Use of Thermocoagulation Within a 'Screen and Treat' Cervical Cancer Screening Programme in Malawi: Outcomes at One Year, Professional Perspectives, and Client Experience

Background: Thermocoagulation (also known as thermoablation, previously as cold coagulation) is increasingly being adopted as an alternative treatment to cryotherapy within 'screen and treat' cervical screening services using visual inspection with acetic acid (VIA) in resource-constrained settings. This ablative treatment is suitable for low-grade squamous epithelial lesions. Given that much of the current systematic review evidence is drawn from high-income settings, it is critical that the evidence base for use within LMICs is strengthened. Aim: To evaluate the effectiveness of thermo-coagulation in the treatment of VIA-positive lesions within a 'screen and treat' program in Malawi, and its acceptability to clients and providers. Methods: Over the last four years, the Nkhoma Cervical Cancer Screening Program has implemented a 'screen and treat' approach using VIA and treatment using thermocoagulation in a rural district general hospital and associated health centers. Women with VIA-positive lesions are offered treatment with thermocoagulation; treated women are requested to return for review at three- six months, and at one year. Mechanisms to ensure monthly data collection and collation are in place. Semistructured qualitative face-to-face interviews were carried out in English with nineteen providers in nine health centers associated with Nkhoma Hospital: a range of issues were explored, including their experience with use of thermocoagulation. A patient experience questionnaire using validated facial pain scales was developed and translated into Chichewa: women complete this following treatment together with a patient attendant. Results: Between October 2013 and July 2017, over 1650 women have received treatment with thermocoagulation. Of a cohort of 446 treated women who had returned for a 1-year review visit by July 2017, 426 (95.5%) were VIA-negative, i.e., a treatment failure rate of < 5%, comparable with the international literature. Relationship between HIV status, initial VIA positivity, and treatment outcomes, will be presented. Staff reported professional satisfaction in being able to offer treatment consistently to VIA-positive clients, closer to their communities. For some, this was contrasted with previous experience of unavailable cryotherapy resulting in loss to treatment of patients. Over 120 women have completed pain scales questionnaires following treatment with the traditional machine, or with one of the two new hand-held models: their experiences (facial pain scales, and free-text comments) will be reported. Conclusion: In many low-resource settings, VIA-based screening with robust treatment protocols will remain central to cervical cancer control until the promise of HPV vaccination is fully realized. Thermocoagulation is an effective treatment modality, acceptable to clients and patients. Ongoing review of outcomes within and across treatment facilities is critical.

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Cervical Cancer Screening Financing in Indonesia

Journal of Global Oncology ◽

10.1200/jgo.18.22700 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 93s-93s ◽

Cited By ~ 1

Author(s):

M. Wahidin

Keyword(s):

