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Kim JY, Hong J, Yoon J, Park J, Kim TH. Regularity of cervical cancer screening in Korea: analysis using national public data for 12 years. J Gynecol Oncol 2024; 35:e18. [PMID: 37921602 PMCID: PMC10948977 DOI: 10.3802/jgo.2024.35.e18] [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: 05/08/2023] [Revised: 09/04/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To assess the frequency of regular uptake of national cervical cancer screening (CCS) program and identify associated factors among Korean women. METHODS This study is a fundamental investigation that employs openly accessible public data of Korea through secondary data analysis. A cohort of 4,663 women from the 2007-2012 Korean National Health and Nutrition Examination Survey, was followed up for up to 12 years (2007-2018) to obtain the frequency of national CCS. Compliance level with CCS was categorized, and an ordinal logistic regression model was employed to investigate the contributing factors. RESULTS The regular uptake of CCS in South Korea was low at 18.9%. The trend of regular screening showed significant association with various factors, including age (40-59 years), household income (100%-150% bracket), occupation (service workers), place of residence (small to medium sized cities), education level (middle school graduates), marital status (married), and possession of private insurance. Moreover, individuals with a history of non-cervical cancer or carcinoma in situ of the cervix, a family history of cervical cancer, or a higher frequency of general check-ups demonstrated a stronger adherence to regular CCS uptake. CONCLUSION Our findings revealed that regular participation in CCS in Korea was lower than anticipated, with factors such as socioeconomic status, personal history of gynecologic issue, and frequency of general health check-ups playing influential roles. However, further research, including an exploration of unexamined psychological barriers to screening, is necessary to gain a better understanding the reasons behind the reduced rates of regular CCS among Korean women.
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Affiliation(s)
- Jong-Yeup Kim
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Korea
| | - Jeeyoung Hong
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Korea
| | - Juhee Yoon
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea
| | - Jinsol Park
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Hyun Kim
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea.
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Al-Ani A, Hammouri M, Sultan H, Al-Huneidy L, Mansour A, Al-Hussaini M. Factors affecting cervical screening using the health belief model during the last decade: A systematic review and meta-analysis. Psychooncology 2024; 33:e6275. [PMID: 38282232 DOI: 10.1002/pon.6275] [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: 06/13/2023] [Revised: 11/15/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024]
Abstract
AIMS To examine the utility of the health belief model (HBM) and other socioeconomic factors in shaping cervical screening behaviors. Also, to provide recommendations on improving screening uptake. METHODOLOGY A systematic literature search was conducted using the PubMed/MEDLINE, Cochrane/CENTRAL, and Web of Science databases for articles reporting on the factors associated with cervical screening using the HBM within the period from January of 2002 to January of 2023. Effect sizes for the various HBM constructs were pre-determined using the log odds ratio (logOR) and expressed with their confidence intervals. All reporting was in line with the PRISMA guidelines. RESULTS A total of 21 studies were included in the final analysis comprised of 15,365 participants. Our pooled analysis demonstrated that perceived susceptibility (OR: 1.40, 95% CI, 1.03-1.89), perceived benefits (OR: 1.30; 95% CI, 1.13-1.50), and self-efficacy (OR: 1.11; 95% CI, 1.05-1.17) were significantly associated with both the uptake of and intention to adopt preventive measures against cervical cancer. Conversely, women with higher perceptions of barriers were less likely to adopt any measure for cervical cancer screening or prevention (OR: 0.72; 95% CI, 0.57-0.91). In terms of sociodemographic effectors, older age (OR: 1.09; 95% CI, 1.01-1.19), graduate/post-graduate education (OR: 2.80; 95% CI, 1.46-5.37), higher knowledge of cervical cancer (OR: 2.21; 95% CI, 1.27-3.84), and being married (OR: 3.89; 95% CI, 1.38-10.92) were all associated with altering preventive behaviors and intentions toward cervical cancer. CONCLUSION This review delineates the most important and effective cognitive components that should be targeted within interventions aiming to promote cervical cancer prevention.
