Barriers to Cervical Cancer Screening and the Cervical Cancer Care Continuum in Rural Guatemala: A Mixed-Method Analysis

Purpose Cervical cancer is an important cause of mortality in low- and middle-income countries. Although screening technologies continue to improve, systems of care remain fragmented. It is important to better understand factors that affect use of screening services and loss to follow-up along the care continuum. Methods We conducted a mixed-methods study of a cytology-based screening program in rural Guatemala. A retrospective electronic chart review was performed on data from all patients from 2013 to 2014. We analyzed progression through care and calculated loss–to–follow-up rates. We also analyzed the prior experiences of patients with cervical cancer screening on the basis of self-reported historical data available in the chart review. Structured interviews with a subset of individuals to explore social supports and barriers to screening and engagement in care were conducted at the time of screening. Results The analysis included 515 women (median age, 36 years). Cytologic screening showed concern for neoplastic changes in 0.83%; half resulted in biopsy-proven cervical intraepithelial neoplasia. An additional 9.9% showed severe inflammation. The rate of loss to follow–up was 11.3%. All losses to follow-up occurred for severe inflammation, not for cervical intraepithelial neoplasia. Historical data showed that 73% of the cohort had previously been screened and had high levels of loss to follow-up (57.4%). Qualitative interviews revealed factors that promoted loss to follow-up; these included cost, lack of social supports, transportation, distrust in public facilities, long turn-around times, and failure to return test results or offer follow-up treatments. Conclusions Taken together, these quantitative and qualitative results highlight the need for cervical cancer screening programs in Guatemala to improve uptake of screening services by eligible women and to improve follow-up after a first abnormal screen.

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Recovery strategies following COVID-19 disruption to cervical cancer screening and their impact on excess diagnoses

British Journal of Cancer ◽

10.1038/s41416-021-01275-3 ◽

2021 ◽

Author(s):

Alejandra Castanon ◽

Matejka Rebolj ◽

Francesca Pesola ◽

Peter Sasieni

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Intraepithelial Neoplasia ◽

Cervical Cancers ◽

Screening Interval ◽

Recovery Strategies ◽

Screening Services ◽

The Impact ◽

Published Research

Abstract Background The COVID-19 pandemic has disrupted cervical cancer screening services. Assuming increases to screening capacity are unrealistic, we propose two recovery strategies: one extends the screening interval by 6 months for all and the other extends the interval by 36/60 months, but only for women who have already missed being screened. Methods Using routine statistics from England we estimate the number of women affected by delays to screening. We used published research to estimate the proportion of screening age women with high-grade cervical intraepithelial neoplasia and progression rates to cancer. Under two recovery scenarios, we estimate the impact of COVID-19 on cervical cancer over one screening cycle (3 years at ages 25–49 and 5 years at ages 50–64 years). The duration of disruption in both scenarios is 6 months. In the first scenario, 10.7 million women have their screening interval extended by 6 months. In the second, 1.5 million women (those due to be screened during the disruption) miss one screening cycle, but most women have no delay. Results Both scenarios result in similar numbers of excess cervical cancers: 630 vs. 632 (both 4.3 per 100,000 women in the population). However, the scenario in which some women miss one screening cycle creates inequalities—they would have much higher rates of excess cancer: 41.5 per 100,000 delayed for screened women compared to those with a 6-month delay (5.9 per 100,000). Conclusion To ensure equity for those affected by COVID-19 related screening delays additional screening capacity will need to be paired with prioritising the screening of overdue women.

