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Quintal C, Antunes M. Picturing Prevalence and Inequalities in Cancer Screening Attendance to Population-Based Programs in Portugal. ACTA MEDICA PORT 2023; 36:577-587. [PMID: 37339163 DOI: 10.20344/amp.19443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/28/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Screening is effective in reducing cancer-related morbidity and mortality. The aim of this study was to analyze the level of, and income-related inequalities in, screening attendance, in Portugal for population-based screening programs. METHODS Data from the Portuguese Health Interview Survey 2019 was used. Variables included in the analysis were self-reported: mammography, pap smear test, fecal occult blood test. Prevalence and concentration indices were computed at national/regional level. We analyzed: up-to-date screening (within recommended age/interval), under-screening (never or overdue screening), and over-screening (due to frequency higher than recommended or screening outside target group). RESULTS Up-to-date screening rates were 81.1%, 72%, and 40%, for breast, cervical and colorectal cancer, respectively. Never-screening was 3.4%, 15.7%, and 39.9%, for breast, cervical, and colorectal cancer, respectively. Over-screening related with frequency was highest for cervical cancer; in breast cancer, over-screening was observed outside recommended age, affecting one third of younger women and one fourth of older women. In these cancers, over-screening was concentrated among women with higher income. Never-screening was concentrated among individuals with lower income for cervical cancer and higher income for colorectal cancer. Beyond the recommended age, 50% of individuals never underwent screening for colorectal cancer and 41% of women never underwent screening for cervical cancer. CONCLUSION Overall, screening attendance was high, and inequalities were low in the case of breast cancer screening. The priority for colorectal cancer should be to increase screening attendance.
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Affiliation(s)
- Carlota Quintal
- Centre for Business and Economics Research (CeBER). Faculdade de Economia. Universidade de Coimbra. Coimbra; Centro de Estudos e Investigação em Saúde da Universidade de Coimbra (CEISUC). Coimbra. Portugal
| | - Micaela Antunes
- Centre for Business and Economics Research (CeBER). Faculdade de Economia. Universidade de Coimbra. Coimbra. Portugal. Portugal
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Mallafré-Larrosa M, Ritchie D, Papi G, Mosquera I, Mensah K, Lucas E, Bøje RB, Kirkegaard P, Andersen B, Basu P. Survey of current policies towards widening cervical screening coverage among vulnerable women in 22 European countries. Eur J Public Health 2023; 33:502-508. [PMID: 37043751 PMCID: PMC10234668 DOI: 10.1093/eurpub/ckad055] [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] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND This study aimed to investigate the status of cervical cancer screening (CCS) implementation in Europe by investigating national or regional policies towards broadening coverage of CCS amongst vulnerable subgroups of the population at high risk for CC. METHODS A web-based survey was conducted between September 2021 and February 2022 with CCS programme managers and experts to identify and rank six population subgroups at high risk considered most vulnerable to CC and to map existing policies that addressed the coverage of CCS towards population sub-groups at risk. RESULTS A total of 31 responses were received from experts covering 22 European countries. The results of this survey suggest that whilst many countries identify lower coverage of CCS amongst population subgroups at high risk of CC as a public health problem, few countries have developed dedicated policies towards broadening coverage among these subgroups. The six countries who reported having done so were concentrated in the Northern or Western European regions, suggesting the existence of geographical disparities within the continent. A key challenge in this respect is the difficulty to categorize subgroups of the target population; many individuals are burdened by intersectionality thereby resting in multiple categories, which may hinder the effectiveness of interventions targeted to reach specific subgroups. CONCLUSION A greater clarity on the conceptualization of vulnerability can help countries to develop and subsequently implement strategies to increase coverage to subgroups of the target population currently underserved with regards to CCS.
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Affiliation(s)
- Meritxell Mallafré-Larrosa
- Association of European Cancer Leagues (ECL), Brussels, Belgium
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - David Ritchie
- Association of European Cancer Leagues (ECL), Brussels, Belgium
| | - Ginevra Papi
- Association of European Cancer Leagues (ECL), Brussels, Belgium
| | - Isabel Mosquera
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer/World Health Organization (IARC), Lyon Cedex 07, France
| | - Keitly Mensah
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer/World Health Organization (IARC), Lyon Cedex 07, France
| | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer/World Health Organization (IARC), Lyon Cedex 07, France
| | - Rikke Buus Bøje
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
| | - Pia Kirkegaard
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer/World Health Organization (IARC), Lyon Cedex 07, France
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer/World Health Organization (IARC), Lyon Cedex 07, France
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Lin W, Huang W, Mei C, Liu P, Wang H, Yuan S, Zhao X, Wang Y. Associations between the signing status of family doctor contract services and cervical cancer screening behaviors: a cross-sectional study in Shenzhen, China. BMC Public Health 2023; 23:573. [PMID: 36973711 PMCID: PMC10045612 DOI: 10.1186/s12889-023-15462-9] [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: 08/19/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND As a core part of the primary healthcare system, family doctor contract services (FDCS) may help healthcare providers promote cervical cancer screening to the female population. However, evidence from population-based studies remains scant. This study aimed to investigate the potential associations between the signing status of FDCS and cervical cancer screening practices in Shenzhen, China. METHODS A cross-sectional survey among female residents was conducted between July to December 2020 in Shenzhen, China. A multistage sampling method was applied to recruit women seeking health services in community health service centers. Binary logistic regression models were established to assess the associations between the signing status of FDCS and cervical cancer screening behaviors. RESULTS Overall, 4389 women were recruited (mean age: 34.28, standard deviation: 7.61). More than half (54.3%) of the participants had signed up with family doctors. Women who had signed up for FDCS performed better in HPV-related knowledge (high-level rate: 49.0% vs. 35.6%, P<0.001), past screening participation (48.4% vs. 38.8%, P<0.001), and future screening willingness (95.9% vs. 90.8%, P<0.001) than non-signing women. Signing up with family doctors was marginally associated with past screening participation (OR: 1.13, 95%CI: 0.99-1.28), which tended to be robust among women with health insurance, being older than 25 years old at sexual debut, using condom consistently during sexual intercourse, and with a low level of HPV related knowledge. Similarly, signing up with family doctors was positively associated with future screening willingness (OR: 1.68, 95%CI: 1.29-2.20), which was more pronounced among women who got married and had health insurance. CONCLUSIONS This study suggests that signing up with family doctors has positive associations with cervical cancer screening behaviors among Chinese women. Expanding public awareness of cervical cancer prevention and FDCS may be a feasible way to achieve the goal of cervical cancer screening coverage.
