Women's attitudes and understanding of cervical cancer and the new National Cervical Screening Program

PURPOSE Until human papillomavirus (HPV)–based cervical screening is more affordable and widely available, visual inspection with acetic acid (VIA) is recommended by the WHO for screening in lower-resource settings. Visual inspection will still be required to assess the cervix for women whose screening is positive for high-risk HPV. However, the quality of VIA can vary widely, and it is difficult to maintain a well-trained cadre of providers. We developed a smartphone-enhanced VIA platform (SEVIA) for real-time secure sharing of cervical images for remote supportive supervision, data monitoring, and evaluation. METHODS We assessed programmatic outcomes so that findings could be translated into routine care in the Tanzania National Cervical Cancer Prevention Program. We compared VIA positivity rates (for HIV-positive and HIV-negative women) before and after implementation. We collected demographic, diagnostic, treatment, and loss-to-follow-up data. RESULTS From July 2016 to June 2017, 10,545 women were screened using SEVIA at 24 health facilities across 5 regions of Tanzania. In the first 6 months of implementation, screening quality increased significantly from the baseline rate in the prior year, with a well-trained cadre of more than 50 health providers who “graduated” from the supportive-supervision training model. However, losses to follow-up for women referred for further evaluation or to a higher level of care were considerable. CONCLUSION The SEVIA platform is a feasible, quality improvement, mobile health intervention that can be integrated into a national cervical screening program. Our model demonstrates potential for scalability. As HPV screening becomes more affordable, the platform can be used for visual assessment of the cervix to determine amenability for same-day ablative therapy and/or as a secondary triage step, if needed.

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Cervical neoplasia

Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health ◽

10.1093/med/9780198783497.003.0030 ◽

2019 ◽

pp. 357-364

Keyword(s):

Cervical Cancer ◽

Screening Program ◽

Cervical Screening ◽

Hpv Vaccination ◽

Invasive Cervical Cancer ◽

Intraepithelial Neoplasia ◽

Cervical Neoplasia ◽

Women Living With Hiv ◽

The Bethesda System ◽

Common Malignancy

Cervical neoplasia provides an overview of the 4th most common malignancy in women worldwide, including the premalignant phase. Specific terminology used in cytology and histology (including atypia, dyskaryosis, cervical intraepithelial neoplasia (CIN), cervical glandular intraepithelial neoplasia (CGIN) and invasive cervical cancer (ICC) are explained, and the epidemiology and risk factors (with an emphasis on human papilloma virus (HPV)) for this common malignancy are included. Clinical presentation is outlined. Cervical screening is discussed, including the role of HPV testing, and both the British Association for Cytopathology/NHS cervical screening program 2013 classification of cervical cytology and the Bethesda system (used more widely worldwide) are explained. Diagnosis includes colposcopic examination of the cervix, and the management of both CIN and cervical cancer are included. HPV vaccination, pregnancy, and women living with HIV (including ICC as AIDS-defining) are discussed.

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Pattern of Cervical Screening Utilization in Italy

Tumori Journal ◽

10.1177/030089168907500504 ◽

1989 ◽

Vol 75 (5) ◽

pp. 420-422 ◽

Cited By ~ 13

Author(s):

Monica Ferraroni ◽

Carlo La Vecchia ◽

Romano Pagano ◽

Eva Negri ◽

Fabio Parazzini ◽

...

Keyword(s):

Cervical Cancer ◽

Screening Program ◽

Cervical Screening ◽

Age Groups ◽

National Health Survey ◽

Italian Population ◽

Common Procedure ◽

Quantitative Evidence ◽

Italian Women ◽

Substantial Decline

The pattern of cervical screening utilization in Italy was analyzed using data from the 1986-1987 National Health Survey on the basis of a sample of 27,455 women aged 20 to 79 randomly selected within strata of municipality of residence and age in order to be representative of the whole Italian population. Overall, about 17% of women aged 20 to 79 were screened per year, for a total of 3.5 to 4 million cervical smears per year. The highest frequency was reported in younger middle age, about one in four women being screened per year in the age groups 30 to 49, and there was a substantial decline above age 50. Cervical smear rates were higher in Northern areas (22 %), where mortality from cervical cancer is lower, than in the Centre (16%) and South (11 %) of the country. Further, there was a strong positive social class gradient in the utilization of cervical screening, in relation to both education and occupation. In spite of the absence of any organised mass screening program, cervical screening is a relatively common procedure among Italian women. However, this study provides further quantitative evidence of a markedly irrational utilization of non-organized cervical screening, which tends to end up selectively used by the groups in which cervical cancer is less common.