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Affiliation(s)
- Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | | | - Hala Sultan
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | | | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
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Ayanto SY, Belachew Lema T, Wordofa MA. Women's and health professionals' perceptions, beliefs and barriers to cervical cancer screening uptake in Southern Ethiopia: a qualitative study. Sex Reprod Health Matters 2023; 31:2258477. [PMID: 37812407 PMCID: PMC10563609 DOI: 10.1080/26410397.2023.2258477] [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] [Indexed: 10/10/2023] Open
Abstract
Cervical cancer remains a public health problem worldwide. Screening for cervical cancer is poorly implemented in resource-limited settings. In Ethiopia, evidence from the community and health professionals regarding implementation of the screening programme is lacking. The objective of this study was to explore women's and health professionals' perceptions, beliefs, and barriers in relation to cervical screening in Southern Ethiopia. Five focus group discussions among women and six key informant interviews with health professionals were conducted from June to July 2022 to gather the required data from a total of 42 participants. The participants were purposively selected from a diverse group to ensure varied viewpoints. Data were collected through group discussions and face-to-face interviews using a semi-structured interview guide. The interview sessions were tape-recorded. The data were analysed using a thematic approach. Women demonstrated a low level of awareness and perceived risk. Also, the perceived benefit of screening for cervical cancer during healthy periods was low. Individual and system-level barriers to screening include low awareness, stigma, poor perceptions towards health screening and causes of cervical cancer, low risk perception and competing domestic priorities, shortage of trained human and other resources, human resource turnover, low implementation and lack of close follow-up of screening programmes. In summary, lack of awareness, misconceptions, and poor perceptions were common. Screening implementation and uptake were low due to individual, psychosocial, and system-related barriers. Therefore, behavioural change communication and system-strengthening efforts need to be in place to effectively tackle the observed gaps.
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Affiliation(s)
- Samuel Yohannes Ayanto
- Assistant Professor, Department of Population and Family Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Tefera Belachew Lema
- Professor, Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia
| | - Muluemebet Abera Wordofa
- Associate Professor, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
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Rai R, Sehgal R, Singhal S, Suri V, Shivkumar P, Balasubramani L, Rajaram S, Shamsunder S, Bagga R, Vashist S, Meena J, Mishra A, Chawla L, Kumari S, Mani K, Bhatla N. Cervical Cancer Screening Coverage at Tertiary Care Institutes Across India. Asian Pac J Cancer Prev 2023; 24:4269-4275. [PMID: 38156863 PMCID: PMC10909083 DOI: 10.31557/apjcp.2023.24.12.4269] [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: 08/13/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES The 70% screening coverage target proposed in the global cervical cancer elimination strategy is not achieved even at tertiary centres in India. A situational analysis was done to assess the currently existing facilities and barriers in tertiary care institutes. METHODS This cross sectional multicentric study was conducted from August to September 2021 in six tertiary care institutes across India. Women aged 30-49 years attending outpatient services (OPD) were invited for cervical screening. Women and health care professionals (HCPs) were administered structured questionnaires to assess knowledge, attitude and practices regarding cervical cancer screening services. RESULTS Out of 6709 eligible women who attended OPD, 1666 (24.8%; range:19-57%) received screening. Availability of screening kits was limited to 10-25 Pap/HPV tests per day. Visual inspection with acetic acid (VIA) and HPV testing were offered only at certain centres. Colposcopy and treatment facilities were optimal at all centres. Knowledge, attitude and practices were analysed for 1800 women: 45.7% had heard of cervical cancer, 78.0% did not know that it is preventable, 75.8% never heard about screening. Common symptoms correctly identified included postmenopausal bleeding (4.8%), postcoital bleeding (5.7%), intermenstrual bleeding (5.8%) and vaginal discharge (12.4%). Risk factors were identified by minority: poor menstrual hygiene (6.6%), oral contraceptive pill use (6.4%), multiparity (4.4%), and HPV infection (3.0%). Out of 21, mean total knowledge score (MTKS) was 2.07± 2.67. Out of 317 HCPs, 96.5% knew that cervical cancer is caused by HPV infection, is preceded by premalignant stage, and that it is preventable by screening and treatment (80.1%). Knowledge about screening modalities was present in 87.4% for cytology, 75.1% for VIA, 68.8% for HPV test. MTKS of HCPs was 20.88±6.61 out of 32. CONCLUSION Even at tertiary centres, limited availability of HPV tests, reluctance to implement VIA and lack of awareness among women remain the major barriers.