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Affiliation(s)
- Wei Lin
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518048, China
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Weikang Huang
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Chaofan Mei
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Peiyi Liu
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
- Research Institute of Maternity and Child Medicine, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - He Wang
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
- Research Institute of Maternity and Child Medicine, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Shixin Yuan
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
- Research Institute of Maternity and Child Medicine, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Xiaoshan Zhao
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518048, China
| | - Yueyun Wang
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518048, China.
- Research Team of Cervical Cancer Prevention Project in Shenzhen, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China.
- Research Institute of Maternity and Child Medicine, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China.
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Jolidon V, De Prez V, Bracke P, Bell A, Burton-Jeangros C, Cullati S. Revisiting the Effects of Organized Mammography Programs on Inequalities in Breast Screening Uptake: A Multilevel Analysis of Nationwide Data From 1997 to 2017. Front Public Health 2022; 10:812776. [PMID: 35198524 PMCID: PMC8858931 DOI: 10.3389/fpubh.2022.812776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/13/2022] [Indexed: 01/04/2023] Open
Abstract
This study revisits the effects of mammography screening programs on inequalities in breast screening uptake in Switzerland. The progressive introduction of regional mammography programs by 12 out of the 26 Swiss cantons (regions) since 1999 offers an opportunity to perform an ecological quasi-experimental study. We examine absolute income and marital status inequalities in mammography uptake, and whether the cantons' implementation of mammography programs moderate these inequalities, as previous research has devoted little attention to this. We use five waves of the Swiss Health Interview Survey covering the 1997-2017 period and comprising data on 14,267 women aged 50-70. Both up-to-date and ever-screening outcomes are analyzed with multilevel models which assess the mammography programs' within-canton effect. Findings show that higher income women and married women (compared to unmarried women) had significantly higher mammography uptake probabilities. Mammography programs did not moderate absolute income differences in up-to-date screening; however, they were associated with smaller absolute income differences in ever-screening uptake. Mammography programs related to higher screening uptake for married women, more than for unmarried women. In conclusion, we showed absolute income inequalities in mammography uptake which were not revealed by previous studies using relative inequality measures. Mammography programs may have contributed to reducing income inequalities in ever-screening, yet this was not observed for up-to-date screening. This study has implication for preventive health interventions-e.g., cancer screening promotion should pay attention to women's marital status since screening programs may widen the screening gap between married and unmarried women.
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Affiliation(s)
- Vladimir Jolidon
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | | | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Andrew Bell
- Sheffield Methods Institute, University of Sheffield, Sheffield, United Kingdom
| | | | - Stéphane Cullati
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
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De Prez V, Jolidon V, Willems B, Cullati S, Burton-Jeangros C, Bracke P. Cervical cancer screening programs and their context-dependent effect on inequalities in screening uptake: a dynamic interplay between public health policy and welfare state redistribution. Int J Equity Health 2021; 20:211. [PMID: 34560888 PMCID: PMC8464130 DOI: 10.1186/s12939-021-01548-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While organized and opportunistic cervical cancer screening (CCS) programs implemented across the European Union have increased participation rates, barriers to socioeconomically deprived women remain substantial, implying high levels of inequality in CCS uptake. AIM This study assesses how the screening strategy (as a score based on the availability of organized population-based CCS programs), accessibility of the healthcare system (as an index of out-of-pocket expenditure as a proportion of total healthcare costs, public health expenditure as a percentage of total GDP, and general practitioner (GP) density per 10'000 inhabitants) and social protection (as a decommodification index), impact education- and income-based inequalities in CCS uptake. METHODS A two-level design with 25-64-year-old women (N = 96'883), eligible for Pap smear screening, nested in 28 European countries, was used to analyze data from the European Health Interview Survey's second wave, using multilevel logistic regression modelling. RESULTS Clear educational and income gradients in CCS uptake were found, which were smaller in countries with organized CCS programs, higher accessibility of the healthcare system and a higher level of decommodification. Furthermore, three-way interaction terms revealed that these gradients were smaller when organized CCS programs were implemented in countries with better accessibility of the healthcare system or a high level of decommodification. CONCLUSION This study indicates that the combination of organized screening and high accessibility of the healthcare system or social protection is essential for having lower levels of inequality in CCS uptake. In such countries, the structural threshold for poorer and lower educated women to engage in CCS is lower. This may be explained by them having a better interaction with their GP, who may convince them of the screening test, lower out-of-pocket payments, and financial support to buffer against a disadvantageous position on the labor market.