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Loss to Follow-Up in a Cervical Cancer Screening and Treatment Program in Western Kenya

Journal of Global Oncology ◽

10.1200/jgo.18.41300 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 97s-97s ◽

Cited By ~ 1

Author(s):

S. Kiptoo ◽

G. Otieno ◽

P. Tonui ◽

A. Mwangi ◽

O. Orango ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Treatment Program ◽

Cox Regression ◽

P Value ◽

Western Kenya ◽

Loss To Follow Up ◽

Follow Up Care

Background: Increasingly, evidence is emerging from developing countries like Kenya on the burden of loss to follow-up care after a positive cervical cancer screening/diagnosis, which impacts negatively on cervical cancer prevention and control. Unfortunately little or no information exists on the subject in the western region of Kenya. This study is designed to determine the proportion of and predictors and reasons for defaulting from follow-up care after positive cervical cancer screen. Aim: To determine the rates and factors associated with loss to follow-up in a multivisit cervical cancer screening and treatment program in western Kenya. Methods: We conducted a prospective study of women, who presented for cervical cancer screening at Chulaimbo and Webuye subcounty hospitals, and screened positive by VIA. A 2-3 weeks appointment was then set for review by a gynae-oncologist. A total of 100 women, scheduled for review, were recruited in the study and followed between August 2016 and May 2017. LTFU was defined as failure to keep a second rescheduled appointment or being unreachable for 3 consecutive months and failure to confirm that a woman sought for care in another health facility. Descriptive statistics was used for summary and the Cox regression model was used to estimate the risk of LTFU for different covariates. Results: The age range was 21-77 years, with a mean of 44.45 years. 39% of the women defaulted from scheduled follow-up appointment of which 25 (64%) were LTFU. Univariate Cox regression was conducted for HIV cases (HR=2.7, P value=0.021), clinic revisits (HR=2.6, P value=0.026), married (HR=0.63, P value=0.237) and previously screened women (HR=1.67, P value=0.198). Increased risk of LTFU was observed for HIV cases (HR=2.4, P value=0.04) and revisits (HR=7.5, P value=0.014) in an adjusted model. Conclusion: LTFU affects cervical cancer management due to several factors some of which are beyond the control of the women. We recommend a larger study be replicated for ease of generalizability of results; awareness and strategies are required to retain them to obey the treatment appointment since they are the highly vulnerable.

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The costs of reducing loss to follow-up in South African cervical cancer screening

Cost Effectiveness and Resource Allocation ◽

10.1186/1478-7547-3-11 ◽

2005 ◽

Vol 3 (1) ◽

Cited By ~ 23

Author(s):

Jeremy D Goldhaber-Fiebert ◽

Lynette E Denny ◽

Michelle De Souza ◽

Thomas C Wright ◽

Louise Kuhn ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

South African ◽

Cervical Cancer Screening ◽

Loss To Follow Up

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An urgent need to re-strategize loss to follow up in cervical cancer screening program in India

Journal of Cancer Policy ◽

10.1016/j.jcpo.2015.08.002 ◽

2015 ◽

Vol 6 ◽

pp. 23-24 ◽

Cited By ~ 1

Author(s):

Sandeep Singh ◽

Sorabh Badaya ◽

Showket Hussain

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Screening Program ◽

Loss To Follow Up ◽

Cancer Screening Program ◽

Cervical Cancer Screening Program

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Male partner involvement in reducing loss to follow-up after cervical cancer screening in Uganda

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2009.07.019 ◽

2009 ◽

Vol 107 (2) ◽

pp. 103-106 ◽

Cited By ~ 13

Author(s):

Twaha Mutyaba ◽

Florence Mirembe ◽

Sven Sandin ◽

Elisabete Weiderpass

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Male Partner ◽

Loss To Follow Up ◽

Male Partner Involvement ◽

Partner Involvement

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The impact of COVID-19 disruption to cervical cancer screening in England on excess diagnoses

10.1101/2020.11.30.20240754 ◽

2020 ◽

Author(s):

