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Garg A, Galvin AM, Griner SB, Rosberger Z, Daley EM, Thompson EL. HPV self-sampling among women in the United States: preferences for implementation. Cancer Causes Control 2024; 35:167-176. [PMID: 37633857 DOI: 10.1007/s10552-023-01778-9] [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: 07/24/2022] [Accepted: 08/09/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE With the inclusion of primary HPV testing in 2018 U.S. Preventive Services Taskforce guidelines, at-home HPV self-sampling may provide a future option for cervical cancer screening, especially among hard-to-reach populations in the U.S. This study evaluated the association of implementation preferences with the willingness of at-home HPV self-sampling. METHODS We conducted a cross-sectional study in 2018 among U.S. women ages 30-65 years, without a hysterectomy (n = 812). The outcome was willingness to have at-home HPV self-sampling (yes/no). Primary predictor variables (i.e., information source, methods of payment, methods of sending or receiving self-sampling kits) measured self-sampling implementation preferences. Adjusted logistic regression identified associations with willingness to have at-home HPV self-sampling. RESULTS Participants who preferred receiving information from healthcare providers (OR = 2.64; 95% CI 1.54,4.52) or from media or other sources (OR = 2.30; 95% CI 1.51,3.48) had higher HPV self-sampling willingness than participants who did not prefer those sources. Participants who did not want to pay for self-sampling (OR = 0.21; 95% CI 0.14,0.32) or did not know if they would pay for self-sampling (OR = 0.35; 95% CI 0.22,0.54) had lower odds of HPV self-sampling willingness compared to participants willing to pay. Participants who did not know which method they preferred for receiving a self-sampling kit (OR = 0.15, 95% CI 0.07,0.31) or preferred delivering the sample to the lab themselves (OR = 0.59; 95% CI 0.36,0.96) had lower odds for self-sampling willingness compared to participants who preferred the mail. CONCLUSION Understanding the preferences of women regarding the implementation of HPV self-sampling can improve uptake in cervical cancer screening, especially among hard-to-reach populations.
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Affiliation(s)
- Ashvita Garg
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Annalynn M Galvin
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stacey B Griner
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Zeev Rosberger
- Department of Oncology, Psychiatry and Psychology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Erika L Thompson
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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Fitch K, Bohn JA, Emerson JB, Boniface ER, Bruegl A. Acceptability of human papillomavirus self-collection and the role of telehealth: a prospective, randomized study stratified by menopausal status. Int J Gynecol Cancer 2023:ijgc-2023-004935. [PMID: 38101813 DOI: 10.1136/ijgc-2023-004935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE We investigated the utility of telehealth instruction versus mail-based written instruction in facilitating high-risk human papillomavirus (hrHPV) self-collection among post-menopausal patients compared with pre-menopausal patients, as well as the impact on acceptability and feasibility. METHODS We conducted a prospective, randomized study of people eligible for cervical cancer screening, stratified by menopausal status, to undergo standard written or telehealth-based instructions for hrHPV self-collection. English speaking individuals residing in Oregon, with a cervix, eligible for primary hrHPV testing, and with access to a video-capable device were included. Patients with prior hysterectomy, trachelectomy, diagnosis of cervical cancer, or pelvic radiation for gynecologic cancer were excluded. We compared preference for and opinions about self-collection and hrHPV test results, by randomization group and stratified by menopausal status using descriptive statistics. RESULTS Among 123 patients enrolled, 61 identified as post-menopausal with a median age of 57 years. While the majority of post-menopausal participants who received telehealth instructions found it helpful, only 6.1% considered telehealth instructions necessary to complete self-testing. There was no difference in opinion of telehealth by menopausal status. Overall, 88.5% of post-menopausal participants preferred self-collection to provider-collection. There were no significant differences between pre- and post-menopausal participants in terms of test preference, discomfort, ease of use, or perceptions of self-collection. CONCLUSION Telehealth instruction did not add significant value to patients participating in hrHPV self-collection, nor did it alter the acceptability of hrHPV-self collection among an English-speaking cohort. Compared with prior experiences with provider-collected screening, hrHPV self-collection was preferred by both pre- and post-menopausal participants. There were no significant differences in preference for provider- versus self-collection when stratified by menopausal status.
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Affiliation(s)
- Katherine Fitch
- Department of Obstetrics & Gynecology, OHSU, Portland, Oregon, USA
| | - Jacqueline A Bohn
- Department of Obstetrics & Gynecology, University of Oklahoma, Norman, Oklahoma, USA
| | - Jenna B Emerson
- Department of Obstetrics & Gynecology, OHSU, Portland, Oregon, USA
| | - Emily R Boniface
- Department of Obstetrics & Gynecology, OHSU, Portland, Oregon, USA
| | - Amanda Bruegl
- Department of Obstetrics & Gynecology, OHSU, Portland, Oregon, USA
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3
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Impelido ML, Brewer K, Burgess P, Curtis J, Currow D, Sara G. Age-specific differences in cervical cancer screening rates in women using mental health services in New South Wales, Australia. Aust N Z J Psychiatry 2023:48674231217415. [PMID: 38095076 DOI: 10.1177/00048674231217415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Women living with mental health conditions have lower cervical cancer screening rates and higher mortality. More evidence is needed to target health system improvement efforts. We describe overall and age-specific cervical cancer screening rates in mental health service users in New South Wales. METHODS Cervical cancer screening registers were linked to New South Wales hospital and community mental health service data. Two-year cervical screening rates were calculated for New South Wales mental health service users aged 20-69 years (n = 114,022) and other New South Wales women (n = 2,110,127). Rate ratios were compared for strata of age, socio-economic disadvantage and rural location, and overall rates compared after direct standardisation. RESULTS Only 40.3% of mental health service users participated in screening, compared with 54.3% of other New South Wales women (incidence rate ratio = 0.74, 95% confidence interval = [0.74, 0.75]). Differences in age, social disadvantage or rural location did not explain screening gaps. Screening rates were highest in mental health service users aged <35 years (incidence rate ratios between 0.90 and 0.95), but only 15% of mental health service users aged >65 years participated in screening (incidence rate ratio = 0.27, 95% confidence interval = [0.24, 0.29]). CONCLUSION Women who use mental health services are less likely to participate in cervical cancer screening. Rates diverged from population rates in service users aged ⩾35 years and were very low for women aged >65 years. Intervention is needed to bridge these gaps. New screening approaches such as self-testing may assist.
