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Kelley-Jones C, Scott SE, Waller J. Acceptability of de-intensified screening for women at low risk of breast cancer: a randomised online experimental survey. BMC Cancer 2024; 24:1111. [PMID: 39243000 PMCID: PMC11378402 DOI: 10.1186/s12885-024-12847-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: 03/14/2024] [Accepted: 08/23/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Risk-stratified approaches to breast screening show promise for increasing benefits and reducing harms. But the successful implementation of such an approach will rely on public acceptability. To date, research suggests that while increased screening for women at high risk will be acceptable, any de-intensification of screening for low-risk groups may be met with less enthusiasm. We report findings from a population-based survey of women in England, approaching the age of eligibility for breast screening, to compare the acceptability of current age-based screening with two hypothetical risk-adapted approaches for women at low risk of breast cancer. METHODS An online survey of 1,579 women aged 40-49 with no personal experience of breast cancer or mammography. Participants were recruited via a market research panel, using target quotas for educational attainment and ethnic group, and were randomised to view information about (1) standard NHS age-based screening; (2) a later screening start age for low-risk women; or (3) a longer screening interval for low-risk women. Primary outcomes were cognitive, emotional, and global acceptability. ANOVAs and multiple regression were used to compare acceptability between groups and explore demographic and psychosocial factors associated with acceptability. RESULTS All three screening approaches were judged to be acceptable on the single-item measure of global acceptability (mean score > 3 on a 5-point scale). Scores for all three measures of acceptability were significantly lower for the risk-adapted scenarios than for age-based screening. There were no differences between the two risk-adapted scenarios. In multivariable analysis, higher breast cancer knowledge was positively associated with cognitive and emotional acceptability of screening approach. Willingness to undergo personal risk assessment was not associated with experimental group. CONCLUSION We found no difference in the acceptability of later start age vs. longer screening intervals for women at low risk of breast cancer in a large sample of women who were screening naïve. Although acceptability of both risk-adapted scenarios was lower than for standard age-based screening, overall acceptability was reasonable. The positive associations between knowledge and both cognitive and emotional acceptability suggests clear and reassuring communication about the rationale for de-intensified screening may enhance acceptability.
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Affiliation(s)
- Charlotte Kelley-Jones
- Cancer Prevention Group, Faculty of Life Sciences & Medicine, King's College London, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK.
- c/o Professor J. Waller, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Suzanne E Scott
- Cancer Prevention Group, Faculty of Life Sciences & Medicine, King's College London, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK
- Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Jo Waller
- Cancer Prevention Group, Faculty of Life Sciences & Medicine, King's College London, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK
- Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
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LA Dunlop K, Smit AK, Keogh LA, Newson AJ, Rankin NM, Cust AE. Acceptability of risk-tailored cancer screening among Australian GPs: a qualitative study. Br J Gen Pract 2024; 74:e156-e164. [PMID: 38373853 PMCID: PMC10904141 DOI: 10.3399/bjgp.2023.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/22/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Cancer screening that is tailored to individual risk has the potential to improve health outcomes and reduce screening-related harms, if implemented well. However, successful implementation depends on acceptability, particularly as this approach will require GPs to change their practice. AIM To explore Australian GPs' views about the acceptability of risk-tailored screening across cancer types and to identify barriers to and facilitators of implementation. DESIGN AND SETTING A qualitative study using semi-structured interviews with Australian GPs. METHOD Interviews were carried out with GPs and audio-recorded and transcribed. Data were first analysed inductively then deductively using an implementation framework. RESULTS Participants (n = 20) found risk-tailored screening to be acceptable in principle, recognising potential benefits in offering enhanced screening to those at highest risk. However, they had significant concerns that changes in screening advice could potentially cause confusion. They also reported that a reduced screening frequency or exclusion from a screening programme for those deemed low risk may not initially be acceptable, especially for common cancers with minimally invasive screening. Other reservations about implementing risk-tailored screening in general practice included a lack of high-quality evidence of benefit, fear of missing the signs or symptoms of a patient's cancer, and inadequate time with patients. While no single preferred approach to professional education was identified, education around communicating screening results and risk stratification was considered important. CONCLUSION GPs may not currently be convinced of the net benefits of risk-tailored screening. Development of accessible evidence-based guidelines, professional education, risk calculators, and targeted public messages will increase its feasibility in general practice.
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Affiliation(s)
- Kate LA Dunlop
- The Daffodil Centre, a joint venture with Cancer Council NSW and Melanoma Institute Australia, University of Sydney, Sydney
| | - Amelia K Smit
- The Daffodil Centre, a joint venture with Cancer Council NSW and Melanoma Institute Australia, University of Sydney, Sydney
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, University of Sydney, Sydney
| | - Nicole M Rankin
- Evaluation and Implementation Science Unit, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
| | - Anne E Cust
- The Daffodil Centre, a joint venture with Cancer Council NSW and Melanoma Institute Australia, University of Sydney, Sydney
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Taylor EV, Dugdale S, Connors CM, Garvey G, Thompson SC. "A Huge Gap": Health Care Provider Perspectives on Cancer Screening for Aboriginal and Torres Strait Islander People in the Northern Territory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:141. [PMID: 38397632 PMCID: PMC10887611 DOI: 10.3390/ijerph21020141] [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] [Received: 12/19/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Cancer is one of the leading causes of death for Aboriginal and Torres Strait Islander people in the Northern Territory (NT). Accessible and culturally appropriate cancer screening programs are a vital component in reducing the burden of cancer. Primary health care plays a pivotal role in facilitating the uptake of cancer screening in the NT, due to the significant challenges caused by large distances, limited resources, and cultural differences. This paper analyses health care provider perspectives and approaches to the provision of cancer screening to Aboriginal people in the NT that were collected as part of a larger study. Semi-structured interviews were conducted with 50 staff from 15 health services, including 8 regional, remote, and very remote primary health care (PHC) clinics, 3 hospitals, a cancer centre, and 3 cancer support services. Transcripts were thematically analysed. Cancer screening by remote and very remote PHC clinics in the NT is variable, with some staff seeing cancer screening as a "huge gap", while others see it as lower priority compared to other conditions due to a lack of resourcing and the overwhelming burden of acute and chronic disease. Conversely, some clinics see screening as an area where they are performing well, with systematic screening, targeted programs, and high screening rates. There was a large variation in perceptions of the breast screening and cervical screening programs. However, participants universally reported that the bowel screening kit was complicated and not culturally appropriate for their Aboriginal patients, which led to low uptake. System-level improvements are required, including increased funding and resourcing for screening programs, and for PHC clinics in the NT. Being appropriately resourced would assist PHC clinics to incorporate a greater emphasis on cancer screening into adult health checks and would support PHCs to work with local communities to co-design targeted cancer screening programs and culturally relevant education activities. Addressing these issues are vital for NT PHC clinics to address the existing cancer screening gaps and achieving the Australian Government pledge to be the first nation in the world to eliminate cervical cancer as a public health problem by 2035. The implementation of the National Lung Cancer Screening Program in 2025 also presents an opportunity to deliver greater benefits to Aboriginal communities and reduce the cancer burden.
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Affiliation(s)
- Emma V Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia
| | - Sarah Dugdale
- Health Statistics and Informatics, NT Health, Darwin, NT 0800, Australia
| | | | - Gail Garvey
- The School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia
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4
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Swanson AA, Pantanowitz L. The evolution of cervical cancer screening. J Am Soc Cytopathol 2024; 13:10-15. [PMID: 37865567 DOI: 10.1016/j.jasc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/23/2023]
Abstract
There are few medical success stories in history as significant as the reduction in cervical cancer incidence. Through the collaborative efforts of dedicated scientific pioneers, the past century has witnessed remarkable advancement that began with the detection of exfoliated cancer cells through cytologic examination to widespread implementation of cervical cancer screening programs to the discovery of the link between cervical cancer and human papillomavirus (HPV). Current screening methods apply HPV-based testing, and artificial intelligence-based screening systems utilizing digitalized cytology images are being used in a continuous effort to optimize the accuracy and efficiency of the Papanicolaou test. This review summarizes the major milestones in cervical cancer screening history to emphasize its evolution as the World Health Organization aims for the global elimination of cervical cancer.
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Affiliation(s)
- Amy A Swanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota.
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Chen CC, Lai CH, Chang CL, Cheng WF, Pwu RF, Tsai J, Wang PH, Whang-Peng J, Lai GM. Managing the transition in cervical screening methods for Taiwan: Policy recommendations and perspectives. J Formos Med Assoc 2023; 122:1213-1218. [PMID: 37451959 DOI: 10.1016/j.jfma.2023.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
Since government-provided annual cervical cytology testing for all Taiwanese women aged 30 years or older became available in 1995, both cervical cancer incidence and death have decreased significantly. However, with the 2018 introduction of the national immunization program for human papillomavirus (HPV) vaccination in all schoolgirls aged 13-15 years old, the positive predictive value of cytology testing is expected to decrease with rising vaccination rates, and therefore a transition to more sensitive HPV-based testing may be needed. This position paper, derived from discussions by a panel of experts in cervical cancer screening, provides short-, medium-, and long-term policy recommendations to manage the transition between cervical screening methods for Taiwan. The recommendations include concrete suggestions regarding testing procedures, standards, accreditation, monitoring, promotion, and implementation. It is hoped that comprehensive preparation and management of this transition will enable Taiwan to repeat the previous successes of the cervical cytology testing program.
