Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement

Smartphone-based urine colourimetric assay for home self-screening of HPV infection

Currently, producing NPSH after HPV infection of cells has been confirmed. These NPSH-containing substances accumulate around the urethral opening and are subsequently washed out with urine. Therefore, indirect detection of HPV infection by assessing NPSH levels in urine is feasible, but it has not been reported in detail so far. Here, an assay using phosphotungstic acid to oxidise and produce colour changes by NPSH in urine was developed. This assay enabled the rapid, non-invasive identification of HPV infection by detecting the metabolic byproduct NPSH produced by HPV-infected cells. Employing a smartphone-based device, developed using an ambient light sensor, reduces the cost and simplifies the operation associated with the colourimetric assay. The colourimetric assay was used to detect L-cysteine and L-ascorbic acid standard substance (as NPSH mimics), the limited of detection were 0.12 mM and 31.25 μM, respectively, with high reproducibility and stability. When this colourimetric assay was used to evaluate urine samples from individuals suspected of HPV infection, along with other at-home self-screening methods for HPV nucleic acid detection in urine, showed comparable sensitivity and specificity. Compared with nucleic acid detection in urine, this colourimetric assay is cost-effective, user-friendly, amenable to self-sampling, and enables testing at one's convenience and location of choice, which is more suitable for home self-testing or population self-screening.

Utility of CINtec PLUS in Identification of High-Grade Lesions on Short-Term Follow-Up in Patients With Negative Cytologic Interpretation

BACKGROUND

Screening for cervical cancer may include cervical cytology and/or high-risk human papillomavirus testing (HPV). The FDA (Food and Drug Administration)-approved CINtec PLUS dual stain (DS) for p16 and Ki-67 can provide helpful information for challenging follow-up care.

METHODS

We retrospectively analyzed 272 cases with negative intraepithelial malignancy (NILM) Papanicolaou (Pap) tests and positive HPV test results. All 272 women had colposcopy-directed biopsies or endocervical curettage (ECC) (histopathology) within a year. We compared DS test results with corresponding ECC/colposcopy specimens. Two subgroup analyses were conducted to examine the correlation of DS results with a prior history of abnormal Pap/colposcopy and to compare DS results with regard to HPV genotype. For analysis purposes, only high-grade lesions were considered positive, while low-grade lesions were grouped with negative results.

RESULTS

Of 272 cases, 113 tested positive for DS, while 159 were negative. On follow-up histopathology within a year, three of the 113 positive cases (2.6%) showed high-grade lesions. In comparison, none of the 159 negative cases showed any high-grade lesions (95% confidence interval [CI]: -0.3% to 5.4% [p = 0.14]). Further analysis by HPV status showed that DS helped in risk discrimination in both subcategories (HPV16/18 and other 12 high-risk HPV), although it was not statistically significant (p = 0.99). Subgroup analysis based on the history of high-grade lesions demonstrated that in cases with no previous history, the risk difference was 2.8% between DS positive and negative results (95% CI -0.3% to 6%, p = 0.134).

CONCLUSION

All three high-grade lesions were in the DS positive category, suggesting DS may help in the risk stratification for HPV-positive NILM women (either HPV16/18 or other). Furthermore, DS may help with risk stratification, specifically in patients with no prior high-grade lesions.

Willingness of adults in the United States to have a multicancer detection test

PURPOSE

Multicancer detection (MCD) testing is an emerging approach with the potential to improve the cancer screening and early detection landscape. As the clinical utility of MCD testing is further determined, it is important to examine patients' willingness to have an MCD test.

METHODS

We conducted an online survey in September 2024 with a national sample of adults aged 45-80 from the United States (n = 1,043). Multivariable logistic regression identified correlates of participants' willingness to have an MCD test.

RESULTS

About three-fourths of participants (75.2%) indicated they were willing to have an MCD test if it was free or covered by health insurance, while only 16.9% were willing if the test cost $1,000 out of pocket. Participants were more willing to have a free MCD test if they had at least a college degree (odds ratio [OR] = 2.48, 95% confidence interval [CI] 1.12-5.48), had some form of health insurance (OR = 3.40, 95% CI 1.84-6.27), or had a routine medical check-up within the last year (OR = 1.62, 95% CI 1.01-2.59). The most commonly endorsed factors that would matter in participants' hypothetical MCD testing decisions were cost or health insurance coverage (60.7%), how well the test works (50.6%), and if a doctor recommended having a test (47.6%).

CONCLUSIONS

Most adults are willing to have an MCD test, if it is free or covered by health insurance. Findings can help guide programs about MCD testing for both patients and healthcare providers that are becoming increasingly necessary as MCD testing continues to be examined as a screening strategy.

Early detection of multiple cancer types using multidimensional cell-free DNA fragmentomics

The multicancer early detection (MCED) test has the potential to enhance current cancer-screening methods. We evaluated a new MCED test that analyzes plasma cell-free DNA using genetic- and fragmentomics-based features from whole-genome sequencing. The present study included an internal validation cohort of 3,021 patients with cancer and 3,370 noncancer controls, and an independent cohort of 677 patients with cancer and 687 noncancer individuals. The results demonstrated an overall sensitivity of 87.4%, specificity of 97.8% and tissue-of-origin prediction accuracy of 82.4% in the independent validation cohort. Preliminary results from a prospective study of 3,724 asymptomatic participants showed a sensitivity of 53.5% (predominantly early stage cancers) and specificity of 98.1%. These findings indicate that the MCED test has strong potential to improve early cancer detection and support clinical decision-making.