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Affiliation(s)
- Vincent De Prez
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium.
| | - Vladimir Jolidon
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland
| | - Barbara Willems
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| | - Stéphane Cullati
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland.,Population Health Laboratory, Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Ch. du Musée 8, CH-1700, Fribourg, Switzerland
| | - Claudine Burton-Jeangros
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland
| | - Piet Bracke
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
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Weisband YL, Torres L, Paltiel O, Sagy YW, Calderon-Margalit R, Manor O. Socioeconomic Disparity Trends in Cancer Screening Among Women After Introduction of National Quality Indicators. Ann Fam Med 2021; 19:396-404. [PMID: 34546946 PMCID: PMC8437575 DOI: 10.1370/afm.2715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Primary care physicians have an important role in encouraging adequate cancer screening. Disparities in cancer screening by socioeconomic status (SES) may affect presentation stage and cancer survival. This study aimed to examine whether breast, colorectal, and cervical cancer screening rates in women differed by SES and age, and whether screening rates and SES disparities changed after introduction of a primary care-based national quality indicator program. METHODS This repeated cross-sectional study spanning 2002-2017 included all female Israeli residents in age ranges appropriate for each cancer screening assessed. SES was measured both as an individual-level variable based on exemption from copayments and as an area-level variable using census data. RESULTS In 2017, the most recent year in the study period, screening rates among 1,529,233 women were highest for breast cancer (70.5%), followed by colorectal cancer (64.3%) and cervical cancer (49.6%). Women in the highest area-level SES were more likely to undergo cervical cancer screening compared with those in the lowest (odds ratio = 3.56; 99.9% CI, 3.47-3.65). Temporal trends showed that after introduction of quality indicators for breast and colorectal cancer screening in 2004 and 2005, respectively, rates of screening for these cancers increased, with greater reductions in disparities for the former. The quality indicator for cervical cancer screening was introduced in 2015, and no substantial changes have occurred yet for this screening. CONCLUSIONS We found increased uptake and reduced socioeconomic disparities after introduction of cancer screening indicators. Recent introduction of a cervical cancer screening indicator may increase participation and reduce disparities, as has occurred for breast and colorectal cancer screening. These findings related to Israel's quality indicators program highlight the importance of primary care clinicians in increasing cancer screening rates to improve outcomes and reduce disparities.
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Affiliation(s)
| | - Luz Torres
- Research Department, Cardioinfantil Foundation-Cardiology Institute, Bogotá, Colombia
| | - Ora Paltiel
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Yael Wolff Sagy
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | | | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
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Takahashi N, Nakao M. Social-life factors associated with participation in screening and further assessment of colorectal cancer: A nationwide ecological study in Japanese municipalities. SSM Popul Health 2021; 15:100839. [PMID: 34189242 PMCID: PMC8215283 DOI: 10.1016/j.ssmph.2021.100839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
The burden of colorectal cancer in developed countries is high, and it is a major public health concern in Japan. Improving the quality of evidence on colorectal cancer screening participation and further assessment participation rates is important to reduce this burden. This study examined the social-life factors that influence colorectal cancer screening programs in Japan, particularly the effects of the proportion of elderly people and social capital, using a municipality-level national database and existing health reports. Data from a national municipality-based study were analyzed to identify social-life factors associated with participation in colorectal cancer screening and further assessment. Administrative data on the Japanese municipal screening programs were drawn from the Report on Regional Public Health Services and Health Promotion Services 2017. Available data used as predictors of interest for all 1719 municipalities as of 2017 were from the national census, statistical reports on the land area by prefecture and municipality, municipal financial surveys, a survey of physicians, dentists and pharmacists, and other databases. The mean rate of participation in colorectal cancer screening was 13.8%, and that of further assessment was 73.6%. Multiple linear regression analyses of the two outcomes showed that the proportion of elderly people was most significantly positively associated with colorectal cancer screening programs (β = 0.51 for participation, β = 0.13 for further assessment participation), and the proportion of single-elderly-person households was most significantly negatively associated (β = −0.45 and −0.19, respectively). It is suggested that the health behaviors required for participation in colorectal cancer programs in Japanese elderly populations are greatly affected by family members. The disease burden of colorectal cancer is increasing in developed countries. An ecological study of the colorectal cancer screening program was conducted. The proportion of elderly people was positively associated with the screening rates. The single-elderly-person households was negatively associated with the screening rates.
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Affiliation(s)
- Noriaki Takahashi
- Division of Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Graduate School of Public Health, International University of Health and Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo, 107-8402, Japan
| | - Mutsuhiro Nakao
- Graduate School of Public Health, International University of Health and Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo, 107-8402, Japan.,Department of Psychosomatic Medicine, School of Medicine, International University of Health and Welfare, Hatakeda 852, Narita, Chiba, 286-8686, Japan
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Nunes MF, Leite AH, Dias SF. Inequalities in adherence to cervical cancer screening in Portugal. Eur J Cancer Prev 2021; 30:171-177. [PMID: 32732693 DOI: 10.1097/cej.0000000000000612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cervical cancer is the second cancer with the highest incidence and mortality in women aged 15-44 living in Europe. Screening is an effective strategy to reduce these rates, although in Portugal, as in other European countries, adherence to screening still presents significant disparities. Thus, this study aimed to assess the prevalence and factors associated with cervical cancer screening (CCS) nonadherence in Portugal. Cross-sectional data from 5929 women aged 25-64 included in the 2014 Portuguese National Health Survey (2014 NHS) were analyzed. The prevalence of CCS nonadherence was estimated. The association between multiple factors and CCS nonadherence was analyzed, using logistic regression, adjusting for age and educational level. The weighted prevalence of nonadherence was 13.2% [95% confidence interval (CI): 12.0-14.0]. Additionally, 10.5% of women had performed the last cervical cytology 3 years ago or more. Higher odds of nonadherence to screening were found for younger women, with low levels of education and income, unemployed, single, born outside Portugal, who never had a medical appointment or had over 12 months ago, who were never pregnant and who had never had a mammography. No association was found with other variables studied, including having public/private health insurance, BMI or smoking status. This study showed that inequalities in CCS adherence in Portugal persist. These findings reinforce the need for developing strategies to reduce inequalities in CCS adherence.