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Cervical Cancer Screening Participation among Women of Russian, Somali, and Kurdish Origin Compared with the General Finnish Population: A Register-Based Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17217899 ◽

2020 ◽

Vol 17 (21) ◽

pp. 7899

Author(s):

Esther E. Idehen ◽

Anni Virtanen ◽

Eero Lilja ◽

Tomi-Pekka Tuomainen ◽

Tellervo Korhonen ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Screening Program ◽

Cervical Screening ◽

Well Being ◽

Migrant Health ◽

Finnish Population ◽

Screening Participation ◽

Cancer Screening Participation

Migrant-origin women are less prone to cervical screening uptake compared with host populations. This study examined cervical cancer screening participation and factors associated with it in the Finnish mass screening program during 2008–2012 in women of Russian, Somali and Kurdish origin compared with the general Finnish population (Finns) in Finland. The study population consists of samples from the Finnish Migrant Health and Well-being Study 2010–2012 and Health 2011 Survey; aged 30–64 (n = 2579). Data from the Finnish screening register linked with other population-based registry data were utilized. For statistical analysis we employed logistic regression. Age-adjusted screening participation rates were Russians 63% (95% CI: 59.9–66.6), Somalis 19% (16.4–21.6), Kurds 69% (66.6–71.1), and Finns 67% (63.3–69.8). In the multiple-adjusted model with Finns as the reference; odds ratios for screening were among Russians 0.92 (0.74–1.16), Somalis 0.16 (0.11–0.22), and Kurds 1.37 (1.02–1.83). Among all women, the substantial factor for increased screening likelihood was hospital care related to pregnancy/birth 1.73 (1.27–2.35), gynecological 2.47 (1.65–3.68), or other reasons 1.53 (1.12–2.08). Screening participation was lower among students and retirees. In conclusion, screening among the migrant-origin women varies, being significantly lowest among Somalis compared with Finns. Efforts using culturally tailored/population-specific approaches may be beneficial in increasing screening participation among women of migrant-origin.

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“A Pap smear saved my life”: Personal experiences of cervical abnormalities shape attitudes to cervical screening renewal

Journal of Medical Screening ◽

10.1177/0969141319889648 ◽

2019 ◽

Vol 27 (4) ◽

pp. 223-226 ◽

Cited By ~ 1

Author(s):

Helena M Obermair ◽

Kirsten J McCaffery ◽

Rachael H Dodd

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Screening Program ◽

Cervical Screening ◽

Personal History ◽

Pap Smears ◽

Increased Risk ◽

Women's Lives ◽

History Of ◽

Screening Intervals

Objective In 2017, the Australian National Cervical Screening Program changed from two-yearly Pap smears between ages 18 and 69, to five-yearly human papillomavirus screening between ages 25 and 74 (the “Renewal”). This study investigated attitudes towards the changes, among individuals previously affected by cervical abnormalities/cervical cancer, personally or through a friend/relative. Methods We conducted a thematic analysis of comments expressing personal history or a family/friend history of cervical abnormalities/cervical cancer as a reason for opposing changes to the cervical screening program. The comments were taken from a 20% random sample of 19,633 comments posted on the “Change.org” petition “Stop May 1st Changes to Pap Smears – Save Women's Lives” in February–March 2017. Results There were 831 (20.8%) commenters who reported that they were concerned about a change in screening due to: feelings of increased personal vulnerability to cervical cancer due to their own personal history of cervical abnormalities; comparison of extended screening intervals and later age of first screening to their own experiences; and a perception of increased personal risk due to family history. Conclusion Women previously affected by cervical abnormalities or cervical cancer, personally or through a friend/relative, expressed concern about changes to cervical screening due to perceived increased risk and feeling vulnerable due to personal history.

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54. CAPITALISING ON THE UNIQUE OPPORTUNITY OF THE HPV VACCINE, FOR A CERVICAL SCREENING PROGRAM

Sexual Health ◽

10.1071/shv4n4ab54 ◽

2007 ◽

Vol 4 (4) ◽

pp. 305

Author(s):

L. Rawlings

Keyword(s):

Cervical Cancer ◽

Hpv Vaccine ◽

Screening Program ◽

Cervical Screening ◽

Hpv Vaccination ◽

National Immunisation ◽

Expert Opinions ◽

Current Program ◽

Huge Impact ◽

Research And Education

The medical advancement of the human papilloma virus (HPV) vaccine and it's swift addition to the National Immunisation Program, caused a sudden surge in the public's awareness and interest in HPV. The challenge for PapScreen Victoria, a state based cervical screening program, was to react quickly and strategically to ensure that this new knowledge did not prevent women from having Pap tests. PapScreen pre-empted that the vaccine would have a huge impact on the current program, and undertook an educational journey to identify issues. The program sought expert opinions, formulated new partnerships in the immunisation sector and examined the current research. The program identified that its role was to inform women about HPV and the importance to continue screening in this new era of HPV vaccination. In the prevention of cervical cancer, there was also a role to inform health professionals, parents and young women about the benefits of the vaccine. The challenge was capatilising on the unique opportunity that the vaccine created. Developing and implementing strategies quickly was paramount in the program's success on capitalising this interest. Across three main areas - community, communications and research - the program implemented a range of strategies, including new resources, media opportunities, formative research and education, among others. PapScreen's aim was to remain the prime source of information for the prevention of cervical cancer in Victoria. The success of these strategies has been profound and immunisation messages are now included in all program messages across a range of sectors. The program was able to capitalise on this unique occasion by being flexible, proactive and strategically adaptable to the public health environment.