Self-Collection for Human Papillomavirus Testing in Clinical Settings: An Opportunity to Reflect on the Disconnect Between Guidelines and Clinical Practice

Cervical cancer remains a preventable yet significant public health concern, particularly among rural, racial and ethnic minority, and LGBTQ+ (lesbian, gay, bisexual, transgender, queer+) populations who are more likely to be unscreened or underscreened. The recent draft guidance by the U.S. Preventive Services Task Force of human papillomavirus (HPV) self-collection for cervical cancer screening offers a transformative opportunity to overcome barriers to traditional cervical cancer prevention methods. Clinician collection and self-collection show strong agreement with HPV test results; however, clinician collection is still more sensitive than self-collection for CIN 2 or worse detection. Human papillomavirus self-collection at health care facilities, as recommended, addresses patient-centric challenges such as embarrassment, discomfort, and logistical constraints, thereby enhancing accessibility and engagement. Despite its potential, self-collection is currently approved by the U.S. Food and Drug Administration only for health care settings, limiting its reach and utility in underserved areas. To maximize the effect of self-collection, targeted educational campaigns for both clinicians and patients are essential to ensure proper utilization. At the patient level, strategies such as mobile clinics and mailed HPV testing kits could improve access, particularly among populations that, despite all other efforts, have not been reached. Clear guidelines at both the system and clinician levels regarding ordering responsibility, result notification for patients, follow-up protocols, specimen processing, and health insurance coverage at each step will be essential for successful implementation.

Time to de-implementation of low-value cancer screening practices: a narrative review

The continued use of low-value cancer screening practices not only represents healthcare waste but also a potential cascade of invasive diagnostic procedures and patient anxiety and distress. While prior research has shown it takes an average of 15 years to implement evidence-based practices in cancer control, little is known about how long it takes to de-implement low-value cancer screening practices. We reviewed evidence on six United States Preventive Services Task Force 'Grade D' cancer screening practices: (1) cervical cancer screening in women<21 years and >65 years, (2) prostate cancer screening in men≥70 years and (3) ovarian, (4) thyroid, (5) testicular and (6) pancreatic cancer screening in asymptomatic adults. We measured the time from a landmark publication supporting the guideline publication and subsequent de-implementation, defined as a 50% reduction in the use of the practice in routine care. The pace of de-implementation was assessed using nationally representative surveillance systems and peer-reviewed literature from the USA. We found the time to de-implementation of cervical cancer screening was 4 years for women<21 and 16 years for women>65. Prostate screening in men ≥70 has not reached a 50% reduction in use since the 2012 guideline release. We did not identify sufficient evidence to measure the time to de-implementation for ovarian, thyroid, testicular and pancreatic cancer screening in asymptomatic adults. Surveillance of low-value cancer screening is sparse, posing a clear barrier to tracking the de-implementation of these screening practices. Improving the systematic measurement of low-value cancer control practices is imperative for assessing the impact of de-implementation on patient outcomes, healthcare delivery and healthcare costs.

Sexual and Reproductive Health Behaviors Among Young Black Women in the U.S. Before the COVID-19 Pandemic: Insights for Addressing Future Challenges in STI and Pregnancy Prevention Within Key Female Populations

New STI/HIV diagnoses disproportionately impact U.S. Black cisgender women at higher rates compared to other racial/ethnic U.S. cisgender women. Biomedical HIV prevention interventions, such as HIV Pre-Exposure Prophylaxis, have demonstrated lower uptake among Black women. Given the need to further develop prevention interventions that meet the sexual and reproductive health (SRH) needs of U.S. Black women, this study aimed to identify and characterize condom use behaviors, sexual communication efficacy, and SRH healthcare utilization among sexually experienced young Black women (YBW) aged 18-25 (N = 206). Participants completed a self-administered questionnaire assessing sexual and conception vulnerability, sexual/reproductive healthcare utilization, and sexual communication efficacy. Descriptive statistics and univariate analyses were conducted to identify correlations in sexual and reproductive behaviors. The results showed that 32% of YBW used a condom during their last sexual encounter. Five distinct trends in condom use were identified, three of which included condomless vaginal/oral sex. YBW reported high levels of sexual communication with sexual partners and consistent engagement in sexual/reproductive health care, including abortion care. Young Black women have diverse sexual/reproductive health needs and require culturally responsive patient-centered clinical practices aimed at reducing STI/HIV rates and unintended pregnancies. Future research could examine healthcare providers' understanding of Black women's SRH priorities and assess how this knowledge aligns with or diverges from established clinical guidelines and best practices. Such inquiries could illuminate potential gaps in provider education and clinical practice, ultimately informing the development of care models that are both evidence-based and responsive to the lived experiences of young Black women.

Cervical Cancer Screening After Menopause

BACKGROUND

About 14,000 women develop cervical cancer each year in the United States. Human Papillomavirus (HPV) vaccination is an effective primary prevention measure for HPV infections and cervical cancer among adolescents and young adults. For middle-aged and older women, they rely on secondary prevention (i.e., cancer screening) for early detection of cervical cancer. The average age at which women receive a cervical cancer diagnosis is around 50, when most women are in the middle of perimenopause. In this study, we use data from a longitudinal survey to examine whether going through menopause is associated with cervical cancer screening behavior four or eight years later.

METHODS

Data were taken from 2012, 2016, and 2020 waves of the Health and Retirement Study (HRS), a longitudinal survey of middle-aged and older adults in America. Using the 2012 and 2016 waves as baselines, two four-year (n = 1011 and n = 1263) and one eight-year (n = 823) longitudinal analyses were conducted. The lost follow-ups and those who have had a hysterectomy were excluded. Hierarchical logistic regression models were used to compare women who had gone through menopause to those who were premenopausal or perimenopausal at each of the baselines in terms of their likelihood of having a pap smear test four or eight years later.

RESULTS

Results show that the women who had gone through menopause were less likely to have a pap smear test four or eight years later when compared to those who were still premenopausal or perimenopausal at baseline. Women who had gone through menopause at the baseline of 2016 were less likely to have a pap smear test by 2020 (Odds Ratio = 0.76, p < 0.05). A similar association was found among women who had gone through menopause at the baseline of 2012 after controlling for their previous pap smear behavior and other covariates.

CONCLUSIONS

The American Cancer Society and other professional organizations recommend that women have cervical cancer screenings regularly until age 65. Our findings suggest that women seem less likely to have a pap smear test after menopause. More research is needed to have a comprehensive understanding of cervical screening behavior in this age group of women.