Primary Care ◽

Cervical Cancer ◽

Health Insurance ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

National Health Insurance ◽

Cervical Screening ◽

Health Centers ◽

Primary Health ◽

Care Facilities

Background: Indonesia has been developing social health insurance as attempt of universal health coverage with target of 100% population by 2019. The coverage was for all diseases from primary care until secondary care. Cervical cancer screening was among these which were covered by the insurance. In line with national program of cervical cancer screening, the insurance will strengthen the development of the program. As a new concept of financing - started in 2014- it need to know many circumstances of cervical cancer screening financing in Indonesia. Aim: The study was aimed to know overview of cervical cancer screening financing in Indonesia. Methods: Design of the study was descriptive study through literature review from related sources. Secondary data were collected from Directorate of Noncommunicable Disease Control and Center of Health Financing, Ministry of Health, and National Health Insurance Body (BPJS). The study was conducted in January- February 2018. Results: Cancer was ranked number 3 of highest claim for national health insurance with total IDR 1.54 trillion in 2014, became IDR 2.3 trillion in 2015. Number of cases of cancer, as claimed in hospitals, was also increasing from 702,207 cases in 2014 became 1,325,776 cases in 2015. Cervical cancer was among the highest claim. Based on Minister of Health Decree No. 52/2016 about tariff of healthcare in social health insurance, cervical cancer screening was covered by the insurance. Tariff of visual inspection with acetic acid (VIA) was maximum IDR 25,000 (USD 2), tariff of Papanicolaou test was maximum IDR 125,000 (USD 10), and tariff of cryotherapy of positive VIA was IDR 150,000 (USD 11.5). These tariffs can be claimed by providers of cervical screening in primary care facilities to BPJS through noncapitation scheme. This scheme was number of claim financing by BPJS to primary health centers according to type and number of health services. Mechanism of claiming was conducted by screening providers to financing officers in primary health centers using specific form to be sent to BPJS. Then, BPJS will process payment for accepted claim. Number of population became of BPJS in 2017 was 187.9 million out of 257 million target (73%). Meanwhile number of primary care facilities collaborated with BPJS was 20,708 (including 9813 primary health centers) out of 24,336 primary care facilities (84%). It means the financing of cervical screening could be used as optimal as possible to achieve national target of screening which was 37.4 million women aged 30-50 years. Conclusion: Cervical cancer screening financing was covered by national health insurance in Indonesia. Majority of primary care facility collaborated with BPJS which become strengthening factor to enhance achievement of national target of cervical screening.

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Knowledge and Practice of Cervical Cancer Screening among Women in Orlu Local Government Area, Imo State, Nigeria.

10.33798/ajmas2019/00266 ◽

2019 ◽

Vol 1 (1) ◽

pp. 55-65

Author(s):

Jude Egwurugwu ◽

S.D. Ejikunle ◽

E.I. Dike ◽

M.C. Ohamaeme ◽

Jude Egwurugwu ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Local Government ◽

Cervical Cancer Screening ◽

Cervical Screening ◽

Local Government Area ◽

Care Providers ◽

Imo State ◽

Study Results ◽

Knowledge And Practice

Background: Cervical cancer is the 2nd commonest cancer among women worldwide and the most common cancer among women in developing countries like Nigeria. Though preventable by screening for premalignant and early cervical lesions, this is predicated on the knowledge and practice of a cervical screening. Objective: To assess the knowledge and practice of cervical cancer screening among women in Orlu, Local Government Area(LGA) Imo State, Nigeria. Materials & Methods: A community based cross-sectional study with the use of 502 interviewer – administered questionnaires was conducted among women in Orlu LGA of Imo State. All the women in the communities attending the annual August Meeting who consented were recruited for this study. Results: The study showed that the mean age of the respondents was 42±2.8years. Furthermore, 82.3% of respondents attained postsecondary school educational level, 61.8% & 21.1% were multiparous and grand multiparous respectively. Also, 80.5% of respondents have heard about cervical cancer screening. Majority (67.5%) of these respondents heard it from health care providers. There was a positive statistically significant relationship between educational status and the likelihood of having knowledge of cervical cancer screening, (p< 0.01). The level of practice of cervical cancer screening was very low among the respondents(13.5%).Though majority of the respondents have high level of educational attainment this did not reflect their practice of cervical cancer screening. Conclusion: There was high knowledge of cervical cancer and cervical screening modalities among women in Orlu but their practice of cervical cancer screening was very low. There is an urgent need to educate and encourage women on the benefits of cervical cancer screening. Key words: cervical cancer, knowledge, Practice, Orlu women, Screening.

