Cervical Cancer Screening in Transgender Men in El Salvador: A Pilot Study

Abstract 27 Purpose Transgender persons are particularly vulnerable to a lack of adequate health care, particularly with regard to sexual and reproductive health. In El Salvador, where cervical cancer is a leading cause of cancer death, transgender men are at high risk of developing this disease. Whereas the Papanicolaou test is the most widely used screening method for cervical cancer, there are reports of high numbers of unsatisfactory results among transgender men compared with nontransgender persons. Human papillomavirus (HPV) testing may be a more viable screening option in this population. In this pilot study, we assessed the feasibility of cervical cancer screening among transgender men using a self-sampling HPV test as an alternative to the Papanicolaou test. Methods Participants were transgender men of the Organización Generación Hombres Trans El Salvador (Trans Men Generation Organization of El Salvador) between age 19 and 55 years. After obtaining informed consent, a questionnaire was administered to 24 participants to collect sociodemographic, lifestyle, and sexual behavior data, and to assess knowledge about cervical cancer prevention. Participants then performed a vaginal, self-sampling HPV test. Participants who received a positive HPV result were offered a colposcopy evaluation. Results Almost all participants—23 of 24—agreed to conduct vaginal self-sampling. Of these, three (13%) of 23 participants tested positive, with the remainder obtaining a negative result. Colposcopies and biopsies were accepted by all three participants who tested positive. One participant was diagnosed with CIN3, whereas two2 were diagnosed with CIN1. Conclusion There is limited information on cervical cancer prevention among transgender men, particularly in low and middle-income countries. Use of HPV self-sampling tests is a viable method that can significantly improve participation in and acceptance of screening in this vulnerable population. HPV testing may reduce the number of unsatisfactory results generated when using Papanicolaou tests as a screening method. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

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A pilot study of community-based self-sampling for HPV testing among non-attenders of cervical cancer screening programs in El Salvador

International Journal of Gynecology & Obstetrics ◽

10.1002/ijgo.12204 ◽

2017 ◽

Vol 138 (2) ◽

pp. 194-200 ◽

Cited By ~ 4

Author(s):

Bari Laskow ◽

Ruben Figueroa ◽

Karla M. Alfaro ◽

Isabel C. Scarinci ◽

Elizabeth Conlisk ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Pilot Study ◽

El Salvador ◽

Cervical Cancer Screening ◽

Hpv Testing ◽

Community Based ◽

Screening Programs

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High Acceptability of Human Papillomavirus Self-Sampling Among Nonattenders of a Public Cervical Cancer Screening Program in El Salvador

Journal of Global Oncology ◽

10.1200/jgo.18.50000 ◽

2018 ◽

Vol 4 (Supplement 1) ◽

pp. 13s-13s

Author(s):

Mauricio Maza ◽

Mario Melendez ◽

Miriam Cremer ◽

Rachel Masch ◽

Todd Alonzo ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cancer Screening ◽

El Salvador ◽

Cancer Prevention ◽

Cervical Cancer Screening ◽

Rural Women ◽

Cervical Cancer Prevention ◽

Middle Income ◽

Hpv Test

Abstract 29 Purpose In high-income countries, human papillomavirus (HPV) self-sampling has been demonstrated to increase adherence to cervical cancer prevention initiatives in underscreened women. El Salvador recently completed the Cervical Cancer Prevention in El Salvador (CAPE) program using a high-risk HPV test as the screening method. Although successful, 12% of targeted women did not attend their screening appointments. HPV self-sampling may offer the opportunity to reach these nonattending women. In the current study, we evaluated HPV self-sampling as a way to increase screening among CAPE nonattenders and to report factors that impact self-sampling acceptability in a low- to middle-income country. Methods Nonattending and underscreened women age 30 to 59 years from the Paracentral region of El Salvador were invited to participate (N = 2,019). Women were visited at home and offered self-sampling with an HPV test. Women who provided consent also received a series of questionnaires to collect demographic and test acceptability data. After tests were analyzed, women were provided with results during another home visit. HPV-positive women were asked to make an appointment at a local clinic to undergo colposcopy, biopsy, and, if eligible, cryotherapy treatment. Women with contraindications for cryotherapy were referred to appropriate treatment or follow-up. Results Of 1,989 eligible women, 94% accepted the HPV self-sampled test. Of these, 11.8% (n = 221) tested positive. All but 13 women attended the colposcopy appointment, and 190 women received cryotherapy. Biopsy results revealed low-grade precancer in 6.3% of women, whereas 12.6% received diagnoses of high-grade precancer. Reasons for not attending the original CAPE appointment included logistic concerns, but also discomfort with male providers, confidentiality fears, and misconceptions regarding HPV, cervical cancer, and the screening procedure. Conclusion HPV self-sampling was shown to be overwhelmingly acceptable to nonattending and underscreened rural women in El Salvador. This method may be a feasible alternative that circumvents barriers to cervical cancer screening in low- to middle-income countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors

