Partnering for Success: Expanding Breast and Cancer Screening in Rural Honduras One Clinic at a Time

Abstract 36 Background: Women in rural Honduras have limited access to cancer education, screening, and care. With village leaders, we piloted breast and cervical cancer screening in El Rosario, Honduras. Our objectives were to improve awareness and access, mitigate barriers, connect community and Honduran providers, and link patients with abnormal findings to cancer treatment. In 2013, health professionals and staff from Norris Cotton Cancer Center at Dartmouth- Hitchcock joined Honduran clinicians and medical students from La Liga Contra el Cáncer for two days of rural cancer screening. Peer educators taught 475 participants from 31 rural communities how to conduct self-breast exams. Of these participants, 238 chose clinical breast exams; 5% were clinically abnormal and 2.9% were referred for services at La Liga with 100% compliance. 34% reported barriers to cervical cancer screening due to distance and lack of transportation. 14.5% tested positive for HPV and 8% were positive for high risk HPV genotypes including 11 of 13 known high risk types. This group has been retested periodically by Pap. The collaborators will return in April 2016 to repeat the study, adding oral and thyroid screening. Genotyping for hrHPV will be onsite with a novel assay for PCR developed at Dartmouth-Hitchcock. Reflex testing with Pap will follow as needed. Follow up will be at La Liga where care is offered for free or at a reduced cost. A similar project for 400 urban factory-workers will also take place in April 2016. Methods: 2-day, multi-modal education and screening outreach run brigade-style combining low-tech primary screening with onsite molecular pathology. Conclusions: Partnerships between local leaders and clinicians are predicted to be essential to project implementation. Targeting populations with education and screening plus building connections to follow up care will provide earlier detection of breast and cervical cancer. We predict that community leadership will be critical to preventing loss to follow-up. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Derek S. Stenquist No relationship to disclose Suyapa Bejarano No relationship to disclose Linda S. Kennedy No relationship to disclose Silvia Portillo No relationship to disclose Ana Barrientos No relationship to disclose Suzanne P. Burgos No relationship to disclose Roberto Armando Elvir Zelaya No relationship to disclose Christine Averill No relationship to disclose Emmeline Liu No relationship to disclose Francine de Abreau No relationship to disclose Paul Burchard No relationship to disclose Torrey Gallagher No relationship to disclose Martha Goodrich No relationship to disclose Scottie Eliassen No relationship to disclose Julie Weiss No relationship to disclose Camilo Mandujano No relationship to disclose Jennifer Alford-Teaster No relationship to disclose Gregory J. Tsongalis Research Funding: Illumina, Qiagen, Thermofisher Tracy Onega No relationship to disclose Mary D. Chamberlin No relationship to disclose

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Community navigators for breast and cervical cancer screening and follow-up

Implementation Science ◽

10.1186/1748-5908-10-s1-a58 ◽

2015 ◽

Vol 10 (S1) ◽

Author(s):

Melissa A Simon ◽

Laura S Tom ◽

Erika E de la Riva ◽

Emily L Malin ◽

Joe Feinglass

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Breast And Cervical Cancer

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Depressive symptoms, neuroticism and participation in breast and cervical cancer screening in the UK

European Journal of Public Health ◽

10.1093/eurpub/ckz185.032 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

C L Niedzwiedz ◽

K A Robb ◽

S V Katikireddi ◽

J P Pell ◽

D J Smith

Keyword(s):

Breast Cancer ◽

Cervical Cancer ◽

Depressive Symptoms ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Breast And Cervical Cancer ◽

Screening Participation ◽

The Uk ◽

Prospective Analyses

Abstract Background Globally, more than 2 million women are diagnosed with breast or cervical cancer every year. Depressive symptoms and personality traits have been implicated in cancer-related mortality, but the potential mechanisms through which these associations may operate are not well understood. We aimed to assess how depressive symptoms and neuroticism are associated with participation in breast and cervical cancer screening. Methods 273 402 women in the UK Biobank cohort who were eligible for breast cancer screening (aged 50-70 years) and/or cervical cancer screening (<65 years) at baseline recruitment (2006-10) and those with follow-up data (2014-March 19) were identified. Depressive symptoms (4 items from Patient Heath Questionnaire) and neuroticism (12 items from Eysenck Personality Inventory Neuroticism Scale) were self-reported at baseline. The primary outcomes were reporting being up to date with breast and cervical cancer screening. For prospective analyses, patterns of screening participation from baseline to follow-up were derived. Logistic regression was used to analyse associations, adjusted for potential confounders. Results More severe depressive symptoms (range 0-12) were associated with reduced screening for breast (OR = 0.960, 95% CI: 0.950,0.970) and cervical cancer (OR = 0.958, 95% CI: 0.950,0.966). Prospective analyses revealed higher baseline depressive symptoms were related to decreased cervical cancer screening at follow-up (OR = 0.955, 95% CI: 0.913,0.999; equivalent to a difference of 4.08% between the highest and lowest depressive symptom score), but not with breast cancer screening. Results for overall neuroticism were inconclusive, but individual neuroticism items including anxiety and nervousness were related to increased screening participation. Conclusions More severe depressive symptoms may act as a barrier for cancer screening participation and could be an indication for more proactive strategies to improve uptake. Key messages Women with more severe depressive symptoms are less likely to be up to date with their breast and cervical cancer screening, which may exacerbate existing health inequalities. Interventions to increase screening participation among women with poor mental health may be merited.