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Affiliation(s)
- Mariana F Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon
| | - Andreia H Leite
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde Amadora, Portugal
| | - Sónia F Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon
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DEGUARA MICHELLE, CALLEJA NEVILLE, ENGLAND KATHLEEN. Cervical cancer and screening: knowledge, awareness and attitudes of women in Malta. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 61:E584-E592. [PMID: 33628965 PMCID: PMC7888396 DOI: 10.15167/2421-4248/jpmh2020.61.4.1521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/12/2020] [Indexed: 11/23/2022]
Abstract
Objectives This study comes at an opportune time due to recent introduction of the National Cervical Cancer Screening programme in Malta. It aims to assess the knowledge of 25-64 year-old females on cervical cancer and attitudes towards screening. Study design A cross-sectional, telephone-based, quantitative survey conducted in 2017. Methods The survey tool was based on the Cervical Cancer Awareness Measure questionnaire and was carried out among a random stratified sample of females of 25-64 years, resident in Malta. Multivariate logistic regression models were applied. Results 407 females (85% response rate) were interviewed. Knowledge of cervical cancer risk factors and symptoms was found to be significantly higher in women with a higher level of education (p < 0.001). Cervical screening was attended every 3 years by 69% of respondents. Regular attendees were more likely to have children (p = 0.001), have experienced cancer in a close family member (p = 0.002), and were between 35-44 and 45-54 years old (p < 0.001). The main reasons for non-attendance were embarrassment, fear of the test and fear of the result. Conclusion This research provides a better understanding of who are the vulnerable groups with respect to cervical cancer knowledge and screening attendance. Improving health literacy and implementing health promotion campaigns will improve early symptom recognition, risk factor knowledge and attendance for screening.
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Affiliation(s)
- MICHELLE DEGUARA
- Correspondence: Michelle Deguara, Directorate Health Information and Research, 95, G’Mangia Hill, G’Mangia, Pieta, PTA 1313 - E-mail:
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Jolidon V, De Prez V, Willems B, Bracke P, Cullati S, Burton-Jeangros C. Never and under cervical cancer screening in Switzerland and Belgium: trends and inequalities. BMC Public Health 2020; 20:1517. [PMID: 33028278 PMCID: PMC7542418 DOI: 10.1186/s12889-020-09619-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/27/2020] [Indexed: 12/18/2022] Open
Abstract
Background Research on inequalities in cervical cancer screening (CCS) participation has overlooked the distinction between ‘never-’ and ‘under-screeners’ while different socioeconomic and demographic determinants may underlie ‘non-’ and ‘under-’ screening participation. This study examines socioeconomic and demographic inequalities in never and under CCS participation. We compare cross-national prevalence and trends among these two groups in Switzerland and Belgium, two countries with similar opportunistic CCS strategy but different healthcare systems. Methods Data on 38,806 women aged 20–70 from the Swiss Health Interview Survey (1992–2012) and 19,019 women aged 25–64 from the Belgian Health Interview Survey (1997–2013), both population-based cross-sectional nationally representative surveys, was analysed. Weighted adjusted prevalence ratios were estimated with multivariate Poisson regressions. Results Over the studied period, never screening prevalence was about 15% in both Switzerland and Belgium and under screening prevalence about 14.0%. Socioeconomic gradients were found among both never- and under-screeners. Higher income women had lower never and under screening prevalence in Switzerland and a similar gradient in education was observed in Belgium. Importantly, distinct socioeconomic and demographic determinants were found to underlie never and under screening participation. Never screening was significantly higher among foreign nationals in both countries and this association was not observed in under screening. Never screening prevalence was lower among older age groups, while under screening increased with older age. Over time, age inequalities diminished among never- and under- screeners in Switzerland while educational inequalities increased among never-screeners in Belgium. Conclusion Findings revealed that determinants of screening inequalities differed among never- and under-screeners and hence these should be addressed with different public health strategies. Crucially, socioeconomic and demographic inequalities were more pronounced among never-screeners who appeared to face more structural and persistent inequalities. Differences between the two countries should also be noted. The more liberal-type Swiss healthcare systems appeared to shape income-related screening inequalities, while education appeared to be a stronger determinant of never- and under-screening in Belgium.
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Affiliation(s)
- Vladimir Jolidon
- Institute of Sociological Research, University of Geneva, 40 Bd du Pont-d'Arve, 1211, Genève 4, Switzerland.
| | - Vincent De Prez
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| | - Barbara Willems
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| | - Piet Bracke
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| | - Stéphane Cullati
- Institute of Sociological Research, University of Geneva, 40 Bd du Pont-d'Arve, 1211, Genève 4, Switzerland.,Population Health Laboratory, University of Fribourg, Rte des Arsenaux 41, 1700, Fribourg, Switzerland
| | - Claudine Burton-Jeangros
- Institute of Sociological Research, University of Geneva, 40 Bd du Pont-d'Arve, 1211, Genève 4, Switzerland
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Rashidi Fakari F, Mohammadzadeh F, Rashidi Fakari F, Saei Ghare Naz M, Ozgoli G. The prediction of cervical cancer screening beliefs based on big five personality traits. Nurs Open 2020; 7:1173-1178. [PMID: 32587737 PMCID: PMC7308704 DOI: 10.1002/nop2.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/22/2020] [Accepted: 03/09/2020] [Indexed: 12/09/2022] Open
Abstract
Aim The present study was designed with the aim to predict Pap smear screening beliefs based on Big Five personality traits. Design The present cross-sectional study was conducted with 235 women over 18 years of age in Tehran (Iran) in 2018. Methods The data collection tools included the demographic information questionnaire, Pap Smear Belief Questionnaire (PSBQ) and the 10-item measure of the Big Five personality traits. Results People with Agreeableness personality trait were more faced with risks and Barriers and factors associated with Pap smear screening beliefs; and those with Conscientiousness personality trait were more faced with risks and Barriers. Results of the present study can help to understand how the personality affects decision-making and interactions. Therefore, consequences of counselling about screening beliefs and behavioural changes can be improved by personality-based education.
