical cancer screening. OBJECTIVE The main goal of this qualitative study was to gain insight in the aspects that influence acceptability of risk-based triage in cervical cancer screening. DESIGN A focus group study in which participants were recruited via four general medical practices, and purposive sampling was used to maximize heterogeneity with regards to age, education level, and cervical cancer screening experiences. APPROACH The focus group discussions were transcribed verbatim and analyzed using reflexive thematic analysis. PARTICIPANTS A total of 28 women (average age: 45.2 years) eligible for cervical cancer screening in The Netherlands participated in seven online focus group discussions. Half of the participants was higher educated, and the participants differed in previous cervical cancer screening participation and screening result. KEY RESULTS In total, 5 main themes and 17 subthemes were identified that determine the acceptability of risk-stratified triage. The main themes are: 1) adequacy of the screening program: an evidence-based program that is able to minimize cancer incidence and reduce unnecessary referrals; 2) personal information (e.g., sensitive topics and stigma); 3) emotional impact: fear and reassurance; 4) communication (e.g., transparency); and 5) autonomy (e.g., prevention). CONCLUSION The current study highlights several challenges regarding the development and implementation of risk-based triage that need attention in order to be accepted by the target group. These challenges include dealing with sensitive topics and a transparent communication strategy.
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Affiliation(s)
- Sharell Bas
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jasmijn Sijben
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik W. M. A. Bischoff
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ruud L. M. Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
- Department of Obstetrics and Gynecology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Inge M. C. M. de Kok
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Willem J. G. Melchers
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Albert G. Siebers
- The Nationwide Network and Registry of Histo-and Cytopathology in the Netherlands (PALGA Foundation), Houten, The Netherlands
| | - Daniëlle van der Waal
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Mireille J. M. Broeders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening, Nijmegen, The Netherlands
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Bermúdez PC, Arrivillaga M, Torres Poveda K, Castrillón Libreros DM, Castillo Castillo LE, Neira Acevedo D. Barriers to adherence to cytology exam: a case study in low-income Colombian women. BMC Health Serv Res 2023; 23:796. [PMID: 37491282 PMCID: PMC10369816 DOI: 10.1186/s12913-023-09700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Cervical cytology is essential for the early detection of cervical cancer. However, in Colombia, only 50% of women with subsidized health insurance were screened in 2019, compared to 100% of women with contributory insurance. This disparity highlights significant barriers that must be addressed. This study aimed to identify the factors that contribute to or hinder adherence to cervical cytology screening among low-income women with subsidized health insurance in a public primary care network in Cali, Colombia, from 2014 to 2018. METHODS In a qualitative case study, the experience of women and health care and administrative personnel was recovered. Forty-seven women participated in seven focus group discussions. Five other women using the program participated in in-depth interviews. Finally, we interviewed eight people from the healthcare area and the health services administration. The qualitative data collected underwent content analysis, guided by the theoretical framework of Social Determinants of Health. Within this framework, five interconnected dimensions that influence adherence were incorporated. RESULTS Adherence is a multifactorial phenomenon, and in relation to attendance at cervical cytology, the analysis delved into the mechanisms that affect it in a low-income context. Barriers to adherence were identified across multiple dimensions, including social and economic factors, health conditions, and patient-related factors, among both adherent and non-adherent women. Among adherent women, barriers and facilitators related to the healthcare team and system, as well as patient-related factors, were identified. CONCLUSIONS The findings of this research can be useful in developing personalized interventions and strategies to improve adherence and screening outcomes in low-income settings. It is necessary to increase the resources of health insurance entities to establish effective communication channels with women who attend the cervical cancer prevention program.
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Affiliation(s)
- Paula C Bermúdez
- Departamento de Salud Pública y Epidemiología, Pontificia Universidad Javeriana Cali, Cali, Colombia.