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Abstract A10: Community navigators for breast and cervical cancer screening and follow up

10.1158/1538-7755.disp14-a10 ◽

2015 ◽

Author(s):

Melissa A. Simon ◽

Laura S. Tom ◽

Erika E. de la Riva ◽

Emily L. Malin

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Breast And Cervical Cancer

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Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort study

BMC Medicine ◽

10.1186/s12916-019-1460-0 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 14

Author(s):

Clare A. Aitken ◽

Heleen M. E. van Agt ◽

Albert G. Siebers ◽

Folkert J. van Kemenade ◽

Hubert G. M. Niesters ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

High Risk ◽

Cervical Cancer Screening ◽

Screening Programme ◽

Referral Rate ◽

Cancer Screening Programme ◽

Cervical Cancer Screening Programme ◽

High Risk Hpv

Abstract Background In January 2017, the Dutch cervical cancer screening programme transitioned from cytomorphological to primary high-risk HPV (hrHPV) DNA screening, including the introduction of self-sampling, for women aged between 30 and 60 years. The Netherlands was the first country to switch to hrHPV screening at the national level. We investigated the health impact of this transition by comparing performance indicators from the new hrHPV-based programme with the previous cytology-based programme. Methods We obtained data from the Dutch nationwide network and registry of histo- and cytopathology (PALGA) for 454,573 women eligible for screening in 2017 who participated in the hrHPV-based programme between 1 January 2017 and 30 June 2018 (maximum follow-up of almost 21 months) and for 483,146 women eligible for screening in 2015 who participated in the cytology-based programme between 1 January 2015 and 31 March 2016 (maximum follow-up of 40 months). We compared indicators of participation (participation rate), referral (screen positivity; referral rate) and detection (cervical intraepithelial neoplasia (CIN) detection; number of referrals per detected CIN lesion). Results Participation in the hrHPV-based programme was significantly lower than that in the cytology-based programme (61% vs 64%). Screen positivity and direct referral rates were significantly higher in the hrHPV-based programme (positivity rate: 5% vs 9%; referral rate: 1% vs 3%). CIN2+ detection increased from 11 to 14 per 1000 women screened. Overall, approximately 2.2 times more clinical irrelevant findings (i.e. ≤CIN1) were found in the hrHPV-based programme, compared with approximately 1·3 times more clinically relevant findings (i.e. CIN2+); this difference was mostly due to a national policy change recommending colposcopy, rather than observation, of hrHPV-positive, ASC-US/LSIL results in the hrHPV-based programme. Conclusions This is the first time that comprehensive results of nationwide implementation of hrHPV-based screening have been reported using high-quality data with a long follow-up. We have shown that both benefits and potential harms are higher in one screening round of a well-implemented hrHPV-based screening programme than in an established cytology-based programme. Lower participation in the new hrHPV programme may be due to factors such as invitation policy changes and the phased roll-out of the new programme. Our findings add further to evidence from trials and modelling studies on the effectiveness of hrHPV-based screening.

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Opportunistic Breast Cancer Education and Screening in Rural Honduras

Journal of Global Oncology ◽

10.1200/jgo.2015.001107 ◽

2016 ◽

Vol 2 (4) ◽

pp. 174-180 ◽

Cited By ~ 5

Author(s):

Linda S. Kennedy ◽

Suyapa A. Bejarano ◽

Tracy L. Onega ◽

Derek S. Stenquist ◽

Mary D. Chamberlin

Keyword(s):

Breast Cancer ◽

Cervical Cancer ◽

Cancer Screening ◽

Health Services ◽

Women's Health ◽

Cervical Cancer Screening ◽

Cancer Education ◽

Breast Cancer Education ◽

Women’S Health Services

Purpose In Honduras, the breast cancer burden is high, and access to women’s health services is low. This project tested the connection of community-based breast cancer detection with clinical diagnosis and treatment in a tightly linked and quickly facilitated format. Methods The Norris Cotton Cancer Center at Dartmouth College partnered with the Honduran cancer hospital La Liga Contra el Cancer to expand a cervical cancer screening program, which included self-breast exam (SBE) education and clinical breast exams (CBEs), to assess patient attitudes about and uptake of breast cancer education and screening services. The cervical cancer screening event was held in Honduras in 2013; 476 women from 31 villages attended. Results Half of the women attending elected to receive a CBE; most had concerns about lactation. Clinicians referred 12 women with abnormal CBEs to La Liga Contra el Cancer for additional evaluation at no cost. All referred patients were compliant with the recommendation and received follow-up care. One abnormal follow-up mammogram/ultrasound result was negative on biopsy. One woman with an aggressive phyllodes tumor had a mastectomy within 60 days. Multimodal education about breast cancer screening maximized delivery of women’s health services in a low-tech rural setting. Conclusion The addition of opportunistic breast cancer education and screening to a cervical cancer screening event resulted in high uptake of services at low additional cost to program sponsors. Such novel strategies to maximize delivery of women’s health services in low-resource settings, where there is no access to mammography, may result in earlier detection of breast cancer. Close follow-up of positive results with referral to appropriate treatment is essential.

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