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Affiliation(s)
- Farzaneh Rashidi Fakari
- Student Research CommitteeDepartment of Reproductive HealthSchool of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Farnaz Mohammadzadeh
- Student Research CommitteeDepartment of Reproductive HealthSchool of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Fahimeh Rashidi Fakari
- Student Research CommitteeDepartment of Reproductive HealthSchool of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Marzieh Saei Ghare Naz
- Student Research CommitteeDepartment of Reproductive HealthSchool of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Giti Ozgoli
- Student Research CommitteeDepartment of Reproductive HealthSchool of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
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12
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Kind AB, Pavelyev A, Kothari S, El Mouaddin N, Schmidt A, Morais E, Guggisberg P, Lienert F. Assessing the epidemiological impact on cervical cancer of switching from 4-valent to 9-valent HPV vaccine within a gender-neutral vaccination programme in Switzerland. BMC Public Health 2020; 20:671. [PMID: 32398057 PMCID: PMC7216682 DOI: 10.1186/s12889-020-08840-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/03/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND An infection with high-risk human papillomavirus (HPV) is the obligatory aetiological factor for the development of cervical cancer. In Switzerland, the prevention strategy for cervical cancer is based on primary prevention via HPV vaccination and secondary prevention with an opportunistic screening programme for precancerous lesions. Vaccination is recommended to 11-26 years old male and female persons. The objective of the study was to assess the epidemiological impact on cervical cancer of switching from the currently implemented programme with the 4-valent vaccine to the 9-valent vaccine, in an 11-26 years old gender-neutral vaccination programme in Switzerland. METHODS A previously validated dynamic transmission model of HPV infections was adapted and calibrated to the Swiss setting assuming an 80% coverage rate in HPV-vaccination and lifelong vaccine type-specific protection. A gender-neutral vaccination programme (males and females) for 11-26 years old with a 9-valent HPV vaccine was compared with the current 11-26 years old gender-neutral 4-valent vaccination programme. Sensitivity analyses were conducted in order to test the impact of lower vaccination coverage rates and a shorter duration of protection on the model outcomes. RESULTS In Switzerland, a 9-valent gender-neutral vaccination programme would result in an additional prevention of 2979 cervical cancer cases, 13,862 CIN3 and 15,000 CIN2 cases, compared with the 4-valent gender-neutral vaccination programme over 100 years. These additional disease cases avoided would correspond to a 24, 36 and 48% cumulative incidence decrease in cervical cancer, CIN3 and CIN2 cases, respectively. It would also prevent additional 741 cervical cancer-related deaths over 100 years. A substantial additional reduction in cervical cancer and precancerous lesions burden is still observed when varying the vaccination coverage rate from 30 to 60% or reducing the duration of protection from lifelong to 20 years. CONCLUSIONS The switch to the 9-valent vaccine in Switzerland to prevent cervical diseases showed an important contribution in terms of public health impact compared with the 4-valent vaccine in an 11-26 years old gender-neutral population, even with very conservative assumptions such as low coverage rates or low duration of protection and limiting analysis to only cervical disease.
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Affiliation(s)
- André B Kind
- Department of Gynaecology and Gynaecological Oncology, University Hospital Basel, Spitalstrasse 21, CH-4056, Basel, Switzerland
| | - Andrew Pavelyev
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc, Kenilworth, NJ, 07033, USA.,HCL America, Inc., Sunnyvale, CA, USA
| | - Smita Kothari
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc, Kenilworth, NJ, 07033, USA
| | | | | | - Edith Morais
- Outcomes Research, MSD, 162 Avenue Jean Jaurès, 69007, Lyon, France
| | | | - Florian Lienert
- Medical Affairs, MSD, Werftestrasse 4, CH-6005, Luzern, Switzerland.
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13
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Malone C, Barnabas RV, Buist DSM, Tiro JA, Winer RL. Cost-effectiveness studies of HPV self-sampling: A systematic review. Prev Med 2020; 132:105953. [PMID: 31911163 PMCID: PMC7219564 DOI: 10.1016/j.ypmed.2019.105953] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023]
Abstract
HPV self-sampling (HPV-SS) can increase cervical cancer screening participation by addressing barriers in high- and low- and middle-income settings. Successful implementation of HPV-SS programs will depend on understanding potential costs and health effects. Our objectives were to summarize the methods and results of published HPV-SS cost and cost-effectiveness studies, present implications of these results for HPV-SS program implementation, and identify knowledge gaps. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. One reviewer searched online databases for articles published through June 12, 2019, identified eligible studies, and extracted data; a second reviewer checked extracted data for accuracy. Eligible studies used an economic model to compare HPV-SS outreach strategies to standard-of-care tests. Of 16 eligible studies, 14 reported HPV-SS could be a cost-effective strategy. Studies differed in model type, HPV-SS delivery methods, triage strategies for positive results, and target populations. Most (9/16) modeled HPV-SS in European screening programs, 6/16 targeted women who were underscreened for cervical cancer, and 5/16 modeled HPV-SS in low- and middle-income countries. The most commonly identified driver of HPV-SS cost-effectiveness was the level of increase in cervical cancer screening attendance. Lower HPV-SS material and testing costs, higher sensitivity to detect cervical precancer, and longer duration of underscreening among HPV-SS users were also associated with increased cost-effectiveness. Future HPV-SS models in high-income settings should explore the effect of widespread vaccination and new triage strategies such as partial HPV genotyping. Knowledge gaps remain about the cost-effectiveness of HPV-SS in low- and middle-income settings.
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Affiliation(s)
- Colin Malone
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104, USA.
| | - Ruanne V Barnabas
- Department of Global Health, University of Washington, Box 359931, 325 9th Ave, Seattle, WA 98104, USA.