Juntas Contra el Virus del Papiloma Humano: protocol for a pilot randomized controlled trial of an HPV self-sampling intervention for underscreened Latinas

BACKGROUND

Rates of cervical cancer incidence and mortality are persistently higher among Latina women in the continental United States (US) and women in Puerto Rico (a US territory) compared with non-Hispanic White (NHW) women. Multiple factors contribute to low participation in cancer screening, including structural barriers (e.g., low access to healthcare services, racism/discrimination, lack of culturally and linguistically adequate information), cultural concerns, and low perceived risk and awareness of cervical cancer. Although community-based education and navigation support can be effective in overcoming some barriers to screening, structural barriers and limited access remain formidable challenges to overcome. Emerging technologies supporting self-sampling for high-risk human papillomavirus (HPV) testing may offer a valuable evidence-based strategy for empowering Latina women to engage in cervical cancer screening. Thus, the objective of this study is to assess the feasibility and acceptability of a novel HPV self-sampling intervention for underscreened Latina women.

METHODS

The study will be a randomized controlled feasibility trial involving 100 Latina women who have not received cervical cancer screening within the recommended guidelines. Participants will be randomly assigned to the intervention condition, which includes a synchronous three-session group cervical cancer educational program delivered virtually along with a mailed HPV self-sampling kit (to obtain self-collected cervical samples for HPV testing), or to a comparison condition that involves receipt of the mailed HPV self-sampling kit with written information about cervical cancer screening and nearby clinics. Study assessments will be obtained at baseline (i.e., study entry) and 1-month post-program. The primary outcome of feasibility will be measured through study enrollment and intervention completion. In addition, acceptability of study materials and the self-sampling procedures will be assessed using self-report surveys at 1-month post-program.

DISCUSSION

Provision of a mailed HPV self-sampling kit may present new options for encouraging participation in cervical cancer screening among underscreened Latina women. This study will evaluate the feasibility and acceptability of such an approach, which will inform the subsequent design of a full-scale randomized trial to assess intervention effectiveness on screening behavior.

TRIAL REGISTRATION

ClinicalTrials.gov no. NCT06439706. Registered 28 May 2024 - retrospectively registered.

Assessment of the impact of multi-cancer early detection test screening intervals on late-stage cancer at diagnosis and mortality using a state-transition model

OBJECTIVE

Multi-cancer early detection (MCED) tests are novel technologies that detect cancer signals from a broad set of cancer types using a single blood sample. The objective of this study was to estimate the effect of screening with an MCED test at different intervals on cancer stage at diagnosis and mortality endpoints.

DESIGN

The current model is based on a previously published state-transition model that estimated the outcomes of a screening programme using an MCED test when added to usual care for persons aged 50-79. Herein, we expand this analysis to model the time of cancer diagnosis and patient mortality with MCED screening undertaken using different screening schedules. Screening intervals between 6 months and 3 years, with emphasis on annual and biennial screening, were investigated for two sets of tumour growth rate scenarios: 'fast (dwell time=2-4 years in stage I) and 'fast aggressive' (dwell time=1-2 years in stage I), with decreasing dwell times for successive stages.

SETTING

Inputs for the model include (1) published MCED performance measures from a large case-control study by cancer type and stage at diagnosis and (2) Surveillance, Epidemiology and End Results (SEER) data describing stage-specific incidence and cancer-specific survival for persons aged 50-79 in the US for all cancer incidence.

OUTCOME MEASURES

We used the following outcome measures: diagnostic yield, stage shift, and mortality.

RESULTS

Annual screening under the fast tumour growth scenario was associated with more favourable diagnostic yield. There were 370 more cancer signals detected/year/100,000 people screened, 49% fewer late-stage diagnoses, and 21% fewer deaths within 5 years than usual care. Biennial screening had a similar, but less substantial, impact (292 more cancer signals detected/year/100,000 people screened; 39% fewer late-stage diagnoses, and 17% fewer deaths within 5 years than usual care). Annual screening prevented more deaths within 5 years than biennial screening for the fast tumour growth scenario. However, biennial screening had a higher positive predictive value (54% vs 43%); it was also more efficient per 100,000 tests in preventing deaths within 5 years (132 vs 84), but prevented fewer deaths per year.

CONCLUSION

Adding MCED test screening to usual care at any interval could improve patient outcomes. Annual MCED test screening provided more overall benefit than biennial screening. Modelling the sensitivity of outcomes to different MCED screening intervals can inform timescales for investigation in trials.

Cancer screening outside of age recommendations: a population-based study

BACKGROUND

Cancer screening outside of evidence-based recommendations can be considered a form of low-value care. We aimed to describe the frequency of colorectal, breast, cervical, and prostate cancer screening outside of recommended age guidelines in Switzerland.

METHODS

We analysed data from the 2022 Swiss Health Survey. Of 21,930 participants aged 15 or more, 20,515 (9,555 men and 10,960 women) were included in this study. We calculated age at last screening and classified individuals as having been not screened, screened within age-specific A, B, and C recommendations from the United States Preventive Services Taskforce (USPSTF), screened within age-specific A and B recommendations, or screened outside of recommendations.

RESULTS

Among adults aged 75 years and above (75+), 40.2% (men: 35.1%; women: 44.5%) had undergone cancer screening outside of USPSTF A, B, and C recommendations. This proportion was 26.0% for adults aged 85+ (men: 27.8%; women: 24.6%). Cervical cancer screening was the most frequently undertaken outside of recommended ages by older adults (women aged 75+: 37.1%), followed by prostate (men aged 75+: 34.0%), breast (women aged 75+: 17.8%), and colorectal cancer screening (adults aged 75+: 1.3%). Screening outside of recommendations was also observed among middle-aged adults 40-59 at 12.3% (men: 20.8%; women 4.0%), and younger-aged women 20-39 at 9.9%. Proportions for screening outside of USPSTF A and B recommendations were high (adults 75+: 50.4%; adults 85+: 40.6%; adults 40-59: 20.9%).

CONCLUSIONS

Cancer screening outside of recommendations is highly prevalent, particularly among older adults. Further research is needed to better understand drivers of this form of low-value care.