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Affiliation(s)
- Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, 600, Taiwan; Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, 717, Taiwan; Ph.D. Program in Translational Medicine, Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, 402, Taiwan; Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, 701, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan; Chang Gung University, Taoyuan, 333, Taiwan
| | - Chih-Long Chang
- Department of Medicine, MacKay Medical College, New Taipei City, 252 Taiwan; Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, 104, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Raoh-Fang Pwu
- School of Health Care Administration, Taipei Medical University, Taipei, 110, Taiwan; Data Science Center, Fu Jen Catholic University, New Taipei City, 242, Taiwan
| | - Jane Tsai
- Formosa Cancer Foundation, Taipei, 105, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, 112, Taiwan; National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | | | - Gi-Ming Lai
- Formosa Cancer Foundation, Taipei, 105, Taiwan.
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Bavor C, Brotherton JM, Smith MA, Prang KH, McDermott T, Rankin NM, Zammit CM, Jennett CJ, Sultana F, Machalek DA, Nightingale CE. The early impacts of primary HPV cervical screening implementation in Australia on the pathology sector: a qualitative study. BMC Health Serv Res 2023; 23:1073. [PMID: 37803335 PMCID: PMC10559573 DOI: 10.1186/s12913-023-10040-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The transition of Australia's National Cervical Screening Program from cytology to a molecular test for human papillomavirus (HPV) (locally referred to as the 'Renewal'), including a longer five-year interval and older age at commencement, significantly impacted all sectors of program delivery. The Renewal had major implications for the roles and requirements of pathology laboratories providing services for the Program. This study aimed to understand the early impacts of the Renewal and its implementation on the pathology sector. METHODS Semi-structured qualitative interviews were conducted with key stakeholders (N = 49) involved in the STakeholder Opinions of Renewal Implementation and Experiences Study (STORIES), 11-20 months after the program transition. A subset of interviews (N = 24) that discussed the pathology sector were analysed using inductive thematic analysis. RESULTS Four overarching themes were identified: implementation enablers, challenges, missed opportunities, and possible improvements. Participants believed that the decision to transition to primary HPV screening was highly acceptable and evidence-based, but faced challenges due to impacts on laboratory infrastructure, resources, staffing, and finances. These challenges were compounded by unfamiliarity with new information technology (IT) systems and the new National Cancer Screening Register ('Register') not being fully functional by the date of the program transition. The limited availability of self-collection and lack of standardised fields in pathology forms were identified as missed opportunities to improve equity in the Program. To improve implementation processes, participants suggested increased pathology sector involvement in planning was needed, along with more timely and transparent communication from the Government, and clearer clinical management guidelines. CONCLUSION The transition to primary HPV screening had a significant and multifaceted impact on the Australian pathology sector reflecting the magnitude and complexity of the Renewal. Strategies to support the pathology sector through effective change management, clear, timely, and transparent communication, as well as adequate funding sources will be critical for other countries planning to transition cervical screening programs.
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Affiliation(s)
- Claire Bavor
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Julia Ml Brotherton
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
- Formerly employed by the Australian Centre for the Prevention of Cervical Cancer, Carlton, VIC, 3053, Australia
| | - Megan A Smith
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW and the University of Sydney, Sydney, NSW, 2011, Australia
| | - Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Tracey McDermott
- Formerly employed by the Australian Centre for the Prevention of Cervical Cancer, Carlton, VIC, 3053, Australia
| | - Nicole M Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Claire M Zammit
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Chloe J Jennett
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW and the University of Sydney, Sydney, NSW, 2011, Australia
| | - Farhana Sultana
- National Cancer Screening Register, Telstra Health, Melbourne, VIC, 3000, Australia
| | - Dorothy A Machalek
- The Kirby Institute, University of New South Wales, Kensington, Sydney, NSW, 2052, Australia
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, 3052, Australia
| | - Claire E Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
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Haarsager J, Legerton P, DeBats C, Austin G, Vardon P. Perceptions and implications for cervical screening and self-collection: A qualitative exploration of never and under-screened Queensland women. Health Promot J Austr 2023; 34:943-952. [PMID: 36828787 DOI: 10.1002/hpja.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Over 70% of cervical cancers are detected in women not currently screening. Queensland Health wanted to better understand the drivers of screening to inform our planning and capitalise on self-collection as an option to reach under-screened women. In 2020 Queensland Health commissioned qualitative research to explore barriers and enablers to cervical screening with never-screened and under-screened women in Queensland (with under-screeners defined as having last screened more than 4 years ago and being more than 2 years overdue). Additionally, the research explored the acceptability of self-collection amongst this cohort. METHODS A mixed methods qualitative approach of online focus groups and in-depth interviews was employed. Online focus groups were conducted with under-screeners. In-depth telephone interviews were conducted with never-screeners due to the anticipated personal nature of their reasons for not screening. RESULTS A total of 51 Queensland women aged 30 to 50 years participated in the research. CONCLUSIONS Queensland women cited several negative experiences and aspects of the current program, as well as barriers in their social and personal lives that limited screening intention and behaviour. Barriers and enablers to cervical screening identified in this research have been classified into four categories: structural, knowledge and attitudinal, social, and personal. The research identified more factors associated with nonparticipation than participation. However, the research did uncover a range of potential enablers to encourage screening, some of which related to the program design. SO WHAT?: The concept of self-collection was broadly well accepted by research participants, particularly by never-screeners. Recommendations resulting from this research include communications, systems, and eligibility changes, particularly regarding the availability and benefits of self-collection.
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Affiliation(s)
- Jennie Haarsager
- Queensland Health, Cancer Screening Branch, Herston, Queensland, Australia
| | - Paula Legerton
- Queensland Health, Cancer Screening Branch, Herston, Queensland, Australia
| | - Claire DeBats
- Queensland Health, Cancer Screening Branch, Herston, Queensland, Australia
| | - Glenn Austin
- Queensland Health, Cancer Screening Branch, Herston, Queensland, Australia
| | - Paul Vardon
- Queensland Health, Cancer Screening Branch, Herston, Queensland, Australia
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Gosbell E, Panambalana A, Stephenson A, Vici C, Dutton T, Bailey J. Awareness and attitudes towards the revised National Cervical Screening Program amongst women in rural New South Wales: a cross-sectional study. Aust J Prim Health 2023; 29:471-479. [PMID: 37037661 DOI: 10.1071/py22267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/06/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Research exploring awareness and attitudes towards the revised National Cervical Screening Program (NCSP) amongst rural Australian women is limited. Given the increased incidence and mortality from cervical cancer in rural Australian women, this gap needs attention. This study examined awareness and attitudes of women in rural New South Wales (NSW) towards the revised NCSP. METHODS A cross-sectional survey was conducted with women aged 18-74years currently residing in the Western NSW Primary Health Network region. The anonymous survey was distributed online via social media and email to eligible women. RESULTS In total, 309 rural women participated. The majority were 30-39years old (35.9%) and had completed tertiary education (73.1%), figures which are higher than average for this rural region. Of these, 51.8% (160/309) were aware there had been a change to the NCSP. This information most commonly came from their healthcare provider (57.5%; 82/160). Three-quarters reported being happy or neutral with the change (76.1%; 235/309). Those who were aware of the revised NCSP were more likely to have a positive attitude toward it (P =0.02). Fewer participants reported that they were never/unlikely to participate in screening under the revised NCSP (4.8%, 9/309) as compared to the previous program (15.5%, 48/309) after being provided with information about the revised NCSP. Women who reported an abnormal result under the previous NCSP were more likely to be concerned about the revised NCSP (P =0.037), in particular the starting age of 25years (P =0.007) and the 5-yearly screening interval (P =0.008). CONCLUSION Awareness and knowledge levels play an important role in attitudes towards the revised NCSP in rural women. Strategies to increase participation rates should therefore target these areas. Healthcare professionals can take a central role in this information sharing process.
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Affiliation(s)
- Elizabeth Gosbell
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
| | - Alisha Panambalana
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
| | - Annabelle Stephenson
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
| | - Carissa Vici
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
| | - Tegan Dutton
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
| | - Jannine Bailey
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
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Marchadier A, Bezannier L, Barré-Pierrel S, Manceau A, A Abadie A, Detournay B. Overview of organisational methods of primary cervical lesion screening programmes that use human papillomavirus testing. J Med Screen 2023; 30:113-119. [PMID: 36974487 PMCID: PMC10399092 DOI: 10.1177/09691413231158932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 03/29/2023]
Abstract
Many factors need to be considered when planning and managing a screening programme for the early detection of cervical cancer (CC). A non-systematic international review of the organisation of CC screening using high-risk human papillomavirus (HPV-HR) testing, aimed at identifying the organisational methods of these programmes, was conducted with a view to supporting the future of the French system in the context of the transition to HPV-HR testing. In countries where HPV testing has been implemented or planned, the initial reflection process has provided an opportunity to rethink the previous (cytological) screening organisation. Despite considerable differences between countries, a nationally or regionally centralised organisational model appears to be the preferred option in most countries. This model is based on a national/regional structure tasked with all invitations, reminders, follow-up and coordination, centralised laboratories integrating both biology and pathology laboratories, and a unified information system integrated with routine health management tools used by health practitioners and nurses. Besides quality considerations, grouped purchasing makes it possible to implement a public procurement policy that includes price negotiations with suppliers. Discussions around the introduction of HPV testing have resulted in most countries reviewing or creating information systems and quality assurance processes. While the WHO seems to recommend the systematic use of vaginal self-sampling, very few countries have considered this option. More and more countries are planning to implement vaginal self-sampling, but no clear organisational model has emerged from the countries where it has been implemented to date.