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute,1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104, USA; Kaiser Permanente Washington Health Research Institute,1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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14
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Bielska-Lasota M, Rossi S, Krzyżak M, Haelens A, Domenic A, De Angelis R, Maciejczyk A, Rodríguez-Barranco M, Zadnik V, Minicozzi P. Reasons for low cervical cancer survival in new accession European Union countries: a EUROCARE-5 study. Arch Gynecol Obstet 2019; 301:591-602. [PMID: 31853712 DOI: 10.1007/s00404-019-05412-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE With better access to early diagnosis and appropriate treatment, cervical cancer (CC) burden decreased in several European countries. In Eastern European (EE) countries, which accessed European Union in 2004, CC survival was worse than in the rest of Europe. The present study investigates CC survival differences across five European regions, considering stage at diagnosis (local, regional and metastatic), morphology (mainly squamous versus glandular tumours) and patients' age. METHODS We analysed 101,714 CC women diagnosed in 2000-2007 and followed-up to December 2008. Age-standardised 5-year relative survival (RS) and the excess risks of cancer death in the 5 years after diagnosis were computed. RESULTS EE women were older and less commonly diagnosed with glandular tumours. Proportions of local stage cancers were similar across Europe, while morphology- and stage-specific RS (especially for non-metastatic disease) were lower in Eastern Europe. Adjusting for age and morphology, excess risk of local stage CC death for EE patients remained higher than that for other European women. CONCLUSION Stage, age and morphology alone do not explain worse survival in Eastern Europe: less effective care may play a role, probably partly due to fewer or inadequate resources being allocated to health care in this area, compared to the rest of Europe.
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Affiliation(s)
- Magdalena Bielska-Lasota
- Department of Health Promotion and Chronic Diseases Prevention, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore Di Sanità, Rome, Italy
| | - Michalina Krzyżak
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, Bialystok, Poland
| | - Annemie Haelens
- Research Department, Belgian Cancer Registry, Brussels, Belgium
| | | | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore Di Sanità, Rome, Italy
| | | | - Miguel Rodríguez-Barranco
- Andalusian School of Public Health, Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain.,Centro de Investigación Biomédica en Red de Epidemiologia Y Salud Pública (CIBERESP), Madrid, Spain
| | - Vesna Zadnik
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. .,Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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15
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Jeannot E, Viviano M, Follonier MC, Kaech C, Oberhauser N, Mpinga EK, Vassilakos P, Kaiser B, Petignat P. Human Papillomavirus Infection and Vaccination: Knowledge, Attitude and Perception among Undergraduate Men and Women Healthcare University Students in Switzerland. Vaccines (Basel) 2019; 7:vaccines7040130. [PMID: 31561629 PMCID: PMC6963720 DOI: 10.3390/vaccines7040130] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/13/2019] [Accepted: 09/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Human Papillomavirus is a common sexually transmitted infection, representing the main cause of genital warts and cervical cancer. The objective of this study was to evaluate basic knowledge and beliefs regarding HPV infection and HPV vaccine among undergraduate healthcare men and women students, as well as their attitudes towards HPV vaccine. Methods: Undergraduate women and men (nursing and midwifery curses) attending three Schools of Health Sciences located in Switzerland. A total of 427 women and 223 men have completed the web questionnaire, which included questions on their socio-demographic background and about basic knowledge and attitudes toward the HPV infection and vaccination. Results: Women undergraduate students have a better knowledge of HPV infection than their men counterparts, although there was a significant gap in knowledge of the disease’s mode of transmission and prevention. Among women, 72.6% of respondents reported having received at least one dose of HPV vaccines versus 31.4% for men respondents. Conclusion: The results of this study revealed a poor understanding among undergraduate healthcare men and women students about the HPV infection, its mode of transmission and its prevention. Our findings highlight the need to improve education on HPV for undergraduate healthcare students in order to increase the awareness of the disease.
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Affiliation(s)
- Emilien Jeannot
- Faculty of Medicine, Institute of Global Health, Chemin de Mines 9, 1202 Geneva, Switzerland.
- Community Psychiatric Service, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland.
| | - Manuela Viviano
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland.
| | | | - Christelle Kaech
- School of Health Sciences (HESAV), 1011 Lausanne, Vaud, Switzerland.
| | - Nadine Oberhauser
- School of Health Sciences (HESAV), 1011 Lausanne, Vaud, Switzerland.
| | | | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Route de Ferney 150, 1211 Geneva, Switzerland.
| | - Barbara Kaiser
- University of Applied Sciences Western Switzerland, 2800 Délémont, Switzerland.
| | - Patrick Petignat
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland.
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16
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Remund A, Cullati S, Sieber S, Burton-Jeangros C, Oris M. Longer and healthier lives for all? Successes and failures of a universal consumer-driven healthcare system, Switzerland, 1990-2014. Int J Public Health 2019; 64:1173-1181. [PMID: 31473783 PMCID: PMC6811388 DOI: 10.1007/s00038-019-01290-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 08/07/2019] [Accepted: 08/23/2019] [Indexed: 11/28/2022] Open
Abstract
Objectives The ability to translate increases in life expectancy into additional years in good health is a crucial challenge for public health policies. We question the success of these policies in Switzerland, a forerunner of longevity, through the evolution of healthy life expectancy (HLE) across socioeconomic groups. Methods Education-specific HLE conditioning on surviving to age 30 was computed for 5-year periods from the Swiss National Cohort, a mortality follow-up of the entire resident population, and the Swiss Health Interview Survey, reporting self-rated health. We compare time trends and decompose them into health, mortality and education components. Results Between 1990 and 2015, comparable gains in LE (males: 5.02 years; females: 3.09 years) and HLE (males: 4.52 years; females: 3.09 years) were observed. People with compulsory education, however, experienced morbidity expansion, while those with middle and high education experienced morbidity compression. Conclusions Divergence of morbid years by educational levels may reflect unequal access to preventive care due to high out-of-pockets contributions in the healthcare system. This growing gap and the exhaustion of the educational dividend jeopardize future increases in HLE. Electronic supplementary material The online version of this article (10.1007/s00038-019-01290-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Remund
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland.