Targeting HPV for the prevention, diagnosis, and treatment of cervical cancer

Despite advances in screening and prevention, cervical cancer (CC) remains an unresolved public health issue and poses a significant global challenge, particularly for women in low-income regions. Human papillomavirus (HPV) infection, especially with the high-risk strains, is a primary driver of cervical carcinogenesis. Emerging evidence indicates that integrating HPV testing with existing approaches, such as cervical cytology and visual inspection, offers enhanced sensitivity and specificity in CC screening. HPV infection-associated biomarkers, including HPV E6/E7 oncogenes, p16^INK4a, DNA methylation signatures, and non-coding RNAs, offer valuable insights into disease progression and the development of personalized interventions. Preventive and therapeutic vaccination against HPV, along with tertiary prevention strategies such as the use of antiviral and immune-modulating drugs for HPV-related lesions, show great clinical potential. At the mechanistic level, single-cell RNA sequencing analysis and the development of organoid models for HPV infection provide new cellular and molecular insights into HPV-related CC pathogenesis. This review focuses on the crucial roles of HPV in the prevention, diagnosis, and treatment of CC, with particular emphasis on the latest advancements in screening and disease intervention.

Eligibility for and reach of the National Breast and Cervical Cancer Early Detection Program, 2018-2021

PURPOSE

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides access to timely breast and cervical cancer screening and diagnostic services to women who have low incomes and are uninsured or underinsured. Documenting the number of women eligible and the proportion of eligible women who receive NBCCEDP-funded services is important for identifying opportunities to increase screening and diagnostic services among those who would not otherwise have access.

METHODS

Using the Census Bureau's Small Area Health Insurance Estimates data, we estimated the number of women who met the NBCCEDP eligibility criteria based on age, income, and insurance status. We used these estimates along with the number of women served by the NBCCEDP to calculate the percent of women served by race/ethnicity and state. We calculated the percent of eligible women who are up to date with screening using the 2019 National Health Interview Survey.

RESULTS

The NBCCEDP served 15.0% of women ages 40-64 eligible for breast cancer services in 2018-2019 and 5.6% of women ages 21-64 eligible for cervical cancer services in 2018-2020. The NBCCEDP served 13.5% of women ages 40-64 eligible for breast cancer services in 2020-2021 and 5.9% of women ages 21-64 eligible for cervical cancer services in 2019-2021. The percent of women ages 40-64 who received breast cancer services declined by 1.5 percentage points between 2018-2019 and 2020-2021. The percent of women ages 21-64 who received cervical cancer services increased by 0.3 percentage points between 2018-2020 and 2019-2021. The percent of eligible women served varied among states. The state interquartile ranges of the percent of women served were 12.3-27.7% for breast cancer services in 2018-2019 and 3.9-14.7% for cervical cancer services in 2018-2020. Among women eligible for the NBCCEDP, 61.4% are not up to date with breast cancer screening and 40.6% are not up to date with cervical cancer screening.

CONCLUSION

There is wide variation between states in the share of eligible women served for breast and cervical cancer screening services. We found that both the number and the percentage of eligible women who received NBCCEDP breast cancer services declined during a period that overlapped with the COVID-19 pandemic. A large proportion of eligible women did not receive breast or cervical cancer screening.

Long-Term Care of the Liver Transplant Recipient

Reflecting continued enhancements of surgical techniques and immunosuppression, liver transplant recipients are experiencing increased longevity. Once patients have successfully navigated the perioperative and early posttransplant period, their survival depends on management of immunosuppression to minimize systemic side effects that will contribute to the development of medical comorbidities while avoiding rejection. This includes mitigating cardiovascular risk factors and other components of the metabolic syndrome. The concept of transplant survivorship emphasizes a holistic approach to improving a patient's quality of life. Highlighting not only the medical management, transplant survivorship also stresses the psychological, mental, and spiritual well-being to further improve long-term outcomes.

Cervical cancer screening and risk factor prevalence by sexual identity: A comparison across three national surveys in the United States

OBJECTIVES

Women identifying as lesbian, gay, bisexual, or queer (LGBQ) have lower cervical cancer screening use and differences in care access. Less known about how differences vary by data sources and within LGBQ subgroups. We evaluated LGBQ disparities in cervical cancer screening use and risk factors across three national surveys in the United States.

METHODS

Data were from the 2019 and 2021 National Health Interview Survey, the 2018 and 2020 Behavioral Risk Factor Surveillance Survey, and the 2017-2019 National Survey of Family Growth. We meta-analyzed self-reported cervical cancer screening to estimate pooled relative risks (pRR), comparing those identifying as LGBQ to those identifying as straight/heterosexual. We also evaluated differences in care access and behavioral risk factors by sexual identity.

RESULTS

Despite demographic differences across surveys, all three surveys demonstrated a small reduction in up-to-date cervical cancer screening for LGBQ vs. straight/heterosexual women (pRR = 0.91 [CI 0.89-0.93]). The screening gap was larger for gay/lesbian (pRR: 0.90 [0.85-0.94]) than bisexual women (pRR: 0.94 [0.92-0.97]) and largest at younger ages (pRR age 21-29: 0.89 [CI 0.85-0.93]). LGBQ women reported consistently lower access to care across multiple measures. Risk factors were mixed, including higher smoking rates and higher HPV vaccination coverage for LGBQ women vs. straight.

DISCUSSION

LGBQ women are less likely to be screened for cervical cancer. Closing disparities in care access and identifying feasible and acceptable screening interventions will help reduce these disparities. We must also ensure high-quality data collection to monitor disparities across and within key subgroups.

Selenium-enhanced recombinase polymerase amplification-CRISPR/Cas12a: A low-noise single-tube assay for human papillomavirus 16 ultrasensitive detection

In vitro amplification represents a critical step in human papillomavirus (HPV) DNA detection. However, DNA polymerases can initiate nonspecific amplification and incorporate erroneous nucleotides due to the lack of cellular repair mechanisms. To address these challenges, we present a novel one-tube selenium-enhanced recombinase polymerase amplification (Se-RPA) coupled with clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated nuclease 12a (Cas12a) (OTSRC) system for the ultrasensitive HPV DNA detection. The Se-RPA incorporates 10 % selenium-modified nucleoside triphosphates (dNTPαSe) into the conventional RPA protocol, effectively suppressing nonspecific amplification while maintaining high-fidelity DNA synthesis. The CRISPR/Cas12a component integrates sequence-specific verification, exponential signal amplification, and fluorescence-based readout capabilities. Optimized in a single-tube format to minimize aerosol contamination, OTSRC exhibits a background signal of 71.77 % compared to the one-tube RPA-CRISPR/Cas12a (OTRC) system. Within a 20-min incubation, the OTSRC demonstrated a detection limit of 169 aM, which is half that of the OTRC without dNTPαSe and comparable to qPCR. Furthermore, the OTSRC system demonstrates the excellent compatibility of dNTPαSe with the RPA-CRISPR/Cas12a system, thereby enhancing HPV detection sensitivity. Overall, OTSRC enables rapid, sensitive, and specific detection of HPV DNA, showing strong potential for clinical point-of-care nucleic acid testing applications.