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Affiliation(s)
- Rakhi Rai
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | - Rohini Sehgal
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India.
| | | | - Latha Balasubramani
- Department of Gynaecology Oncology, VN Cancer Centre, GKNM Hospital, Coimbatore, India.
| | - Shalini Rajaram
- Department of Obstetrics and Gynaecology AIIMS, Rishikesh, India.
| | - Saritha Shamsunder
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India.
| | - Rashmi Bagga
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India.
| | - Shachi Vashist
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | - Archana Mishra
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India.
| | - Latika Chawla
- Department of Obstetrics and Gynaecology AIIMS, Rishikesh, India.
| | - Sarita Kumari
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | | | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
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Anderson JR, Yogeshkumar S, Lu E, Yenokyan G, Thaler K, Mensa M, Chikaraddi S, Lokare L, Gudadinni MR, Antartani R, Donimath K, Patil B, Bidri S, Goudar SS, Derman R, Dalal A. The CryoPop study: Screening for high-grade cervical dysplasia in Karnataka, India. BJOG 2023; 130 Suppl 3:158-167. [PMID: 37932903 PMCID: PMC10659137 DOI: 10.1111/1471-0528.17702] [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: 03/31/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To describe our experience of screening with visual inspection with acetic acid (VIA) and colposcopy to identify women with high-grade precancerous cervical lesions who were candidates for cryotherapy. Women were screened to determine eligibility for a clinical trial testing the safety and efficacy of a new, simple and inexpensive cryotherapy device (CryoPop®) targeted for use in low and middle-income countries (LMICs). DESIGN Prospective cohort study. SETTING Primary and urban health centres in Belagavi, Hubballi and Vijayapur, India. POPULATION Women in the age-group 30-49 years, premenopausal, with no prior hysterectomy and no known HIV infection were eligible for screening. METHODS Visual inspection with acetic acid was performed on eligible women following informed consent. VIA-positive women were referred for colposcopy and biopsy. Biopsies were read by two pathologists independently, with a third pathologist acting as tie-breaker if needed. MAIN OUTCOME MEASURES The primary outcome measures were the number/proportion of women screening positive by VIA and the number/proportion of those women screening VIA-positive found to have high-grade cervical lesions on biopsy (cervical intraepithelial neoplasia 2/3 [CIN 2/3]). Demographic variables were compared between women who screened VIA-positive and those who screened VIA-negative; a separate comparison of demographic and limited reproductive variables was performed between women who had CIN 2/3 on biopsy and those without CIN 2/3 on biopsy. Chi-square or Fisher's exact tests for categorical data and t-tests or analysis of variance for numeric data were used with all tests two-sided and performed at an alpha 0.05 level of statistical significance. RESULTS A total of 9130 women were screened with VIA between 4 July 2020 and 31 March 2021. The mean age of all women screened was 37 years (standard deviation = 5.6 years) with 6073 of the women (66.5%) in the 30-39 year range. Only 1% of women reported prior cervical cancer screening. A total of 501 women (5.5%) were VIA-positive; of these, 401 women underwent colposcopy. Of those who had colposcopy, 17 (4.2%) had high-grade lesions on biopsy, an additional 164 (40.9%) had low-grade cervical lesions on biopsy or endocervical curettage and one woman (0.2%) was found to have invasive cancer. VIA-positive women were younger and had higher levels of education and income; however, women who were VIA-positive and found to have CIN 2/3 were older, were more likely to be housewives and had higher household income than those without CIN 2/3. CONCLUSION Despite the COVID-19 pandemic, over 9100 women were screened with VIA for precancerous lesions. However, only 17 (4.2%) were found to have biopsy-proven high-grade cervical lesions, underscoring the subjective performance of VIA as a screening method. Given that this is significantly lower than rates reported in the literature, it is possible that the prevalence of high-grade lesions in this population was impacted by screening a younger and more rural population. This study demonstrates that screening is feasible in an organised fashion and can be scaled up rapidly. However, while inexpensive and allowing for same-day treatment, VIA may be too subjective and have insufficient accuracy clearly to identify lesions requiring treatment, particularly in low-prevalence and low-risk populations, calling into question its overall cost-effectiveness.
