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Wong A, Morgis R, Entenman J, Ramirez SI, Hays AL, Wright TS, Scartozzi CM, Ruffin MT, Moss JL. Exploratory Analysis of Concordance Between Clinician-Collected and Self-Sampled Human Papillomavirus Tests in a Small Cohort of Average- and High-Risk Patients. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:259-266. [PMID: 38516651 PMCID: PMC10956530 DOI: 10.1089/whr.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/23/2024]
Abstract
Objectives Cervical cancer screening rates have stagnated, but self-sampling modalities have the potential to increase uptake. This study compares the test characteristics of self-sampled high-risk human papillomavirus (hrHPV) tests with clinician-collected hrHPV tests in average-risk (i.e., undergoing routine screening) and high-risk patients (i.e., receiving follow-up after abnormal screening results). Methods In this cross-sectional study, a relatively small cohort of average-risk (n = 35) and high-risk (n = 12) participants completed both clinician-collected and self-sampled hrHPV testing, along with a brief phone survey. We assessed hrHPV positivity, concordance, positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity across both methods (for types 16, 18, or other hrHPV). We also explored the relationship between test concordance and sociodemographic/behavioral factors. Results Among average-risk participants, hrHPV positivity was 6% for both test methods (i.e., hrHPV-positive cases: n = 2), resulting in reported concordance, PPV, NPV, sensitivity, and specificity of 100%. Among high-risk participants, hrHPV positivity was 100% for clinician-collected tests but only 67% for self-sampled tests, showing varied concordance and sensitivity. Concordance was not associated with sociodemographic or behavioral factors. Conclusions Self-sampled hrHPV testing demonstrated high accuracy for average-risk patients in this exploratory study. However, its performance was less consistent in high-risk patients who had already received an abnormal screening result, which could be attributed to spontaneous viral clearance over time. The limited number of participants, particularly HPV-positive cases, suggests caution in interpreting these results. Further research with larger cohorts is necessary to validate these findings and to explore the integration of self-sampled hrHPV testing into routine clinical care, particularly for patients with a history of cervical abnormalities. Clinical Trial Registration NCT04591977, NCT04585243.
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Affiliation(s)
- Ashley Wong
- Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Rebecca Morgis
- Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Juliette Entenman
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Sarah I. Ramirez
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Amy L. Hays
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Tonya S. Wright
- Department of Obstetrics and Gynecology, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Christina M. Scartozzi
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Reading, Pennsylvania, USA
| | - Mack T. Ruffin
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jennifer L. Moss
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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Waite F, Marlow LAV, Nemec M, Waller J. The impact of age-relevant and generic infographics on knowledge, attitudes and intention to attend cervical screening: A randomized controlled trial. Br J Health Psychol 2024; 29:204-220. [PMID: 37770383 PMCID: PMC10952565 DOI: 10.1111/bjhp.12695] [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: 02/21/2023] [Revised: 07/10/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Cervical screening uptake in England is falling. Infographics could strengthen intention to attend, increase positive attitudes and improve knowledge. Age targeting could improve these outcomes further. We tested the impact of generic and age-targeted infographics. DESIGN A randomized controlled trial using an age-stratified, parallel-group design. METHODS Women aged 25-64 (n = 2095) were recruited through an online panel and randomized to see one of the three infographics. We tested: (i) impact of a generic cervical screening infographic compared to a control infographic on an unrelated topic with all screening age women and (ii) impact of an age-targeted infographic compared to a generic cervical screening infographic with older women (50-64 years). Intentions, knowledge and attitudes were measured. RESULTS Women aged 25-64 years who viewed the generic infographic had significantly higher intentions [F(1, 1513) = 6.14, p = .013,η p 2 = .004], more accurate beliefs about the timeline of cervical cancer development (OR: 5.18, 95% CI: 3.86-6.95), more accurate social norms (OR: 3.03, 95% CI: 2.38-3.87) and more positive beliefs about screening benefits (OR: 2.23, 95% CI: 1.52-3.28) than those viewing the control infographic. In the older age group, there was no significant difference in intention between those viewing the generic versus age-targeted versions [F(1, 607) = .03, p = .853,η p 2 < .001], but the age-targeted version was more engaging [F(1, 608) = 9.41, p = .002,η p 2 = .015]. CONCLUSIONS A cervical screening infographic can result in more positive attitudes and better knowledge and may have a small impact on intentions. Although age targeting did not affect intention, it had a positive impact on engagement and may therefore be useful in encouraging women to read and process materials.