Patient Perceptions on the Follow-Up of Abnormal Cancer Screening Test Results

BACKGROUND

Timely follow-up after an abnormal cancer screening test result is needed to maximize the benefits of screening, but is frequently not achieved. Little is known about patient experiences with the process of following up abnormal screening results.

OBJECTIVE

Assess patient experiences and perceptions regarding the process of a diagnostic workup following abnormal breast, cervical, or colorectal cancer screening results.

DESIGN

Survey of participating patients between April 2021 and June 2022 after reaching the primary outcome time point in a randomized controlled trial to improve follow-up of overdue abnormal screening results.

PARTICIPANTS

Patients from 44 participating practices in three primary care practice networks.

MAIN MEASURES

Self-reported ease of scheduling follow-up, perceived barriers or concerns, provider trust, and satisfaction with communication and care received for the follow-up of abnormal screening results.

RESULTS

Overall, 241 (25.0%) patients completed the survey including 66 (32.8%) with breast, 79 (25.3%) with cervical, and 96 (21.3%) with colorectal screening test; median age 55 years, 79.7% women, 80.5% non-Hispanic white, and 51.0% did not complete recommended follow-up. Most patients were worried that the test would find cancer (63.1%), but fewer worried about discomfort or side effects (34.4%), and neither were associated with completing follow-up. However, 17% of patients did not think they needed follow-up tests or appointments and were less likely to complete follow-up (10.5% vs. 24.0%, respectively, p-value 0.009). Most patients were very satisfied with their overall care (71.0%), but only 50.2% strongly agreed that they trusted their provider to put their medical needs above all else when making recommendations.

CONCLUSIONS

Patients with overdue abnormal breast, cervical, and colorectal cancer screening test results reported important deficiencies in the management of recommended follow-up. Addressing patient concerns about fear of cancer and effectively communicating the need for follow-up procedures may improve timely follow-up after an abnormal cancer screening result.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03979495.

Clinical Validation of a Vaginal Cervical Cancer Screening Self-Collection Method for At-Home Use: A Nonrandomized Clinical Trial

Importance

One-quarter of US women who are at risk for cervical cancer delay screening. Self-collected (SC) cervical screening was recently US Food and Drug Administration (FDA)-approved in the US for use in a health care setting only; an at-home SC option is crucial to address clinic-related barriers to screening.

Objective

To clinically validate the use of an SC device that was designed for optimal at-home performance, safety, ease-of-use, and dry storage and transport.

Design, Setting, and Participants

This nonrandomized clinical trial used a prospective method comparison study design. Participants aged 25 to 65 years were recruited from 16 clinical sites in the US including community and academic practices from November 20, 2023, to April 5, 2024. Data analysis was conducted from April to August 2024.

Intervention

Eligible participants collected a sample with the SC method, followed by a clinician-collected (CC) sample. The SC sample was eluted into PreservCyt at the laboratory and both samples were tested on an FDA-approved high risk human papillomavirus (hrHPV) test approved for primary screening. Participants were followed up for safety and completed usability and screening preference surveys.

Main Outcome and Measures

The primary outcome measures were positive percentage agreement (PPA) and negative percentage agreement for detection of hrHPV between the SC and CC samples. Other study measures included clinical sensitivity for high grade cervical dysplasia and usability.

Results

Of 609 screening-eligible participants, 599 (262 aged 30-39 years [43.7%]; 583 identified as female [97.3%]) had paired SC-CC samples, of which 582 had valid paired samples included in the end point analysis. Among the 582 evaluable paired samples, the PPA between SC compared with paired CC samples for detection of hrHPV was 95.2% (95% CI, 92.1%-97.1%; 278 of 292 participants). The absolute clinical sensitivity for detection of high-grade cervical dysplasia was 95.8% (95% CI, 86.0%-98.8%; 46 of 48 participants), equivalent to the CC (relative sensitivity, 1.00). Nearly all participants (555 of 601 participants [92.3%]) reported that the device instructions were easy or very easy to understand and also that they would choose SC if they knew the results were comparable to CC results (560 of 602 participants [93.0%]).

Conclusions and Relevance

In this nonrandomized clinical trial, SC samples collected with the device showed equivalent clinical sensitivity and exceeded the PPA end point for cervical screening. This SC method was found to be easy to use and to be a preferred option with high clinical performance intended for use in an at-home setting.

Trial Registration

ClinicalTrials.gov Identifier: NCT06120205.

Association between cancer screenings uptake and genetic testing for cancer risk among US adults: findings from HINTS 2017-2020

Genetic testing for cancer risk is a vital tool for preventive care, yet its association with the uptake of evidence-based cancer screening remains unclear. This study examined the association between cancer-risk genetic testing and cancer screening uptake using data from the Health Information National Trends Survey (2017 and 2020), a nationally representative sample of US adults. We focused on the United States Preventive Services Task Force (USPSTF)-recommended screening tests for colorectal (CRC), breast, and cervical cancers. Multivariable logistic regression models, adjusted for sociodemographic and clinical factors, were used to assess the relationship between cancer screening uptake and cancer-risk genetic testing. The analysis included 6,629 respondents (mean age 48.5 years; 50.7% female; 61.1% non-Hispanic White). Of the respondents, 3.3% had undergone genetic testing for cancer risk. Among eligible populations, screening uptake was 85.2% for Pap tests, 80.8% for mammograms, and 81.3% for CRC. Unadjusted analysis showed a significant association between breast cancer screening and genetic testing (p = 0.005), which lost significance after covariate adjustment. Most respondents who underwent genetic testing received result interpretation assistance from healthcare providers and genetic counselors. Among those who received genetic testing, all respondents who received assistance from genetic counselors were adherent to cancer screening recommendations. Our results suggest that while genetic testing was associated with breast cancer screening in unadjusted analyses, this association was not maintained after adjusting for covariates. No significant associations were found between genetic testing and cervical cancer or CRC screening. Further research using prospective designs is needed to examine the effectiveness of genetic testing in enhancing cancer prevention and screening efforts.