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Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing

Viruses ◽

10.3390/v10120729 ◽

2018 ◽

Vol 10 (12) ◽

pp. 729 ◽

Cited By ~ 42

Author(s):

Andreas Chrysostomou ◽

Dora Stylianou ◽

Anastasia Constantinidou ◽

Leondios Kostrikis

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Hpv Vaccination ◽

Screening Method ◽

Population Based ◽

Screening Tests ◽

Screening Methods ◽

Hpv Testing ◽

Screening Programs

Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.

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Identification of ideal strategy of cervical cancer screening in Japan based on Fukui cervical cancer screening study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17025 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17025-e17025

Author(s):

Tetsuji Kurokawa ◽

Akiko Shinagawa ◽

Yoko Chino ◽

Motohiro Kobayashi ◽

Yoshio Yoshida

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Positive Predictive Value ◽

Cervical Cancer Screening ◽

Predictive Value ◽

Screening Method ◽

Hpv Testing ◽

Abnormal Cytology ◽

Predictive Values ◽

Hpv Status

e17025 Background:The estimated age-standardized incidence rate for cervical cancer is higher in Japan than in North America and the UK. It is important to improve cancer screening. The introduction of HPV testing with cytology for triage of those that test positive for cervical cancer screening has been challenging. The Fukui Cervical Cancer Screening (FCCS) study was designed to determine the best cervical cancer screening method in the Japanese population. We performed a subanalysis using baseline data of FCCS study to determine the performance of cytology, the human papillomavirus (HPV) testing and cotesting with cytology and HPV testing, and to evaluate whether the stratification of HPV16, HPV18, and 12 other hrHPV types appropriately balances risks and harms in the Japanese cancer screening population. Methods:The study enrolled 7,584 women aged 25 years or older undergoing routine screening. All women underwent liquid-based cytology (LBC) and cobas HPV testing. Women with abnormal cytology regardless of the HPV status, women with positive hrHPV results regardless of cytology results, and women randomly selected from among those with normal cytology and negative hrHPV results were referred for colposcopy. Results:The prevalence of hrHPV, HPV16, and HPV18 was 6.8%, 1.2%, and 0.5%, respectively. The estimated sensitivities for cervical intraepithelial neoplasia (CIN) 2 or worse for cytology, HPV testing, and cotesting with cytology and HPV testing were 71%, 92%, and 100%, respectively. The estimated positive predictive values for cytology, HPV testing, and cotesting with cytology and HPV testing were 33%, 21% and 21%, respectively. Using a strategy whereby those with abnormal cytology or positive HPV16 genotype undergo colposcopy and biopsy results in a sensitivity of 85% and a positive predictive value of 33%. This strategy results in improved sensitivity while at the same time maintains the positive predictive value compared to screening with cytology alone. Conclusions:Baseline data from the FCCS study suggests that strategy of using colposcopy for women with abnormal cytology and/or HPV16 positivity appropriately balances risks and harms for Japanese women. Clinical trial information: UMIN000025977.

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Can mystery patients evaluate the quality of cervical cancer screenings? A pilot study in Bolivia

Revista de Salud Pública ◽

10.15446/rsap.v23n4.92654 ◽

2021 ◽

Vol 23 (4) ◽

pp. 1-8

Author(s):

Sarah Sullivan ◽

Maria Teresa Solis ◽

Sahai Burrowes ◽

Armando Basagoitia

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Pilot Study ◽

Health Education ◽

Missing Observations ◽

Test Results ◽

Papanicolaou Test ◽

Cancer Screenings ◽

Local Officials

Objective This pilot study assesses the feasibility of using mystery patients to evaluate cervical cancer screenings provided to women in rural Bolivia. Methods We developed a protocol with local officials and adapted and pre-tested a debriefing tool. Eight mystery patients with existing appointments at four purposively selected rural facilities were recruited and trained. An interviewer debriefed patients after their screenings, and entered responses into a spreadsheet for analysis. Ques- tionnaire response frequencies and missing observations were presented. Results All patients completed screening and debriefing. On average, 93% of the questions were completed, with non-responses largely due to questions that were irrelevant to the screening venue. Responses revealed problems with confidentiality and dignity, minimal exam explanations or health education, inconsistencies across health facilities in Papanicolaou test availability, and problems in delivering and receiving test results. Conclusion Our findings suggest that the mystery patient method can be useful in evaluating the quality of cervical cancer screening and the delivery of test results in rural Bolivia.

