Knowledge is Power? Pap Testing Habits of Female OB/GYNs Compared To Other Female Physicians

Background. To investigate whether knowledge regarding cervical cancer risk factors and Pap testing influence OB/GYN physicians’ compliance to cervical cancer screening and prevention.Methods. Female physicians working in the Tel Aviv Sourasky Medical Center were asked to complete an anonymous questionnaire assessing their knowledge of cervical cancer related factors, Pap testing and compliance with screening guidelines. Reported data was compared between resident and senior OB/GYN physicians and physicians from non-OB/GYN specialties.Results. 42 female OB/GYNs ( residents – 18, seniors- 24) and 80 female physicians of other specialties (“non-OB/GYNs”, residents -48, seniors -32) volunteered to participate in our study, with similar proportions of resident and senior participents between the two groups (p=0.0865). Generally, OB/GYNs were more knowledgable about cervical cancer prevention and risk factors compared to non-OB/GYNs. OB/GYN residents knew less about world health organization (WHO) recommendations for age at last Pap compared to senior OB/GYNs (answered correctly – 50% vs. 83%, respectively, p=0.04). They also knew less about the upper age for vaccine administration (answered correctly – 11% vs 50%, respectively, p=0.01). Even so, the majority of physician recommended Human Papillomavirus vaccination, in all groups compared. A similar proportion of OB/GYNs and non-OB/GYNs had performed a Pap smear in the last 3 years (OB/GYN – 75% non-OB/GYN – 83%, p=0.3). Of note, a higher percentage of residents, both OB/GYNs and non- OBGYNs were vaccinated against Human Papillomavirus compared to their senior counterparts (OB/GYNs -38.89% vs. 4.17%, p=0.013, non-OB/GYNs 50% vs. 12.5%, p=0.0007). Only half of OB/GYNs (residents – 50%, seniors –66.67%, p>0.99) initiated their Pap testing, similar to non-OB/GYNs. Human Papillomavirus vaccination was more prevalent among residents than among seniors, regardless of their specialty (OB/GYNs – 38.89% vs. 4.17%, p=0.013, non OB/GYN – 50% vs. 12.5%, p=0.0007) with a trend toward higher porportions of vaccinated physicians in non-OBGYNs.Conclusion. Female OB/GYNs’ knowledge of the importance of Pap test and their accessibility to Pap smear services, do not improve their compliance for Pap smear performance or Human Papillomavirus vaccination. Residents tend to have better general personal health habits out of their field of specialty.

Exploring the barriers to Pap smear test in Iranian women: a qualitative study

Background Cervical cancer is one of the most frequent types of cancer in females. The Pap smear is one of the most essential ways of diagnosing and screening for this malignancy, and any failure can be caused by a number of causes. The current study sought to investigate barriers to Pap smear in Iranian women. Method This qualitative content analysis study was conducted in Iran in 2019. Data was gathered through focus groups and individual semi-structured interviews with 32 women and health professionals. The interviewees were chosen using a combination of purposive and theoretical sampling. The data was then analyzed using the content analysis approach developed by Graneheim and Lundman. Guba and Lincoln's criteria for establishing trustworthiness were explored. Results Data analysis resulted in the identification of four primary categories, seventeen subcategories, and 186 original concepts. The main categories include weakness of health system, difficult accessibility, low health literacy, and socio-cultural factors. Conclusion By informing women about the necessity and importance of Pap smear, providing the conditions, facilities, and equipment to facilitate the testing process, and paying more attention to cultural and social factors in cervical cancer and Pap smear planning, interventions, and policies, barriers to Pap testing can be eliminated.

Effect of comorbid mood and anxiety disorders on breast and cervical cancer screening in immune-mediated inflammatory disease