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Affiliation(s)
| | - Kate Brewer
- System Information and Analytics Branch, NSW Ministry of Health, St Leonards, NSW, Australia
| | - Philip Burgess
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Jackie Curtis
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Grant Sara
- System Information and Analytics Branch, NSW Ministry of Health, St Leonards, NSW, Australia
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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4
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Bohn JA, Fitch KC, Currier JJ, Bruegl A. HPV self-collection: what are we waiting for? Exploration of attitudes from frontline healthcare providers. Int J Gynecol Cancer 2022; 32:1519-1523. [PMID: 36351745 DOI: 10.1136/ijgc-2022-003860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Polymerase chain reaction based human papilloma virus (HPV) self-collection for cervical cancer screening is well established. It is utilized worldwide, accepted by patients, is cost-effective, has comparable sensitivity to provider-collected samples, and increases screening rates, however clinical practice in the United States has not shifted to include HPV self-collection. This study sought to examine provider knowledge and attitudes to better understand why HPV self-collection is not being utilized. METHODS An observational, qualitative study was conducted. Data were collected with semi-structured focus groups and individual interviews with Oregon healthcare providers. Focus groups and interviews were continued until data saturation was achieved. A grounded theory method was used for analysis, a cyclical process of coding data, memo-writing, and theoretical sampling to the point of saturation. RESULTS Eighteen healthcare providers participated in the focus group and interviews. They represented 14 of 36 counties across Oregon and 50% were physicians, 33% were nurse practitioners, and 94% worked within family medicine. All providers performed cervical cancer screening according to current American Society for Colposcopy and Cervical Pathology guidelines. Five overarching themes emerged: provider concerns, clinical and provider barriers, patient perspective and barriers, process-based themes, and barriers to cervical cancer screening. Nearly all providers stated they will offer HPV self-collection to most of their patients once available. CONCLUSION While providers identified concerns and barriers for initiating HPV self-collection, there was a strong desire to implement HPV self-collection and acceptance within patient populations was assumed. Providers indicated the need for HPV self-collection to be incorporated into national screening guidelines along with best practices on how to successfully implement this modality to further increase cervical cancer screening rates.
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Affiliation(s)
- Jacqueline A Bohn
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Katherine C Fitch
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Jessica J Currier
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Amanda Bruegl
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
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Zammit CM, Creagh NS, McDermott T, Smith MA, Machalek DA, Jennett CJ, Prang KH, Sultana F, Nightingale CE, Rankin NM, Kelaher M, Brotherton JML. "So, if she wasn't aware of it, then how would everybody else out there be aware of it?"-Key Stakeholder Perspectives on the Initial Implementation of Self-Collection in Australia's Cervical Screening Program: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15776. [PMID: 36497850 PMCID: PMC9739016 DOI: 10.3390/ijerph192315776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In December 2017, the Australian National Cervical Screening Program transitioned from 2-yearly cytology-based to 5-yearly human papillomavirus (HPV)-based cervical screening, including a vaginal self-collection option. Until July 2022, this option was restricted to under- or never-screened people aged 30 years and older who refused a speculum exam. We investigated the perspectives and experiences of stakeholders involved in, or affected by, the initial implementation of the restricted self-collection pathway. METHODS Semi-structured interviews were conducted with 49 stakeholders as part of the STakeholder Opinions of Renewal Implementation and Experiences Study. All interviews were audio recorded and transcribed. Data were thematically analysed and coded to the Conceptual Framework for Implementation Outcomes. RESULTS Stakeholders viewed the introduction of self-collection as an exciting opportunity to provide under-screened people with an alternative to a speculum examination. Adoption in clinical practice, however, was impacted by a lack of clear communication and promotion to providers, and the limited number of laboratories accredited to process self-collected samples. Primary care providers tasked with communicating and offering self-collection described confusion about the availability, participant eligibility, pathology processes, and clinical management processes for self-collection. Regulatory delay in developing an agreed protocol to approve laboratory processing of self-collected swabs, and consequently initially having one laboratory nationally accredited to process samples, led to missed opportunities and misinformation regarding the pathway's availability. CONCLUSIONS Whilst the introduction of self-collection was welcomed, clear communication from Government regarding setbacks in implementation and how to overcome these in practice were needed. As Australia moves to a policy of providing everyone eligible for screening the choice of self-collection, wider promotion to providers and eligible people, clarity around pathology processes and the scaling up of test availability, as well as timely education and communication of clinical management practice guidelines, are needed to ensure smoother program delivery in the future. Other countries implementing self-collection policies can learn from the implementation challenges faced by Australia.
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Affiliation(s)
- Claire M. Zammit
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Nicola S. Creagh
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Tracey McDermott
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, VIC 3010, Australia
| | - Megan A. Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2011, Australia
| | - Dorothy A. Machalek
- The Kirby Institute, Wallace Wurth Building, University of New South Wales Kensington, Sydney, NSW 2052, Australia
- Centre for Women’s Infectious Diseases, The Royal Women’s Hospital, Melbourne, VIC 3052, Australia
| | - Chloe J. Jennett
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2011, Australia
| | - Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Farhana Sultana
- National Cancer Screening Register, Telstra Health, Melbourne, VIC 3000, Australia
| | - Claire E. Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Nicole M. Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Julia M. L. Brotherton
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, VIC 3010, Australia
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Wedisinghe L, Sasieni P, Currie H, Baxter G. The impact of offering multiple cervical screening options to women whose screening was overdue in Dumfries and Galloway, Scotland. Prev Med Rep 2022; 29:101947. [PMID: 36161116 PMCID: PMC9502330 DOI: 10.1016/j.pmedr.2022.101947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 10/27/2022] Open
Abstract
Most women who develop cancer have not been screened regularly. One in four women in Scotland, is overdue for cervical screening. Aim was to assess the impact of offering multiple cervical screening options to women whose screening is overdue. A prospective cohort study including all women whose screening was overdue, aged 30-60 years in Dumfries and Galloway in 2012. Potentially eligible women (n = 4146) were identified split into six groups. Women aged 30-55 years were allocated to three different groups. Group 1 (letter, n = 1246), Group 2 (letter and kit, n = 221), Group 3 (letter, n = 2031). Women aged 56-60 years were allocated to: Group 4 (letter, n = 292), Group 5 (letter and kit, n = 292) and Group 6 (control, n = 64). Women who self-collected a vaginal sample were requested to complete a questionnaire. The percentages of women responding were 24 % (21-26), 32 % (25-38), 16 % (14-18), 15 % (11-20) and 12 % (9-17) in groups 1 to 5 respectively, compared with 3 % (0-11) among controls. A significantly higher number of women (n = 383, 10 % of 3815) opted for self-sampling in comparison with undergoing a cervical screening test (CST) at the GP practice (n = 197, 5 %, x2 = 59.0, p < 0.0001). The Evalyn® Brush was well accepted (218/313 = 70 %) by those who requested self-sampling. Almost all (265/272 = 97 %) women who self-collected a vaginal sample said that if they had the option of self-sampling, they would regularly participate in future cervical screening. Offering more flexible screening options, self-sampling in particular, appears to increase cervical screening participation.