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Affiliation(s)
- Frances Waite
- Cancer Prevention Group, School of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
| | - Laura A. V. Marlow
- Cancer Prevention Group, School of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
| | - Martin Nemec
- Cancer Prevention Group, School of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
- Behavioural Science and Health, Institute of Epidemiology & HealthUniversity College LondonLondonUK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
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Wearn A, Shepherd L. Determinants of routine cervical screening participation in underserved women: a qualitative systematic review. Psychol Health 2024; 39:145-170. [PMID: 35296200 DOI: 10.1080/08870446.2022.2050230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Routine, population-wide cervical screening programmes reduce cervical cancer incidence and mortality. However, socioeconomically deprived communities and ethnic minority groups typically have lower uptake in comparison to the general population and thus are described as 'underserved.' A systematic qualitative literature review was conducted to identify relevant determinants of participation for these groups. METHODS Online databases were searched for relevant literature from countries with well-established, call-recall screening programmes. Overall, 24 articles were eligible for inclusion. Data was synthesized via Framework synthesis. Dahlgren & Whitehead's social model of health was used as a broad a priori coding framework. RESULTS Participation was influenced by determinants at multiple levels. Overall, patient-provider relationships and peer support facilitated engagement. Cultural disparities, past healthcare experience and practical barriers hindered service access and exacerbated negative thoughts, feelings and attitudes towards participation. Complex interrelationships between determinants suggest barriers have a cumulative effect on screening participation. CONCLUSIONS These findings present a framework of psychosocial determinants of cervical screening uptake in underserved women and emphasise the role of policy makers and practitioners in reducing structural barriers to screening services. Additional work, exploring the experience of those living within socioeconomically disadvantaged areas, is needed to strengthen understanding in this area.
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Affiliation(s)
- Angela Wearn
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Lee Shepherd
- Department of Psychology, Northumbria University, Northumberland Building, Newcastle Upon Tyne, UK
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Goodwin B, Anderson L, Collins K, Sanjida S, Riba M, Singh GK, Campbell KM, Green H, Ishaque S, Kwok A, Opozda MJ, Pearn A, Shaw J, Sansom-Daly UM, Tsirgiotis JM, Janda M, Grech L. Anticipatory anxiety and participation in cancer screening. A systematic review. Psychooncology 2023; 32:1773-1786. [PMID: 37929985 DOI: 10.1002/pon.6238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To synthesize current evidence on the association between anticipatory anxiety, defined as apprehension-specific negative affect that may be experienced when exposed to potential threat or uncertainty, and cancer screening to better inform strategies to maximize participation rates. METHODS Searches related to cancer screening and anxiety were conducted in seven electronic databases (APA PsycINFO, Scopus, Web of Science, Embase, Cochrane Library, PubMed, CINAHL), with potentially eligible papers screened in Covidence. Data extraction was conducted independently by multiple authors. Barriers to cancer screening for any type of cancer and relationships tested between anticipatory anxiety and cancer screening and intention were categorized and compared according to the form and target of anxiety and cancer types. RESULTS A total of 74 articles (nparticipants = 119,990) were included, reporting 103 relationships tested between anticipatory anxiety and cancer screening and 13 instances where anticipatory anxiety was reported as a barrier to screening. Anticipatory anxiety related to a possible cancer diagnosis was often associated with increased screening, while general anxiety showed no consistent relationship. Negative relationships were often found between anxiety about the screening procedure and cancer screening. CONCLUSION Anticipatory anxiety about a cancer diagnosis may promote screening participation, whereas a fear of the screening procedure could be a barrier. Public health messaging and primary prevention practitioners should acknowledge the appropriate risk of cancer, while engendering screening confidence and highlighting the safety and comfort of screening tests.
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Affiliation(s)
- Belinda Goodwin
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Laura Anderson
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Katelyn Collins
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia
| | - Saira Sanjida
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Marcos Riba
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- Cancer and Palliative Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Kimberley M Campbell
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Heather Green
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sana Ishaque
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Alastair Kwok
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Oncology, Monash Health, Clayton, Victoria, Australia
| | - Melissa J Opozda
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
| | - Amy Pearn
- The Gene Council, North Perth, Washington, Australia
| | - Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ursula M Sansom-Daly
- Psycho-oncology Co-operative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Joanna M Tsirgiotis
- Sydney Youth Cancer Centre, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Monika Janda
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Grech
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Zhang ZF, Liu F, Zhang HR, Liu B, Zheng SQ, Ye WQ, Ding JN, Zhou ZJ, Luo HX, Wu F, Guo XM, Zhou JY, Guo YH. Upregulation of TMEM40 is associated with the malignant behavior and promotes tumor progression in cervical cancer. Discov Oncol 2023; 14:43. [PMID: 37052818 PMCID: PMC10102277 DOI: 10.1007/s12672-023-00648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE Recent studies indicated that transmembrane protein 40 (TMEM40) is associated with several types of cancers but is not clear in cervical cancer (CC). The study aimed to examine the role of TMEM40 in CC and related mechanisms. METHODS The expression of TMEM40 in CC tissues and cell lines was studied with western blot and real-time quantitative RT-PCR. The effect of TMEM40 on proliferation was evaluated by CCK-8, EdU and colony formation assay. The migration, invasion, cell cycle and apoptosis of CC cells were studied with wound healing, transwell assays and flow cytometry. Tumor growth was evaluated in vivo using a xenogenous subcutaneously implant model. RESULTS The results revealed that the TMEM40 elevation in CC tissues and cell lines was closely correlated with tumor size and lymph node metastasis in clinical patients. Upregulation of TMEM40 with OE-TMEM40 vector promoted the invasion, migration and proliferation, inhibited the apoptosis and led to distinct S cell cycle arrest in CC cell lines. Silencing TMEM40 with shRNA inhibited the invasion, migration and proliferation, promoted apoptosis and led to a G0/G1 cell cycle arrest in CC cell lines. Silence of TMEM40 downregulated the expression of c-MYC, Cyclin D1, matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-9 (MMP-9), but in contrast, activated p53 and several apoptosis related proteins such as p53, Caspase-3, Caspase-9 and PARP1. In addition, TMEM40 silencing dramatically decreased tumor growth in mice models. CONCLUSION The present study demonstrates that TMEM40 upregulation can be a potential prognostic biomarker and contribute to CC development.