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Affiliation(s)
- Jean R Anderson
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Yogeshkumar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Enriquito Lu
- Jhpiego, an Affiliate of Johns Hopkins University, Baltimore, Maryland, USA
| | - Gayane Yenokyan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katrina Thaler
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Margaret Mensa
- Jhpiego, an Affiliate of Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Muttappa R Gudadinni
- BLDE (Deemed-to-be-University) Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, India
| | | | | | - Basavaraj Patil
- Karnataka Cancer Therapy & Research Institute, Hubballi, India
| | - Shailaja Bidri
- BLDE (Deemed-to-be-University) Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, India
| | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Richard Derman
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anita Dalal
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
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Raj S, Kattepur AK, Shylasree T, Mishra GA, Patil A, Pimple S, Noronha S, Pramesh C. Novel educational training of para medical professionals in cervical cancer screening. Gynecol Oncol Rep 2023; 48:101241. [PMID: 37520786 PMCID: PMC10372157 DOI: 10.1016/j.gore.2023.101241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/02/2023] [Accepted: 07/09/2023] [Indexed: 08/01/2023] Open
Abstract
Background Cervical cancer is a public health problem in India due to weak national screening policy compounded by lack of resources including scarcity of trained personnel to carry out community-based screening program. Para medical professionals (PMPs) are closely related to women in local communities. Hence, training PMPs by incorporating novel technology and reduced time duration to achieve adequate competence in screening is an area underutilized and needs to be explored. Materials and methods A pilot cross sectional analytical study was conducted at a tertiary referral cancer center using a shorter version of educational intervention of 2 weeks duration (EI2W) involving PMPs. Pre- and post-training assessment of knowledge, attitude, and practice (KAP) was done using questionnaires consisting of 5 domains viz. awareness of cervical cancer, awareness of cervical pre-cancer, practical screening methodology (practice oriented), data management and aspects of human papilloma virus (HPV). Wilcoxon signed-rank test was used for comparison and the degree of change was measured using analysis of covariance (ANCOVA). A p value of <0.05 was considered significant. Results 118 PMPs were included. There was a significant improvement in scores of all domains (except cervical pre-cancer domain), following introduction of EI2W. Knowledge scores, post EI2W was better in Auxiliary Nurse Midwives (ANMs) than other participants. Awareness regarding cervical cancer was higher with more years of experience. The KAP analysis showed excellent interrater reliability in the practice 0.726 (0.649-0.792) followed by knowledge domain 0.711 (0.626-0.783). Conclusion EI2W was effective in significantly improving the competence of PMPs, thus reducing human resource constraints in cervical cancer prevention and elimination.
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Affiliation(s)
- Sneha Raj
- Department of Gynecological Oncology and Preventive Oncology, Tata Memorial Centre, Dr Ernst Borges Marg, Parel, Mumbai 400012, India
| | - Abhay K. Kattepur
- Department of Gynecological Oncology and Preventive Oncology, Tata Memorial Centre, Dr Ernst Borges Marg, Parel, Mumbai 400012, India
- Department of Surgical Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
| | - T.S. Shylasree
- Department of Gynecological Oncology and Preventive Oncology, Tata Memorial Centre, Dr Ernst Borges Marg, Parel, Mumbai 400012, India
- Gynecological Oncology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen AB25 2ZN, United Kingdom
| | - Gauravi A Mishra
- Department of Gynecological Oncology and Preventive Oncology, Tata Memorial Centre, Dr Ernst Borges Marg, Parel, Mumbai 400012, India
| | - Akshay Patil
- Department of Gynecological Oncology and Preventive Oncology, Tata Memorial Centre, Dr Ernst Borges Marg, Parel, Mumbai 400012, India
- Royal Papworth NHS Foundation Trust, University of Cambridge, Cambridge CB2 0AY, England
| | - Sharmila Pimple
- Department of Gynecological Oncology and Preventive Oncology, Tata Memorial Centre, Dr Ernst Borges Marg, Parel, Mumbai 400012, India
| | - Santosh Noronha
- Department of Chemical Engineering, Indian Institute of Technology (IIT) Bombay, Powai, Mumbai, India
| | - C.S. Pramesh
- Department of Gynecological Oncology and Preventive Oncology, Tata Memorial Centre, Dr Ernst Borges Marg, Parel, Mumbai 400012, India
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Jones M, Subramanian S, Jose R. Cancer screening behaviors and preferences among women in southern India. J Cancer Policy 2023; 35:100401. [PMID: 36632974 DOI: 10.1016/j.jcpo.2023.100401] [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: 07/08/2022] [Revised: 12/26/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION In 2020, India's cancer cases were estimated at 1.32 million (International Agency for Research on Cancer et al., 2020) and were predicted to double by 2040 (Smith and Mallath, 2019). METHODS Starting in March 2019, we recruited 211 adult women in the Trivandrum area of India who had an outpatient office visit within the past 6 months to participate in a structured survey. We identified the study population from the Gokulam Medical College and four peripheral centers. Two trained interviewers collected survey information from the participants, including information on breast, oral, and cervical cancer screening eligibility, history, recommendations, and screening initiation. For analysis, we stratified the sample into two groups by age: a priority screening group, aged 30-65 (n = 132), and an overall group, containing the entire sample, aged 19-85 (n = 211). RESULTS 14.22% of respondents in the overall group and 14.39% in the priority screening group reported receiving a prior cancer screening. Among women who had not received cancer screening, the most common reasons were "no provider recommendation" (42.18%) and not knowing they needed to be screened (40.76%). Most women estimated their risk of developing cancer to be "very low" (64.93%), although the vast majority also believed early detection could improve cancer outcomes (84.83%). Among those who had not been screened for cancer, 61.61% overall and 65.15% in the priority screening group responded that they would undergo all eligible cancer screenings if recommended by their provider. The figure jumps to 79.62% in the overall group and 77.27% in the priority screening group if additional respondent-identified barriers to screening were addressed. CONCLUSION Provider recommendations can be used to mitigate the suboptimal screening uptake and late-stage diagnosis that exacerbate the mortality and economic burden due to cancer in India. POLICY SUMMARY This study finds that provider recommendations can shape the trajectory of outcomes by increasing cancer screening among women.