Influencing factors on attendance in cervical cancer screening among women with diabetes in Hungary: a cross-sectional study using European Health Interview Surveys 2009-2019

Introduction

With this study, we examined the participation in cervical cancer screening among women with diabetes and the influencing factors of attendance.

Methods

Data from the European Health Interview Surveys in Hungary (2009, 2014, 2019) were analyzed with multivariate and multiple logistic regressions.

Results

A higher level of education (OR=2.56, 95% CI: 1.03-6.33 in the case of secondary level in 2014; and OR=3.09, 95% CI: 1.17-8.13 in the case of tertiary level in 2019, OR= 2.24, 95% CI: 1.12-4.46 in the case of tertiary level in the pooled data), a perceived good economic situation (OR=2.31, 95% CI: 1.30-4.09 in the pooled data), participation in breast cancer screening (OR= 5.41, 95% CI: 3.49-8.38 in the pooled data), and social support (OR= 2.04 95% CI: 1.03-4.03 in 2019) have a positive effect on participation in screening. Taking prescription drugs (OR= 0.31 95% CI: 0.12-0.83, in the pooled data), lower economic status (OR=0.25 95% CI:0.07-0.88, in 2009) and worse perceived health (OR= 0.20, 95% CI: 0.06-0.64 in 2014) can be considered factors with a negative effect.

Conclusion

This study identified groups with low participation rates and made it clear that those groups with unfavorable health factors (bad financial status, bad perceived health, taking prescription drugs) participate the least in screening.

A biosensor based on tetrahydroxyborate-bismuth vanadate for early diagnosis towards lncRNA markers in cervical cancer tumors

This study is concerned with the development of a long non-coding RNA (lncRNA) BCRT1 bio-platform based on tetrahydroxyborate-bismuth vandate ([B(OH)4]--BiVO4) for early diagnosis of cervical cancer (CC). A biosensor based on ([B(OH)4]--BiVO4 was constructed towards CC exosomal lncRNA biomarker. Formation of [B(OH)4]- ligand passivated BiVO4 helps to eliminate surface defects, reducing charge recombination. [B(OH)4]--BiVO4 serves as a base material with excellent photoelectric properties, showing a signal response up to 0.89 mA∙cm-2. This study focused on designing a capture probe for exosomal lncRNA BCRT1 in order to effectively detect early warning signs of the CC. The probe achieved a low detection limit of 5.53 fmol∙L-1 within a range of 0.01-10000 pmol∙L-1, demonstrating good stability, reproducibility and selectivity. This research offers a promising method for the early diagnosis of CC.

Efficacy of ALA-PDT in treating cervical low-grade squamous intraepithelial lesions with high-risk HPV patients: A multicentre randomized controlled trial

Persistent infection with high-risk human papillomavirus (hrHPV) is a major cause of cervical cancer. Current management of low-grade squamous intraepithelial lesions (LSIL) primarily involves monitoring, though some cases progress to cervical precancer or cancer, requiring timely intervention. This study aimed to evaluate the efficacy of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in treating cervical LSIL with hrHPV infection. A total of 155 women with LSIL and hrHPV infection were enrolled and randomly assigned to either the treatment group, which received six sessions of ALA-PDT, or the control group, which underwent routine follow-up. Outcomes were assessed at 6 and 12 months using hrHPV testing, cytology, colposcopy, and biopsy. Results showed that ALA-PDT significantly improved lesion regression and hrHPV clearance rates at both 6 and 12 months. At 6 months, the lesion regression rate in the treatment group was 80.43% versus 56.10% in the control group (p = 0.0203), and the hrHPV clearance rate was 61.96% versus 29.27% (p = 0.0005). At 12 months, both rates remained significantly higher in the treatment group. Age was found to influence hrHPV clearance, with younger women (<45 years) showing significantly higher clearance rates. ALA-PDT was well tolerated, with only minor side effects, such as localized pain and pruritus, reported. The study suggests that ALA-PDT is a safe, effective, and non-invasive treatment option for patients with cervical LSIL and hrHPV infection who require active intervention.

Developing standardized informed consent for hysterectomy and vulva cancer surgery

Informed consent is a fundamental aspect of surgical care, designed to reinforce patient autonomy, promote shared decision-making, and potentially mitigate legal conflicts by ensuring the provision of comprehensive and consistent information. in clinical practice. The Korean Society of Gynecologic Oncology (KSGO) previously published detailed informed consent documents for cervical, endometrial, and ovarian cancer surgery. However, standardized consent forms remain relatively lacking for laparoscopic-robotic hysterectomy performed for non-malignant indications, as well as for vulvar cancer surgery. Hence, the KSGO subcommittee collected, reviewed, and discussed consent forms from domestic medical institutions and subsequently developed informed consent for laparoscopic-robotic hysterectomy and vulvar cancer surgery, aiming to build patient trust and understanding.

Epigenome-wide differential methylation and differential variability as predictors of high-grade cervical intraepithelial neoplasia (CIN2+)

CpG site methylation patterns have potential to improve differentiation of high-grade screening-detected cervical abnormalities. We assessed CpG differential methylation (DM) and differential variability (DV) in high-grade (CIN2+) vs low-grade (≤ CIN1) lesions. In ≤ CIN1 (n = 117) and CIN2+ (n = 31) samples, cervical sample DNA underwent testing with Illumina HumanMethylation arrays. We assessed DM and DV of CpG methylation M-values among 9 cervical cancer-associated genes. We fit CpG-specific linear models and estimated empirical Bayes standard errors and false discovery rates (FDRs). An exploratory epigenome-wide association study (EWAS) aimed to detect novel DM and DV CpGs (FDR < 0.05) and Gene Ontology (GO) term enrichment. Compared to ≤ CIN1, CIN2+ exhibited greater methylation at CCNA1 cluster 1 (M-value difference 0.24; 95% CI, 0.04-0.43) and RARB cluster 2 (0.16; 95% CI, 0.05-0.28), and lower methylation at CDH1 cluster 1 (-0.15; 95% CI, -0.26 to -0.04). CIN2+ exhibited lower variability at CDH1 cluster 2 (variation difference -0.24; 95% CI, -0.41 to -0.05) and FHIT cluster 1 (-0.30; 95% CI, -0.50 to -0.09). EWAS detected 3534 DM and 270 DV CpGs. Forty-four GO terms were enriched with DM CpGs related to transcriptional, structural, developmental, and neuronal processes. Methylation patterns may help triage screening-detected cervical abnormalities and inform US screening algorithms. This article is part of a Special Collection on Gynecological Cancer.