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Affiliation(s)
- Zhen-Fei Zhang
- Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue Central, Guangzhou, 510280, People's Republic of China
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Fang Liu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Han-Rong Zhang
- Department of Nursing and Health, Nanfang College-Guangzhou, Guangzhou, 510970, Guangdong, People's Republic of China
| | - Bing Liu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Shu-Qian Zheng
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Wan-Qian Ye
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Jia-Nan Ding
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Ze-Jie Zhou
- Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue Central, Guangzhou, 510280, People's Republic of China
| | - Hui-Xian Luo
- Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue Central, Guangzhou, 510280, People's Republic of China
| | - Fang Wu
- Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue Central, Guangzhou, 510280, People's Republic of China
| | - Xuan-Min Guo
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Jue-Yu Zhou
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, People's Republic of China.
| | - Yong-Hui Guo
- Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue Central, Guangzhou, 510280, People's Republic of China.
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Śniadecki M, Poniewierza P, Jaworek P, Szymańczyk A, Andersson G, Stasiak M, Brzeziński M, Bońkowska M, Krajewska M, Konarzewska J, Klasa-Mazurkiewicz D, Guzik P, Wydra DG. Thousands of Women’s Lives Depend on the Improvement of Poland’s Cervical Cancer Screening and Prevention Education as Well as Better Networking Strategies Amongst Cervical Cancer Facilities. Diagnostics (Basel) 2022; 12:diagnostics12081807. [PMID: 35892517 PMCID: PMC9394414 DOI: 10.3390/diagnostics12081807] [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: 07/02/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/21/2022] Open
Abstract
Proper targeted cancer prophylaxis reduces the incidence of cancer in all forms; this includes cancers with significant progression potential and poor prognosis. Based on the assumption that one of the risk factors of cervical cancer is the avoidance of screening tests, we analyzed the current scenario of cervical cancer (CC) screening and recommendations in Poland (country with a well-off socioeconomic status). Based on the comprehensive literature review concerning documents of guidelines and recommendations of various bodies, including national ones, data on the implementation of CC screening in Poland, and different models for medium-to-high-income countries, we proposed how the CC screening strategy could be improved. Finally, the new strategy was further developed for those who are prone to not being screened. The proposal on how to improve the Polish CC screening program is the following: refinement of the public education on CC risk factors, popularization of CC screening incentives amongst the public, and improvement of networking strategies between CC screening facilities (“cervical screening clinical”), allowing screenings to be more efficient and rapid. We believe that, to enhance the future quality of life of those with rapid CC progression by catching the disease preemptively and limiting the sequelae of the disease, we have to improve education and access to medical services.
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Affiliation(s)
- Marcin Śniadecki
- Department of Obstetrics and Gynecology, Gynecological Oncology and Gynecological Endocrinology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.J.); (A.S.); (G.A.); (M.S.); (M.K.); (D.K.-M.); (D.G.W.)
- Correspondence: ; Tel.: +48-501-337-941
| | | | - Paulina Jaworek
- Department of Obstetrics and Gynecology, Gynecological Oncology and Gynecological Endocrinology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.J.); (A.S.); (G.A.); (M.S.); (M.K.); (D.K.-M.); (D.G.W.)
| | - Ada Szymańczyk
- Department of Obstetrics and Gynecology, Gynecological Oncology and Gynecological Endocrinology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.J.); (A.S.); (G.A.); (M.S.); (M.K.); (D.K.-M.); (D.G.W.)
| | - Gorm Andersson
- Department of Obstetrics and Gynecology, Gynecological Oncology and Gynecological Endocrinology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.J.); (A.S.); (G.A.); (M.S.); (M.K.); (D.K.-M.); (D.G.W.)
| | - Maria Stasiak
- Department of Obstetrics and Gynecology, Gynecological Oncology and Gynecological Endocrinology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.J.); (A.S.); (G.A.); (M.S.); (M.K.); (D.K.-M.); (D.G.W.)
| | - Michał Brzeziński
- Department of Gynecologic Oncology, PCK Marine Hospital in Gdynia, 81-519 Gdynia, Poland;
| | - Małgorzata Bońkowska
- Emergency Department, University Clinical Center in Gdańsk, 80-952 Gdańsk, Poland;
| | - Magdalena Krajewska
- Department of Obstetrics and Gynecology, Gynecological Oncology and Gynecological Endocrinology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.J.); (A.S.); (G.A.); (M.S.); (M.K.); (D.K.-M.); (D.G.W.)
| | - Joanna Konarzewska
- Department of Radiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Dagmara Klasa-Mazurkiewicz
- Department of Obstetrics and Gynecology, Gynecological Oncology and Gynecological Endocrinology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.J.); (A.S.); (G.A.); (M.S.); (M.K.); (D.K.-M.); (D.G.W.)
| | - Paweł Guzik
- Clinical Department of Gynecology and Obstetrics, City Hospital Rzeszów, 35-241 Rzeszów, Poland;
| | - Dariusz Grzegorz Wydra
- Department of Obstetrics and Gynecology, Gynecological Oncology and Gynecological Endocrinology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.J.); (A.S.); (G.A.); (M.S.); (M.K.); (D.K.-M.); (D.G.W.)