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Affiliation(s)
- Madeleine Jones
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA
| | - Sujha Subramanian
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA.
| | - Regi Jose
- Sree Gokulam Medical College, Aalamthara-Bhoothamadakki Rd, Venjarammoodu, Kerala 695607, India
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Parikh PM, Mullapally SK, Hingmire S, Kamal Uddin AFM, Thinn MM, Shahi A, Tshomo U, Mohan I, Kaur S, Ghadyalpatil N. Cervical Cancer in SAARC Countries. South Asian J Cancer 2023; 12:1-8. [PMID: 36851937 PMCID: PMC9966176 DOI: 10.1055/s-0043-1764227] [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] [Indexed: 02/27/2023] Open
Abstract
Purvish M. ParikhIn the year 2020, a total of 342 000 women were estimated to die of cervical cancer, of which 90%) were expected amongst low- and middle-income countries (LMIC). Globally incidence of cervical cancer has reduced as a result of improved personal hygiene, better living conditions and higher application of opportunistic screening programs. Yet GLOBOCAN shows that absolute number of cases are still increasing. We therefore conducted a 21 question multiple choice questionnaire online survey in Jan 2023 amongst 9 SAARC countries. A total of 367 replies were received and the representative answers for each country are being reported in this manuscript. A good possibility of achieving World Health Assembly target (Nov 17, 2020) was felt only by Bhutan and Nepal. For screening, most countries (Bhutan, India, Myanmar, Nepal, Pakistan and Sri Lanka) recommend for all asymptomatic eligible patients. Public health experts have suggested VIA / VILI as the best solution for LMICs. However, a dual screening strategy (HPV DNA plus) cytology was preferred by doctors in Afghanistan, Bhutan, India, Myanmar, Pakistan and Sri Lanka. Screening, triage and then treatment was the preferred by Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka. HPV vaccination was recommended in all girls between ages 10 to 26 years in Bangladesh, India, Myanmar, Nepal, Pakistan and Sri Lanka. All the 9 countries would use HPV vaccination to all eligible patients if the cost of the vaccine was reasonably low. Our survey clearly outlines challenges faced in tackling cervical cancer in SAARC countries. We also provide consensus regarding several potential solutions that can be used in both public and private cervical cancer control programs.