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De-implementation and Substitution of Clinical Care Processes: Stakeholder Perspectives on the Transition to Primary Human Papillomavirus (HPV) Testing for Cervical Cancer Screening

10.21203/rs.3.rs-318847/v1 ◽

2021 ◽

Author(s):

Erin E Hahn ◽

Corrine Munoz-Plaza ◽

Danielle Altman ◽

Chunyi Hsu ◽

Nancy Cannizzaro ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Clinical Practice ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Readiness To Change ◽

Barriers And Facilitators ◽

Hpv Testing ◽

Cost Cutting ◽

Hpv Test

Abstract Background: New cervical cancer screening guidelines recommend primary human papillomavirus (HPV) testing for women age 30-65 years. Healthcare organizations are preparing to de-implement the previous recommended strategies of Pap testing or co-testing (Pap plus HPV test) and substitute primary HPV testing. However, there may be significant challenges to replacement of this entrenched clinical practice, even with an evidence-based substitution. We sought to identify stakeholder-perceived barriers and facilitators to this substitution within a large healthcare system, Kaiser Permanente Southern California.Methods: We conducted semi-structured qualitative interviews with clinician, administrative and patient stakeholders regarding: (a) acceptability and feasibility of the planned substitution; (b) perceptions of barriers and facilitators, with an emphasis on those related to the de-implementation/implementation cycle of substitution; and (c) perceived readiness to change. Our interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). Using a team coding approach, we developed an initial coding structure refined during iterative analysis; the data were subsequently organized thematically into domains, key themes, and sub-themes using thematic analysis, followed by framework analysis informed by CFIR.Results: We conducted 23 interviews: 5 patient and 18 clinical/administrative. Clinicians perceived that patients feel more tests equals better care, and clinicians and patients expressed fear of missed cancers (“…it’ll be more challenging convincing the patient that only one test is…good enough to detect cancer.”). Patients perceived practice changes resulting in “less care” are driven by desire to cut costs. In contrast, clinicians/administrators viewed changing from two tests to one as acceptable and a workflow efficiency (“…It’s very easy and half the work.”). Stakeholder-recommended strategies included focusing on the increased efficacy of primary HPV testing and developing clinician talking points incorporating national guidelines to assuage ‘cost-cutting’ fears. Conclusions: Substitution to replace an entrenched clinical practice is complex. Leveraging available facilitators is key to ease the process for clinical and administrative stakeholders—e.g., emphasizing the efficiency of going from two tests to one. Identifying and addressing clinician and patient fears regarding cost-cutting and perceived poorer quality of care is critical for substitution. Multicomponent and multilevel strategies for engagement and education will be required.Trial registration: ClinicalTrials.gov #NCT04371887

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HrHPV testing vs liquid-based cytology in cervical cancer screening among women aged 50 and older: a prospective study

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001457 ◽

2020 ◽

Vol 30 (11) ◽

pp. 1678-1683

Author(s):

Berit Andersen ◽

Sisse Helle Njor ◽

Anne Marie Schak Jensen ◽

Tonje Johansen ◽

Ulla Jeppesen ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Prospective Study ◽

Cervical Cancer Screening ◽

Gynecological Cancer ◽

Dna Amplification ◽

Hpv Testing ◽

Promising Alternative ◽

Hpv Test ◽

Liquid Based Cytology

IntroductionEvidence supports high-risk human papilloma virus (HPV) testing as the primary cervical cancer screening tool. However, benefits and harms should be carefully considered before replacing liquid-based cytology. In women age 50 and older, we evaluated how a commercially available DNA amplification HPV test compares with routine liquid-based cytology.MethodsThis prospective study included 4043 patients who had a cervical sample analyzed from September 2011 to September 2012. Patients were followed between 64 and 76 months (median: 70 months). Samples were analyzed using both liquid-based cytology and the Cobas 4800 HPV DNA test. We calculated the diagnostic efficacy of liquid-based cytology and HPV, with or without the opposite test as triage, using cervical intraepithelial neoplasia (CIN2+/CIN3+) as reference.ResultsThe patients had a median age of 58 years, (range; 50–90). At baseline, HPV prevalence was 8.0%: a total of 3.7% of patients had atypical squamous cells of undetermined significance or worse (ASCUS+). Positive test results were 1.9% for liquid-based cytology with HPV triage and 3.0% for HPV with liquid-based cytology triage. The cumulative incidence of CIN3+ was 1.0% (40/4043). Sensitivities for CIN3+ were: liquid-based cytology 47.5% (31.5%–63.9%); liquid-based cytology with HPV triage 45.0% (29.3%–61.5%); HPV 90.0% (76.3%–97.2%); and HPV with liquid-based cytology triage 67.5% (50.9%–81.4%). Corresponding specificities were: liquid-based cytology 96.6% (96.0%–97.2%); liquid-based cytology with HPV triage 98.5% (98.0%–98.8%); HPV 92.8% (92.0%–93.6%); and HPV with liquid-based cytology triage 97.7% (97.2%–98.1%). At baseline, HPV testing overlooked five cases of gynecological cancer other than cervical cancer. Five cervical cancers were detected, two had been overlooked at baseline by liquid-based cytology and two by HPV testingConclusionHPV screening using DNA amplification is a promising alternative to liquid-based cytology in women age 50 and older, but evaluation of alternative triage methods is warranted. The risk of overlooking cancers needs consideration when replacing liquid-based cytology with HPV testing as a method for primary screening.