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Affiliation(s)
| | | | | | - Antoine Manceau
- PwC Advisory - Healthcare & Pharmaceuticals Life-Sciences, Neuilly-sur-Seine, France
| | - Audrey A Abadie
- PwC Advisory - Healthcare & Pharmaceuticals Life-Sciences, Neuilly-sur-Seine, France
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Rebolj M, Sargent A, Njor SH, Cuschieri K. Widening the offer of human papillomavirus self-sampling to all women eligible for cervical screening: Make haste slowly. Int J Cancer 2023; 153:8-19. [PMID: 36385698 PMCID: PMC10952475 DOI: 10.1002/ijc.34358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/20/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
Self-collection of samples for human papillomavirus (HPV) testing has the potential to increase the uptake of cervical screening among underscreened women and will likely form a crucial part of the WHO's strategy to eliminate cervical cancer by 2030. In high-income countries with long-standing, organised cervical screening programmes, self-collection is increasingly becoming available as a routine offer for women regardless of their screening histories, including under- and well-screened women. For these contexts, a validated microsimulation model determined that adding self-collection to clinician collection is likely to be cost-effective on the condition that it meets specific thresholds relating to (1) uptake and (2) sensitivity for the detection of high-grade cervical intraepithelial neoplasia (CIN2+). We used these thresholds to review the 'early-adopter' programme-level evidence with a mind to determine how well and how consistently they were being met. The available evidence suggested some risk to overall programme performance in the situation where low uptake among underscreened women was accompanied by a high rate of substituting clinician sampling with self-collection among well-screened women. Risk was further compounded in a situation where the slightly reduced sensitivity of self-sampling vs clinician sampling for the detection of CIN2+ was accompanied with lack of adherence to a follow-up triage test that required a clinician sample. To support real-world programmes on their pathways toward implementation and to avoid HPV self-collection being introduced as a screening measure in good faith but with counterproductive consequences, we conclude by identifying a range of mitigations and areas worthy of research prioritisation.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Alexandra Sargent
- Cytology Department, Manchester Royal InfirmaryManchester University NHS Foundation TrustManchesterUK
| | - Sisse Helle Njor
- University Research Clinic for Cancer Screening, Department of Public Health ProgrammesRanders Regional HospitalRandersDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian ScotlandEdinburghUK
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Brotherton JM, McDermott T, Smith MA, Machalek DA, Shilling H, Prang KH, Jennett C, Nightingale C, Zammit C, Pagotto A, Rankin NM, Kelaher M. Implementation of Australia's primary human papillomavirus (HPV) cervical screening program: The STakeholders Opinions of Renewal Implementation and Experiences Study. Prev Med Rep 2023; 33:102213. [PMID: 37223565 PMCID: PMC10201842 DOI: 10.1016/j.pmedr.2023.102213] [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: 01/29/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/25/2023] Open
Abstract
In this study, we aimed to document stakeholders' experiences of implementing Australia's renewed National Cervical Screening Program. In December 2017, the program changed from 2nd yearly cytology for 20-69 year olds to 5 yearly human papillomavirus (HPV) screening for women 25-74 years. We undertook semi-structured interviews with key stakeholders including government, program administrators, register staff, clinicians and health care workers, non-government organisations, professional bodies, and pathology laboratories from across Australia between Nov 2018 - Aug 2019. Response rate to emailed invitations was 49/85 (58%). We used Proctor et al's (2011) implementation outcomes framework to guide our questions and thematic analysis. We found that stakeholders were evenly divided over whether implementation was successful. There was strong support for change, but concern over aspects of the implementation. There was some frustration related to the delayed start, timeliness of communication and education, shortcomings in change management, lack of inclusion of Aboriginal and Torres Strait Islander people in planning and implementation, failure to make self-collection widely available, and delays in the National Cancer Screening Register. Barriers centred around a perceived failure to appreciate the enormity of the change and register build, and consequent failure to resource, project manage and communicate effectively. Facilitators included the good will and dedication of stakeholders, strong evidence base for change and the support of jurisdictions during the delay. We documented substantial implementation challenges, offering learnings for other countries transitioning to HPV screening. Sufficient planning, significant and transparent engagement and communication with stakeholders, and change management are critical.
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Affiliation(s)
- Julia M.L. Brotherton
- Formerly Employed at the Australian Centre for the Prevention of Cervical Cancer, Victoria, Australia
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Tracey McDermott
- Formerly Employed at the Australian Centre for the Prevention of Cervical Cancer, Victoria, Australia
| | - Megan A. Smith
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, New South Wales, Australia
| | - Dorothy A. Machalek
- Centre for Women’s Infectious Diseases, Royal Women’s Hospital Melbourne, Victoria, Australia
- Kirby Institute, University of NSW, New South Wales, Australia
| | - Hannah Shilling
- Centre for Women’s Infectious Diseases, Royal Women’s Hospital Melbourne, Victoria, Australia
| | - Khic-Houy Prang
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Chloe Jennett
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, New South Wales, Australia
| | - Claire Nightingale
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Claire Zammit
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Amy Pagotto
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, New South Wales, Australia
| | - Nicole M. Rankin
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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Zammit C, Creagh N, Nightingale C, McDermott T, Saville M, Brotherton J, Kelaher M. 'I'm a bit of a champion for it actually': qualitative insights into practitioner-supported self-collection cervical screening among early adopting Victorian practitioners in Australia. Prim Health Care Res Dev 2023; 24:e31. [PMID: 37185205 PMCID: PMC10156465 DOI: 10.1017/s1463423623000191] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Self-collection for cervical screening has been available in the Australian National Cervical Screening Program since 2017 and is now available to all people as an option for cervical screening through a practitioner-supported model. Documenting early adopting practitioner experiences with self-collection as a mechanism to engage people in cervical screening is crucial to informing its continuing roll-out and implementation in other health systems. AIM This study aimed to describe the experiences of practitioners in Victoria, Australia, who used human papillomavirus (HPV)-based self-collection cervical screening during the first 17 months of its availability. METHODS Interviews (n = 18) with practitioners from Victoria, who offered self-collection to their patients between December 2017 and April 2019, analysed using template analysis. FINDINGS Practitioners were overwhelmingly supportive of self-collection cervical screening because it was acceptable to their patients and addressed patients' barriers to screening. Practitioners perceived that knowledge and awareness of self-collection were variable among the primary care workforce, with some viewing self-collection to be inferior to clinician-collected screening. Practitioners championed self-collection at an individual level, with the extent of practice-level implementation depending on resourcing. Concerns regarding supporting the follow-up of self-collected HPV positive patients were noted. Other practical barriers included gaining timely, accurate screening histories from the National Cancer Screening Register to assess eligibility. Practitioners' role surrounded facilitating the choice between screening tests through a patient-centred approach.
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Affiliation(s)
- Claire Zammit
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4 207 Bouverie Street Carlton, Melbourne, VIC3053, Australia
| | - Nicola Creagh
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4 207 Bouverie Street Carlton, Melbourne, VIC3053, Australia
| | - Claire Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4 207 Bouverie Street Carlton, Melbourne, VIC3053, Australia
| | - Tracey McDermott
- Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street Carlton, Melbourne, VIC3053, Australia (formally known as VCS Foundation)
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street Carlton, Melbourne, VIC3053, Australia (formally known as VCS Foundation)
| | - Julia Brotherton
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4 207 Bouverie Street Carlton, Melbourne, VIC3053, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4 207 Bouverie Street Carlton, Melbourne, VIC3053, Australia
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Tatar O, Haward B, Zhu P, Griffin-Mathieu G, Perez S, McBride E, Lofters AK, Smith LW, Mayrand MH, Daley EM, Brotherton JML, Zimet GD, Rosberger Z. Understanding the Challenges of HPV-Based Cervical Screening: Development and Validation of HPV Testing and Self-Sampling Attitudes and Beliefs Scales. Curr Oncol 2023; 30:1206-1219. [PMID: 36661742 PMCID: PMC9858121 DOI: 10.3390/curroncol30010093] [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: 12/09/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
The disrupted introduction of the HPV-based cervical screening program in several jurisdictions has demonstrated that the attitudes and beliefs of screening-eligible persons are critically implicated in the success of program implementation (including the use of self-sampling). As no up-to-date and validated measures exist measuring attitudes and beliefs towards HPV testing and self-sampling, this study aimed to develop and validate two scales measuring these factors. In October-November 2021, cervical screening-eligible Canadians participated in a web-based survey. In total, 44 items related to HPV testing and 13 items related to HPV self-sampling attitudes and beliefs were included in the survey. For both scales, the optimal number of factors was identified using Exploratory Factor Analysis (EFA) and parallel analysis. Item Response Theory (IRT) was applied within each factor to select items. Confirmatory Factor Analysis (CFA) was used to assess model fit. After data cleaning, 1027 responses were analyzed. The HPV Testing Attitudes and Beliefs Scale (HTABS) had four factors, and twenty-two items were retained after item reduction. The HPV Self-sampling Attitudes and Beliefs Scale (HSABS) had two factors and seven items were retained. CFA showed a good model fit for both final scales. The developed scales will be a valuable resource to examine attitudes and beliefs in anticipation of, and to evaluate, HPV test-based cervical screening.