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Affiliation(s)
- Purvish M Parikh
- Department of Clinical Hematology, Mahatma Gandhi University of Health Sciences and Technology, Jaipur, Rajasthan, India
| | | | - Sachin Hingmire
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - A F M Kamal Uddin
- Department of Radiation Oncology, National Institute of ENT, Dhaka, Bangladesh
| | - M M Thinn
- Department of Gynaecology, Yangon Central Women's Hospital, Yangon, Myanmar
| | - Arun Shahi
- Department of Medical Oncology, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Ugyen Tshomo
- Department of Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Indu Mohan
- Department of Community Medicine, Mahatma Gandhi University of Health Sciences and Technology, Jaipur, Rajasthan, India
| | - Satinder Kaur
- Department of Gynaecological Oncology, Dharamshila Narayana Superspeciality Hospital, New Delhi, India
| | - Nikhil Ghadyalpatil
- Department of Medical Oncology, Yashoda Hospitals, Hyderabad, Telangana, India
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Sen S, Khan PK, Wadasadawala T, Mohanty SK. Socio-economic and regional variation in breast and cervical cancer screening among Indian women of reproductive age: a study from National Family Health Survey, 2019-21. BMC Cancer 2022; 22:1279. [PMID: 36476339 PMCID: PMC9727878 DOI: 10.1186/s12885-022-10387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In India, breast and cervical cancers account for two-fifths of all cancers and are predominantly prevalent among women in the reproductive age group. The Government of India recommended screening of breast and cervical cancer among women aged 30 years and over. This study examines the socio-economic and regional variations of breast and cervical screening among Indian women in the reproductive age. METHODS A full sample of 707,119 women aged 15-49 and a sub-sample of 357,353 women aged 30-49 from National Family Health Survey-5 (2019-21) were used in the analysis. Self-reported ever screening for breast and cervical cancer for women aged 15-49 and women aged 30-49 were outcome variables. A set of socio-economic and risk factors associated with breast and cervical cancer screening were used as the predictors. Logistic regression was used to understand the significant correlates of cancer screening and, concentration index and concentration curve were used to assess the socio-economic inequality in breast and cervical cancer screening. RESULTS The proportion of breast and cervical cancer screening among women aged 30-49 were 877 and 1965 per 100,000 women respectively. Cancer screening was lower among women who were poor, young, had lower educational attainment and resided in rural areas. The concentration index was 0.2 for ever screening of breast cancer and 0.15 for cervical cancer among women aged 30-49 years. The concertation curve for screening of both breast and cervical cancers was pro-rich. Women with higher educational attainment [OR:1.46, 95% CI: 1.31-1.62], aged 40-49 years [OR:1.35; 95% CI: 1.28-1.43], resided in the western [OR:1.62; 95% CI:1.4-1.87] or southern [OR:6.66; 95% CI:5.93-7.49] region had significantly higher odds of up taking either of the screening. The pattern of breast and cervical cancer screening among women aged 15-49 was similar to that of women 30-49. CONCLUSION The overall proportion of cancer screening among women in 30-49 age group is low in India. Early screening and treatment can reduce the burden of these cancers. Creating awareness and providing knowledge on cancer could be a key strategy for reducing the burden of breast and cervical cancers among women in the reproductive age in India.
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Affiliation(s)
- Soumendu Sen
- grid.419349.20000 0001 0613 2600Department of Population and Development, International Institute for Population Sciences, Mumbai, India
| | - Pijush Kanti Khan
- grid.464858.30000 0001 0495 1821International Institute of Health Management Research, Delhi, India
| | - Tabassum Wadasadawala
- grid.450257.10000 0004 1775 9822Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sanjay K Mohanty
- grid.419349.20000 0001 0613 2600Department of Population and Development, International Institute for Population Sciences, Mumbai, India
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Dsouza JP, Van den Broucke S, Pattanshetty S, Dhoore W. Factors explaining men's intentions to support their partner's participation in cervical cancer screening. BMC Womens Health 2022; 22:443. [PMID: 36369003 PMCID: PMC9652784 DOI: 10.1186/s12905-022-02019-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 10/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cervical cancer represents a high burden of disease. Many women in low- and middle-income countries face opposition from their partners and families to undergo cervical cancer screening. Identifying the social, cultural, and psychological factors that underly the opposition to screening by male partners is an important step towards reducing barriers for men to support their wives' participation in cervical screening. This study explored the role of structural and psychological factors deriving from theoretical models as determinants of Indian men's opposition to their partners being screened for cervical cancer. METHODS A survey among 500 sexually active males was conducted between April 2020 and August 2020 to measure knowledge of cervical cancer and screening, awareness of screening possibilities, attitude towards screening, perceived barriers to screening, and health literacy. Regression analysis was performed to assess which of the potential factors contributed to the intention to support their wives' screening. RESULTS The majority of participants had very poor knowledge and awareness about cervical cancer and screening procedures, tended towards a negative attitude towards screening, and perceived several structural barriers. Attitude towards the screening procedure and routine participation in general screening significantly predicted their intention to support their wives' screening for cervical cancer. Education moderated the association between knowledge and awareness and the intention to support their wives' screening. CONCLUSION As women often rely on their spouses' financial and emotional support of cervical screening, there is a need for men to be encouraged to support their wives' screening participation. Programs to encourage men to support their wives' cervical screening should focus on their attitude towards screening, educate about cervical cancer and screening procedures, and reduce perceived barriers.