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Affiliation(s)
- L. Wedisinghe
- Department of Obstetrics and Gyanecology, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
- NHS Dumfries and Galloway, Dumfries and Galloway Royal Infirmary, Dumfries DG2 8RX, United Kingdom
| | - P. Sasieni
- School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, United Kingdom
| | - H. Currie
- NHS Dumfries and Galloway, Dumfries and Galloway Royal Infirmary, Dumfries DG2 8RX, United Kingdom
| | - G. Baxter
- NHS Dumfries and Galloway, Dumfries and Galloway Royal Infirmary, Dumfries DG2 8RX, United Kingdom
- North Cumbria Integrated Care NHS Foundation Trust, Newtown Road, Carlisle CA2 7HY, United Kingdom
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Boyard J, Caille A, Brunet-Houdard S, Sengchanh-Vidal S, Giraudeau B, Marret H, Rolland-Lozachmeur G, Rusch E, Gaudy-Graffin C, Haguenoer K. A Home-Mailed Versus General Practitioner-Delivered Vaginal Self-Sampling Kit for Cervical Cancer Screening: A Cluster Randomized Controlled Trial with a Cost-Effectiveness Analysis. J Womens Health (Larchmt) 2022; 31:1472-1480. [PMID: 35834620 DOI: 10.1089/jwh.2021.0597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: We assessed whether general practitioner (GP) delivery of a vaginal self-sampling kit was non-inferior to home-mailed delivery on cervical cancer screening (CCS) participation. Methods: Two hundred and ten French GPs from Indre-et-Loire French department were randomized into two groups, and their unscreened women patients aged 30-65 were included in February-March 2015. In the GP delivery group (n = 105 GPs; 1,806 women), women were sent a reminder letter inviting them to collect a vaginal self-sampling kit at their regular GP's practice. In the home-mailed delivery group (n = 105 GPs; 1,806 women), women were sent a reminder letter with a vaginal self-sampling kit directly at home. The primary outcome was participation in complete CCS within 9 months. A cost-effectiveness analysis was also performed. Results: At 9 months, 14.9% (95% CI: 12.9-16.9) and 27.9% (95% CI: 25.7-30.0) of women in the GP and home-mailed delivery groups participated in complete CCS. The absolute between-group difference was -13.0 percentage points (95% CI: -15.9 to -10.0) in favor of the home-mailed delivery group, crossing the non-inferiority pre-defined non-inferiority margin of 5%. The home-mailed delivery strategy cost 50.81€ more per additional woman screened. Conclusions: The GP delivery was inferior to home-mailed delivery in increasing participation in CCS. Home-mailed delivery of a vaginal self-sampling kit is a cost-effective way to increase CCS in that the additional cost of this strategy seems acceptable. This study is registered at www.Clinicaltrials.gov NCT02255084.
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Affiliation(s)
- Julie Boyard
- Cancer Screening Department, CHRU de Tours, Tours, France.,Équipe d'accueil Recherche EA7505 (Éducation, Éthique, Santé), Université de Tours, Tours, France
| | - Agnès Caille
- INSERM CIC1415, CHRU de Tours, Tours, France.,Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France
| | - Solène Brunet-Houdard
- Équipe d'accueil Recherche EA7505 (Éducation, Éthique, Santé), Université de Tours, Tours, France.,Health Economics Evaluation Unit, CHRU de Tours, Tours, France
| | | | - Bruno Giraudeau
- INSERM CIC1415, CHRU de Tours, Tours, France.,Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France
| | - Henri Marret
- PRES Centre-Val de Loire Université, Université de Tours, Tours, France.,Department of Gynecology and Obstetrics, CHRU de Tours, Tours, France
| | | | - Emmanuel Rusch
- Équipe d'accueil Recherche EA7505 (Éducation, Éthique, Santé), Université de Tours, Tours, France.,Health Economics Evaluation Unit, CHRU de Tours, Tours, France.,PRES Centre-Val de Loire Université, Université de Tours, Tours, France
| | - Catherine Gaudy-Graffin
- PRES Centre-Val de Loire Université, Université de Tours, Tours, France.,Department of Bacteriology, Virology and Hygiene, CHRU de Tours, Tours, France.,INSERM U1259, Tours, France
| | - Ken Haguenoer
- Cancer Screening Department, CHRU de Tours, Tours, France.,Équipe d'accueil Recherche EA7505 (Éducation, Éthique, Santé), Université de Tours, Tours, France
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8
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Sultana F, Gertig DM, English DR, Simpson JA, Drennan KT, Wrede CD, Mullins RM, Heley S, Saville M, Brotherton JM. HPV self-sampling and follow-up over two rounds of cervical screening in Australia - the iPap trial. J Med Screen 2022; 29:185-193. [PMID: 35313763 DOI: 10.1177/09691413221080635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Previously, based on 6 months of follow-up, we showed that HPV self-sampling improved participation in cervical screening compared to a reminder letter for Pap testing for never- and under-screened women. Here, we report follow-up and related screening outcomes for women who participated in the initial self-sampling over two screening rounds. SETTING The randomised controlled trial was conducted in Australia. METHODS Never- and under-screened women were randomly allocated to the HPV self-sampling or the reminder for Pap test arm and followed at 6 and 36 months since the kits were first mailed. RESULTS The first round of HPV self-sampling kits were mailed from May-July 2014 to 12 572 women. After 36 months, 19% of never-screened and 9% of under-screened women returned a kit for HPV testing; 2.7% were HPV 16/18 and 5.8% non-16/18 HPV positive. Compliance with first round follow-up was 84% (95% CI: 77.1-89.5%). Non-compliant and cytology triage negative women were mailed another kit at 12 months. Compliance at 12-month follow-up was 59.3% (49.4 to 68.6%). Of 37 women with a 12-month repeat HPV, 70% were positive. Of women who tested negative for HPV in the first round (n = 1573), 25% attended regular screening in the next round and none had CIN2 + detected. The overall prevalence of CIN2 + was 8.5 per 1000 screened (4.8 to 13.9 per 1000). CONCLUSION While self-sampling can successfully engage women, compliance with repeat testing may require monitoring. The clinician-supported self-collection pathway now in use in Australia will likely improve women's engagement with follow-up.
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Affiliation(s)
- Farhana Sultana
- formerly VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, 50066University of Melbourne, Melbourne, Victoria, Australia.,Population Health Solutions, 423080Telstra Health, Melbourne, Victoria, Australia
| | - Dorota M Gertig
- formerly VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, 50066University of Melbourne, Melbourne, Victoria, Australia.,Population Health Solutions, 423080Telstra Health, Melbourne, Victoria, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, 50066University of Melbourne, Melbourne, Victoria, Australia.,Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, 50066University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly T Drennan
- formerly VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia.,Population Health Solutions, 423080Telstra Health, Melbourne, Victoria, Australia
| | - C David Wrede
- Dysplasia Clinic, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Robyn M Mullins
- Australian Institute for Primary Care & Ageing, College of Science, Health and Engineering, 2080La Trobe University, Melbourne, Victoria, Australia
| | - Stella Heley
- formerly VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia
| | - Marion Saville
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,VCS Foundation, Carlton, Victoria, Australia
| | - Julia Ml Brotherton
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, 50066University of Melbourne, Melbourne, Victoria, Australia.,VCS Foundation, Carlton, Victoria, Australia
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9
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Cervical Cancer Prevention and High-Risk HPV Self-Sampling Awareness and Acceptability among Women Living with HIV: A Qualitative Investigation from the Patients’ and Providers’ Perspectives. Curr Oncol 2022; 29:516-533. [PMID: 35200547 PMCID: PMC8870184 DOI: 10.3390/curroncol29020047] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Routine cervical cancer screening is important for women living with HIV (WLH) due to the greater incidence and persistence of high-risk HPV (HR-HPV) infection. HR-HPV self-sampling has been proposed to overcome barriers to in-office cervical cancer screening in underserved populations. However, little is known about baseline knowledge of HR-HPV and the acceptability of HR-HPV self-sampling among WLH. This paper describes WLH’s experiences and needs regarding cervical cancer screening, specifically HR-HPV self-sampling, and seeks to reconcile their experiences with the views of their providers. In total, 10 providers and 39 WLH participated in semi-structured interviews and group discussions, respectively. Knowledge of cervical cancer and HR-HPV was generally limited among WLH; when present, it was often due to personal experience of or proximity to someone affected by cervical cancer. Most WLH were not familiar with HR-HPV self-sampling but, despite some of the providers’ skepticism, expressed their willingness to participate in a mail-based HR-HPV self-sampling intervention and highlighted convenience, ease of use, and affordability as facilitators to the uptake of HR-HPV self-sampling. The experiences identified can be used to guide patient-centered communication aimed at improving cervical cancer knowledge and to inform interventions, such as HR-HPV self-sampling, designed to increase cervical cancer screening among under-screened WLH.