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The Clinical Role of HPV Testing in Primary and Secondary Cervical Cancer Screening

Obstetrics and Gynecology International ◽

10.1155/2013/610373 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

G. Hoste ◽

K. Vossaert ◽

W. A. J. Poppe

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cervical Screening ◽

Screening Methods ◽

Hpv Testing ◽

Clinical Role ◽

Screening Programs ◽

Hpv Test

Traditional population-based cervical screening programs, based on cytology, have successfully reduced the burden of cervical cancer. Nevertheless limitations remain and new screening methods are emerging. Despite vaccination against the 2 most oncogenic types (HPV 16/18), cervical cancer screening will have to continue as an essential public health strategy. As the acquisition of an HR-HPV infection is critical in the progression to (pre-)cancerous cervical lesions, recent research has focused on HR-HPV detection. The sensitivity of HPV testing in primary and secondary prevention outweighs that of cytology, at the cost of slightly lower specificity. Although most of the HR-HPV infections are cleared after conization, new evidence from numerous studies encourages the implementation of HR-HPV testing and genotyping to improve posttreatment surveillance. An HR-HPV test 6 months after conization is a promising useful clinical marker to detect persistence and prevent progression. This review highlights the clinical role of HPV testing in primary and secondary cervical cancer screening.

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Religious Gathering as a Tool for Collaborative Cervical Cancer Prevention: Report From Nigeria

Journal of Global Oncology ◽

10.1200/jgo.18.75900 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 137s-137s

Author(s):

C. Onwuka ◽

C. Umezurike ◽

C.-E. Hendricks ◽

K. Eguzo

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cancer Prevention ◽

Cervical Cancer Screening ◽

Cancer Survivor ◽

Cervical Cancer Prevention ◽

Low Grade ◽

Religious Leaders ◽

Papanicolaou Test ◽

Cancer Awareness

Background and context: Cervical cancer is the second most common cancer and a leading cause of mortality affecting Nigerian women. There is prevalent ignorance about the disease and reduced access to screening services in Nigeria due to a variety of reasons. Many religious leaders often view cancer as evil, thus perpetuating a culture of fear and denial. Religious events have been used to promote health awareness and access to preventive services in Nigeria, but not usually for cancer screening. A cancer survivor might use a religious event to provide a strong avenue for improving cancer awareness and access to screening. Aim: Report describes a successful collaborative integration of cervical cancer screening into a religious event led by a breast cancer survivor. Strategy/Tactics: The 2018 Annual Women's Gospel Forum at Susanna Homes was used by a cancer survivor to teach women about cervical cancer and early diagnosis. Information was circulated among the Church of Christ fellowship in southern Nigeria. Program/Policy process: A medical team (gynecologist and pathologist) provided free cancer screening to consenting women using Papanicolaou test VIA simultaneously, with Pap preceding VIA. All smears were handled according to standard protocol and the findings were classified using the Bethesda system for reporting Papanicolaou test. Participants were taught about cervical cancer, counseled on screening and follow-up care prior to consent. Data were analyzed using descriptive statistics. Outcomes: Seventy-nine women at the event consented to the screening. The average participant was aged 51 years, but 90.6% (58/64) were above 30 years. Most (92.4%; 73/79) women were negative for squamous intraepithelial lesions (SILs), and six women had a low grade squamous intraepithelial lesion (LSIL). The prevalence of abnormal cervical cytology in this outreach was 7.6% (6/79), and mostly affected women aged 61-60 years. Table 1 describes the Papanicolaou test results. The result of VIA was recorded as positive or negative. What was learned: Participants provided positive feedback regarding integrating cervical cancer screening into a religious event, as it improved access and addressed ignorance. Leadership by a cancer survivor helped demystify the disease and encouraged women to be screened. Having a pathologist on site improved slides quality and reporting turn-around time. Project shows that collaboration between clinicians and religious leaders can improve cancer prevention. More physicians should be trained to provide these services and collaborate with community/religious organizations to provide screening outside of the clinical setting.[Table: see text]

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