Effectiveness of cervical cancer screening with cytology and human papillomavirus co-testing: A 12-year retrospective study in Oyama district, Japan

BACKGROUND

This study aimed to evaluate the effectiveness of cervical cancer screening with cytology and human papillomavirus (HPV) co-testing in Japan.

METHODS

The study was conducted in Oyama district, Japan, where cytology and HPV co-testing has been implemented since 2012. Data for 2012-2020 were retrospectively analyzed; results were compared with those of cytology-alone screening conducted from 2009 to 2011. Screening outcomes, including referral rate and cervical intraepithelial neoplasia (CIN)2, CIN3/adenocarcinoma in situ, and invasive carcinoma detection rates, were assessed.

RESULTS

Co-testing and cytology-alone screening were performed in 62,155 and 34,040 individuals, respectively; the corresponding referral rates were 4.1 % and 1.9 %. Co-testing resulted in significantly higher referral rates but decreasing trends over time (4.6 %, 4.0 %, and 3.8 % in 2012-2014, 2015-2017, and 2018-2020, respectively). The CIN2 detection rate, which was 0.2 % during the era of cytology alone, significantly increased to 0.49 % during 2012-2014 after the introduction of co-testing and remained higher at 0.31 % during 2015-2017 and 0.37 % during 2018-2020. In contrast, the CIN3 + detection rate increased from 0.13 % during the era of cytology alone to 0.19 % during 2012-2014 but significantly decreased to 0.14 % and 0.06 % during 2015-2017 and 2018-2020, respectively.

CONCLUSION

Our long-term data and comparison with historical controls indicate that co-testing resulted in a higher CIN2 detection rate, potentially reducing CIN3 + community incidence. Although referral rate initially increased with co-testing, a decreasing trend was noted over time.

AGA Clinical Practice Update on Noncolorectal Cancer Screening and Vaccinations in Patients With Inflammatory Bowel Disease: Expert Review

DESCRIPTION

The aim of this American Gastroenterological Association (AGA) Clinical Practice Update (CPU) is to provide Best Practice Advice statements for gastroenterologists and other healthcare providers who provide care to patients with inflammatory bowel disease (IBD). The focus is on IBD-specific screenings (excluding colorectal cancer screening, which is discussed separately) and vaccinations. We provide guidance to ensure that patients are up to date with the disease-specific cancer screenings and vaccinations, as well as advice for mental health and general well-being.

METHODS

This expert review was commissioned and approved by the AGA CPU Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPU Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. The Best Practice Advice statements were drawn from reviewing existing literature combined with expert opinion to provide practical advice on the screening for noncolorectal cancers and vaccinations in patients with IBD. Because this was not a systematic review, formal rating of the quality of evidence or strength of the presented considerations was not performed. Best Practice Advice Statements BEST PRACTICE ADVICE 1: All adult patients with IBD should receive age-appropriate cancer screening. BEST PRACTICE ADVICE 2: Adult women with IBD should follow age-appropriate screening for cervical dysplasia. Data are insufficient to determine whether patients receiving combined immunosuppression or thiopurines require more frequent screening. Shared decision making and individual risk stratification are encouraged. BEST PRACTICE ADVICE 3: All adult patients with IBD should follow skin cancer primary prevention practices by avoiding excessive exposure to the sun's ultraviolet radiation. Patients on immunomodulators, anti-tumor necrosis factor biologic agents, or small molecules should undergo yearly total body skin exam. Patients with any history of thiopurine use should continue with yearly total body skin exam even after thiopurine cessation. BEST PRACTICE ADVICE 4: At every colonoscopy, a thorough perianal and anal examination should be performed. Special attention should be made to inspection of the anal canal of patients with perianal Crohn's disease, with anal stricture, with human papillomavirus, with human immunodeficiency virus, and who engage in anoreceptive intercourse. BEST PRACTICE ADVICE 5: Gastroenterology clinicians should discuss age-appropriate vaccines with adult patients who have IBD and share responsibility with primary care providers for administering these vaccines. Patients with IBD should follow the adult immunization schedule advised by the Centers for Disease Control and Prevention (CDC) for all vaccines with the exception of live vaccines; Patients receiving immune-modifying agents should be counseled against receiving live vaccines; Immunization history to the 2 live pediatric vaccines, varicella and measles, mumps, and rubella vaccine series, is presumptive evidence of immunity. All adults 18 to 26 years of age should receive human papillomavirus vaccine series, and those between 27 and 45 of age years should be vaccinated if they are likely to have a new sexual partner. BEST PRACTICE ADVICE 6: Inactivated vaccines are safe in patients with IBD, and their administration is not associated with exacerbation of IBD activity. We suggest that patients receive vaccines at the earliest opportunity and preferably be off corticosteroids or at the lowest tolerable corticosteroid dose. BEST PRACTICE ADVICE 7: All adult patients with IBD should be evaluated for latent hepatitis B infection. Patients who have previously completed a full hepatitis B vaccine series but are not seroprotected (hepatitis B surface antibody [anti-HBs] <10 mIU/mL) should receive a single challenge dose of hepatitis B vaccine; Four to 8 weeks after this challenge dose, their anti-HBs levels should be measured to evaluate for an amnestic response. An amnestic response, indicated by an anti-HBs level ≥10 mIU/mL (seroprotection), suggests immunologic memory, and no further doses are needed. If no amnestic response is observed, the patient should complete a second full 2- or 3-dose series of hepatitis B vaccination. BEST PRACTICE ADVICE 8: All adult patients with IBD should receive an annual inactivated influenza vaccine. Patients receiving anti-tumor necrosis factor monotherapy or who have undergone a solid organ transplant recipients can benefit from a high-dose influenza vaccine. Adults 65 years of age and older should receive a high-dose, recombinant, or adjuvanted influenza vaccine. Live attenuated intranasal vaccines should be avoided. BEST PRACTICE ADVICE 9: All adult patients with IBD 19 to 64 years of age should receive an initial pneumococcal vaccine, with an subsequent second pneumococcal vaccine administered at 65 years of age and older. BEST PRACTICE ADVICE 10: All adult patients with IBD who are 60 years of age and older should receive a respiratory syncytial virus vaccine. There is no preference for any of the available respiratory syncytial virus vaccines. BEST PRACTICE ADVICE 11: All adult patients 19 years of age and older receiving immune-modifying therapies, or with plans to initiate immune-modifying therapies, should receive a recombinant herpes zoster vaccine series, regardless of their prior varicella vaccination status. BEST PRACTICE ADVICE 12: Bone densitometry should be considered in patients with IBD, regardless of age, when risk factors for osteopenia and osteoporosis are present. These risk factors include low body mass index (<20 kg/m2), >3 months of cumulative corticosteroid exposure, current smoking, postmenopausal status, or hypogonadism. In the absence of other factors, bone densitometry should be considered for postmenopausal women and men 65 years or older. BEST PRACTICE ADVICE 13: All adult patients with IBD should be screened for depression and anxiety annually. Patients who screen positive for depression or anxiety should be referred to the appropriate specialist, be it their primary care physician or a mental health specialist.