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10
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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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11
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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12
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Moxham R, Moylan P, Duniec L, Fisher T, Furestad E, Manolas P, Scott N, OAM DK, Finlay S. Knowledge, attitudes, beliefs, intentions and behaviours of Australian Indigenous women from NSW in response to the National Cervical Screening Program changes: a qualitative study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 13:100195. [PMID: 34527986 PMCID: PMC8403896 DOI: 10.1016/j.lanwpc.2021.100195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 10/25/2022]
Abstract
Background: Indigenous women in New South Wales Australia are nearly four times more likely to die from cervical cancer than non-Indigenous women due to lower screening rates. We aimed to understand Indigenous women's cervical screening awareness, behaviours, knowledge, perceptions, motivators and barriers since the December 2017 National Cervical Screening Program changed to HPV testing, new screening age and screening interval, and introduced the new self-collection test. Methods: A qualitative study was conducted with 94 Indigenous women 25 to 74 years of age across metropolitan, regional and remote New South Wales. A team of six specialist researchers conducted the fieldwork, analysis and reporting. All data were coded thematically. Findings: Participants showed limited awareness of the renewed cervical screening program and the role of cervical screening in cervical cancer prevention, with most having a strong negative attitude towards cervical screening. Several motivators and behavioural barriers to screening were identified into four audience segments based on key characteristics. Most participants eligible to self-collect were unwilling to, due to concerns they would administer it incorrectly, injure themselves or have to return for a more invasive test. Interpretation: This study demonstrates the complex and heterogenous nature of attitudes and behaviours, among Indigenous women and highlights the intrinsic negative attitudes and social norms that are currently shaping community discourse and ultimately limiting screening. Our findings support the need for enhancing positive sentiment and community advocacy. Funding: Cancer Institute NSW Cervical Screening Program.
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Affiliation(s)
- Rosalind Moxham
- Cancer Institute NSW, NSW Health, NSW Government, Locked Bag 2030 St Leonards NSW 1590, Australia
| | - Penny Moylan
- ORIMA Research Pty Ltd, PO Box 7543 Melbourne VIC 3004, Australia
| | - Liz Duniec
- ORIMA Research Pty Ltd, PO Box 7543 Melbourne VIC 3004, Australia
| | - Teresa Fisher
- Cancer Institute NSW, NSW Health, NSW Government, Locked Bag 2030 St Leonards NSW 1590, Australia
| | - Erin Furestad
- Cancer Institute NSW, NSW Health, NSW Government, Locked Bag 2030 St Leonards NSW 1590, Australia
| | - Pene Manolas
- Cancer Institute NSW, NSW Health, NSW Government, Locked Bag 2030 St Leonards NSW 1590, Australia
| | - Nicola Scott
- Cancer Institute NSW, NSW Health, NSW Government, Locked Bag 2030 St Leonards NSW 1590, Australia
| | - Deborah Kenna OAM
- Molong Health Service, Western NSW Local Health District, NSW Government, King Street, Molong NSW, Australia
| | - Summer Finlay
- School of Population Health, University of South Australia, Adelaide SA, Australia
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13
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Pedrão PG, de Carvalho AC, Possati-Resende JC, de Paula Cury F, Campanella NC, de Oliveira CM, Tavares Guerreiro Fregnani JH. DNA Recovery Using Ethanol-Based Liquid Medium from FTA Card-Stored Samples for HPV Detection. Acta Cytol 2021; 65:264-271. [PMID: 33951624 DOI: 10.1159/000515913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/09/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Alternative methods of dry storage and transportation may be a viable alternative to the use of liquid storage medium for cervical samples, especially for screening programs in places with few resources. OBJECTIVE The objective of this study is to verify the viability and efficacy of human papillomavirus DNA (HPV-DNA) detection in cervical cell samples collected and stored on a Flinders Technology Associates (FTA) card (Whatman Indicating FTA® Elute Micro Card) and subsequently recovered in ethanol-based liquid medium and to compare the results to those obtained using samples stored directly in ethanol-based liquid medium. STUDY DESIGN Thirty-four women submitted to ETZ (excision of the transformation zone of the cervix) were included in this study. Before ETZ, 2 samples of exfoliated cervical cells were collected from each woman by a doctor and stored in ethanol-based liquid medium and on an FTA card. DNA recovery from FTA samples was performed using ethanol-based liquid medium. Detection of HPV-DNA in the samples was performed using the Cobas® 4800 HPV Test Platform. RESULTS AND CONCLUSIONS The HPV-DNA detection positivity rates were 70.6% for the samples collected directly in liquid medium and 64.7% for the samples stored on the FTA card, with high detection accuracy in the DNA samples recovered from the FTA card (area under the curve = 0.958; 95% confidence interval = 0.890-1.000). The concordance between the results obtained using the 2 storage media was 94.1% (Kappa = 0.866). These preliminary results suggest that collection of cervical material on an FTA card may be an alternative to storage in liquid medium since the liquid medium has some limitations. In addition, DNA recovery from the card using ethanol-based liquid medium streamlines the workflow in the laboratory and reduces the cost associated with reagents, thereby facilitating access to the HPV test in places with few resources and potentially improving cervical cancer screening.
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Affiliation(s)
- Priscila Grecca Pedrão
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | | | | | - Nathália C Campanella
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Cristina Mendes de Oliveira
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- DASA Laboratories, São Paulo, Brazil
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14
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Smith MA, Hall MT, Saville M, Brotherton JML, Simms KT, Lew JB, Bateson D, Skinner SR, Kelaher M, Canfell K. Could HPV Testing on Self-collected Samples Be Routinely Used in an Organized Cervical Screening Program? A Modeled Analysis. Cancer Epidemiol Biomarkers Prev 2020; 30:268-277. [PMID: 33219163 DOI: 10.1158/1055-9965.epi-20-0998] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/10/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cervical screening on self-collected samples has mainly been considered for targeted use in underscreened women. Updated evidence supports equivalent sensitivity of PCR-based human papillomavirus (HPV) testing on self-collected and clinician-collected samples. METHODS Using a well-established model, we compared the lifetime impact on cancer diagnoses and deaths resulting from cervical screening using self-collected samples only, with and without the existing restriction in Australia to women aged 30+ years and ≥2 years overdue, compared with the mainstream program of 5-yearly HPV screening on clinician-collected samples starting at 25 years of age. We conservatively assumed sensitivity of HPV testing on self-collected relative to clinician-collected samples was 0.98. Outcomes were estimated either in the context of HPV vaccination ("routinely vaccinated cohorts;" uptake as in Australia) or in the absence of HPV vaccination ("unvaccinated cohorts"). RESULTS In unvaccinated cohorts, the health benefits of increased participation from self-collection outweighed the worst case (2%) loss of relative test sensitivity even if only 15% of women, who would not otherwise attend, used it ("additional uptake"). In routinely vaccinated cohorts, population-wide self-collection could be marginally (0.2%-1.0%) less effective at 15% additional uptake but 6.2% to 12.4% more effective at 50% additional uptake. Most (56.6%-65.0%) of the loss in effectiveness in the restricted self-collection pathway in Australia results from the requirement to be 2 or more years overdue. CONCLUSIONS Even under pessimistic assumptions, any potential loss in test sensitivity from self-collection is likely outweighed by improved program effectiveness resulting from feasible levels of increased uptake. IMPACT Consideration could be given to offering self-collection more widely, potentially as an equal choice for women.See related commentary by Lim, p. 245.