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Cervical Cancer Screening and Associated Barriers among Women in India: A Generalized Structural Equation Modeling Approach. Cancers (Basel) 2022; 14:cancers14133076. [PMID: 35804848 PMCID: PMC9264854 DOI: 10.3390/cancers14133076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/05/2022] [Accepted: 06/21/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Exploring the barriers and facilitators of cervical cancer screening is essential to reduce the incidence and mortality, particularly in India. There is a paucity of studies presenting the mediation effects of known barriers and facilitators. The study investigates individual-level social barriers, facilitators, and the factors that mediate the relationships between suspected factors and cervical cancer screening. Understanding the mediation analysis and the effect of mediators will help us acquire a profound understanding of the mechanism of action, which will facilitate in devising strategies keeping the most important factor and their mediators in mind. Abstract Exploring the barriers and facilitators of cervical cancer screening (CCS) is essential to reduce the incidence and mortality, particularly in low and middle-income countries. The present study investigates the direct, indirect, and total effects of the barriers and facilitators on CCS in India through the generalized structural equation modeling using data from women files of the fourth round of the National Family Health Survey (NFHS-4). Generalized structural equation models were used to quantify the hypothetical pathway via fitting a series of regression equations. Age, body mass index, religion, years of schooling, awareness of sexually transmitted infection, contraception use, lifetime number of sex partners, number of children, and wealth index were shown to have significant direct effects on the CCS. Older women had 1.16 times the odds of getting screened for cervical cancer as compared to their younger counterpart. The odds of CCS among the women in richest wealth quintile is 2.50 times compared to the poorest. Those who are aware of STIs have 1.39 times the odds of getting screened for cervical cancer. Wealth index, years of schooling, and religion have a substantial indirect and total impact on the CCS. The findings will aid in policy formulations for enhancing the CCS in India.
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Creagh NS, Zammit C, Brotherton JM, Saville M, McDermott T, Nightingale C, Kelaher M. The experience of under-screened and never-screened participants using clinician-supported self-collection cervical screening within the Australian National Cervical Screening Program. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221075905. [PMID: 35147064 PMCID: PMC8841921 DOI: 10.1177/17455065221075905] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Australia has had significant successes in the prevention of cervical cancer. However, there is considerable scope for improving screening participation. In December 2017, Australia shifted from cytology to a human papillomavirus–based screening program as part of the renewed National Cervical Screening Program. This provided the opportunity to introduce a clinician-supported self-collection cervical screening pathway, which allows screening participants aged 30 years or more and who are under-screened or never-screened to screen via a self-collected human papillomavirus test. Objective: This study aimed to explore screening participant experiences of a clinician-supported self-collection cervical screening pathway. Methods: Interviews (n = 45) were conducted with participants who had used the clinician-supported self-collection cervical screening pathway in the Australian National Cervical Screening Program between December 2017 and April 2019. Interviews were analyzed using template analysis. Results: Under-screened and never-screened participants reported a variety of interrelated barriers to cervical screening due to the nature of the test. For these participants, self-collection was a preferable way to perform screening as it overcame various barriers, was easy to use and promoted a sense of empowerment. Participants reported that the role of their practitioner was influential in their decision to undertake cervical screening, and that the support and information provided was a key factor in their experiences of the self-collection pathway. Conclusion: Findings support the use of a clinician-supported model of care, as an alternative screening modality in Australia’s National Cervical Screening Program. As more countries consider the move from a cytology to human papillomavirus–based cervical screening program, this model may assist in greater engagement of under-screened participants.
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Affiliation(s)
- Nicola S Creagh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Claire Zammit
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Julia Ml Brotherton
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,VCS Population Health, VCS Foundation, Carlton, VIC, Australia
| | - Marion Saville
- VCS Population Health, VCS Foundation, Carlton, VIC, Australia.,University Department of Obstetrics and Gynecology, The Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | | | - Claire Nightingale
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Margaret Kelaher
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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9
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Shin HY, Song SY, Jun JK, Kim KY, Kang P. Barriers and strategies for cervical cancer screening: What do female university students know and want? PLoS One 2021; 16:e0257529. [PMID: 34610022 PMCID: PMC8491915 DOI: 10.1371/journal.pone.0257529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aimed to identify the distinct barriers and knowledge level of cervical cancer screening among female university students and establish intervention strategies to overcome these barriers. METHODS This study used a mixed-methods design with 26 female university students aged 20-29 years. We first conducted a quantitative online survey for the same study participants, divided them into three groups, and conducted focus group interviews (FGIs). Group A: participants who had sexual experience and had undergone cervical cancer screening; Group B: participants who had sexual experience and had not undergone cervical cancer screening; Group C: participants who did not have sexual experience and had not undergone cervical cancer screening. RESULTS The participants' ages were 21.92 ± 1.26 years. The knowledge levels for cervical cancer and screening were low to moderate. The four main themes that emerged as barriers to cervical cancer screening through the FGIs were: 1) socio-cultural barrier: conservative social perception of unmarried women's sexual life, 2) knowledge barrier: lack of knowledge and information, 3) psychological barrier: discomfort, and 4) practical barrier: time-consuming. The three themes identified for strategies were: 1) socio-cultural intervention: changing social perceptions and ensuring confidentiality, 2) educational intervention: improvement of knowledge and accessibility, and 3) alternative screening intervention: comfortable screening methods. CONCLUSIONS While university students' sexual experience rapidly increased, the socio-cultural perceptions of sexual health remained closed, and they had a reasonably low level of knowledge about cervical cancer screening. Therefore, various strategies sensitive to female university students' culture should be implemented to increase the knowledge level, and social efforts should be made to change the socio-cultural perception of unmarried young women's sexual health.