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Affiliation(s)
- Jyoshma Preema Dsouza
- Psychological Sciences Research Institute, Université catholique de Louvain, Ottignies-Louvain-la-Neuve - Louvain-la-Neuve, Belgium.
- Institute of Health and Society, School of Public Health, 1200 Woluwe-Saint-Lambert, Belgium.
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Université catholique de Louvain, Ottignies-Louvain-la-Neuve - Louvain-la-Neuve, Belgium
| | - Sanjay Pattanshetty
- Prasanna School of Public Health, Manipal Academy of Higher education, Manipal, India
| | - William Dhoore
- Institute of Health and Society, School of Public Health, 1200 Woluwe-Saint-Lambert, Belgium
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Algabr GA, AlSaud L, Ismail AAS. Knowledge, attitudes and practices toward cervical cancer and screening among sexually active Saudi females visiting a primary care center in Saudi Arabia. J Family Med Prim Care 2022; 11:6121-6126. [PMID: 36618148 PMCID: PMC9810906 DOI: 10.4103/jfmpc.jfmpc_141_22] [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: 01/18/2022] [Revised: 03/21/2022] [Accepted: 05/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background/Aim Women's knowledge of cervical cancer (CC) and awareness of screening procedures are important to improve adherence and reduce mortality. This study was conducted to determine the knowledge, attitudes, and practices toward cervical cancer and screening among sexually active Saudi females visiting a primary care center in Riyadh, Saudi Arabia. Methods We conducted a cross-sectional study among sexually active Saudi females who visited the primary care center of our institution using a self-administered survey questionnaire between July and December 2020. Results Six hundred and one Saudi women participated in the survey with a mean age of 34.0 ± 10.8 years. Three in four women (75.7%) were aware of cervical cancer and 325 (54.1%) believed that doing a Paps smear helped them diagnose and prevent CC. However, 479 participants (79.7%) do not see the need to go for CC screening (n = 199, 41.5%) and 113 (23.6%) had not heard of Paps smear screening. There were 109 women (18.1%) who has good knowledge of cervical cancer and screening and 492 women (81.9%) had poor knowledge. Conclusion There was a high proportion of women with poor knowledge and awareness about cervical cancer and screening. Most women do not feel the need to undergo screening. Primary care physicians and healthcare providers should revisit the implementation of policies or information dissemination of programs and materials to increase awareness and knowledge for cervical cancer screening and vaccination throughout primary healthcare centers.
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Affiliation(s)
- Ghadah Abdulrahman Algabr
- Family Medicine Center, Security Forces Hospital, Riyadh, Saudi Arabia,Address for correspondence: Dr. Ghadah Abdulrahman Algabr, Family Medicine Center, Security Forces Hospital, P.O. Box 3643, Riyadh - 11481, Saudi Arabia. E-mail:
| | - Lama AlSaud
- Family Medicine Center, Security Forces Hospital, Riyadh, Saudi Arabia
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Dsouza JP, Broucke SVD, Pattanshetty S, Dhoore W. A comparison of behavioural models explaining cervical cancer screening uptake. BMC Womens Health 2022; 22:235. [PMID: 35710374 PMCID: PMC9204900 DOI: 10.1186/s12905-022-01801-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention. METHODS A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models. RESULTS CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers. CONCLUSION Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women's screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening.
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Affiliation(s)
- Jyoshma Preema Dsouza
- School of Public Health, Psychological Research Institute, Université Catholique de Louvain, 1348, Ottignies Louvain-la-Neuve, Belgium.