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Affiliation(s)
- Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia. .,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michaela T Hall
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Mathematics and Statistics, UNSW, Sydney, New South Wales, Australia
| | - Marion Saville
- VCS Foundation, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate T Simms
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Deborah Bateson
- Family Planning NSW, Sydney, New South Wales, Australia.,Discipline of Obstetrics, Gynaecology & Neonatology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - S Rachel Skinner
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Children's Hospital Westmead, Westmead, New South Wales, Australia
| | - Margaret Kelaher
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia
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15
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Biederman E, Champion V, Zimet G. A conjoint analysis study on self-sampling for human papillomavirus (HPV) testing characteristics among black women in Indiana. BMC WOMENS HEALTH 2020; 20:55. [PMID: 32192493 PMCID: PMC7082901 DOI: 10.1186/s12905-020-00921-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/09/2020] [Indexed: 12/30/2022]
Abstract
Background Self-sampling for HPV testing may be a method to increase overall cervical cancer screening rates among Black women, who are underscreened for cervical cancer in parts of the US. The purpose of this study was to assess preferred characteristics for delivery of HPV self-sampling kits, return of HPV self-sampling kits, and communication of HPV test results and explore sociodemographic factors (income, education, and marital status) associated with acceptability of self-sampling for HPV testing. Methods Survey data were gathered at an Indiana minority health fair. Participants evaluated 9 scenarios that varied along 3 dimensions: HPV self-sampling kit delivery (mail, pharmacy pick-up, or clinic pick-up), HPV self-sampling kit return (mail, pharmacy drop-off, or clinic drop-off), and HPV test results (mail, phone call, or text message). The 9 scenarios were produced from a fractional factorial design and rated on a 0 to 100 scale. Ratings-based conjoint analysis (RBCA) determined how each dimension influenced ratings. A measure for acceptability of self-sampling was obtained from the ratings of all 9 scenarios. The acceptability measure was regressed on sociodemographics. Results The 98 participants ranged in age from 21 to 65 (M = 45). Across the 9 scenarios, overall acceptability to self-sample had a mean of 60.9 (SD = 31.3). RBCA indicated that HPV self-sampling kit return had the most influence on ratings, followed by HPV self-sampling kit delivery, and finally, HPV test result communication. Thirty-six percent of participants rated all self-sampling scenarios the same. Sociodemographic characteristics were not associated with acceptability of self-sampling. Conclusions Self-sampling for HPV testing was found to be generally acceptable to Black women in this pilot survey study. This information could be used by researchers developing self-sampling interventions and the implementation of self-sampling among providers.
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Affiliation(s)
- Erika Biederman
- Indiana University School of Nursing, 600 Barnhill Drive, NU317, Indianapolis, IN, 46202, USA.
| | - Victoria Champion
- Indiana University School of Nursing, 600 Barnhill Drive, NU317, Indianapolis, IN, 46202, USA
| | - Gregory Zimet
- Department of Pediatrics-Adolescent Medicine, Indiana University School of Medicine, 410 West 10th Street, Suite 1001, Indianapolis, IN, 46202, USA
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16
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Malone C, Barnabas RV, Buist DSM, Tiro JA, Winer RL. Cost-effectiveness studies of HPV self-sampling: A systematic review. Prev Med 2020; 132:105953. [PMID: 31911163 PMCID: PMC7219564 DOI: 10.1016/j.ypmed.2019.105953] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023]
Abstract
HPV self-sampling (HPV-SS) can increase cervical cancer screening participation by addressing barriers in high- and low- and middle-income settings. Successful implementation of HPV-SS programs will depend on understanding potential costs and health effects. Our objectives were to summarize the methods and results of published HPV-SS cost and cost-effectiveness studies, present implications of these results for HPV-SS program implementation, and identify knowledge gaps. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. One reviewer searched online databases for articles published through June 12, 2019, identified eligible studies, and extracted data; a second reviewer checked extracted data for accuracy. Eligible studies used an economic model to compare HPV-SS outreach strategies to standard-of-care tests. Of 16 eligible studies, 14 reported HPV-SS could be a cost-effective strategy. Studies differed in model type, HPV-SS delivery methods, triage strategies for positive results, and target populations. Most (9/16) modeled HPV-SS in European screening programs, 6/16 targeted women who were underscreened for cervical cancer, and 5/16 modeled HPV-SS in low- and middle-income countries. The most commonly identified driver of HPV-SS cost-effectiveness was the level of increase in cervical cancer screening attendance. Lower HPV-SS material and testing costs, higher sensitivity to detect cervical precancer, and longer duration of underscreening among HPV-SS users were also associated with increased cost-effectiveness. Future HPV-SS models in high-income settings should explore the effect of widespread vaccination and new triage strategies such as partial HPV genotyping. Knowledge gaps remain about the cost-effectiveness of HPV-SS in low- and middle-income settings.
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Affiliation(s)
- Colin Malone
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104, USA.
| | - Ruanne V Barnabas
- Department of Global Health, University of Washington, Box 359931, 325 9th Ave, Seattle, WA 98104, USA.
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute,1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104, USA; Kaiser Permanente Washington Health Research Institute,1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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17
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Reiter PL, Shoben AB, McDonough D, Ruffin MT, Steinau M, Unger ER, Paskett ED, Katz ML. Results of a Pilot Study of a Mail-Based Human Papillomavirus Self-Testing Program for Underscreened Women From Appalachian Ohio. Sex Transm Dis 2020; 46:185-190. [PMID: 30461597 DOI: 10.1097/olq.0000000000000944] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) self-testing is an emerging cervical cancer screening strategy, yet few mail-based HPV self-testing programs have been implemented in the United States. We report the results of a pilot study of a mail-based program, the Health Outcomes through Motivation and Education Project. METHODS In 2015 to 2016, we recruited 103 women from Appalachian Ohio who were aged 30 to 65 years and had not received a Papanicolaou (Pap) test in at least 3 years. Women were mailed an HPV self-test and randomized to receive either (a) self-test instructions developed by the device manufacturer and a standard information brochure about cervical cancer (control group) or (b) self-test instructions developed by the Health Outcomes through Motivation and Education Project and a photo story information brochure about cervical cancer (intervention group). Logistic regression compared study arms on HPV self-test return and receipt of a Pap test. RESULTS Overall, 80 (78%) women returned their HPV self-test. Return was similar among the intervention and control groups (78% vs. 77%; odds ratio, 1.09; 95% confidence interval, 0.43-2.76). Among returners, 26% had an oncogenic HPV type detected in their sample. Women who returned their self-test reported high levels of satisfaction and positive experiences with the self-testing process. Few women overall received a Pap test (11%), and Pap testing was similar among the intervention and control groups (14% vs. 8%; odds ratio, 1.91; 95% confidence interval, 0.52-6.97). CONCLUSIONS Mail-based HPV self-testing programs are a potentially promising strategy for reaching underscreened women in Appalachia. Efforts are needed to better understand how to optimize the success of such programs.