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Affiliation(s)
- Hye Young Shin
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
- College of Nursing, Baekseok Culture University, Cheonan-si, Republic of Korea
| | - Soo Yeon Song
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Ka Young Kim
- Department of Nursing, College of Nursing, Gachon University, Incheon, Republic of Korea
| | - Purum Kang
- College of Nursing, Woosuk University, Wanju, Jeollabuk-do, Republic of Korea
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Freer-Smith C, Harvey-Kelly L, Mills K, Harrison H, Rossi SH, Griffin SJ, Stewart GD, Usher-Smith JA. Reasons for intending to accept or decline kidney cancer screening: thematic analysis of free text from an online survey. BMJ Open 2021; 11:e044961. [PMID: 34006549 PMCID: PMC8137225 DOI: 10.1136/bmjopen-2020-044961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/17/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Kidney cancer has been identified as a disease for which screening might provide significant benefit for patients. The aim of this study was to understand in detail the facilitators and barriers towards uptake of a future kidney cancer screening programme, and to compare these across four proposed screening modalities. DESIGN An online survey including free-text responses. SETTING UK PARTICIPANTS: 668 adults PRIMARY AND SECONDARY OUTCOME MEASURES: The survey assessed participants' self-reported intention to take-up kidney cancer screening with four different test methods (urine test, blood test, ultrasound scan and low-dose CT). We conducted thematic analysis of 2559 free-text comments made within the survey using an inductive approach. RESULTS We identified five overarching themes that influenced screening intention: 'personal health beliefs', 'practicalities', 'opinions of the test', 'attitudes towards screening' and 'cancer apprehension'. Overall, participants considered the tests presented as simple to complete and the benefits of early detection to outweigh any drawbacks to screening. Dominant facilitators and barriers varied with patterns of intention to take up screening across the four tests. Most intended to take up screening by all four tests, and for these participants, screening was seen as a positive health behaviour. A significant minority were driven by practicalities and the risks of the tests offered. A smaller proportion intended to reject all forms of screening offered, often due to fear or worry about results and unnecessary medical intervention or a general negative view of screening. CONCLUSIONS Most individuals would accept kidney cancer screening by any of the four test options presented because of strong positive attitudes towards screening in general and the perceived simplicity of the tests. Providing information about the rationale for screening in general and the potential benefits of early detection will be important to optimise uptake among uncertain individuals.
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Affiliation(s)
| | - Laragh Harvey-Kelly
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Katie Mills
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Hannah Harrison
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sabrina H Rossi
- Department of Oncology, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Simon J Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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11
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Chua B, Ma V, Asjes C, Lim A, Mohseni M, Wee HL. Barriers to and Facilitators of Cervical Cancer Screening among Women in Southeast Asia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4586. [PMID: 33926019 PMCID: PMC8123618 DOI: 10.3390/ijerph18094586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/24/2021] [Accepted: 04/24/2021] [Indexed: 01/27/2023]
Abstract
In Southeast Asia, cervical cancer is the second most common cancer in women. Low coverage for cervical cancer screening (CCS) becomes a roadblock to disease detection and treatment. Existing reviews on CCS have limited insights into the barriers and facilitators for SEA. Hence, this study aims to identify key barriers and facilitators among women living in SEA. A systematic literature review was conducted on Pubmed, Embase, PsycINFO, CINAHL, and SCOPUS. Primary qualitative and quantitative studies published in English that reported barriers and facilitators to CCS were included. The Mix Methods Appraisal Tool was used for the quality assessment of the included studies. Among the 93 included studies, pap smears (73.1%) were the most common screening modality. A majority of the studies were from Malaysia (35.5%). No studies were from Timor-Leste and the Philippines. The most common barriers were embarrassment (number of articles, n = 33), time constraints (n = 27), and poor knowledge of screening (n = 27). The most common facilitators were related to age (n = 21), receiving advice from healthcare workers (n = 17), and education status (n = 11). Findings from this review may inform health policy makers in developing effective cervical cancer screening programs in SEA countries.
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Affiliation(s)
- Brandon Chua
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore; (B.C.); (M.M.)