| | - Marcela Arrivillaga
- Oficina de Investigación, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Kirvis Torres Poveda
- Chronic Infections and Cancer Division, National Institute of Public Health, Cuernavaca, Morelos, México
| | | | | | - Daniela Neira Acevedo
- Hospital de Siloé Siglo XXI, Red de Salud Ladera Empresa Social del Estado, Cali, Colombia
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Chughtai N, Perveen K, Gillani SR, Abbas A, Chunara R, Manji AA, Karani S, Noorali AA, Zakaria M, Shamsi U, Chishti U, Khan AA, Soofi S, Pervez S, Samad Z. National cervical cancer burden estimation through systematic review and analysis of publicly available data in Pakistan. BMC Public Health 2023; 23:834. [PMID: 37147640 PMCID: PMC10163779 DOI: 10.1186/s12889-023-15531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/27/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Cervical cancer is a major cause of cancer-related deaths among women worldwide. Paucity of data on cervical cancer burden in countries like Pakistan hamper requisite resource allocation. OBJECTIVE To estimate the burden of cervical cancer in Pakistan using available data sources. METHODS We performed a systematic review to identify relevant data on Pakistan between 1995 to 2022. Study data identified through the systematic review that provided enough information to allow age specific incidence rates and age standardized incidence rates (ASIR) calculations for cervical cancer were merged. Population at risk estimates were derived and adjusted for important variables in the care-seeking pathway. The calculated ASIRs were applied to 2020 population estimates to estimate the number of cervical cancer cases in Pakistan. RESULTS A total of 13 studies reported ASIRs for cervical cancer for Pakistan. Among the studies selected, the Karachi Cancer Registry reported the highest disease burden estimates for all reported time periods: 1995-1997 ASIR = 6.81, 1998-2002 ASIR = 7.47, and 2017-2019 ASIR = 6.02 per 100,000 women. Using data from Karachi, Punjab and Pakistan Atomic Energy Cancer Registries from 2015-2019, we derived an unadjusted ASIR for cervical cancer of 4.16 per 100,000 women (95% UI 3.28, 5.28). Varying model assumptions produced adjusted ASIRs ranging from 5.2 to 8.4 per 100,000 women. We derived an adjusted ASIR of 7.60, (95% UI 5.98, 10.01) and estimated 6166 (95% UI 4833, 8305) new cases of cervical cancer per year. CONCLUSION The estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.
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Affiliation(s)
- Novera Chughtai
- Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Kausar Perveen
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | | | - Aamir Abbas
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Rumi Chunara
- Department of Biostatistics, School of Global Public Health, New York University, New York, USA
- Department of Computer Science and Engineering, Tandon School of Engineering, New York University, New York, USA
| | - Afshan Ali Manji
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Salima Karani
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Maheen Zakaria
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Uzma Shamsi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Uzma Chishti
- Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Adnan A Khan
- Research and Development Solutions, Islamabad, Pakistan
| | - Sajid Soofi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahid Pervez
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
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Petrie K, Wells A, Eckert LO. Human Papillomavirus Vaccine. Obstet Gynecol Clin North Am 2023; 50:339-348. [PMID: 37149314 DOI: 10.1016/j.ogc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Cervical cancer is the fourth most common cancer in women worldwide with immense associated morbidity and mortality. Although most of the cervical cancer cases are caused by the human papillomavirus (HPV) and can effectively be prevented by HPV vaccination, vaccination unfortunately remains underused on a global scale with vast inequities in distribution. A vaccine as a tool to prevent cancer, cervical and others, is largely unprecedented. Then why do HPV vaccination rates globally remain so low? This article explores the burden of disease, development of the vaccine and its subsequent uptake, cost-effectiveness, and associated equity issues.
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18
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Holt HK, Peterson CE, MacLaughlan David S, Abdelaziz A, Sawaya GF, Guadamuz JS, Calip GS. Mediation of Racial and Ethnic Inequities in the Diagnosis of Advanced-Stage Cervical Cancer by Insurance Status. JAMA Netw Open 2023; 6:e232985. [PMID: 36897588 PMCID: PMC10726717 DOI: 10.1001/jamanetworkopen.2023.2985] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Importance Black and Hispanic or Latina women are more likely than White women to receive a diagnosis of and to die of cervical cancer. Health insurance coverage is associated with diagnosis at an earlier stage of cervical cancer. Objective To evaluate the extent to which racial and ethnic differences in the diagnosis of advanced-stage cervical cancer are mediated by insurance status. Design, Setting, and Participants This retrospective, cross-sectional population-based study used data from the Surveillance, Epidemiology, and End Results (SEER) program on an analytic cohort of 23 942 women aged 21 to 64 years who received a diagnosis of cervical cancer between January 1, 2007, and