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Affiliation(s)
| | | | | | - Mack T Ruffin
- Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Martin Steinau
- Division of Global HIV and TB, Center for Global Health, and
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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18
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Lovell RC, Botfield JR, Cheng Y, Tilley DM, Fazio A, Estoesta J. Promoting cervical screening among women experiencing homelessness and socio-economic disadvantage in Sydney. Health Promot J Austr 2020; 31:357-368. [PMID: 31978250 DOI: 10.1002/hpja.322] [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: 06/26/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 11/07/2022] Open
Abstract
ISSUE ADDRESSED Australia's national cervical screening program has reduced rates of cervical cancer morbidity and mortality. However, these benefits have not been experienced by all women. A Cervical Cancer Screening Project was implemented with lay health educators to address inequitable screening access by women experiencing socio-economic disadvantage. METHODS Resources and a training program were developed and piloted with the specialist homelessness services workforce in Sydney, NSW. Data was collected to inform their development and evaluation through interviews, focus groups, self-administered surveys and analysis of NSW Pap Test Register data. RESULTS Women reported low familiarity with the term 'cervical screening'. They identified a good patient-doctor relationship, and seeing a female practitioner, as screening enablers. While the majority reported having cervical screening before, NSW Pap Test Register data showed only 74% had screened previously and of those, 69% were overdue. Homelessness service workers expressed interest in talking with clients about cervical screening, and reported increased knowledge and confidence following training. CONCLUSION The homelessness sector is an appropriate venue to access women who are disadvantaged and under-screened. However, increasing workforce capacity to discuss screening does not lead to increased screening for women accessing these services. Further efforts are required. SO WHAT?: Access to cervical screening by women experiencing disadvantage remains a challenge. Sustained multi-faceted health promotion efforts are required to increase access. These should be informed by additional research exploring barriers and enablers for this group of women.
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Affiliation(s)
- Renee C Lovell
- Women's Health, Community Health, Sydney Local Health District, Camperdown, NSW, Australia
| | | | - Yan Cheng
- Family Planning NSW, Ashfield, NSW, Australia
| | - Donna M Tilley
- Women's Health, Community Health, Sydney Local Health District, Camperdown, NSW, Australia
| | - Alice Fazio
- Family Planning NSW, Ashfield, NSW, Australia
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19
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Malone C, Tiro JA, Buist DS, Beatty T, Lin J, Kimbel K, Gao H, Thayer C, Miglioretti DL, Winer RL. Reactions of women underscreened for cervical cancer who received unsolicited human papillomavirus self-sampling kits. J Med Screen 2019; 27:146-156. [PMID: 31744374 DOI: 10.1177/0969141319885994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate experiences and reactions after receiving a mailed, unsolicited human papillomavirus self-sampling kit and identify psychosocial correlates of using kits. METHODS Survey participants were underscreened women aged 30-64 who were mailed human papillomavirus kits as part of a pragmatic trial at Kaiser Permanente Washington, a United States integrated health care system. Six months after the mailing, we invited kit returners and non-returners to complete a web survey that measured psychosocial factors (e.g. cervical cancer/human papillomavirus knowledge, attitudes toward screening), experiences, and reactions to kits. We compared responses between kit returners and non-returners. RESULTS Comparing 116 kit returners (272 invited) and 119 non-returners (1083 invited), we found no clinically significant differences in psychosocial factors. Overall, survey respondents showed knowledge gaps in human papillomavirus natural history (82% did not know human papillomavirus infection can clear on its own) and interpreting human papillomavirus test results (37% did not know a human papillomavirus-negative result indicates low cancer risk). Kit returners found kits convenient and easy to use (>90%). The most common reason for non-return was low confidence in ability to correctly use a kit, although many non-returners (49%) indicated that they would consider future use. Women reported low trust in human papillomavirus testing to identify women at high risk for cervical cancer (52% in returners, 42% in non-returners). CONCLUSIONS Screening programs could improve uptake and acceptability of human papillomavirus self-sampling through outreach materials that emphasize the high efficacy of human papillomavirus testing for cervical cancer screening and educate patients about how to interpret results.
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Affiliation(s)
- Colin Malone
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Diana Sm Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - John Lin
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Kilian Kimbel
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Division of Biostatistics, University of California Davis, Davis, CA, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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20
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Winer RL, Lin J, Tiro JA, Miglioretti DL, Beatty T, Gao H, Kimbel K, Thayer C, Buist DSM. Effect of Mailed Human Papillomavirus Test Kits vs Usual Care Reminders on Cervical Cancer Screening Uptake, Precancer Detection, and Treatment: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1914729. [PMID: 31693128 PMCID: PMC6865279 DOI: 10.1001/jamanetworkopen.2019.14729] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE In the United States, more than 50% of cervical cancers are diagnosed in underscreened women. Cervical cancer screening guidelines now include primary human papillomavirus (HPV) testing as a recommended strategy. Home-based HPV self-sampling is a viable option for increasing screening compliance and effectiveness; however, US data are needed to inform health care system implementation. OBJECTIVE To evaluate effectiveness of mailed HPV self-sampling kits vs usual care reminders for in-clinic screening to increase detection and treatment of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and uptake of cervical cancer screening. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted in Kaiser Permanente Washington, a US integrated health care delivery system. Women aged 30 to 64 years with health plan enrollment for 3 years and 5 months or more, a primary care clinician, no Papanicolaou test within 3 years and 5 months, and no hysterectomy were identified through electronic medical records and enrolled from February 25, 2014, to August 29, 2016, with follow-up through February 26, 2018. INTERVENTIONS The control group received usual care (annual patient reminders and ad hoc outreach from primary care clinics). The intervention group received usual care plus a mailed HPV self-sampling kit. MAIN OUTCOMES AND MEASURES Two primary outcomes were (1) CIN2+ detection within 6 months of screening and (2) treatment within 6 months of CIN2+ detection. Screening uptake within 6 months of randomization was a secondary outcome. RESULTS A total of 19 851 women (mean [SD] age, 50.1 [9.5] years) were included, with 9960 randomized to the intervention group and 9891 randomized to the control group. All women randomized were included in analysis. In the intervention group, 12 participants with CIN2+ were detected compared with 8 in the control group (relative risk, 1.49; 95% CI, 0.61-3.64) and 12 cases were treated vs 7 in the control group (relative risk, 1.70; 95% CI, 0.67-4.32). Screening uptake was higher in the intervention group (2618 participants [26.3%] vs 1719 participants [17.4%]; relative risk, 1.51; 95% CI, 1.43-1.60). CONCLUSIONS AND RELEVANCE Mailing HPV kits to underscreened women increased screening uptake compared with usual care alone, with no significant differences in precancer detection or treatment. Results support the feasibility of mailing HPV kits to women who are overdue for screening as an outreach strategy to increase screening uptake in US health care systems. Efforts to increase kit uptake and follow-up of positive results are warranted to maximize detection and treatment of CIN2+. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02005510.