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Role of Protein Biomarkers in the Detection of High-Grade Disease in Cervical Cancer Screening Programs

Journal of Oncology ◽

10.1155/2012/289315 ◽

2012 ◽

Vol 2012 ◽

pp. 1-11 ◽

Cited By ~ 12

Author(s):

Charlotte A. Brown ◽

Johnannes Bogers ◽

Shaira Sahebali ◽

Christophe E. Depuydt ◽

Frans De Prins ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cervical Screening ◽

False Negative ◽

Pap Test ◽

Developed Countries ◽

Protein Biomarkers ◽

Ki 67 ◽

Screening Programs

Since the Pap test was introduced in the 1940s, there has been an approximately 70% reduction in the incidence of squamous cell cervical cancers in many developed countries by the application of organized and opportunistic screening programs. The efficacy of the Pap test, however, is hampered by high interobserver variability and high false-negative and false-positive rates. The use of biomarkers has demonstrated the ability to overcome these issues, leading to improved positive predictive value of cervical screening results. In addition, the introduction of HPV primary screening programs will necessitate the use of a follow-up test with high specificity to triage the high number of HPV-positive tests. This paper will focus on protein biomarkers currently available for use in cervical cancer screening, which appear to improve the detection of women at greatest risk for developing cervical cancer, including Ki-67,p16INK4a, BD ProEx C, and Cytoactiv HPV L1.

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“They Should Be Asking Us”: A Qualitative Decisional Needs Assessment for Women Considering Cervical Cancer Screening

Global Qualitative Nursing Research ◽

10.1177/2333393618783632 ◽

2018 ◽

Vol 5 ◽

pp. 233339361878363 ◽

Cited By ~ 4

Author(s):

Brianne Wood ◽

Virginia L. Russell ◽

Ziad El-Khatib ◽

Susan McFaul ◽

Monica Taljaard ◽

...

Keyword(s):

Health Care ◽

Cervical Cancer ◽

Decision Making ◽

Cancer Screening ◽

Shared Decision Making ◽

Cervical Cancer Screening ◽

Cervical Screening ◽

Hpv Testing ◽

Shared Decision ◽

Care Providers

In this study, we examine from multiple perspectives, women’s shared decision-making needs when considering cervical screening options: Pap testing, in-clinic human papillomavirus (HPV) testing, self-collected HPV testing, or no screening. The Ottawa Decision Support Framework guided the development of the interview schedule. We conducted semi-structured interviews with seven screen-eligible women and five health care professionals (three health care providers and two health system managers). Women did not perceive that cervical screening involves a “decision,” which limited their knowledge of options, risks, and benefits. Women and health professionals emphasized how a trusted primary care provider can support women making a choice among cervical screening modalities. Having all cervical screening options recommended and funded was perceived as an important step to facilitate shared decision making. Supporting women in making preference-based decisions in cervical cancer screening may increase screening among those who do not undergo screening regularly and decrease uptake in women who are over-screened.

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'Have a Pap smear!' – doctors, their clients, and opportunistic cervical cancer screening

International Journal of STD & AIDS ◽

10.1258/0956462053420266 ◽

2005 ◽

Vol 16 (3) ◽

pp. 233-236 ◽

Cited By ~ 7

Author(s):

L C Chingang ◽

U Bischof ◽

G Andall-Brereton ◽

O Razum

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Pap Smear ◽

Cervical Screening ◽

Pap Test ◽

Community Members ◽

Middle Income ◽

Middle Income Countries ◽

High Incidence

In many middle-income countries with a high incidence of cervical cancer, organized screening programmes with the Pap test are being planned. We assessed the knowledge of, and attitudes towards, cervical screening among 63 doctors and 102 randomly selected community members in Trinidad where screening is still opportunistic. Doctors were well informed about cervical cancer, but not all knew the approximate specificity of the Pap test. Many did not routinely discuss the benefits and disadvantages of screening with their clients. Most women had heard of the Pap test, but only 56% knew its purpose; 25% would not participate in screening, stating reasons such as being in menopause or not having symptoms. More information about the aim of screening and the purpose of the Pap test must be communicated. Doctors need to keep their knowledge on screening up-to-date, and offer counselling that helps women to make an informed decision whether or not to participate in screening.