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Opportunities and challenges in cervical cancer screening program in Kazakhstan: Results after imPACT review.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e18020 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e18020-e18020

Author(s):

Dilyara Kaidarova ◽

Raikhan Bolatbekova ◽

Alma Zhylkaidarova ◽

Tolkyn Sadykova ◽

Yerlan Kukubassov ◽

...

Keyword(s):

Cervical Cancer ◽

Mortality Rate ◽

Screening Program ◽

Early Stage ◽

Gynecological Cancer ◽

Cervical Screening ◽

Pap Test ◽

Target Population ◽

Developed Countries ◽

Screening Programs

e18020 Background: Cervical cancer is the second most common cancer in women worldwide, where the majority of registered patients are in developing countries. Screening programs in developed countries have reduced morbidity and mortality from cervical cancer by more than 2 times. Cervical cancer (CC) is the most common gynecological cancer in Kazakhstan (KZ). Standardized incidence rate of CC was 18.2 per 100,000, while the mortality rate was 6.2 per 100,000, in 2019. The National Cervical Screening program in KZ uses cytology (Pap test) from 2008. Screening program funded by the State budget. In 2016, Experts of imPACT Mission analyzed the CC screening and made recommendations for improvement. Since 2018 target age of CC screening expanded to 30-70 years and shortened the interval to 4 years, strengthened the control of patients with pre-cancerous pathology. Until 2018, people came to a fixed age; today we start CC screening within the target age at any age at the time of the first visit. The purpose of this study is to analyze cytological screening results in KZ after imPACT recommendations. Methods: Coverage, the number of screened women, the level of pre-cancer detection and cervical cancer during screening have been obtained from specific reports (form № 025, № 08) for 2008-2019. Results: The total number of screened women was in 6.775.975. There is a decrease in the number of screened women by 32% from 2008 to 2017. Since improvement of CC screening we increased coverage from 49.9% in 2017 (abs. number 409.124) to 89% in 2019 (abs. number 954.322). According to the results of screening, 2603 cases of CC were registered in 12 years. Analysis of screening results showed a marked increase in the detection of CC with an increasing by 67%. The persentage of registered cases of ASH+HSIL increased from 0.136% to 0.673%. Conclusions: there has been an increase in the coverage by screening of the target population since the screening update. During the study period, there has been an improvement in the detection of precancerous pathology and cancer in the early stage. Despite the positive results of screening, sufficient coverage by screening, certain successes in detecting the initial stage of CC, mortality rate from CC remain high, which makes it necessary to improve the screening of CC in KZ through the introduction of HPV-screening.

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Prevalence and Predictors of Cervical Cytological (Pap Smear) Abnormalities Among HIV-infected Women at the HIV Treatment Center of Jos University Teaching Hospital Jos, Nigeria.

10.21203/rs.3.rs-46916/v1 ◽

2020 ◽

Author(s):

Olugbenga Akindele Silas ◽

Philip O. Akpa ◽

Tolulope O. Afolaranmi ◽

Samuel Robsam Ohayi ◽

Jonah Musa ◽

...

Keyword(s):