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Affiliation(s)
- Rachel L. Winer
- Department of Epidemiology, University of Washington, Seattle
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - John Lin
- Department of Epidemiology, University of Washington, Seattle
| | - Jasmin A. Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Kilian Kimbel
- Kaiser Permanente Washington Health Research Institute, Seattle
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Improving the promise of embedded pragmatic trials: Surmountable barriers encountered in an evaluation of home-based HPV self-sampling to increase cervical cancer screening in overdue women. Contemp Clin Trials Commun 2019; 15:100413. [PMID: 31372572 PMCID: PMC6661276 DOI: 10.1016/j.conctc.2019.100413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/10/2019] [Accepted: 07/18/2019] [Indexed: 12/23/2022] Open
Abstract
Despite increased attention on how to conduct pragmatic trials and their importance, there remains an under-appreciation for the reality of what they take to design, compete and secure funding and execute. Many barriers are surmountable through increased exposure to experiences from completed trials. This report summarizes our experience in designing, securing funding and implementing the Home-Based Options to Make screening Easier (HOME) pragmatic trial, which was designed to evaluate home human papillomavirus testing for cervical cancer screening in underscreened women (women who had not received a cervical cancer screening test in ≥3.5 years). This report highlights factors at the level of research teams, organizations seeking to conduct embedded research, reviewers and funding agencies that challenge pragmatic trial design and execution. There is an urgent need to train on peer-reviewers how to evaluate embedded trial grant proposals, for agencies to pursue more rapid and innovative funding strategies, and to consider strategies for reviewers and funders to evaluate stakeholder buy-in (beyond letters of support). These factors together are needed to realize the promise of pragmatic trials to more efficiently and effectively generate critical data that inform changes in health care delivery and benefit patients.
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22
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Bishop E, Katz ML, Reiter PL. Acceptability of Human Papillomavirus Self-Sampling Among a National Sample of Women in the United States. Biores Open Access 2019; 8:65-73. [PMID: 31057989 PMCID: PMC6497327 DOI: 10.1089/biores.2018.0040] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
As human papillomavirus (HPV) self-sampling continues to emerge as a potential cervical cancer screening strategy in the United States, it is necessary to examine women's acceptability of this screening approach. Furthermore, since several HPV self-sampling devices exist, it is important to determine if women's preferences differ by device type. We conducted an online survey in Fall 2017 with a national sample of women (n = 605) ages 21–65 years (the recommended age range for cervical cancer screening). Multivariable linear regression identified correlates of women's willingness to use an HPV self-sample at home. We used repeated measures analysis of variance to determine if preferences differed across four self-sampling devices: Evalyn® Brush (Device A), HerSwab® (Device B), Catch-All® Swab (Device C), and Qvintip® (Device D). Most women were willing to use an HPV self-sample at home (mean = 4.03 [possible range: 1–5], standard deviation = 1.09, 72.7% indicated “probably willing” or “definitely willing”). The most common concerns about self-sampling were related to test accuracy (53.1%) and obtaining the sample incorrectly (51.1%). Women were more willing to use an HPV self-sample at home if they reported greater perceived severity of cervical cancer (β = 0.16), reported an annual income less than $50,000 (β = 0.13), or were a former smoker (β = 0.11). Women were more willing to use Device A (mean = 3.72, 67.6% indicated “agree” or “strongly agree”), Device C (mean = 3.86, 73.9% indicated “agree” or “strongly agree”), and Device D (mean = 3.81, 72.1% indicated “agree” or “strongly agree”) than Device B (mean = 3.36, 49.4% indicated “agree” or “strongly agree”; all p < 0.05). Acceptability of HPV self-sampling as a cervical cancer screening strategy is generally high among women. Future efforts should consider the potential impact that device type may have on women's use of an HPV self-sample at home.
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Affiliation(s)
- Erin Bishop
- Medical Student Research Program, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Mira L Katz
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio.,Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Paul L Reiter
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio.,Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
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23
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Smith MA, Hall M, Lew JB, Canfell K. Potential for HPV vaccination and primary HPV screening to reduce cervical cancer disparities: Example from New Zealand. Vaccine 2018; 36:6314-6324. [DOI: 10.1016/j.vaccine.2018.08.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 12/19/2022]
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24
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Zhao P, Liu S, Zhong Z, Hou J, Lin L, Weng R, Su L, Lei N, Hou T, Yang H. Prevalence and genotype distribution of human papillomavirus infection among women in northeastern Guangdong Province of China. BMC Infect Dis 2018; 18:204. [PMID: 29724192 PMCID: PMC5934871 DOI: 10.1186/s12879-018-3105-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 04/20/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) DNA testing is an important method in cervical cancer screening. However, the studies on prevalence and genotype distribution of HPV among women in northeastern Guangdong Province of China are very limited. METHODS A total of 28,730 women attending the Department of Gynecology of Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University between January 1st, 2013 and June 1st, 2015 were enrolled in this study. HPV type-specific distribution was tested using flow-through hybridization and gene chip. RESULTS The overall prevalence of HPV infection was 19.81%, among which 79.09% were infected with high-risk HPV subtypes in the subjects. The 5 most predominant genotypes were HPV16, 52, 58, 18 and 81. Most HPV infections were observed in women aged 41-50 and women aged 30-59 accounted for a proportion of over 80%. CONCLUSIONS Our findings suggested a high burden of HPV infection among women in northeastern Guangdong Province of China. We identified the top 5 HPV genotypes as well as the age-specific distribution of HPV infections in this area.
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Affiliation(s)
- Pingsen Zhao
- Clinical Core Laboratory, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China.
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China.
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China.
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China.
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou, 514031, People's Republic of China.