- Health Economics and Outcomes Research Centre of Excellence (Greater Asia), Becton, Dickinson and Company, 2 International Business Park Road, Singapore 609930, Singapore;
| | - Viva Ma
- Health Economics and Outcomes Research Centre of Excellence (Greater Asia), Becton, Dickinson and Company, 2 International Business Park Road, Singapore 609930, Singapore;
| | - Caitlin Asjes
- Government and Public Affairs, Becton, Dickinson and Company, 2 International Business Park Road, Singapore 609930, Singapore;
| | - Ashley Lim
- Department of Pharmacy, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore;
| | - Mahsa Mohseni
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore; (B.C.); (M.M.)
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore; (B.C.); (M.M.)
- Faculty of Science, Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117543, Singapore
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12
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Wilding S, Wighton S, Halligan D, West R, Conner M, O'Connor DB. What factors are most influential in increasing cervical cancer screening attendance? An online study of UK-based women. Health Psychol Behav Med 2020; 8:314-328. [PMID: 34040874 PMCID: PMC8114340 DOI: 10.1080/21642850.2020.1798239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Cervical cancer is the fourth most commonly occurring cancer in women worldwide. The UK has one of the highest cervical screening rates in Europe, yet attendance has been decreasing. This study aimed to identify barriers and facilitators to screening attendance and assess the perceived importance of these factors. Methods: 194 women living in the UK were recruited via an online research recruitment website to an online survey. Most participants (N = 128, 66.0%) were currently up-to-date with cervical screening, 66 participants (34.0%) had never been screened, or were overdue for screening. Participants identified barriers and facilitators to cervical screening attendance via free-text responses and were also asked to rate a list of factors as most to least influential over decision making. Results were analysed using thematic content analysis and ratings analysed using multivariable analyses. Results: The most commonly reported barriers were: Pain/discomfort; Embarrassment; and Time. These were also rated as most influential for decision making. The most commonly reported facilitators were: Ease of making appointments; Peace of mind; and Fear of cancer/preventing serious illness. While importance rating of barriers did not differ by previous screening behaviour, ratings of some facilitators significantly differed. Up-to-date women rated believing screening is potentially life-saving and part of personal responsibility as significantly more important than overdue/never screened women. Conclusion: This study confirmed that factors which encourage screening are key to the decision of whether to attend screening. Women suggested several improvements that might make attending easier and improve uptake, including flexibility of screening locations to fit around work hours and childcare arrangements. Psychological facilitators included the peace of mind that screening brings and the belief that cervical cancer screening is potentially life-saving. Public health interventions should target factors which facilitate screening and how these interplay with barriers in order to improve uptake.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Sarah Wighton
- NHS England and NHS Improvement (North East & Yorkshire), Leeds, UK
| | | | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
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13
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Biddell CB, O'Leary MC, Wheeler SB, Spees LP. Variation in Cervical Cancer Screening Preferences among Medically Underserved Individuals in the United States: A Systematic Review. Cancer Epidemiol Biomarkers Prev 2020; 29:1535-1548. [PMID: 32457182 DOI: 10.1158/1055-9965.epi-20-0306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/16/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
Underutilization of effective screening is one driver of disparities in cervical cancer incidence and mortality. Consideration of patient preferences could help to improve screening rates in populations facing substantial barriers to preventive care. We conducted a systematic review of the literature on cervical cancer screening preferences among medically underserved patients in the United States. We searched six electronic databases (PubMed, Web of Science, EMBASE, Scopus, CINAHL, and PsycINFO) for articles published through February 2019 (Prospero ID: CRD42019125431). Among the 43 articles included, 23 reported screening modality preferences, 11 reported preferences related to provider demographics and attributes, six reported screening scheduling and results delivery preferences, and nine reported preferences related to health education and communication. This review demonstrates the wide variety of medically underserved patient preferences related to cervical cancer screening. It also draws attention to two key preference trends that emerged despite heterogeneity in study design, populations, and preference assessment. Consistent preferences for human papillomavirus self-testing over traditional Pap testing highlight a key potential mechanism for increasing cervical cancer screening uptake among medically underserved populations. In addition, preferences for gender- and language-concordant providers underscore the need for continued efforts toward expanding diversity among medical professionals.
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Affiliation(s)
- Caitlin B Biddell
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Meghan C O'Leary
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie B Wheeler
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lisa P Spees
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Tiro JA, Betts AC, Kimbel K, Buist DSM, Mao C, Gao H, Shulman L, Malone C, Beatty T, Lin J, Thayer C, Miglioretti DL, Winer RL. Understanding Patients' Perspectives and Information Needs Following a Positive Home Human Papillomavirus Self-Sampling Kit Result. J Womens Health (Larchmt) 2018; 28:384-392. [PMID: 30481121 DOI: 10.1089/jwh.2018.7070] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We explored patient perspectives after a positive human papillomavirus (HPV) self-sampling result to describe experiences and information needs for this home-based screening modality. MATERIALS AND METHODS We recruited women who tested high-risk (hr) HPV positive during a pragmatic trial evaluating mailed hrHPV self-sampling kits as an outreach strategy for women overdue for Pap screening in a U.S. integrated health care system. Telephone interviews were conducted from 2014 to 2017. Five independent coders analyzed transcripts using iterative content analysis. RESULTS Forty-six women (61% of invited; median age 55.5 years) completed a semistructured interview. Six themes emerged: (1) convenience of home-based screening, (2) intense feelings and emotions after receiving positive kit results, (3) importance of seeing provider and discussing kit results, (4) information seeking from various sources, (5) confusion about purpose and meaning of HPV versus Pap tests, and (6) concern that HPV self-sampling is inaccurate when the subsequent Pap test is normal. CONCLUSIONS Although women liked the kit's convenience, discussion about discordant home HPV and in-clinic Pap results led them to question the accuracy of HPV self-sampling. Patient-provider communication around home HPV kits is more complex than for reflex or cotesting because clinician-collected Pap results are unknown at the time of the positive kit result. Patients need education about differences between HPV and Pap tests and how they are used for screening and follow-up. To reassure patients and keep them interested in self-sampling, education should be provided at multiple time points during the screening process.