December 31, 2016. Statistical analysis was performed from February 24, 2022, to January 18, 2023. Exposures Health inusurance status (private or Medicare insurance vs Medicaid or uninsured). Main Outcomes and Measures The primary outcome was a diagnosis of advanced-stage cervical cancer (regional or distant stage). Mediation analyses were performed to assess the proportion of observed racial and ethnic differences in the stage at diagnosis that were mediated by health insurance status. Results A total of 23 942 women (median age at diagnosis, 45 years [IQR, 37-54 years]; 12.9% were Black, 24.5% were Hispanic or Latina, and 52.9% were White) were included in the study. A total of 59.4% of the cohort had private or Medicare insurance. Compared with White women, patients of all other racial and ethnic groups had a lower proportion with a diagnosis of early-stage cervical cancer (localized) (American Indian or Alaska Native, 48.7%; Asian or Pacific Islander, 49.9%; Black, 41.7%; Hispanic or Latina, 51.6%; and White, 53.3%). A larger proportion of women with private or Medicare insurance compared with women with Medicaid or uninsured received a diagnosis of an early-stage cancer (57.8% [8082 of 13 964] vs 41.1% [3916 of 9528]). In models adjusting for age, year of diagnosis, histologic type, area-level socioeconomic status, and insurance status, Black women had higher odds of receiving a diagnosis of advanced-stage cervical cancer compared with White women (odds ratio, 1.18 [95% CI, 1.08-1.29]). Health insurance was associated with mediation of more than half (ranging from 51.3% [95% CI, 51.0%-51.6%] for Black women to 55.1% [95% CI, 53.9%-56.3%] for Hispanic or Latina women) the racial and ethnic inequities in the diagnosis of advanced-stage cervical cancer across all racial and ethnic minority groups compared with White women. Conclusions and Relevance This cross-sectional study of SEER data suggests that insurance status was a substantial mediator of racial and ethnic inequities in advanced-stage cervical cancer diagnoses. Expanding access to care and improving the quality of services rendered for uninsured patients and those covered by Medicaid may mitigate the known inequities in cervical cancer diagnosis and related outcomes.
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Affiliation(s)
- Hunter K Holt
- Department of Family and Community Medicine, University of Illinois at Chicago, Chicago
| | - Caryn E Peterson
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago
| | | | - Abdullah Abdelaziz
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago
| | - George F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Jenny S Guadamuz
- Flatiron Health, New York, New York
- Program on Medicines and Public Health, University of Southern California, Los Angeles
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago
- Flatiron Health, New York, New York
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19
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Johnson S, Adams C. Invited Editorial: Why all countries should include psycho-oncology in their cancer response. Psychooncology 2023; 32:10-12. [PMID: 36632661 DOI: 10.1002/pon.6042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Sonali Johnson
- Union for International Cancer Control (UICC), Geneva, Switzerland
| | - Cary Adams
- Union for International Cancer Control (UICC), Geneva, Switzerland
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20
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Dykens JA, Peterson CE, Holt HK, Harper DM. Gender neutral HPV vaccination programs: Reconsidering policies to expand cancer prevention globally. Front Public Health 2023; 11:1067299. [PMID: 36895694 PMCID: PMC9989021 DOI: 10.3389/fpubh.2023.1067299] [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: 10/11/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
Human papillomavirus (HPV) infection is responsible for many cancers in both women and men. Cervical cancer, caused by HPV, is the fourth most common cancer among women worldwide, even though it is one of the most preventable cancers. Prevention efforts include HPV vaccination, however these programs remain nascent in many countries. In 2020 the World Health Assembly adopted the Global Strategy for cervical cancer elimination including a goal to fully vaccinate 90% of girls with the HPV vaccine by the age of 15. However, very few countries have reached even 70% coverage. Increased vaccine availability in the future may allow the opportunity to vaccinate more people. This could add to the feasibility of introducing gender-neutral HPV vaccination programs. Adopting a gender-neutral HPV vaccine approach will reduce HPV infections transmitted among the population, combat misinformation, minimize vaccine-related stigma, and promote gender equity. We propose approaching programmatic research through a gender-neutral lens to reduce HPV infections and cancers and promote gender equality. In order to design more effective policies and programs, a better understanding of the perspectives of clients, clinicians, community leaders, and policy-makers is needed. A clear, multi-level understanding of these stakeholders' views will facilitate the development of target policy and programs aimed at addressing common barriers and optimizing uptake. Given the benefit of developing gender-neutral HPV vaccination programs to eliminate cervical cancer and address other HPV associated cancers, we must build knowledge through implementation research around this topic to inform policy-makers and funders for future policy shifts.