Cervical Cancer ◽

Teaching Hospital ◽

Pap Smear ◽

Screening Program ◽

Cervical Screening ◽

University Teaching ◽

Treatment Center ◽

Adult Women ◽

Pap Smear Screening ◽

Women With Hiv

Abstract Introduction: Cervical cancer is the most common cancer among women living with HIV with the highest burden in sub-Sahara African countries with the highest prevalence of HIV. Early detection of precursor cervical lesions through routine Pap smear screening is central to cervical cancer prevention. This study was aimed at determining the prevalence and predictors of abnormal Pap smear findings among women with HIV in our cervical cancer screening program. Methodology: We carried out a cross sectional study of adult women with HIV who presented for Pap smear test for the first time at the Jos University Teaching Hospital, Jos, North Central Nigeria between November2018 and January 2020. Prevalence of abnormal cervical finding was reported in percentage and also expressed per 100 population of women. The effects of the characteristics of the women of the abnormal pap smear finding was determined using the logistic regression model where 95% confidence interval and adjusted odds were used as point and interval estimates respectively while a probability value of < 0.05 was considered statistically significant. Results: A total of 949 women with HIV participated in the cervical screening program with mean age 43.3 ± 8.1 years. Abnormal smear findings were observed among 183 (19.3%: 19 cases per 100 women) with ASCUS, ASC-H, LSIL, HSIL, HSIL with suspicion of invasion and AGUS accounting for 96 (10.1%), 50(5.3%), 27 (2.9%), 6 (0.6%), 2 (0.2%) and 2(0.2%) respectively. Of the abnormal smear findings, 125 (68.3%) were adjudged to have mild cytological feature while the complementing proportion adjudged to have severe cytological features. Unadjusted odds of abnormal Pap smear result was associated with increasing age, OR 1.15(95% CI 1.127, 1.186; p = 0.001); parity, OR1.08 (95% CI 1.019, 1.141; p = 0.009). In the adjusted model, increasing age remained the only factor predicting abnormal Pap smear finding. Conclusion: Prevalence of abnormal Pap smear results remains high in HIV- infected women and is associated with increasing age. Advocacy to institutionalize screening at earlier age is therefore key to improving dismal outcomes.

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Opportunistic cervical cancer screening by papanicolaou stain Pap smear among women: a pilot study at urban health training centre of All India Institute of Medical Sciences, Patna, Bihar, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202525 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2714

Author(s):

Ruchi Sinha ◽

Pragya Kumar ◽

Geetika Singh ◽

Rubina Saha

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Pap Smear ◽

Screening Program ◽

Cervical Screening ◽

Locally Advanced ◽

Sampling Technique ◽

Training Centre ◽

Tertiary Center ◽

Associated Risk Factors

Background: Cancer of the uterine cervix is the second most common cancer among women world-wide and accounts for 17% of all cancer deaths among females aged 30-69 years in India. Locally advanced cervical cancer is rampant in Bihar because of the high prevalence of associated risk factors. However, there is lack of organized screening programmes and treatment facilities for these patients. Thus, the study aimed at screening women for cervical cancer opportunistically during their visit to the health centres and to assess the various socio-demographic and other risk factors associated with positive screening test results.Methods: Using purposive sampling technique, all women aged 18-59 years who visited the centre for any purpose were interviewed using a pre-designed questionnaire. All eligible women were screened using the conventional Pap Smear and evaluation was done using the 2014 Bethesda system. This study is still underway and 71 women have been screened so far. An interim analysis was done.Results: Only 4.23% of the women ever had Pap smear testing in their life earlier. Mean age was 35.3±9.12 years and majority of the women were married and multi-parous. Vaginal discharge (55.74%) was the most common perceived gynecological morbidity. Most (36.62%) smears were reported as inflammatory cervical smears while epithelial cell abnormalities were seen in 4 (5.63%) cases.Conclusions: This study reiterates the need to start organized cervical screening program not only at tertiary center but also at primary health centers which will definitely help to reduce the burden to some extent

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Prevalence, Types, and Factors of HPV Infection Among Women With Abnormal Cervical Cytology Screening at Ramathibodi Hospital

Ramathibodi Medical Journal ◽

10.33165/rmj.2021.44.3.249847 ◽

2021 ◽

Vol 44 (3) ◽

pp. 12-19

Author(s):

Nithitda Boonthum ◽

Somsak Suthutvoravut

Keyword(s):

Cervical Cancer ◽

Screening Program ◽

Cervical Screening ◽

Hpv Infection ◽

Cervical Cytology ◽

Single Infection ◽

Pcr Analysis ◽

Abnormal Cytology ◽

Abnormal Cervical Cytology ◽

Cytology Screening

Background: Cervical cancer is the second leading cancer among Thai women. Human papillomavirus (HPV) is the most common cause of cervical cancer. HPV16 and HPV18 are the most prevalence types in women with cervical cancer. Objectives: To study the prevalence and types of HPV infection and its associated risk factors among women with abnormal cervical cytology screening. Methods: This cross-sectional study purposively recruited 376 women who had abnormal cervical cytology screening by liquid-based cytology at the outpatient clinic, Ramathibodi Hospital from August 2015 until March 2016. HPV genotyping was done by the polymerase chain reaction (PCR). Analysis of the personal characteristics was done using descriptive statistics. Results: The prevalence of HPV infection was 41.5%. Among them, a single infection was found in 78.8% of women. The most common genotypes were HPV16 (8.5%) and HPV52 (7.7%). But HPV18 was found in only 1.9%. The characteristic which was significantly associated with HPV infection was age, nulliparity, and high-graded dysplasia (P < .05). Conclusions: High prevalence rate of HPV infection was found among women with abnormal cytology. High-risk HPV prevalence and type distribution may be useful for public health authorities in assessing the cervical screening program.

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