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9747AD, Groningen, The Netherlands.
| | - S Cullati
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - S Sieber
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland
| | - C Burton-Jeangros
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - M Oris
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland
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17
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Amadane M, de Pree C, Viviano M, Vassilakos P, Jeannot E, Petignat P. Characteristics of HPV-unvaccinated undergraduate health students in Switzerland, a cross sectional study. ACTA ACUST UNITED AC 2019; 77:29. [PMID: 31236272 PMCID: PMC6580451 DOI: 10.1186/s13690-019-0348-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/16/2019] [Indexed: 01/27/2023]
Abstract
Background Human Papillomavirus (HPV) vaccination, intended for young women aged 11-14 years old, has been introduced in Switzerland in 2007. Ten years after its introduction, only a few studies have explored the reasons associated with uptake and non-uptake of the vaccination. Our objective was to identify the sociodemographic characteristics of a population of vaccinated and unvaccinated undergraduate healthcare female students, to define the reasons of non-uptake of vaccination, and compare our findings with those found in other Swiss cantons. Methods Between January and November 2017, women studying in Health Sciences School and Medical School in Geneva, aged 18-31 years old, were recruited in a large trial assessing HPV prevalence. As part of a smaller, observational study nested in this larger trial, women were invited to complete a questionnaire. Self-reported HPV vaccination uptake or non-uptake, as well as knowledge and attitude about HPV vaccination were assessed. T-Test and Chi square test were used to compare characteristics of vaccinated and unvaccinated women. Results Overall, 409 women were recruited in the study. The majority of them (69.1%) reported having been vaccinated for HPV, while 30.9% of them had never received any dose of the HPV vaccine. The only factor associated with a higher vaccination rate was the participants' origin, as women from Geneva were more represented in the vaccinated group than women from other Swiss regions or countries. Unvaccinated women were more likely to consider HPV vaccination as less important than the vaccinated ones (50.4% vs 3.5% p < 0.001). Conclusion Although no typical profile can be established in this studied population of unvaccinated women, a lack of information was a major reason of non-uptake of vaccination among the study participants. An effort by health authorities and carefully designed messages are essential to increase the population's awareness over cervical cancer and its prevention. Trial registration The trial was registered under cliniclatrials.gov with the identifier: NCT03474211.
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Affiliation(s)
- Mona Amadane
- 1Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, Geneva, 1206 Switzerland
| | - Charlotte de Pree
- 1Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, Geneva, 1206 Switzerland
| | - Manuela Viviano
- 2Gynecologic Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Route de Ferney 150, 1211 Geneva 2, Switzerland
| | - Emilien Jeannot
- Institute of Global Health - Faculty of Medicine, Chemin de Mines 9, 1202 Geneva, Switzerland.,5Community Psychiatry Service, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Patrick Petignat
- 2Gynecologic Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland
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18
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Egli-Gany D, Spaar Zographos A, Diebold J, Masserey Spicher V, Frey Tirri B, Heusser R, Dillner J, Petignat P, Sahli R, Low N. Human papillomavirus genotype distribution and socio-behavioural characteristics in women with cervical pre-cancer and cancer at the start of a human papillomavirus vaccination programme: the CIN3+ plus study. BMC Cancer 2019; 19:111. [PMID: 30700274 PMCID: PMC6354352 DOI: 10.1186/s12885-018-5248-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/26/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The Swiss Federal Office of Public Health has recommended vaccination against human papillomavirus (HPV) to prevent cervical cancer since 2008. To establish monitoring of the future public health impact of vaccination, baseline population-based data are required. The objectives of this study were to examine the distribution of oncogenic HPV genotypes in biopsies with cervical intraepithelial neoplasia stage 3 or more severe lesions (CIN3+) at the beginning of HPV vaccination programmes and to compare sociodemographic and behavioural factors of women with CIN3+ with women in the Swiss general population. METHODS We conducted a retrospective and prospective cross-sectional study with women diagnosed with CIN3+ in Switzerland. Ten pathology institutes from six cantons and three language regions participated. We conducted HPV typing on formaldehyde fixed-paraffin embedded specimens from 2014 and 2015. Women enrolled in 2015 were asked to complete a questionnaire. We described frequencies of HPV types. We also compared demographic characteristics and socioeconomic status in the CIN3 + plus group with the Swiss National Cohort in 2014 and compared risk factors for HPV infection with the Swiss Health Survey in 2012. RESULTS We included 768 biopsies from 767 women. Four hundred and seventy-five (61.8%) biopsies were positive for HPV 16 and/or 18, 687 (89.5%) were positive for oncogenic HPV genotypes 16, 18, 31, 33, 45, 52, and/or 58 and five (0.7%) were HPV negative. Twenty-eight (10.3%) of the 273 women who completed the patient questionnaire reported having received at least one dose of an HPV vaccine. When compared with Swiss women in the six study cantons, fewer women in the CIN3+ plus study group were of Swiss nationality, more were born abroad and more were single. The study group also had a higher proportion of women with ≥2 partners in the last year, current smokers and was younger at age of first sexual intercourse. CONCLUSIONS Introduction of the nonavalent vaccine could cover approximately 90% of CIN3+ lesions in Swiss women compared with around 60% with the quadrivalent vaccine. Surveillance of HPV genotype distribution in CIN3+, together with information about vaccination and CIN3+ incidence will allow monitoring of the public health impact of vaccination programmes. TRIAL REGISTRATION ClinicalTrials.gov, NCT02323997 . Registered 24 December 2014.
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Affiliation(s)
- Dianne Egli-Gany
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Anne Spaar Zographos
- Federal Office of Public Health, Schwarzenburgstrasse 157, 3003 Bern, Switzerland
| | - Joachim Diebold
- Institute of Pathology, Cantonal Hospital Lucerne, Spitalstrasse, 6000 Luzern 16, Switzerland
| | | | - Brigitte Frey Tirri
- Department of Gynaecology and Obstetrics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Rolf Heusser
- National Institute for Cancer Epidemiology and Registration, Hirschengraben 82, 8001 Zurich, Switzerland
| | - Joakim Dillner
- WHO HPV LabNet Global Reference Laboratory, Department of Clinical Microbiology, Center for Cervical Cancer Prevention, Skåne University Hospital, Malmö, Karolinska Institute and Hospital, SE-171, 77 Stockholm, Sweden
| | - Patrick Petignat
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Genève, Switzerland
| | - Roland Sahli
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 48, 1011 Lausanne, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
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19
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Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing. Viruses 2018; 10:v10120729. [PMID: 30572620 PMCID: PMC6315375 DOI: 10.3390/v10120729] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 12/25/2022] Open
Abstract
Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.