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Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis

10.1101/2020.12.26.20248864 ◽

2021 ◽

Author(s):

Nigus Bililign Yimer ◽

Mohammed Akibu Mohammed ◽

Kalkidan Solomon ◽

Mesfin Tadese ◽

Stephanie Grutzmacher ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Meta Analysis ◽

Cervical Screening ◽

Sub Saharan Africa ◽

African Countries ◽

Screening Uptake ◽

Analytic Review ◽

Sub Saharan

AbstractBackgroundCervical cancer screening and prevention programs have been given considerable attention in high-income countries, while only receiving minimal effort in many African countries. This meta-analytic review aimed to estimate the pooled uptake of cervical cancer screening uptake and identify its predictors in Sub-Saharan Africa.MethodsPubMed, EMBASE, CINAHL, African Journals Online, Web of Science and SCOPUS electronic databases were searched. All observational studies conducted in Sub-Saharan Africa and published in English language from January 2000 to 2019 were included. The Newcastle-Ottawa Scale was applied to examine methodological quality of the studies. Inverse variance-weighted random-effects model meta-analysis was done to estimate the pooled uptake and odds ratio of predictors with 95% confidence interval. I2 test statistic was used to check between-study heterogeneity, and funnel plot and Egger’s regression statistical test were used to check publication bias. To examine the source of heterogeneity, subgroup analysis based on sample size, publication year and geographic distribution of the studies was carried out.ResultsOf 3,537 studies identified, 29 studies were included with 36,374 women. The uptake of cervical cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I2= 98.5%). Meta-analysis of seven studies showed that knowledge about cervical cancer increased screening uptake by nearly 5-folds (OR: 4.81; 95% CI: 3.06, 7.54). Other predictors include educational status, age, HIV status, contraceptive use, perceived susceptibility, and awareness about screening locations.ConclusionCervical screening uptake is low in Sub-Saharan Africa and influenced by several factors. Health outreach and promotion targeting identified predictors are needed to increase uptake of screening service in the region.sProtocol registrationCRD42017079375

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Cervical cytochemistry: a potential adjunct to cytomorphology for detection of abnormal cells in cervical cancer screening

Journal of Pathology of Nepal ◽

10.3126/jpn.v10i1.27880 ◽

2020 ◽

Vol 10 (1) ◽

pp. 1639-1644

Author(s):

Indrani Krishnappa ◽

Kalyani R. ◽

Raja Parthiban ◽

Abhishek Agrawal

Keyword(s):

Cervical Cancer ◽

Acid Phosphatase ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cancer Detection ◽

Pap Smear ◽

Pap Test ◽

Low Grade ◽

Smear Examination ◽

Intraepithelial Lesion

Background: Pap smear examination has been universally used as an effective screening tool for early detection of cervical carcinoma. The aim of this study was to assess the utility of Cervical Acid Phosphatase staining as an adjunct to routine Pap smear testing to improvethe sensitivity and specificity of routine Pap smear examination for cervical cancer detection. Materials and Methods: Cervical smears were taken from patients attending the gynecology department and a few cervical cancer screening programmes. One set of slides were alcohol fixed and stained with rapid pap stain and another set of slides were fixed in a special fixative and stained with Cervical Acid Phosphatase -Pap stain. The nuclear features of these Cervical Acid Phosphatase stained dysplastic cells was studied on Pap stain to diagnose cervical intraepithelial lesion/ malignancy. Results: Out of 489 cases included in the study 6 cases were diagnosed with intraepithelial lesion/ malignancy. On Cervical Acid Phosphatase -Pap stain 2 of the cases diagnosed as inflammatory smears on pap stain showed Cervical Acid Phosphatase positivity and thus were re evaluated. Mild nuclear atypia was observed in the Cervical Acid Phosphatase positive cells and these cases were diagnosed as Low grade squamous intraepithelial lesion and later biopsy proven to be Cervical intraepithelial Neoplasia I. Therefore Cervical Acid Phosphatase -Pap test was 100% sensitive and specific for cervical cancer detection. Conclusions: With 100% sensitivity Cervical Acid Phosphatase -Pap test satisfies the criteria of an efficient screening test.