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Affiliation(s)
- Ovidiu Tatar
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Research Center, Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
| | - Ben Haward
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Patricia Zhu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Gabrielle Griffin-Mathieu
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Samara Perez
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Cedars Cancer Centre, McGill University Health Centre (MUHC), Montreal, QC H4A 3J1, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
| | - Emily McBride
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Aisha K. Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Department of Family and Community Medicine, Women’s College Hospital, Toronto, ON M5S 1B3, Canada
| | | | - Marie-Hélène Mayrand
- Research Center, Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Ellen M. Daley
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Julia M. L. Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VI 3010, Australia
- Population Health, Australian Centre for the Prevention of Cervical Cancer, Melbourne, VI 3053, Australia
| | - Gregory D. Zimet
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
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Zammit CM, Creagh NS, McDermott T, Smith MA, Machalek DA, Jennett CJ, Prang KH, Sultana F, Nightingale CE, Rankin NM, Kelaher M, Brotherton JML. "So, if she wasn't aware of it, then how would everybody else out there be aware of it?"-Key Stakeholder Perspectives on the Initial Implementation of Self-Collection in Australia's Cervical Screening Program: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15776. [PMID: 36497850 PMCID: PMC9739016 DOI: 10.3390/ijerph192315776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In December 2017, the Australian National Cervical Screening Program transitioned from 2-yearly cytology-based to 5-yearly human papillomavirus (HPV)-based cervical screening, including a vaginal self-collection option. Until July 2022, this option was restricted to under- or never-screened people aged 30 years and older who refused a speculum exam. We investigated the perspectives and experiences of stakeholders involved in, or affected by, the initial implementation of the restricted self-collection pathway. METHODS Semi-structured interviews were conducted with 49 stakeholders as part of the STakeholder Opinions of Renewal Implementation and Experiences Study. All interviews were audio recorded and transcribed. Data were thematically analysed and coded to the Conceptual Framework for Implementation Outcomes. RESULTS Stakeholders viewed the introduction of self-collection as an exciting opportunity to provide under-screened people with an alternative to a speculum examination. Adoption in clinical practice, however, was impacted by a lack of clear communication and promotion to providers, and the limited number of laboratories accredited to process self-collected samples. Primary care providers tasked with communicating and offering self-collection described confusion about the availability, participant eligibility, pathology processes, and clinical management processes for self-collection. Regulatory delay in developing an agreed protocol to approve laboratory processing of self-collected swabs, and consequently initially having one laboratory nationally accredited to process samples, led to missed opportunities and misinformation regarding the pathway's availability. CONCLUSIONS Whilst the introduction of self-collection was welcomed, clear communication from Government regarding setbacks in implementation and how to overcome these in practice were needed. As Australia moves to a policy of providing everyone eligible for screening the choice of self-collection, wider promotion to providers and eligible people, clarity around pathology processes and the scaling up of test availability, as well as timely education and communication of clinical management practice guidelines, are needed to ensure smoother program delivery in the future. Other countries implementing self-collection policies can learn from the implementation challenges faced by Australia.
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Affiliation(s)
- Claire M. Zammit
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Nicola S. Creagh
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Tracey McDermott
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, VIC 3010, Australia
| | - Megan A. Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2011, Australia
| | - Dorothy A. Machalek
- The Kirby Institute, Wallace Wurth Building, University of New South Wales Kensington, Sydney, NSW 2052, Australia
- Centre for Women’s Infectious Diseases, The Royal Women’s Hospital, Melbourne, VIC 3052, Australia
| | - Chloe J. Jennett
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2011, Australia
| | - Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Farhana Sultana
- National Cancer Screening Register, Telstra Health, Melbourne, VIC 3000, Australia
| | - Claire E. Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Nicole M. Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Julia M. L. Brotherton
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, VIC 3010, Australia
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The role of nutrition in harnessing the immune system: a potential approach to prevent cancer. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2022; 39:245. [PMID: 36180759 DOI: 10.1007/s12032-022-01850-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
Cancer is a vital barrier to increase the life expectancy and the foremost cause of death globally. The initial diagnosis and proper management of cancer can expand the survival rate of individuals. This review provides an in-depth investigation of cancer causes symptoms, types of cancer, and worldwide distribution of cancer. The relation between nutrition (i.e., various food items) and cancer is also emphasized to offer a framework of nutrition management in different cancer types. The microbiota is closely associated with the occurrence of cancer. Thus, genomics of intestinal microbes and nutrigenomics have been discussed based on the reported meta-analysis studies. A dramatic increase in cancer rates has been observed due to intake of alcohol, microbial infections, and deficiency of nutrition. Malnutrition is a substantial problem in cancer patients linked with improper treatment and increased morbidity. The detail studies of cancer and nutrigenomics are an eminent approach to comprehend the relation between microbes and the consumption of certain food types which can further reduce the cancer risk. The incorporation of specific nutrients and probiotics improved the gut microbial health, increased life expectancy, and also decreased the incidence of tumorigenesis in individuals.
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Swid MA, Monaco SE. Should screening for cervical cancer go to primary human papillomavirus testing and eliminate cytology? Mod Pathol 2022; 35:858-864. [PMID: 35256738 DOI: 10.1038/s41379-022-01052-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 12/21/2022]
Abstract
This review will systematically highlight the pros and cons of cervical cancer screening with HPV (human papillomavirus) testing and cytological methods (Papanicolaou (Pap) test). When comparing the screening modalities, various facets will be addressed, such as cost effectiveness, and harms and benefits across different demographics and age groups. It is important to note that due to the expansive variance in material costs, practices, and resource availability across different geographical regions, these comparisons are far from straight forward, and ultimately make it challenging to render definitive global recommendations. Thus, the intent of this review is to highlight some of the differences in difference cervical cancer screening modalities that can help one to choose an optimal screening method in their specific situation.
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Affiliation(s)
- Mohammed Amer Swid
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, PA, 17822, USA
| | - Sara E Monaco
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, PA, 17822, USA.
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Improving Access to Cancer Treatment Services in Australia’s Northern Territory—History and Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137705. [PMID: 35805361 PMCID: PMC9265828 DOI: 10.3390/ijerph19137705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 12/28/2022]
Abstract
Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment.
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Kaljouw S, Jansen EEL, Aitken CA, de Kok IMCM. Shift in harms and benefits of cervical cancer screening in the era of HPV screening and vaccination: a modelling study. BJOG 2022; 129:1862-1869. [PMID: 35429107 PMCID: PMC9541905 DOI: 10.1111/1471-0528.17190] [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: 12/23/2021] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
Objective To calculate the changes in harms and benefits of cervical cancer screening over the first three screening rounds of the Dutch high‐risk human papillomavirus (hrHPV) screening programme. Design Microsimulation study. Setting Dutch hrHPV screening programme; women are invited for screening every 5 or 10 years (depending on age and screening history) from age 30 to 65. Population Partly vaccinated population of 100 million Dutch women. Methods Microsimulation model MISCAN was used to estimate screening effects. Sensitivity analyses were performed on test characteristics and attendance. Main outcome measures Harms (screening tests, unnecessary referrals, treatment‐related health problems), benefits (CIN2+ diagnoses) and programme efficiency (number needed to screen [NNS]) over the first (period 2017–2021), second (period 2022–2026) and third (period 2027–2031) rounds of hrHPV‐based screening. Results The number of screening tests and CIN2+ diagnoses decreased from the first to the second round (−25.8% and −23.6%, respectively). In the third screening round, these numbers decreased further, albeit only slightly (−2.7% and −5.3%, respectively). NNS to detect a CIN2+ remained constant over the rounds; however, it increased in younger age groups while decreasing in older age groups. Conclusion Both harms and benefits of hrHPV screening decreased over the first screening rounds. For younger women, the efficiency would decrease, whereas longer screening intervals would lead to increased efficiency in older women. Programme efficiency overall remained stable, showing the importance of longer intervals for low‐risk women. Tweetable abstract: Cervical cancer screening: both harms and benefits of hrHPV screening will decrease in the future. Cervical cancer screening: both harms and benefits of hrHPV screening will decrease in the future.
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Affiliation(s)
- Sylvia Kaljouw
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erik E L Jansen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Clare A Aitken
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Smith MA, Sherrah M, Sultana F, Castle PE, Arbyn M, Gertig D, Caruana M, Wrede CD, Saville M, Canfell K. National experience in the first two years of primary human papillomavirus (HPV) cervical screening in an HPV vaccinated population in Australia: observational study. BMJ 2022; 376:e068582. [PMID: 35354610 PMCID: PMC8965648 DOI: 10.1136/bmj-2021-068582] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review the first two years of the primary human papillomavirus (HPV) cervical screening programme in an HPV vaccinated population. DESIGN Observational study. SETTING Australia. PARTICIPANTS 3 745 318 women with a primary HPV test between 1 December 2017 and 31 December 2019; most women aged <40 years had previously been offered vaccination against HPV16 and HPV18. INTERVENTIONS Primary HPV screening with referral if HPV16 or HPV18 (HPV16/18) positive and triage with liquid based cytology testing (threshold atypical squamous cells-cannot exclude high grade squamous intraepithelial lesion) for women who were positive for high risk HPV types other than 16/18. A 12 month follow-up HPV test was recommended in triaged women with a negative or low grade cytology result, with referral if they tested positive for any high risk HPV type at follow-up. MAIN OUTCOME MEASURES Proportion of women who had attended for their first HPV screening test, tested positive, and were referred for colposcopy; and short term risk of detecting cervical intraepithelial neoplasia (CIN) grade 2 or worse, CIN grade 3 or worse, or cancer. RESULTS 54.6% (n=3 507 281) of an estimated 6 428 677 eligible women aged 25-69 had undergone their first HPV test by the end of 2019. Among those attending for routine screening, positivity for HPV16/18 and for HPV types not 16/18 was, respectively, 2.0% and 6.6% in women aged 25-69 (n=3 045 844) and 2.2% and 13.3% in highly vaccinated cohorts of women aged 25-34 (n=768 362). Colposcopy referral (ages 25-69 years) was 3.5%, increasing to an estimated 6.2% after accounting for women who had not yet had a 12 month repeat test. Cervical cancer was detected in 0.98% (456/46 330) of women positive for HPV16/18 at baseline, including 0.32% (89/28 003) of women with HPV16/18 and negative cytology. Women with HPV types not 16/18 and negative or low grade cytology at both baseline and 12 months were at low risk of serious disease (3.4% CIN grade 3 or worse; 0.02% cancer; n=20 019) but estimated to account for 62.0% of referrals for this screening algorithm. CONCLUSIONS Colposcopy referral thresholds need to consider underlying cancer risk; on this basis, women with HPV16/18 in the first round of HPV screening were found to be at higher risk regardless of cytology result, even in a previously well screened population. Women with HPV types not 16/18 and negative or low grade cytology showed a low risk of serious abnormalities but constitute most referrals and could be managed safely with two rounds of repeat HPV testing rather than one. HPV16/18 driven referrals were low in HPV vaccinated cohorts.