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Son YJ, Kim SH, Kim GY, Son H. Associations between Health Literacy, Cancer-Related Knowledge, and Preventive Health Behaviors in Community-Dwelling Korean Adults. JOURNAL OF HEALTH COMMUNICATION 2017; 22:999-1006. [PMID: 29206573 DOI: 10.1080/10810730.2017.1401687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This cross-sectional study aimed to examine the association between health literacy, cancer-related knowledge, and preventive health behaviors among community-dwelling adults in Korea. Data were collected from 542 adults aged ≥ 18 years living in five big provinces in Korea (Seoul, Gyeonggi-do, Gyeongsang-do, Chungcheong-do, and Gangwon-do). Socio-demographic and health-related characteristics were determined using structured questionnaires. Health literacy, cancer-related knowledge, and engagement in preventive health behaviors were measured using validated instruments. These three variables differed according to socio-demographic and health-related characteristics, such as education, sex, age, and marital status. In the hierarchical regression analysis, health literacy (β = 0.26, p < .001) and cancer-related knowledge (β = 0.21, p < .001) were significant predictors of preventive health behavior after adjusting for confounding variables. Cancer-related knowledge partially mediated the effect of health literacy on preventive health behaviors. Health literacy can play a key role in cancer prevention. It is important for healthcare providers to know how to deliver cancer-related knowledge and how to help people with low health literacy to engage in preventive health behaviors, using a variety of health information resources. Further research is needed to develop the instruments to assess comprehension of spoken and written health messages for cancer prevention and screening.
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Affiliation(s)
- Youn-Jung Son
- a Red Cross College of Nursing , Chung-Ang University, Seoul, Korea
| | - Sun-Hee Kim
- b College of Nursing , Korea University, Seoul, Korea
| | - Gi Yon Kim
- c Department of Nursing , Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Heesook Son
- a Red Cross College of Nursing , Chung-Ang University, Seoul, Korea
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21
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Viviano M, Catarino R, Jeannot E, Boulvain M, Malinverno MU, Vassilakos P, Petignat P. Self-sampling to improve cervical cancer screening coverage in Switzerland: a randomised controlled trial. Br J Cancer 2017; 116:1382-1388. [PMID: 28427086 PMCID: PMC5520090 DOI: 10.1038/bjc.2017.111] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/17/2017] [Accepted: 03/30/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate whether self-sampling can increase screening attendance of women who do not attend regular screening in Switzerland. METHODS Participants were proactively recruited in Geneva between September 2011 and November 2015. Women (25-69 years) who had not undergone CC screening in the last 3 years were considered eligible. Through a 1 : 1 ratio randomisation, enrolled participants were invited to either undergo liquid-based cytology, which was performed by a health-care provider (control group, CG) or to take a self-sample for HPV-testing, which was mailed to their home (intervention group, IG). RESULTS A total of 331 and 336 women were randomised in the CG and in the IG, respectively. Overall, 7.3% (95% CI: 4.9-10.6) women in the CG and 5.7% (95% CI: 3.6-8.7) women in the IG did not undergo the initial screening (P=0.400). There were 1.95% (95% CI: 0.8-4.3) women in the CG and 5.05% (95% CI: 3.1-8.1) women in the IG with a positive screen who did not attend triage and colposcopy (P=0.036). CONCLUSIONS The participation in CC screening in women offered self-sampling was not higher than among those offered specimen collection by a clinician. Compliance with further follow-up for women with a positive HPV test on the self-sample requires further attention.
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Affiliation(s)
- Manuela Viviano
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1205, Switzerland
| | - Rosa Catarino
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1205, Switzerland
| | - Emilien Jeannot
- Institute of Global Health-Faculty of Medicine, Chemin de Mines 9, Geneva 1202, Switzerland.,School of Health Sciences, University of Applied Sciences and Arts of Western Switzerland, Avenue de Champel 47, Geneva 1206, Switzerland
| | - Michel Boulvain
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1205, Switzerland
| | - Manuela Undurraga Malinverno
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1205, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Route de Ferney 150, Geneva 1211, Switzerland
| | - Patrick Petignat
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1205, Switzerland
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Abstract
Zusammenfassung. Die neusten Erkenntnisse zu der Pathogenese des Zervixkarzinoms führten zu Anpassungen in der zytologischen und histologischen Nomenklatur seiner Vorstufen. Die aktuelle, 2014 eingeführte histologische WHO-Terminologie unterscheidet, analog zum zytologischen Bethesda-System, zwischen zwei histologischen Stufen der HPV-bedingten Veränderungen: LSIL und HSIL, die mit unterschiedlichen Risiken der Progredienz zum invasiven Karzinom einhergehen und klinisch entsprechend unterschiedlich gehandhabt werden sollen. Die immunhistochemische Detektion des p16-Proteins als Surrogat der neoplastischen Transformation der HPV-infizierten Zellen hilft, die rein mikroskopische Diagnose zu objektivieren und zu sichern, und ist ein wichtiges Hilfsmittel in der Histopathologie. Die Verfügbarkeit der HPV-Impfung und die HPV-Detektion werden in den kommenden Jahren die Abläufe in der Frühentdeckung und die Epidemiologie der Zervixkarzinom-Vorstufen beeinflussen.
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Affiliation(s)
| | - Rosmarie Caduff
- 1 Institut für Pathologie und Molakularpathologie, Universitätsspital Zürich
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