We aimed to examine rates of breast and cervical cancer screening in women with immune-mediated inflammatory diseases (IMID), including inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) versus a matched cohort with IMID; and examine the association of psychiatric comorbidity with screening in these populations. We conducted a retrospective cohort study in Manitoba, Canada using administrative data. We identified women with IBD, MS and RA, and controls without these IMID matched on age and region. Annually, we identified individuals with any active mood/anxiety disorder. Using physician claims, we determined the proportion of each cohort who had cervical cancer screening within three-year intervals, and mammography screening within two-year intervals. We modeled the difference in the proportion of the IMID and matched cohorts who underwent mammography; and pap tests using log-binomial regression with generalized estimating equations, adjusting for sociodemographics, comorbidity and immune therapy use. We tested for additive interactions between cohort and mood/anxiety disorder status. During 2006–2016, we identified 17,230 women with IMID (4,623 with IBD, 3,399 with MS, and 9,458 with RA) and 85,349 matched controls. Having an IMID was associated with lower (-1%) use of mammography; however, this reflected a mixture of more mammography in the IBD cohort (+2.9%) and less mammography in the MS (-4.8 to -5.2%) and RA (-1.5%) cohorts. Within the IBD, MS and RA cohorts, having an active mood/anxiety disorder was associated with more mammography use than having an inactive mood/anxiety disorder. The MS and RA cohorts were less likely to undergo Pap testing than their matched cohorts. In the absence of an active mood/anxiety disorder, the IBD cohort was more likely to undergo Pap testing than its matched cohort; the opposite was true when an active mood/anxiety disorder was present. Among women with an IMID, mood/anxiety disorder influence participation in cancer screening.

Abnormal Pap Follow-Up among Criminal-Legal Involved Women in Three U.S. Cities

Criminal-legal involved women experience significant barriers to preventive cervical care, and consequently there is a higher incidence of cervical cancer in this population. The purpose of this study is to identify variables that may facilitate abnormal Pap follow-up among criminal-legal involved women living in community settings. The study included n = 510 women with criminal-legal histories, from three U.S. cities—Birmingham, AL; Kansas City, KS/MO; Oakland, CA. Participants completed a 288-item survey, with questions related to demographics, social advantages, provider communication, and reasons for missing follow-up care. There were n = 58 women who reported abnormal Pap testing, and n = 40 (69%) received follow-up care. Most women received either repeat Pap/HPV testing (n = 15, 38%), or colposcopy and/or biopsy (n = 14, 35%). Women who did not follow-up (n = 15, 26%) cited that they forgot (n = 8, 53%), were uninsured (n = 3, 20%), or were reincarcerated (n = 3, 20%). In a multivariate analysis, both having a primary care provider (OR 4.6, 95% CI 1.3–16.0) and receiving specific provider communication about follow-up (OR 3.8, 95% CI 1.1–13.2) were independent predictors for abnormal Pap follow-up. Interventions that offer linkages to providers in the community or ensure abnormal Pap care plans are communicated effectively may mitigate the disparate incidence of cervical cancer among criminal-legal involved women.

Treatment with an intravaginal gel containing siliceous dioxide, selenite, and citric acid to promote regression of ASC-US, LSIL, ASC-H, HSIL, p16/Ki67 status and improve clearance of hr-HPV in cervical specimens

Objective: An intravaginal gel containing highly dispersed silicon dioxide (SiO2) and an anti-oxidative combination of citric acid and sodium selenite was tested for its ability to promote regression of abnormal cytological findings and its influence on hr-HPV status and tumor markers p16/Ki67 (CINtec® PLUS test).Patients and methods: A control study was performed, including women (n=100) diagnosed with conspicuous cervical smears (ASC-US, LSIL, ASC-H, or HSIL). The gel was applied for 3x28 days. After three months, participants were analyzed for Pap status, hr-HPV strains, and expression of tumor markers p16/Ki67. Three months later, Pap testing and p16/Ki67 analysis were repeated. The results were compared to those of 106 women who met the same inclusion criteria but did not obtain any treatment.Results: After six months, cytological Pap findings were improved in 80.9% of the participants in the treated group, and the clearing of hr-HPV was observed in 53% of cases. Only 5.3% were tested p16/Ki67 positive after six months in comparison to 75.0% at baseline. In the comparison group, 37.1% of the Pap smears and 18.6% of the CinTec results were improved, but no hr-HPV clearance was observed. The improvements were highly significant for the treatment. Conclutions: The vaginal gel containing SiO2 sodium selenite, and citric acid may support the healing of conspicuous cytological findings and clearance of hr-HPV.

High-resolution anoscopy, is there a benefit in proceeding directly to the operating room?