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Affiliation(s)
- Megan A Smith
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
| | - Maddison Sherrah
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
| | - Farhana Sultana
- National Cancer Screening Register, Telstra Health, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Philip E Castle
- Division of Cancer Prevention, and Senior Investigator, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, NIH, Rockville, MD, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Dorota Gertig
- National Cancer Screening Register, Telstra Health, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Caruana
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
| | - C David Wrede
- Oncology and Dysplasia Unit, The Royal Women's Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | - Marion Saville
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, VIC, Australia
| | - Karen Canfell
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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20
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Brotherton JML, Hawkes D, Saville M. Reasons for rejection of self‐collected samples for cervical screening. Med J Aust 2022; 216:214. [DOI: 10.5694/mja2.51412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/01/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Julia ML Brotherton
- Australian Centre for the Prevention of Cervical Cancer Melbourne VIC
- University of Melbourne Melbourne VIC
| | - David Hawkes
- Australian Centre for the Prevention of Cervical Cancer Melbourne VIC
- University of Melbourne Melbourne VIC
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer Melbourne VIC
- University of Melbourne Melbourne VIC
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21
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Whop LJ, Butler TL, Lee N, Cunningham J, Garvey G, Anderson K, Condon JR, Tong A, Moore S, Maher CM, Mein JK, Warren EF, Brotherton JML. Aboriginal and Torres Strait Islander women's views of cervical screening by self-collection: a qualitative study. Aust N Z J Public Health 2022; 46:161-169. [PMID: 35112767 DOI: 10.1111/1753-6405.13201] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to describe Aboriginal and Torres Strait Islander women's views of self-collection introduced in the renewed National Cervical Screening Program. METHODS A total of 79 Aboriginal and/or Torres Strait Islander women (50 screened in previous five years, 29 under-screened) from five clinics across three Australian states/territories participated. Topics discussed were perceptions of self-collection, the instruction card and suggestions for implementing self-collection. We employed yarning (a qualitative method), which established relationships and trust between participants and researchers to facilitate culturally safe conversations. Transcripts were analysed thematically. RESULTS Most women were unaware of self-collection before the yarn but found it to be an acceptable way to participate in cervical screening. Women perceived self-collection would be convenient, provide a sense of control over the screening experience, and maintain privacy and comfort. The instructions were perceived to be simple and easy to follow. Women had concerns about collecting the sample correctly and the accuracy of the sample (compared to clinician-collected samples). CONCLUSIONS Self-collection is acceptable to Aboriginal and Torres Strait Islander women. Implications for public health: Given the inequitable burden of cervical cancer experienced by Aboriginal and Torres Strait Islander women, self-collection is likely to significantly improve participation and ultimately improve cervical cancer outcomes.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Australian National University, Australian Capital Territory.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Tamara L Butler
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - Natasha Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - Kate Anderson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - John R Condon
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, New South Wales
| | - Suzanne Moore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Northern Territory
| | - Clare M Maher
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Jacqueline K Mein
- Tropical Public Health Services Cairns, Cairns and Hinterland Hospital Health Service, Queensland Health, Queensland
| | - Eloise F Warren
- Yerin Eleanor Duncan Aboriginal Health Centre, New South Wales
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, Victoria.,Melbourne School of Population and Global Health, University of Melbourne, Victoria
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22
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Azar D, Murphy M, Fishman A, Sewell L, Barnes M, Proposch A. Barriers and facilitators to participation in breast, bowel and cervical cancer screening in rural Victoria: A qualitative study. Health Promot J Austr 2022; 33:272-281. [PMID: 33713368 PMCID: PMC9292328 DOI: 10.1002/hpja.478] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
ISSUE ADDRESSED Population cancer screening rates are around 50% for the general population and even lower in rural areas. This study aimed to explore knowledge, attitudes, behaviours, motivators and barriers to breast, bowel and cervical screening participation in under-screened men and women. METHODS We used a qualitative research design. Focus groups were segmented by age, sex and screening participation. Participants were under-screened in at least one of the cancer screening programs, with separate groups for each of the programs. The discussion guides were designed around the Health Belief Model and group discussions were coded using a thematic content analysis approach. RESULTS Fourteen focus groups were held with 80 participants. Key themes were that the concept of cancer screening was not well understood, a low priority for preventive health behaviours, issues relating to local general practitioners (GP) and screening was unpleasant, embarrassing and/or inconvenient. A key determinant of participation in cancer screening was exposure to prompts to action, and it was evident that participants often required multiple prompts before they took action. CONCLUSIONS Opportunities that develop attitudes to health that place disease prevention as a high priority; improve understanding of the benefit of screening in terms of early detection and treatment; improve GP availability and the patient-practitioner relationship; and the development of messages for each of the screening programs should be further explored as factors that may influence rural population screening rates. SO WHAT?: Addressing health attitudes, beliefs, knowledge, health practitioner and test-related barriers and improving messaging may increase cancer screening participation in under-screened rural populations.
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Affiliation(s)
- Denise Azar
- Gippsland Primary Health NetworkTraralgonVICAustralia
| | | | | | - Lauren Sewell
- Gippsland Primary Health NetworkTraralgonVICAustralia
| | - Megan Barnes
- Gippsland Primary Health NetworkTraralgonVICAustralia
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23
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Torres KL, Rondon HHDMF, Martins TR, Martins S, Ribeiro A, Raiol T, Marques CP, Corrêa F, Migowski A, Minuzzi-Souza TTCE, Schiffman M, Rodriguez AC, Gage JC. Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city-Lessons learned from the Amazon city of Manaus, Brazil. PLoS One 2021; 16:e0258539. [PMID: 34662368 PMCID: PMC8523067 DOI: 10.1371/journal.pone.0258539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Abstract
The World Health Organization Call to Eliminate Cervical Cancer resonates in cities like Manaus, Brazil, where the burden is among the world's highest. Manaus has offered free cytology-based screening since 1990 and HPV immunization since 2013, but the public system is constrained by many challenges and performance is not well-defined. We obtained cervical cancer prevention activities within Manaus public health records for 2019 to evaluate immunization and screening coverage, screening by region and neighborhood, and the annual Pink October screening campaign. We estimated that among girls and boys age 14-18, 85.9% and 64.9% had 1+ doses of HPV vaccine, higher than rates for age 9-13 (73.4% and 43.3%, respectively). Of the 90,209 cytology tests performed, 24.9% were outside the target age and the remaining 72,230 corresponded to 40.1% of the target population (one-third of women age 25-64). The East zone had highest screening coverage (49.1%), highest high-grade cytology rate (2.5%) and lowest estimated cancers (38.1/100,000) compared with the South zone (32.9%, 1.8% and 48.5/100,000, respectively). Largest neighborhoods had fewer per capita screening locations, resulting in lower coverage. During October, some clinics successfully achieved higher screening volumes and high-grade cytology rates (up to 15.4%). Although we found evidence of some follow-up within 10 months post-screening for 51/70 women (72.9%) with high-grade or worse cytology, only 18 had complete work-up confirmed. Manaus has successfully initiated HPV vaccination, forecasting substantial cervical cancer reductions by 2050. With concerted efforts during campaigns, some clinics improved screening coverage and reached high-risk women. Screening campaigns in community locations in high-risk neighborhoods using self-collected HPV testing can achieve widespread coverage. Simplifying triage and treatment with fewer visits closer to communities would greatly improve follow-up and program effectiveness. Achieving WHO Cervical Cancer Elimination goals in high-burden cities will require major reforms for screening and simpler follow-up and treatment.