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Intimate Stories: Aboriginal Women’s Lived Experiences of Health Services in Northern British Columbia and the Potential of Creative Arts to Raise Awareness About HPV, Cervical Cancer, and Screening

International Journal of Indigenous Health ◽

10.18357/ijih81201212385 ◽

2013 ◽

Vol 8 (1) ◽

pp. 18 ◽

Cited By ~ 2

Author(s):

Virginia L. Russell ◽

Sarah De Leeuw

Keyword(s):

Cervical Cancer ◽

British Columbia ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Health Care Services ◽

Formal Education ◽

Cervical Screening ◽

Sexual Health Care ◽

Wide Range ◽

Screening Services

Guided by feminist and community-based participatory methodologies and by efforts to decolonize health research practices, and undertaken with qualitative research methods (interviews, open-ended questionnaires, and analysis of arts-based expressions like storytelling, journaling, and picture-making), this research identified challenges and barriers that (predominantly Aboriginal) women in northern British Columbia faced when trying to access sexual health care services related to HPV and cervical cancer screening. The research also examined the possible effectiveness of creative or arts-based strategies to promote cervical health and screening awareness among young and/or traditionally underserved or marginalized women. We review findings from data gathered over six months during multiple interactions with 22 women from a wide range of ethnic backgrounds. Results confirm that ethnicity, finances, and formal education are determinants in women’s awareness about, access to, and use of cervical screening services, and that experiences of gendered victimization, feelings of disempowerment, and life circumstances all influenced women’s comfort levels with, access to, and use of cervical cancer screening services.

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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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Visual techniques for cervical cancer screening in Colombia

Biomédica ◽

10.7705/biomedica.v39i1.4007 ◽

2019 ◽

Vol 39 (1) ◽

pp. 65-74

Author(s):

Óscar Gamboa ◽

Mauricio González ◽

Jairo Bonilla ◽

Joaquín Luna ◽

Raul Murillo ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

False Positive ◽

Gold Standard ◽

Visual Inspection ◽

Low Grade ◽

High Grade ◽

Detection Rates ◽

Lower Detection

Introduction: Direct visual inspection for cervical cancer screening remains controversial, whereas colposcopy-biopsy is considered the gold standard for diagnosis of preneoplastic cervical lesions.Objectives: To determine the rates of cervical intraepithelial neoplasia grade 2 or more and of false positives for colposcopy and direct visual inspection.Materials and methods: Women aged 25-59 underwent direct visual inspection with acetic acid (VIA), Lugol’s iodine (VIA-VILI), and colposcopy. Punch biopsies were obtained for all positive tests. Using histology as the gold standard, detection and false positive rates were compared for VIA, VIA-VILI, and colposcopy (two thresholds). Sensitivity and false positive ratios with the corresponding 95% confidence intervals were estimated.Results: We included 5,011 women in the analysis and we obtained 602 biopsies. Positivity rates for colposcopy high-grade and low-grade diagnosis were 1.6% and 10.8%. Positivity rates for VIA and VIA-VILI were 7.4% and 9.9%. VIA showed a significantly lower detection rate than colposcopy with low-grade diagnosis as the threshold (SR=0.72; 95% CI 0.57-0.91), and significantly lower false positive rate (FPR=0.70; 95% CI 0.65-0.76). No differences between VIA-VILI and colposcopy low-grade threshold were observed. VIA and VIA-VILI showed significantly higher detection and false positive rates than colposcopy high-grade threshold. Sensitivity rates for visual inspection decreased with age and false positive rates increased. For all age groups, false positive rates for VIA and VIA-VILI were significantly higher than colposcopy.Conclusions: Detection rates for VIA-VILI similar to colposcopy low-grade threshold represent a chance to reduce cervical cancer mortality through see-and-treat approaches among women with limited access to health care. Lower detection rates suggest reviewing high-grade colposcopy findings as the threshold for biopsy in certain settings.

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