Background The development of high-resolution anoscopy (HRA) has advanced our ability to detect anal dysplasia. Historically, HRA is performed in a clinical setting and subsequent ablation is performed in the clinical setting or operating room. The aim of this study was to determine the most effective venue for the performance of HRA. Methods Following institutional review board (IRB) approval, the correlation between anal cytology and HRA performed in the clinic versus in the operating room was evaluated. Data were extracted from our IRB-approved prospective HRA database over the time period of 2013–2017. Results One hundred twenty-eight HRAs were compared (101 in the clinical setting, 27 in the operating room). There was a statistically significant difference in the correlation between anal cytology and HRA pathology for procedures performed in the clinical setting (55% [56/101]) versus those performed in the operating room (82% [22/27]) (p = 0.014). More biopsies were obtained in the operating room than in the clinic setting (3 vs. 1, p < 0.0001). The majority of patients who had HRA in a clinical setting with subsequent HRA in the operating room stated that they preferred to have their HRAs performed in the operating room due to discomfort from the HRA procedure. Conclusions Detection rates for anal dysplasia on HRA, are significantly higher when performed in the operating room. To prevent discomfort in the clinical setting, patients with high-grade dysplasia on anal pap testing may benefit from proceeding directly to the operating room for concurrent HRA and ablation.

“Let’s Chat”: process evaluation of an intergenerational group chat intervention to increase cancer prevention screening among Vietnamese American families

Vietnamese Americans have a higher rate of cervical and colorectal cancer (CRC) compared to other ethnicities. Increasing CRC screening, Pap testing, and HPV vaccination is critical to preventing disproportionate cancer burden among Vietnamese families. To describe the successes and challenges of implementing a novel intergenerational family group chat intervention that encourages CRC screening, Pap testing, and HPV vaccination. Young adult Family Health Advocates (FHAs) were trained to facilitate online family group chat conversations to encourage cancer screenings. Ten families participated in a 4-week intervention. Data collection included screenshot data of family group chat conversations, family member surveys, and post-intervention FHA interviews. Intervention implementation successes included (a) cultural and language brokering, (b) active co-facilitation by family members to follow up on cancer screenings, (c) high levels of family group chat engagement, (d) high acceptability of intervention among families, and (e) accessibility of intervention curriculum. FHA challenges to implement the intervention included (a) sustaining cancer prevention conversations, (b) comfort with navigating family conversations around cancer screening, (c) relevance for all family members, and (d) missed opportunities for correcting misinformation. Researcher challenges included family recruitment and retention. The intervention made cancer-screening messages more accessible and was well accepted by Vietnamese families. Scaling up the intervention will require (a) training FHAs to monitor family conversations and build confidence in sharing medical accurate messages, (b) segmenting group chats by age and gender, and (c) employing multiple family engagement strategies.

Primary HPV and Molecular Cervical Cancer Screening in US Women Living with HIV

Background Primary human papillomavirus (HPV) screening (PHS) utilizes oncogenic human papillomavirus (oncHPV) testing as the initial cervical cancer screening method and typically, if positive, additional reflex-triage (e.g., HPV16/18-genotyping, Pap testing). While US guidelines support PHS usage in the general population, PHS has been little studied in women living with HIV (WLWH) Methods We enrolled n=865 WLWH (323 from the Women’s Interagency HIV Study [WIHS] and 542 from WIHS-affiliated colposcopy clinics). All participants underwent Pap and oncHPV testing, including HPV16/18-genotyping. WIHS WLWH who tested oncHPV[+] or had cytologic atypical squamous cells of undetermined significance or worse (ASC-US+) underwent colposcopy, as did a random 21% of WLWH who were oncHPV[-]/Pap[-] (controls). Most participants additionally underwent p16/Ki-67 immunocytochemistry Results Mean age was 46 years, median CD4 was 592 cells/μL, 95% used antiretroviral therapy. Seventy WLWH had histologically-determined cervical intraepithelial neoplasia grade 2 or greater (CIN-2+), of which 33 were defined as precancer (i.e., [i] CIN-3+ or [ii] CIN-2 if concurrent with cytologic high grade squamous intraepithelial lesions [HSILs]). PHS had 87% sensitivity (Se) for precancer, 9% positive predictive value (PPV), and a 35% colposcopy referral rate (Colpo). “PHS with reflex HPV16/18-genotyping and Pap testing” had 84% Se, 16% PPV, 30% Colpo. PHS with only HPV16/18-genotyping had 24% Colpo. “Concurrent oncHPV and Pap Testing”(Co-Testing) had 91% Se, 12% PPV, 40% Colpo. p16/Ki-67 immunochemistry had the highest PPV, 20%, but 13% specimen inadequacy. Conclusions PHS with reflex HPV16/18-genotyping had fewer unnecessary colposcopies and (if confirmed) could be a potential alternative to Co-Testing in WLWH