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Affiliation(s)
- Kátia Luz Torres
- Amazon State Oncology Control Foundation (FCECON), Manaus, Amazonas, Brazil
- Post Graduation Program in Health Sciences and Basic and Applied Immunology at The Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
| | - Heidy Halanna de Melo Farah Rondon
- Post Graduation Program in Health Sciences and Basic and Applied Immunology at The Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
| | - Toni Ricardo Martins
- Tropical Medicine Institute, São Paulo University, Virology Laboratory (LIM52) (USP-SP) - São Paulo, São Paulo, Brazil
| | - Sandro Martins
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
| | - Ana Ribeiro
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
- Department of Pharmacy, Faculty of Health Sciences, University of Brasília (UNB), Brasília, Federal District, Brazil
| | - Taina Raiol
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
| | - Carla Pintas Marques
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
- Collective Health, Universidade de Brasília (UnB), Brasília, Federal District, Brazil
| | - Flavia Corrêa
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arn Migowski
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thais Tâmara Castro e Minuzzi-Souza
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (Fiocruz), Brasília, Federal District, Brazil
- National Immunization Program, Health Surveillance Secretariat (SVS), Ministry of Health, Brasília, Federal District, Brazil
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, United States of America
| | - Ana Cecilia Rodriguez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, United States of America
| | - Julia C. Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, United States of America
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24
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Xie H, Morton R, Balendran J, Philp S, Saidi S, Farrell R, Anderson L, Pather S. The impact of primary human papillomavirus screening on negative loop excision histology following biopsy-proven high-grade cervical intra-epithelial lesions: A review from a large tertiary colposcopy unit. Aust N Z J Obstet Gynaecol 2021; 61:941-948. [PMID: 34506036 DOI: 10.1111/ajo.13426] [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: 01/28/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The renewed National Cervical Screening Program incorporating primary human papillomavirus (HPV) screening was implemented in Australia in December 2017. In a previous study conducted in the UK, primary HPV screening was found to be associated with a 25% reduction in the incidence of negative histology following loop electrosurgery excision procedure (LEEP). AIM To examine the change in incidence and associated risk factors for a negative LEEP with introduction of primary HPV screening. MATERIALS AND METHODS A retrospective review of the records of all patients undergoing a LEEP excision for biopsy-proven high-grade cervical intra-epithelial lesions between 1 January 2014 and 30 June 2019 in a specialised centre. RESULTS There were 1123 patients who underwent a LEEP included in the analysis. The incidence of a negative LEEP specimen was 7.5% (59/784) and 5.3% (18/339) in the pre- and post-HPV screening cohort. More patients in the post-HPV screening group had low-grade cytology on referral (P < 0.001), smaller cervical lesions on colposcopy (P = 0.012) and longer biopsy to treatment interval (P = 0.020). Primary HPV screening was associated with a significant reduction in the incidence of a negative LEEP specimen in a propensity matched cohort (11.2% to 5.1%, P = 0.006) and a 41% (P = 0.045) decreased relative risk of a negative LEEP on multivariate analysis. CONCLUSIONS Primary HPV screening results in a lower incidence of negative LEEP histology, despite a longer biopsy to treatment wait time and higher proportion of low-grade cytology at triage.
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Affiliation(s)
- Huan Xie
- Lifehouse Gynaecological Oncology Group, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Rhett Morton
- Lifehouse Gynaecological Oncology Group, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jananie Balendran
- Department of Gynaecology and Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Shannon Philp
- Lifehouse Gynaecological Oncology Group, Chris O'Brien Lifehouse, Susan Wakil School of Nursing, Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Samir Saidi
- Lifehouse Gynaecological Oncology Group, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Rhonda Farrell
- Lifehouse Gynaecological Oncology Group, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Lyndal Anderson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Selvan Pather
- Lifehouse Gynaecological Oncology Group, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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25
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Ju X, Canfell K, Howard K, Garvey G, Hedges J, Smith M, Jamieson L. Population-based utility scores for HPV infection and cervical squamous cell carcinoma among Australian Indigenous women. PLoS One 2021; 16:e0254575. [PMID: 34292987 PMCID: PMC8298063 DOI: 10.1371/journal.pone.0254575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Working in partnership with Indigenous communities in South Australia, we aimed to develop, pilot test and estimate utility scores for health states relating to cervical cancer screening, precancer, and invasive cervical cancer and precancer/cancer treatment among Indigenous women. Methods Development and pilot testing of hypothetical cervical cancer health states, specifically through the lens of being an Indigenous Australian woman, was done with an Indigenous Reference Group in conjunction with five female Indigenous community members. Six health states were developed. These included: (1) Screened: cytology normal; (2) human papillomaviruses (HPV) positive with cytology normal; (3) low grade cytology (LSIL);(4) high grade cytology (HSIL); (5) early stage cervical cancer and; (6) later stage cervical cancer. Utility scores were calculated using a two-stage standard gamble approach among a large cohort of Indigenous Australian women taking part in a broader study involving oral HPV infection. The mean and standard deviation (SD) of the rank, percentage of respondents with a utility = 1 (perfect health) and utility score of each health state was summarised. Mean (SD) and medians and inter-quartile range (IQR) over 12 months and lifetime duration were calculated. Potential differences by age and residential location were assessed using the Wilcox Sum Rank test. Results Data was obtained from 513 Indigenous women aged 19+ years. Mean utility scores were higher for the four non-cancer health states than for invasive cervical cancer states (p-values <0.05). Lower mean utility scores were observed for late stage cervical cancer, with 0.69 at 12 months and 0.70 for lifetime duration (Intra-class correlation coefficients = 0.425). Higher utility scores were observed for the four non-cancer health states among non-metropolitan participants (ranged from 0.93 to 0.98) compared with metropolitan participants (ranged from 0.86 to 0.93) (p-values<0.05). Conclusion Among a large cohort of Indigenous Australian women, the reduction in quality of life (which utilities reflect) was perceived to be greater with increasing severity of cervical cancer health states. There were differences observed by geographic location, with positive cervical screening and precursor cancer-related quality of life being much higher among non-metropolitan-dwelling participants. These utility values, from one of the largest such studies ever performed in any population will be uniquely able to inform modelled evaluations of the benefits and costs of cervical cancer prevention interventions in Indigenous women.
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Affiliation(s)
- Xiangqun Ju
- Adelaide Dental School, Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - Karen Canfell
- Cancer Council of NSW, Sydney, Australia.,School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten Howard
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Gail Garvey
- Menzies School of Health Research, Tiwi, Australia
| | - Joanne Hedges
- Adelaide Dental School, Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - Megan Smith
- Cancer Council of NSW, Sydney, Australia.,School of Public Health, The University of Sydney, Sydney, Australia
| | - Lisa Jamieson
- Adelaide Dental School, Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
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26
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Mitchell G, Phung J, Holliday E, Day T. Colposcopic outcomes for symptomatic patients with a negative oncogenic human papillomavirus test. Aust N Z J Obstet Gynaecol 2021; 61:798-801. [PMID: 34151422 PMCID: PMC8596814 DOI: 10.1111/ajo.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/10/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
This study assesses outcomes of colposcopy referrals for post‐coital, intermenstrual, or other abnormal bleeding with negative oncogenic human papillomavirus and negative to low‐grade cytology. Of 112 cases with median age of 34.5 years, cervical biopsy occurred in 19%, treatment of ectropion in 19%, endometrial sampling in 8%, polypectomy in 4%, and contraceptive change in 2%. No cervical or endometrial neoplasia was detected. Patients with bleeding symptoms and reassuring co‐test may instead attend a general gynaecology clinic.
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Affiliation(s)
- Georgina Mitchell
- Maternity and Gynaecology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Jason Phung
- Maternity and Gynaecology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Elizabeth Holliday
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Tania Day
- Maternity and Gynaecology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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27
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Chin FHX, Wrede CDH, Richards A, Steele A, Vicario E, McNally OM, Tan JHJ. Primary HPV cervical screening: Clinical audit of outcomes of women seen at a tertiary referral centre for colposcopy in Australia. Aust N Z J Obstet Gynaecol 2021; 61:750-758. [PMID: 33963546 DOI: 10.1111/ajo.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/27/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Primary human papillomavirus (HPV) screening was introduced in Australia in December 2017. AIMS Outcomes for women after positive HPV in their cervical screening test (CST). MATERIALS AND METHODS A retrospective observational study of 4458 women seen at the Royal Women's Hospital Colposcopy Clinic from 1 January 2018 to 31 July 2020. RESULTS HPV16/18 was positive (considered higher-risk CST) in 42.2% of women in the study, 16.6% with reflex possible with high-grade squamous intraepithelial lesions (pHSIL) or worse and 54.9% with normal cytology. There were 24.8% of women with positive HPV16/18 who had histological confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+), 10.3% CIN2+ (including six cancers) among women with reflex negative cytology and 87.7% CIN2+ among women with reflex HSIL cytology. In women with positive HPV (not 16/18), CIN2+ was found in 60.2% with reflex pHSIL or worse cytology (higher risk) and 10.2% with reflex low-grade SIL (LSIL) or normal cytology (intermediate risk). Median waiting time to colposcopy with the intermediate-risk group went up to 181 days. Our colposcopists were able to achieve a positive predictive value (PPV) for CIN2+ of 69.9%, higher than 57.8% PPV in the National Cervical Screening Program (NCSP) 2020 monitoring report. Women with type 3 transformation zone on colposcopy could be followed up with CST if no HSIL was suspected on screening or at colposcopy as their risk of CIN2+ was only 2.5%. CONCLUSIONS Our findings support direct referral to colposcopy for women with higher-risk CST, with all cancers confined to this group. The NCSP recommendation to refer for colposcopy only after three intermediate-risk CST will need monitoring with the LSIL triage group.