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Affiliation(s)
- Jasmin A Tiro
- 1 Department of Clinical Sciences, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Andrea C Betts
- 1 Department of Clinical Sciences, University of Texas Southwestern Medical Center , Dallas, Texas.,2 Department of Health Promotion and Behavioral Sciences, UT , School of Public Health in Dallas, Dallas, Texas
| | - Kilian Kimbel
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Diana S M Buist
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Constance Mao
- 4 Department of Obstetrics and Gynecology, University of Washington , Seattle, Washington
| | - Hongyuan Gao
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Lisa Shulman
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Colin Malone
- 5 Department of Epidemiology, University of Washington , Seattle, Washington
| | - Tara Beatty
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - John Lin
- 6 Department of Pathology, University of Washington , Seattle, Washington
| | - Chris Thayer
- 7 Kaiser Permanente Washington , Renton, Washington
| | - Diana L Miglioretti
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington.,8 Division of Biostatistics, University of California Davis , Davis, California
| | - Rachel L Winer
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington.,5 Department of Epidemiology, University of Washington , Seattle, Washington
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15
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Smith JS, Des Marais AC, Deal AM, Richman AR, Perez-Heydrich C, Yen-Lieberman B, Barclay L, Belinson J, Rinas A, Brewer NT. Mailed Human Papillomavirus Self-Collection With Papanicolaou Test Referral for Infrequently Screened Women in the United States. Sex Transm Dis 2018; 45:42-48. [PMID: 28876298 PMCID: PMC5846187 DOI: 10.1097/olq.0000000000000681] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Testing for high-risk human papillomavirus (HPV) infection using mailed, self-collected samples is a promising approach to increase screening in women who do not attend clinic screening at recommended intervals. METHODS To assess this intervention among high-risk women in the United States, 429 women without a Papanicolaou (Pap) test in 4 or more years (overdue by US guidelines) were recruited from the general population. Participants aged 30 to 65 years were mailed a kit to self-collect a cervicovaginal sample at home, return the sample by mail, and receive HPV results by telephone, with referral to follow-up cytological Pap testing at a local clinic. Cervicovaginal self-samples were collected with a Viba brush, stored in Scope mouthwash, and tested by Hybrid Capture 2. Data were collected in 2010 to 2011 and analyzed in 2017. RESULTS Two-thirds (64%) of participants returned a self-collected sample, of whom 15% tested HPV DNA positive. Human papillomavirus self-test-positive women reported higher rates of follow-up Pap tests (82%) than did those with self-test negative results (51%). No demographic differences were found in self-test return rate or HPV positivity. High acceptability was reported in participant surveys: most women (81%) had "mostly positive" overall thoughts about the self-test, and most reported being comfortable receiving the kit in the mail (99%), returning their self-collected sample by mail (82%), and receiving their test results by telephone (97%). CONCLUSIONS Conducting HPV self-testing through population-based recruitment, mailed kit delivery and return by mail, and results delivery by telephone has the potential to reach a broad segment of US underscreened women.
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Gesink D, Nattel L. A qualitative cancer screening study with childhood sexual abuse survivors: experiences, perspectives and compassionate care. BMJ Open 2015; 5:e007628. [PMID: 26246075 PMCID: PMC4538265 DOI: 10.1136/bmjopen-2015-007628] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The childhood sexual abuse (CSA) survivor population is substantial and survivors have been identified as part of the population who were under-screened or never-screened for breast, cervical and colon cancer. Our objective was to learn CSA survivor perspectives on, and experiences with, breast, cervical and colon cancer screening with the intention of generating recommendations to help healthcare providers improve cancer screening participation. DESIGN A pragmatic constructivist qualitative study involving individual, semistructured, in-depth interviews was conducted in January 2014. Thematic analysis was used to describe CSA survivor perspectives on cancer screening and identify potential facilitators for screening. PARTICIPANTS A diverse purposive sample of adult female CSA survivors was recruited. The inclusion criteria were: being a CSA survivor, being in a stable living situation, where stable meant able to meet one's financial needs independently, able to maintain supportive relationships, having participated in therapy to recover from past abuse, and living in a safe environment. 12 survivors were interviewed whose ages ranged from the early 40s to mid-70s. Descriptive saturation was reached after 10 interviews. SETTING Interviews were conducted over the phone or Internet. CSA survivors were primarily from urban and rural Ontario, but some resided elsewhere in Canada and the USA. RESULTS The core concept that emerged was that compassionate care at every level of the healthcare experience could improve cancer screening participation. Main themes included: desire for holistic care; unique needs of patients with dissociative identity disorder; the patient-healthcare provider relationship; appointment interactions; the cancer screening environment; and provider assumptions about patients. CONCLUSIONS Compassionate care can be delivered by: building a relationship; practising respect; focusing attention on the patient; not rushing the appointment; keeping the environment positive and comfortable; maintaining patient dignity; sharing control whenever possible; explaining procedures; and using laughter to reduce power imbalance through shared humanity.