| | - Stephan Van den Broucke
- School of Public Health, Psychological Research Institute, Université Catholique de Louvain, 1348, Ottignies Louvain-la-Neuve, Belgium
| | - Sanjay Pattanshetty
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - William Dhoore
- School of Public Health, Psychological Research Institute, Université Catholique de Louvain, 1348, Ottignies Louvain-la-Neuve, Belgium
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Sociodemographic correlates of cervix, breast and oral cancer screening among Indian women. PLoS One 2022; 17:e0265881. [PMID: 35544475 PMCID: PMC9094566 DOI: 10.1371/journal.pone.0265881] [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: 06/08/2021] [Accepted: 03/09/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Cervix, breast and oral cancers account for about one-third of all cancers in India which as a group is a major contributor to all non-communicable disease-related morbidity and mortality among women. Existing evidence suggests that early diagnosis plays a pivotal role in the prevention and intervention of these cancers, and many community-based early screening and awareness programs have been in place in developed countries. Currently, there is not enough research evidence regarding the sociodemographic correlates of cervix, breast and oral cancer screening among Indian women. In the present study, we aimed to assess the self-reported percentage and sociodemographic factors associated with the use of these three types of cancer screening services among Indian women aged 15–49 years. Methods Data were collected from National Family Health Survey conducted during 2015–16. Sample population was 699,686 women aged 15–49 years. Associations between self-reported cervical, breast and oral cancer screening status and the associated sociodemographic factors were analyzed using multivariable logistic regression methods. Results The percentage of screening for cervical (21%), breast (8.95%), and oral cancers (13.45%) varied significantly across the population sub-groups. Higher age, urban residence, higher education, having employment, health insurance, use of electronic media, higher household wealth quintile, having healthcare autonomy, showed a positive effect on taking screening services. Further analyses revealed that the strength of the associations varied considerably between urban and rural residents, denoting the need for region-specific intervention strategies. Sex of household head, age, watching TV, using radio, and having health insurance were the most significant contributors to the outcome effects. Conclusions The present study provides important insights regarding the current scenario of seeking cancer screening services among women in India. These findings could inform policy analysis and make an avenue for further in-depth analysis for future studies. Our findings conclude that cancer prevention policies should focus on leveraging the positive effects of better socioeconomic status, employment, health insurance ownership, exposure to electronic media, and better healthcare autonomy to improve the cancer screening service uptake among Indian women.
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Mehrotra R, Yadav K. Cervical Cancer: Formulation and Implementation of Govt of India Guidelines for Screening and Management. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022; 20:4. [PMID: 34977333 PMCID: PMC8711687 DOI: 10.1007/s40944-021-00602-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
Purpose Cervical cancer is the second most common cancers of women in India, despite being largely preventable. This review traces the journey of formulation of the Operational Guidelines for the management of common cancers and its implementation. Methods A literature review was done to document the process of formulation of the guidelines, in addition to inputs from the officials involved in the process of developing them. Results The review covers the pre-existing challenges in the National cancer control program and helps in providing recommendations for the future of cervical cancer screening, considering the COVID pandemic and the limitations of the public health system in India. Conclusion The implementation of early diagnosis of cervical cancer on a national scale as envisaged in the Operational Guidelines for the management of common cancers is a herculean task. A concerted approach for the implementation of cervical cancer control and HPV vaccination will hopefully bring fruitful results going forward.
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Affiliation(s)
- Ravi Mehrotra
- Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Kavita Yadav
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
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Dsouza JP, Van den Broucke S, Pattanshetty S, Dhoore W. Cervical cancer screening status and implementation challenges: Report from selected states of India. Int J Health Plann Manage 2021; 37:824-838. [PMID: 34716616 DOI: 10.1002/hpm.3353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 07/28/2021] [Accepted: 10/04/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cervical cancer contributes to 6%-29% of the cancers in India. Although the Government of India in 2010 integrated cancer screening within the National Programme for the prevention of Non-communicable Diseases, only 22% of women aged 15-45 years had undergone examination of the cervix by 2016. This prompts the question regarding the organisation of the program's implementation and service delivery and regarding challenges that may explain poor screening uptake. METHODS Semi-structured interviews were held with program managers and implementers in seven districts of three selected States of India. The data analysis looked at program content, the organisation of screening delivery, and the challenges to the implementation of the program, considering six theoretically derived dimensions of public health capacity: leadership and governance, organisational structure, financial resources, workforce, partnerships, and knowledge development. RESULTS Participants perceive the existing capacities across the six domains as insufficient to implement the CCS program nationwide. A context specific implementation, a better coordination between the program and district health facilities, timely remuneration, better maintenance of data and a strong monitoring system are possible solutions to remove health system related barriers. CONCLUSION The study provides evidence on the practical challenges and provides recommendations for strengthening the capacities of the health system.
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Affiliation(s)
- Jyoshma Preema Dsouza
- Psychological Sciences Research Institute (IPSY), School of Public Health, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Sanjay Pattanshetty
- School of Public Health, Manipal Academy of Higher Education, Manipal University, Manipal, India
| | - William Dhoore
- School of Public Health, Université Catholique de Louvain, Woluwe, Brussels, Belgium
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