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Affiliation(s)
- J Andrew Dykens
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Center for Global Health, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Caryn E Peterson
- Center for Global Health, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Hunter K Holt
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Diane M Harper
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Obstetrics & Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Women's Studies, College of Literature, Science and the Arts, University of Michigan, Ann Arbor, MI, United States
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21
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Information needs during cancer care: qualitative research with advanced cervical cancer patients in Brazil, China, Germany, and the United States. Gynecol Oncol Rep 2022. [DOI: 10.1016/j.gore.2022.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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22
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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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23
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GLTP Is a Potential Prognostic Biomarker and Correlates with Immunotherapy Efficacy in Cervical Cancer. DISEASE MARKERS 2022; 2022:9109365. [PMID: 35845139 PMCID: PMC9282991 DOI: 10.1155/2022/9109365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022]
Abstract
Cervical cancer (CC) is the fourth most commonly diagnosed cancer in women worldwide. The prognosis of CC patients remains poor. The objective of our study was to explore the potential of glycolipid transfer protein (GLTP) in predicting the prognosis of CC and patients' response to immunotherapy. The expression of GLTP was determined using TCGA and GEO datasets. The prognostic value of GLTP in CC patients was analyzed using Kaplan-Meier analysis and multivariate analysis. The relationships between BTBD10 and immunological checkpoints, immune checkpoint genes, and ferroptosis-related genes were analyzed to explore the impact of GLTP on CC immunotherapy. According to the dysregulated expressions of BTBD10, the IC50 distribution of various targeted medicines was studied. In this study, we found that GLTP expression was distinctly upregulated in CC specimens. However, Kaplan-Meier assays showed that CC patients with low GLTP expressions tended to exhibit a shorter overall survival. Importantly, multivariate assays revealed that GLTP expression was an independent prognostic factor for CC patients. Moreover, we observed that GLTP expression was related to CD4+ T cells, macrophages, and dendritic cells (DCs). Meanwhile, GLTP expressions were associated with those of immune checkpoints, ferroptosis-related genes, and m6A-related genes. The IC50 of Cisplatin, Docetaxel, and Paclitaxel was lower in the high-GLTP-expressing group. Taken together, GLTP was expected to be a prognostic and immunotherapeutic marker for CC.
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24
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Zhang X, DeSantes K, Dodge A, Larson M, Eickhoff J, Moreno M, Peterson A. Practices and Attitudes Regarding Pediatric Cholesterol Screening Recommendations Differ Between Pediatricians and Family Medicine Clinicians. Pediatr Cardiol 2022; 43:631-635. [PMID: 34727231 DOI: 10.1007/s00246-021-02767-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Abstract
Pediatricians had higher rates of ordering pediatric cholesterol screening than family medicine (FM) clinicians. This study aims to compare knowledge, attitude, and practices of clinicians' pediatric cholesterol screening practices and attitudes between these two specialties. A 14-item electronic survey using Likert scales was sent to all clinicians in the institution's Departments of Pediatrics and FM between 2018 and 2019. Chi-square and t-tests were used to compare pediatricians and FM clinicians. 22 clinicians from Pediatrics and 111 from FM completed the survey. Compared to FM clinicians, pediatricians were more familiar with the National Heart, Lung, and Blood Institute guidelines, which are more vigorous in their recommendation of universal cholesterol screening. Pediatricians reported being more supportive of universal cholesterol screening in children (p < 0.05). In practice, pediatricians reported screening almost two thirds (64.8%) of eligible patients during the past year, while FM clinicians reported screening approximately one third (34.1%) of eligible patients (p < 0.001). Pediatricians were more likely to screen based on patient-specific risk factors and their practice decisions were more heavily influenced by published guidelines, institutional education, availability of non-fasting blood to be used for screening, and the availability of an institutional pediatric lipid clinic (p < 0.05). The differences in knowledge, attitudes, and practices of cholesterol screening may contribute to different screening rates among clinicians from FM and pediatrics. To improve patient care and reduce gaps, it is important to implement interventions at the institutional level as well as to adopt uniform guideline recommendations at the national level.
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Affiliation(s)
- Xiao Zhang
- Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, CSC H6/534 MC 4108, 600 Highland Ave., Madison, WI, 53792, USA.
| | - Kathleen DeSantes
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of Wisconsin School of Medicine and Public Health, 2870 University Ave. Ste. 200 MC 9010, Madison, WI, 53705, USA
| | - Ann Dodge
- Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, CSC H6/534 MC 4108, 600 Highland Ave., Madison, WI, 53792, USA
| | - Magnolia Larson
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 100 North Nine Mound Road, Verona, WI, 53593, USA
| | - Jens Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 207 J WARF, 610 Walnut Street, Madison, WI, 53726, USA
| | - Megan Moreno
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of Wisconsin School of Medicine and Public Health, 2870 University Ave. Ste. 200 MC 9010, Madison, WI, 53705, USA
| | - Amy Peterson
- Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, CSC H6/534 MC 4108, 600 Highland Ave., Madison, WI, 53792, USA
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