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Affiliation(s)
- Felicia H X Chin
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - C David H Wrede
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Richards
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Angela Steele
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Estefania Vicario
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Orla M McNally
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey H J Tan
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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28
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Jaenke R, Butler TL, Condon J, Garvey G, Brotherton JML, Cunningham J, Anderson K, Tong A, Moore SP, Whop LJ. Health care provider perspectives on cervical screening for Aboriginal and Torres Strait Islander women: a qualitative study. Aust N Z J Public Health 2021; 45:150-157. [PMID: 33683744 DOI: 10.1111/1753-6405.13084] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/01/2020] [Accepted: 01/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate perspectives of primary health care providers (HCPs) on providing cervical screening for Aboriginal and Torres Strait Islander women, who experience a higher burden of cervical cancer than other Australian women. METHODS Semi-structured interviews with 13 HCPs from four Australian Indigenous primary health care centres (PHCCs). Transcripts were thematically analysed. RESULTS HCPs discussed the need to approach cervical screening with sensitivity to women's emotional and cultural needs and sustaining relationships built on trust and respect. HCPs reported challenges in promoting screening to Aboriginal and Torres Strait Islander women due to cumbersome systems, competing clinical priorities, workforce capacity limitations and specific challenges associated with implementing the renewed National Cervical Screening Program. CONCLUSIONS In practice, HCPs experience several challenges to delivering cervical screening. Understanding HCPs' perspectives on their approach to cervical screening delivery, and the systems in which this occurs, can help to ensure that they receive adequate support and resources to deliver cervical screening to Aboriginal and Torres Strait Islander women. Implications for public health: It is important that HCPs adopt a multi-faceted, person-centred approach to cervical screening that is responsive to women's needs and that works synchronously with supportive PHCC services and systems and the National Cancer Screening Register.
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Affiliation(s)
- Rachael Jaenke
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Tamara L Butler
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - John Condon
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | | | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Kate Anderson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, New South Wales
| | - Suzanne P Moore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Lisa J Whop
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,National Centre for Epidemiology and Population Health, Australian National University, Australian Capital Territory
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29
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Lim AWW. Will COVID-19 Be the Tipping Point for Primary HPV Self-sampling? Cancer Epidemiol Biomarkers Prev 2021; 30:245-247. [PMID: 33547144 DOI: 10.1158/1055-9965.epi-20-1538] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/11/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022] Open
Abstract
Self-sampling is poised to be a disruptor for cervical screening. So far, cancer screening has been a causality of COVID-19; however, the opposite may transpire for self-sampling. Self-sampling enables socially distanced cervical screening with an outreach that extends to underserved populations. As evidence mounts that self-sampling is noninferior to clinician-taken samples, the focus for self-sampling is now as a primary screening option for all women. Now, we have evidence from a modeling study (using Australia as an exemplar) to suggest that program effectiveness with primary self-sampling would be better than the current program, even if sensitivity is lower. Regulatory issues, suitable triage strategies, and clear communication about self-sampling are hurdles yet to be overcome. Nevertheless, existing evidence coupled with COVID-19 could be the tipping point for wider introduction of self-sampling.See related article by Smith et al., p. 268.
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Affiliation(s)
- Anita W W Lim
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, Comprehensive Cancer Centre, King's College London, London, United Kingdom.
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30
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Obermair HM, Bennett KF, Brotherton JML, Smith MA, McCaffery KJ, Dodd RH. Australian National Cervical Screening Program renewal: Attitudes and experiences of general practitioners, and obstetricians and gynaecologists. Aust N Z J Obstet Gynaecol 2021; 61:416-423. [PMID: 33512715 DOI: 10.1111/ajo.13310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/13/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND In 2017, the Australian National Cervical Screening Program (NCSP) implemented five-yearly primary human papillomavirus (HPV) screening for women aged 25-74. It is important that clinicians are able to explain the NCSP changes to women and confidently address concerns. AIMS This study examined Australian clinicians' attitudes toward and experiences of the NCSP renewal since its implementation. MATERIALS AND METHODS Cross-sectional survey of clinicians (general practitioners, obstetricians and gynaecologists) involved in cervical screening, distributed two years after implementation of the renewed NCSP. Responses were analysed using descriptive statistics and thematic analysis. RESULTS Six hundred and seven participants completed the survey. More than 80% of clinicians were comfortable with the main NCSP changes: extended screening intervals, increased age of first screening, and screening test used. However, only 47% of clinicians reported having utilised the National Cancer Screening Register, and a third of clinicians did not believe that self-collection was a reasonable alternative to practitioner-collected screening for under-screened women. Increased demands for colposcopy were reported. All clinicians identified at least one area of educational need, including the management of women with a history of screen-detected abnormalities in the previous program (34.9%), post-colposcopy management for women with no abnormalities detected (25.5%), and screening in complex scenarios (eg immunocompromise) (26.5%). CONCLUSIONS Overall, Australian clinicians are comfortable with the main changes to the cervical screening program. Certain areas may require further policy review, such as screening in complex clinical scenarios, colposcopy availability, accessibility of the Register and self-collection. These issues could be meaningful for other countries switching to HPV-based screening.
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Affiliation(s)
- Helena M Obermair
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics & Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kirsty F Bennett
- Department of Behavioural Science and Health, University College London, London, UK
| | - Julia M L Brotherton
- VCS Foundation, Melbourne, Victoria, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Megan A Smith
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Cancer Council NSW, Sydney, New South Wales, Australia
| | - Kirsten J McCaffery
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rachael H Dodd
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Kaljouw S, Jansen EEL, Aitken CA, Harrijvan LM, Naber SK, de Kok IMCM. Reducing unnecessary referrals for colposcopy in hrHPV-positive women within the Dutch cervical cancer screening programme: A modelling study. Gynecol Oncol 2021; 160:713-720. [PMID: 33451725 DOI: 10.1016/j.ygyno.2020.12.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/24/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND With the implementation of primary high-risk human papillomavirus (hrHPV) screening in the Netherlands, an increase was observed in the number of unnecessary referrals (≤Cervical Intraepithelial Neoplasia (CIN) 1) to colposcopy. We aimed to investigate which alternative triage strategies safely reduce unnecessary referrals in HPV-based cervical cancer screening programmes. METHODS Microsimulation model MISCAN was used to simulate an unvaccinated cohort of ten million 30-year old Dutch women. We calculated unnecessary referrals, cervical cancer incidence, mortality, costs and QALYs for 24 triage strategies. Condition for direct referral (atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), conditional on HPV-genotype 16/18/other high risk (OHR)), type of triage test (cytology alone or combined with hrHPV) and time to triage test (6 or 12 months) was varied. RESULTS The 24 triage strategies had varying effects on the number of unnecessary referrals ranging from -72% to +35%. Adjusting conditions for referral to 'HPV16/18+ and ASC-US+' and 'HPVOHR+ and HSIL+' and extending the interval between tests to 12 months resulted in a reduction in unnecessary referrals of 40% (incidence +0%, mortality -1%). Reduction in unnecessary referrals without genotyping was achieved by adjusting conditions for direct referral to LSIL (12 months to repeat test) (unnecessary referrals -37%, incidence +2%, mortality +0%). CONCLUSIONS To reduce the number of unnecessary referrals without increasing incidence and mortality by more than 2% in the Dutch cervical cancer screening programme, genotyping for HPV16 or HPV16/18 should be implemented with 12 months to repeat testing.
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Affiliation(s)
- Sylvia Kaljouw
- Department of Public Health, Erasmus MC University Medical Center, 3015GD, Rotterdam, the Netherlands.
| | - Erik E L Jansen
- Department of Public Health, Erasmus MC University Medical Center, 3015GD, Rotterdam, the Netherlands
| | - Clare A Aitken
- Department of Public Health, Erasmus MC University Medical Center, 3015GD, Rotterdam, the Netherlands
| | - Lotte M Harrijvan
- Department of Public Health, Erasmus MC University Medical Center, 3015GD, Rotterdam, the Netherlands
| | - Steffie K Naber
- Department of Public Health, Erasmus MC University Medical Center, 3015GD, Rotterdam, the Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC University Medical Center, 3015GD, Rotterdam, the Netherlands
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Marlow L, Forster AS, McBride E, Rockliffe L, Kitchener H, Waller J. Information needs among women taking part in primary HPV screening in England: a content analysis. BMJ Open 2020; 10:e044630. [PMID: 33323451 PMCID: PMC7745520 DOI: 10.1136/bmjopen-2020-044630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/09/2020] [Accepted: 11/25/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Introducing primary human papillomavirus (HPV) testing to cervical screening programmes means changes to the results women receive. We explored additional information needs among women undergoing HPV primary screening. DESIGN Women were sent a postal questionnaire shortly after receiving their results and 6 and 12 months later. Each questionnaire asked if women had any unanswered questions about cervical screening or HPV testing. Free-text responses constituted the data. Themes were identified using content analysis. SETTING National Health Service (NHS) Cervical Screening Programme, England. PARTICIPANTS 381 women who recorded one or more free-text responses. RESULTS The most common theme represented women's emotional responses and attempts to understand their results. This theme was raised by 45% of women overall, but was as high as 59% in the HPV cleared group. General questions about the cause and epidemiology of HPV were raised by 38% of women and were more common among those testing HPV positive with normal cytology (52%). Questions about the purpose and procedure for HPV testing were most common among HPV-negative women (40%, compared with 16%-24% of the other results groups). Questions about future implications of test results were raised by 19% of women, and this theme was most common among those with persistent HPV. CONCLUSIONS Despite provision of information alongside screening invitations, women can still have unanswered questions following receipt of their results. Details about the epidemiology of HPV and why cervical screening procedures are changing should be included with screening invitations. Some results groups may benefit from additional tailored information with their results letter.