| | - Sudong Liu
- Clinical Core Laboratory, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou, 514031, People's Republic of China
| | - Zhixiong Zhong
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
| | - Jingyuan Hou
- Clinical Core Laboratory, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou, 514031, People's Republic of China
| | - Lifang Lin
- Clinical Core Laboratory, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou, 514031, People's Republic of China
| | - Ruiqiang Weng
- Clinical Core Laboratory, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou, 514031, People's Republic of China
| | - Luxian Su
- Clinical Core Laboratory, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou, 514031, People's Republic of China
| | - Nanxiang Lei
- Department of Gynaecology, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
| | - Tao Hou
- Department of Gynaecology, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
| | - Haikun Yang
- Department of Gynaecology, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
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Gupta S, Palmer C, Bik EM, Cardenas JP, Nuñez H, Kraal L, Bird SW, Bowers J, Smith A, Walton NA, Goddard AD, Almonacid DE, Zneimer S, Richman J, Apte ZS. Self-Sampling for Human Papillomavirus Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs. Front Public Health 2018; 6:77. [PMID: 29686981 PMCID: PMC5900042 DOI: 10.3389/fpubh.2018.00077] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/01/2018] [Indexed: 12/23/2022] Open
Abstract
In most industrialized countries, screening programs for cervical cancer have shifted from cytology (Pap smear or ThinPrep) alone on clinician-obtained samples to the addition of screening for human papillomavirus (HPV), its main causative agent. For HPV testing, self-sampling instead of clinician-sampling has proven to be equally accurate, in particular for assays that use nucleic acid amplification techniques. In addition, HPV testing of self-collected samples in combination with a follow-up Pap smear in case of a positive result is more effective in detecting precancerous lesions than a Pap smear alone. Self-sampling for HPV testing has already been adopted by some countries, while others have started trials to evaluate its incorporation into national cervical cancer screening programs. Self-sampling may result in more individuals willing to participate in cervical cancer screening, because it removes many of the barriers that prevent women, especially those in low socioeconomic and minority populations, from participating in regular screening programs. Several studies have shown that the majority of women who have been underscreened but who tested HPV-positive in a self-obtained sample will visit a clinic for follow-up diagnosis and management. In addition, a self-collected sample can also be used for vaginal microbiome analysis, which can provide additional information about HPV infection persistence as well as vaginal health in general.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Zachary S Apte
- uBiome, San Francisco, CA, United States.,University of California San Francisco, San Francisco, CA, United States
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26
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Projected future impact of HPV vaccination and primary HPV screening on cervical cancer rates from 2017-2035: Example from Australia. PLoS One 2018; 13:e0185332. [PMID: 29444073 PMCID: PMC5812553 DOI: 10.1371/journal.pone.0185332] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022] Open
Abstract
Background Many countries are transitioning from cytology-based to longer-interval HPV screening. Trials comparing HPV-based screening to cytology report an increase in CIN2/3 detection at the first screen, and longer-term reductions in CIN3+; however, population level year-to-year transitional impacts are poorly understood. We undertook a comprehensive evaluation of switching to longer-interval primary HPV screening in the context of HPV vaccination. We used Australia as an example setting, since Australia will make this transition in December 2017. Methods Using a model of HPV vaccination, transmission, natural history and cervical screening, Policy1-Cervix, we simulated the planned transition from recommending cytology every two years for sexually-active women aged 18–20 to 69, to recommending HPV screening every five years for women aged 25–74 years. We estimated rates of CIN2/3, cervical cancer incidence, and mortality for each year from 2005 to 2035, considering ranges for HPV test accuracy and screening compliance in the context of HPV vaccination (current coverage ~82% in females; ~76% in males). Findings Transient increases are predicted to occur in rates of CIN2/3 detection and invasive cervical cancer in the first two to three years following the screening transition (of 16–24% and 11–14% in respectively, compared to 2017 rates). However, by 2035, CIN2/3 and invasive cervical cancer rates are predicted to fall by 40–44% and 42–51%, respectively, compared to 2017 rates. Cervical cancer mortality rates are predicted to remain unchanged until ~2020, then decline by 34–45% by 2035. Over the period 2018–2035, switching to primary HPV screening in Australia is expected to avert 2,006 cases of invasive cervical cancer and save 587 lives. Conclusions Transient increases in detected CIN2/3 and invasive cancer, which may be detectable at the population level, are predicted following a change to primary HPV screening. This is due to improved test sensitivity bringing forward diagnoses, resulting in longer term reductions in both cervical cancer incidence and mortality. Fluctuations in health outcomes due to the transition to a longer screening interval are predicted to occur for 10–15 years, but cervical cancer rates will be significantly reduced thereafter due to the impact of HPV vaccination and HPV screening. In order to maintain confidence in primary HPV screening through the transitional phase, it is important to widely communicate that an initial increase in CIN2/3 and perhaps even invasive cervical cancer is expected after a national transition to primary HPV screening, that this phenomenon is due to increased prevalent disease detection, and that this effect represents a marker of screening success.
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Zehbe I, Wakewich P, King AD, Morrisseau K, Tuck C. Self-administered versus provider-directed sampling in the Anishinaabek Cervical Cancer Screening Study (ACCSS): a qualitative investigation with Canadian First Nations women. BMJ Open 2017; 7:e017384. [PMID: 28864487 PMCID: PMC5588934 DOI: 10.1136/bmjopen-2017-017384] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND While (Pap)anicolaou screening has helped to decrease cervical cancer incidence in Canada, First Nations women continue to have a higher burden and mortality relative to mainstream populations. Many First Nations women may feel uncomfortable with the invasiveness of this test, contributing to this statistic. Implemented from 2009 to 2015 in 10 Northwest Ontario First Nations communities, the Anishinaabek Cervical Cancer Screening Study (ACCSS) uniquely addressed this Indigenous health inequity through a mixed methods approach. OBJECTIVE Our goal was to offer an alternative test which the women could do themselves: human papillomavirus (HPV) testing based on self-sampling. We investigated whether First Nations women preferred HPV self-sampling over healthcare provider (HCP)-administered Pap screening. METHODS Participatory action researchinformed by the ethical space concept has guided all stages of the ACCSS. We conducted qualitative interviews with 16 HCPs and 8 focus group discussions with 69 female community members followed by a cluster-randomised controlled trial (RCT). Here, we draw on the qualitative field data and an end-of-study community update gathering to disseminate and contextualise research findings. Informant data were evaluated using thematic analysis. RESULTS We discuss factors influencing participants' strong preference for HPV self-sampling over physician-conducted Pap screening. Key arguments included enhanced accessibility and more personal control, less physical and emotional discomfort and fewer concerns regarding privacy of test results. For future implementation of HPV self-sampling, study participants emphasised the need for more culturally sensitive education addressed to community members of all genders, starting at school, clarifying that HPV causes cervical cancer. Further, HPV infection should be de-stigmatised by accentuating that it affects men and women alike. CONCLUSION Here we show that self-sampling in conjunction with community engagement and culturally sensitive education and could be a viable option for underscreened Canadian First Nations women. These informant data echo our previous RCT results.
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Affiliation(s)
- Ingeborg Zehbe
- Department of Biology, Lakehead University, Thunder Bay, Canada
- Probe Development and Biomarker Exploration, Thunder Bay Regional Health Research Institute, Thunder Bay, Canada
| | - Pamela Wakewich
- The Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, Canada
- Department of Sociology and Women's Studies, Lakehead University, Thunder Bay, Canada
| | - Amy-Dee King
- Band Office, Biinjitiwaabik Zaaging Anishinaabek First Nation, Thunder Bay, Canada
| | - Kyla Morrisseau
- Band Office, Animbiigo Zaagi'igan Anishinaabek First Nation, Thunder Bay, Canada
| | - Candace Tuck
- Band Office, Red Rock Indian Band, Thunder Bay, Canada
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Aitken S. The primary health care of transgender adults. Sex Health 2017; 14:477-483. [DOI: 10.1071/sh17048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
Gender dysphoria is associated with significant health disparity. Gender services perform specialised activities such as diagnosis, endocrine management and liaison with surgical services. Although providing these specialised transition services appears to be safe and improves well-being, significant health disparity remains. Engaging primary care providers is an important part of any strategy to improve the health care of transgender people. The relationships between gender dysphoria and a range of primary care issues such as mental health, cardiovascular disease and cancer are explored.
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29
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Oehler MK. Cervical Pap smear screening is coming to an end. Maturitas 2016; 94:11-12. [PMID: 27823728 DOI: 10.1016/j.maturitas.2016.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Martin K Oehler
- Dept. of Gynaecological Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia.
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Hanley SJB, Fujita H, Tamakoshi A, Dong P, Sakuragi N. Challenges in breast and cervical cancer control in Japan. Lancet Oncol 2016; 17:e372. [PMID: 27599140 DOI: 10.1016/s1470-2045(16)30411-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 07/25/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Sharon J B Hanley
- Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | | | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Peixin Dong
- Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Noriaki Sakuragi
- Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Reproductive Endocrinology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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