Alejandra Castanon ◽

Rebolj M Matejka ◽

Francesca Pesola ◽

Peter Sasieni

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Intraepithelial Neoplasia ◽

Cervical Cancers ◽

Screening Interval ◽

Screening Services ◽

The Impact ◽

Published Research ◽

Estimate Number

AbstractBackgroundCervical cancer screening services in England have been disrupted by the COVID-19 pandemic.MethodsUsing routine statistics we estimate number of women affected by delays to screening. We used published research to estimate the proportion of screening age women with high-grade cervical intraepithelial neoplasia and progression rates to cancer. Under two scenarios we estimate the impact of COVID-19 on cervical cancer over one screening cycle (3y at ages 25-49 and 5y at ages 50-64). The duration of disruption in both scenarios is six months. In the first scenario all women have their screening interval is extended by six months. In the second some women (those who would have been screened during the disruption) miss one screening cycle, but most women have no delay.ResultsBoth scenarios result in similar numbers of excess cervical cancers: 630 vs. 632 (both 4.3 per 100,000 women in the population). However the scenario in which some women miss one screening cycle creates inequalities - they would have much higher rates of excess cancer: 41.5 per 100,000 screened women compared to those with a six month delay (5.9 per 100,000 screened).ConclusionTo ensure equity for those affected by COVID-19 related screening delays additional screening capacity will need to be paired with prioritising the screening of overdue women.

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Three-year follow-up of women who participated in a prison cervical cancer screening intervention

PsycEXTRA Dataset ◽

10.1037/e508992013-086 ◽

2005 ◽

Author(s):

Ruth Elwood Martin ◽

Greg Hislop ◽

Veronika Moravan ◽

Garry Grams ◽

Betty Calam

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening

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Effect of introducing human papillomavirus genotyping into real-world screening on cervical cancer screening in China: a retrospective population-based cohort study

Therapeutic Advances in Medical Oncology ◽

10.1177/17588359211010939 ◽

2021 ◽

Vol 13 ◽

pp. 175883592110109

Author(s):

Binhua Dong ◽

Huachun Zou ◽

Xiaodan Mao ◽

Yingying Su ◽

Hangjing Gao ◽

...

Keyword(s):

Cervical Cancer ◽

Cohort Study ◽

Human Papillomavirus ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cox Regression ◽

Intraepithelial Neoplasia ◽

Population Based ◽

Hpv Genotyping ◽

Cytology Screening

Background: China’s Fujian Cervical Pilot Project (FCPP) transitioned cervical cancer screening from high-risk human papillomavirus (HR-HPV) nongenotyping to genotyping. We investigated the clinical impact of this introduction, comparing performance indicators between HR-HPV genotyping combined with cytology screening (HR-HPV genotyping period) and the previous HR-HPV nongenotyping combined with cytology screening (HR-HPV nongenotyping period). Methods: A retrospective population-based cohort study was performed using data from the FCPP for China. We obtained data for the HR-HPV nongenotyping period from 1 January 2012 to 31 December 2013, and for the HR-HPV genotyping period from 1 January 2014 to 31 December 2016. Propensity score matching was used to match women from the two periods. Multivariable Cox regression was used to assess factors associated with cervical intraepithelial neoplasia of grade 2 or worse (CIN2+). The primary outcome was the incidence of CIN2+ in women aged ⩾25 years. Performance was assessed and included consistency, reach, effectiveness, adoption, implementation and cost. Results: Compared with HR-HPV nongenotyping period, in the HR-HPV genotyping period, more CIN2+ cases were identified at the initial screening (3.06% versus 2.32%; p < 0.001); the rate of colposcopy referral was higher (10.87% versus 6.64%; p < 0.001); and the hazard ratio of CIN2+ diagnosis was 1.64 (95% confidence interval, 1.43–1.88; p < 0.001) after controlling for health insurance status and age. The total costs of the first round of screening (US$66,609 versus US$65,226; p = 0.293) were similar during the two periods. Higher screening coverage (25.95% versus 25.19%; p = 0.007), higher compliance with age recommendations (92.70% versus 91.69%; p = 0.001), lower over-screening (4.92% versus 10.15%; p < 0.001), and reduced unqualified samples (cytology: 1.48% versus 1.73%, p = 0.099; HR-HPV: 0.57% versus 1.34%, p < 0.001) were observed in the HR-HPV genotyping period. Conclusions: Introduction of an HR-HPV genotyping assay in China could detect more CIN2+ lesions at earlier stages and improve programmatic indicators. Evidence suggests that the introduction of HR-HPV genotyping is likely to accelerate the elimination of cervical cancer in China.

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