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Affiliation(s)
- Laura Marlow
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Alice S Forster
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Emily McBride
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Lauren Rockliffe
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Henry Kitchener
- Women's Cancer Centre, Institute of Cancer Sciences, University of Manchester, Manchester, Greater Manchester, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Research Department of Behavioural Science and Health, University College London, London, UK
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Dodd RH, Mac OA, McCaffery KJ. Women's experiences of the renewed National Cervical Screening Program in Australia 12 months following implementation: a qualitative study. BMJ Open 2020; 10:e039041. [PMID: 32665351 PMCID: PMC7359067 DOI: 10.1136/bmjopen-2020-039041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore women's experiences of the renewed National Cervical Screening Program in Australia from the perspective of women who have received different human papillomavirus (HPV) test results. Women aged 25 to 74 are now screened every 5 years with primary HPV screening. DESIGN Qualitative interview study. SETTING Australia. PARTICIPANTS Women in Australia aged 25 to 74 who reported participating in cervical screening since December 2017, purposively sampled by test result (HPV positive, HPV negative and HPV status unknown). METHODS 26 interviews with women aged 25 to 74 were conducted and analysed thematically. RESULTS Three main themes emerged: knowledge and attitudes about the programme changes, information dissemination, the meaning and responses to test results and the new cervical screening test (CST). Some women showed little awareness of the changes, but others understood that HPV is detected earlier than abnormal cells. Some expressed positive attitudes towards the CST and were not anxious about less frequent screening. Most women envisaged the changes would have minimal impact on their screening behaviour. Women mainly wanted more information about the changes and the possible results from the new CST. Overall women could recall their HPV results and understand the implications for future cervical screening. Anxiety about being at 'increased risk' was more apparent in women who were HPV positive without history of abnormal results. CONCLUSIONS Women show some understanding of HPV and the new CST, but more written and public communication about the changes and possible results are warranted. Efforts are needed to ensure that women who are HPV positive without history of abnormal results receive the information needed to alleviate anxiety.
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Affiliation(s)
- Rachael H Dodd
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivia A Mac
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten J McCaffery
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Farnsworth A, Roberts JM, Garland SM, Crescini J, Kaldor JM, Machalek DA. Detection of high-grade cervical disease among women referred directly to colposcopy after a positive HPV screening test varies with age and cytology findings. Int J Cancer 2020; 147:3068-3074. [PMID: 32484236 DOI: 10.1002/ijc.33128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 11/06/2022]
Abstract
Australia's new HPV-based cervical screening program is based on an algorithm that incorporates reflex cytology to guide decisions about further follow-up with colposcopy and, if indicated, biopsy. We reviewed results for 2300 women referred directly for colposcopy after their first positive HPV screening test, to determine the proportion that had underlying histological high-grade abnormality (HGA). Overall, HGA was detected in 24.3% of women. Among HPV16/18 positive women, 18.0% had HGA, increasing from 6.6% among women with negative cytology to 79.7% among women with high-grade squamous lesion or worse, or any glandular lesion on cytology (HSIL+; P-trend < .001). For this latter group, the proportion with HGA was higher among HPV16/18 positive women than among those positive for other oncogenic types (68.8%; P = .029). Among women with ASC-H cytology, 51.8% had HGA, with no difference between HPV groups (P = .314). In analyses by age-groups, detection of HGA was highest, at 36.4%, among women younger than 35 years, then decreased significantly to 5.9%, among women aged 65 to 74 years (P-trend < .001). The relationship of decreasing HGA detection with increasing age was strong for women with negative cytology, and those with ASC-H cytology (P-trend < .001 for each). For women with HSIL+ cytology, detection of HGA was high and stable, regardless of age (P-trend = .211). This report describes the first follow-up colposcopy findings in Australia's new HPV-based cervical screening program. The results demonstrate the additional value of reflex cytology in managing HPV positive women and suggest that further refinement of the risk-based algorithm to account for age may be warranted.
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Affiliation(s)
- Annabelle Farnsworth
- Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia.,School of Medicine Sydney Campus, Department of Pathology, University of Notre Dame, New South Wales, Australia
| | | | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, New South Wales, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Molecular Microbiology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Joanne Crescini
- Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Dorothy A Machalek
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, New South Wales, Australia.,Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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35
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Dodd RH, Obermair HM, McCaffery KJ. Implementing changes to cervical screening: A qualitative study with health professionals. Aust N Z J Obstet Gynaecol 2020; 60:776-783. [PMID: 32510586 DOI: 10.1111/ajo.13200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Profound changes were made to the Australian National Cervical Screening Program in December 2017, which included a reduction in the frequency of screening and a new cervical screening test. AIM To explore the attitudes and experiences of health professionals practising in Australia since implementation of these changes. MATERIALS AND METHODS Thirty-one semi-structured interviews were conducted with general practitioners, obstetricians and gynaecologists, pathologists and nurses involved in cervical screening Australia-wide. Data were analysed using Framework Analysis. RESULTS Overall, health professionals had positive attitudes toward the changes but described many challenges associated with their implementation. Participants discussed practical system challenges, communication and education, finding ways around the guidelines and other perceived 'collateral'. Practical system challenges included increased colposcopy referrals, limited access to the National Cancer Screening Register, a complex primary screening approach, and issues with self-collection. In terms of communication and education, limited public education was recognised, in addition to challenges with particular age groups of women. Finding ways around the guidelines were described, for example over-referring women for co-testing by stating symptoms, which could lead to overtreatment. Other perceived collateral were demonstrated through reduced opportunistic screening opportunities due to less frequent primary care presentations, and concern over the potential for further underscreening in already under-screened populations. CONCLUSIONS These findings provide insight into the challenges health professionals face with renewing programs, in terms of practical issues and unexpected downstream effects which need to be addressed to ensure future implementation of the program is streamlined.
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Affiliation(s)
- Rachael H Dodd
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Helena M Obermair
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics & Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kirsten J McCaffery
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Sultana F, Roeske L, Malloy MJ, McDermott TL, Saville M, Brotherton JML. Implementation of Australia's renewed cervical screening program: Preparedness of general practitioners and nurses. PLoS One 2020; 15:e0228042. [PMID: 31995585 PMCID: PMC6988932 DOI: 10.1371/journal.pone.0228042] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022] Open
Abstract
The National Cervical Screening Program (NCSP) in Australia underwent major changes on December 1st, 2017. The program changed from 2-yearly Pap testing for women aged 18–69 years to 5-yearly HPV testing for women aged 25–74 years including differential management pathways for oncogenic HPV 16/18 positive versus HPV non16/18 positive test results and the option of self-collection for under-screened women. We conducted a survey among cervical screening providers in primary care to assess their level of preparedness in undertaking cervical screening before (pre-renewal) and after (post-renewal) the new program was implemented. Surveys were conducted between 14th August and 30th November 2017 (pre-renewal) and 9th February and 26th October 2018 (post-renewal) among cervical screening providers who attended education sessions related to the new guidelines. Preparedness was assessed in three areas: 1) level of comfort implementing the new guidelines (7 questions), 2) level of confidence in their ability to convey information about the new guidelines (9 questions) and 3) level of agreement regarding access to resources to support implementation (11 questions). Proportions were calculated for each question response and pre- and post-renewal periods compared using generalised linear models. Open-ended questions related to anticipated barriers and ways to overcome barriers were also included in the questionnaires. Compared to the pre-renewal period, a higher proportion of practitioners in the post-renewal period were more comfortable offering routine screening to women ≥25 years (p = 0.005) and more confident explaining the rationale for not screening before 25 years (p = 0.015); confident explaining a positive HPV 16/18 (p = 0.04) and HPV non 16/18(p = 0.013) test result and were comfortable with not referring women with a positive HPV non 16/18 test result and low grade/negative cytology for colposcopy (p = 0.01). A higher proportion of Victorian practitioners in the post-renewal period sample were also comfortable (p = 0.04) and confident (p = 0.015) recommending self-collection to under-screened women and agreed that self-collection is a reliable test (p = 0.003). The most commonly reported suggestion was to provide information, education and communication materials to both patients and practitioners. Compared to the pre-renewal period, practitioners in the post-renewal period were better prepared to implement the renewed screening program. Healthcare providers require further support to implement the self-collection pathway.
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Affiliation(s)
- Farhana Sultana
- Formerly VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Lara Roeske
- VCS Pathology, VCS Foundation, Carlton, Victoria, Australia
| | - Michael J. Malloy
- Formerly VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | | | - Marion Saville
- VCS Pathology, VCS Foundation, Carlton, Victoria, Australia
- VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Julia M. L. Brotherton
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia
- * E-mail:
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37
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Sweeney S, Cheng Y, Botfield JR, Bateson D. National Cervical Screening Program renewal in Australia: survey of clinician views and attitudes. Aust J Prim Health 2020; 26:410-416. [DOI: 10.1071/py20032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022]
Abstract
From 1 December 2017, the National Cervical Screening Program was renewed in Australia, with updated national cervical screening guidelines released. This study was performed to determine clinicians’ familiarity with the updated guidelines and explore their views and attitudes towards the renewed program. Clinicians providing cervical screening in New South Wales, Australia, were invited to complete an online survey in 2018. Of the 241 clinicians who responded, 91.5% supported the change to 5-yearly human papillomavirus screening from the age of 25 years. However, nearly 13% indicated they did not know where to access the renewed guidelines and 37% had never or rarely accessed them. Open-ended responses highlighted clinicians’ concerns about missed cancers and missed opportunities for health checks. Those raising these concerns accessed the guidelines less frequently. The findings highlight important areas for additional education and support for clinicians in translating guidelines into practice to ensure successful delivery of the renewed program.
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