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Affiliation(s)
- Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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17
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Collins T, Stradtman LR, Vanderpool RC, Neace DR, Cooper KD. A Community-Academic Partnership to Increase Pap Testing in Appalachian Kentucky. Am J Prev Med 2015; 49:324-30. [PMID: 26190807 PMCID: PMC4753790 DOI: 10.1016/j.amepre.2015.04.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Appalachian Kentucky is recognized for elevated rates of cervical cancer, which exerts an undue burden in this medically underserved region. The purpose of this study was to examine the impact of an academic-community partnership, specifically a regional health department and a CDC Prevention Research Center, in conducting outreach aimed at improving Pap testing rates and examining barriers among under-screened women in Appalachian Kentucky. Differences between women with abnormal and negative results were also examined. METHODS The Prevention Research Center provided technical assistance to the district health department that, in turn, hosted "Women's Health Day" events at county health departments, providing incentives to women who had never had a Pap test or those who had not received one in at least 3 years to receive guideline-recommended screening. RESULTS From 2011 to 2014, 317 women were screened for cervical cancer; data were analyzed in 2014. The mean age was 42.1 (SD=13.6) years. More than half (54.5%) of the sample reported high school as their highest level of education, and 57.7% had an annual household income of <$25,000. The most commonly reported barriers to Pap testing were cost (28.4%) and lack of a perceived need for screening (25.6%). Approximately one in five (21.7%) women received abnormal Pap results. CONCLUSIONS As a result of this community-academic public health partnership and its shared resources, Appalachian Kentucky women received needed cervical cancer screening and appropriate follow-up for abnormal results, thereby increasing this population's compliance with guideline-recommended screening.
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Affiliation(s)
- Tom Collins
- Rural Cancer Prevention Center, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Lindsay R Stradtman
- Rural Cancer Prevention Center, University of Kentucky College of Public Health, Lexington, Kentucky.
| | - Robin C Vanderpool
- Department of Health Behavior, University of Kentucky College of Public Health, Lexington, Kentucky
| | | | - Karen D Cooper
- Kentucky River District Health Department, Hazard, Kentucky
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VALLE I, TRAMALLONI D, BRAGAZZI N. Cancer prevention: state of the art and future prospects. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2015; 56:E21-7. [PMID: 26789828 PMCID: PMC4718348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/10/2015] [Indexed: 11/16/2022]
Abstract
Cancer imposes a heavy societal burden worldwide, in terms of both epidemiology and costs. The introduction of more sophisticated imaging and diagnostic techniques and advanced drugs that specifically target tumor cells is leading to increasingly expensive treatments, which may be affordable only for few patients. Prevention, and particularly primary prevention, is an effective way of addressing the challenging issue of cancer, since between a third and a half of cancers could be prevented on the basis of our current knowledge of risk factors. Moreover, prevention is cost-effective, its effects are not limited to high-risk subjects but extend to the entire population, and it is not dependent on socioeconomic status. Regulatory measures can have a broad impact, even on future generations; by empowering and educating subjects, promoting healthy behaviours and teaching self-care, they can trigger a virtuous cycle. In recent decades, oncology has shifted from being merely reactive to being proactive; this shift has led to the development of so-called "P4 medicine", where the 4 Ps stand for "preventive", "predictive", "personalized" and "participatory". Prevention programs are an important part of the effort to control cancer, as they are able to reduce both the incidence of cancer and mortality. For instance, screening for colorectal, breast and cervical cancer is reducing the burden of these common tumors. Anti-cancer vaccines, both prophylactic and therapeutic, constitute another important preventive tool. Although progress has been made in these areas, much remains to be done. With regard to screening programs, coverage could be increased by introducing new, more acceptable, less invasive tests, stratifying screening through correlation with anamnestic, clinical, radiological and genomic data (so-called "populationbased personalized cancer screening"), and exploiting new information and communication technologies, such as smartphone applications or personalized text messages (so-called "screening 2.0"). Advocacy and recommendations by physicians can also play a role, in that eligible subjects need to be able to discuss their doubts and their perceived psycho-social barriers. However, new screening initiatives should be implemented only after a careful health technology assessment has been performed within the framework of evidence-based medicine, organized screening programs have been strengthened and opportunistic or spontaneous programs have been limited.
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Affiliation(s)
- I. VALLE
- SSD "Popolazione a rischio", Health Prevention Department, Local Health Unit ASL 3 Genova, Italy
| | - D. TRAMALLONI
- School of Public Health, Department of Health Sciences (DISSAL), Genova, Italy
| | - N.L. BRAGAZZI
- School of Public Health, Department of Health Sciences (DISSAL), Genova, Italy
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