Utilization and outcomes of serial cervical cancer screening in a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in a non-Medicaid expansion state

PURPOSE

Since 1990, the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has offered free cervical cancer screening to low-income, uninsured patients, increasing single time point screening and early detection rates. Little is known about NBCCEDP's longitudinal effectiveness. The objective of this study was to assess utilization of Kansas's NBCCEDP, early detection works (EDW) for one-time versus serial screening and compare rates of cervical dysplasia between groups.

METHODS

A retrospective cohort study was conducted among patients who received cervical cancer screening through EDW from 2001 to 2021. Demographic factors, Papanicolaou (Pap) test, and human papillomavirus (HPV) results were compared between patients with one screening versus multiple. Descriptive statistics were performed.

RESULTS

From 2014 to 2021, 3.71-7.06% of eligible patients completed screening through EDW annually. 17.4% of 58,582 eligible patients were up-to-date with screening in 2020. Rural patients and those under age forty were less likely to have EDW screening. Of 43,916 ever-screened patients, 14,638 (33.3%) received multiple screenings. 77% of patients did not have HPV testing; rates were lower in serially screened patients. Cervical dysplasia rates differed minimally between groups.

CONCLUSION

Despite screening 24,017 patients over 7 years, EDW maintains up-to-date screening for under one-fourth of eligible Kansans. Young and rural patients less frequently access EDW. HPV testing is underutilized, which limits the negative predictive value of screening. Serial screening is largely used by low-risk patients currently. Identification and prioritization of serial screening in high risk could increase program impact.

Validating the predicted impact of HPV vaccination on HPV prevalence, cervical lesions, and cervical cancer: A systematic review of population level data and modelling studies

BACKGROUND

We compared model predictions with independently published primary data from population-based studies on the impact of HPV vaccination on HPV prevalence, cervical cancer and its precursors.

METHODS

We searched Cochrane Library, EMBASE, MEDLINE, Web of Science for studies concerning high-income countries published between 2005 to June 2, 2023. Relative risk (RR) for HPV-related outcomes comparing the pre-vaccination and post-vaccination periods were collected from observational and modelling studies. The relationship between vaccination coverage and observed relative reductions was determined using meta-regressions, and we compared model prediction to observations.

FINDINGS

We identified a total of 5649 potential articles, of which one systematic review, 14 observational studies and 32 modelling studies met our inclusion criteria. A clear relation was found between the RR of HPV diseases related outcomes in the pre- versus post-vaccination era and the vaccination coverage, with 23 out of 28 data points and 19 out of 20 data points showing significant reductions in HPV prevalence and CIN2+ prevalence respectively. Around 67 % (n/N = 12/18) of model predictions were more optimistic on HPV prevalence reductions compared to the 95 % CI of the meta-regression derived from observational studies. For CIN2+ lesions, 48 % (n/N = 31/64) of model predictions for CIN2+ outcomes fell within the 95 % CI.

INTERPRETATION

Model predictions and observational data agree that HPV vaccination can have a substantial impact on HPV related outcomes on a population level. Despite large heterogeneity in observational data and modelling studies, it is particularly encouraging that model predictions on the impact of HPV vaccination on CIN2+ model lesions align with observational studies.

FUNDING

Ontario Health (formerly known as Cancer Care Ontario).

Extended HPV genotyping and dual stain for the triage of primary HPV screen-positive cases: Practical guidance for the cytopathology laboratory

Because of many factors, the landscape of cervical cancer prevention is again at a pivot point within the United States. Primary human papillomavirus (HPV) screening has been recommended as the preferred testing method by the American Cancer Society since 2020. Although primary HPV testing provides high negative predictive value in screening, women who screen positive for HPV need triage using methods that have an optimal balance between sensitivity for precancer and the number of colposcopies required for detection. The triage test ideally should maximize specificity while also reassuring patients who test negative, although it should be acknowledged that no screening or triage test can entirely exclude disease in a screen-positive patient. While cervical cytology (the Papanicolaou test) triage of primary HPV screen-positive patients is currently recommended by most screening strategies, additional triage tests, specifically extended HPV genotyping and combined p16/Ki-67 dual-stain immunocytochemistry, are now approved by the US Food and Drug Administration and incorporated into cervical cancer screening and management guidelines. Incorporating these triage methods into practice should be achieved by using appropriate validation/verification and implementation steps and, in the case of dual-stain immunocytochemistry, appropriate cytologist/cytopathologist training. The US Food and Drug Administration approval of vaginal self-collection in May 2024 is another significant advance for increasing access to screening. These samples can only be tested using primary HPV screening platforms, and guidance for management has been endorsed by the ASCCP's enduring guidelines process. This review discusses issues that warrant consideration before implementation and provides practical guidance for the incorporation of self-collected specimens and extended genotyping/dual-stain tests into the workflow of the cytopathology laboratory.

Evaluating the trend of time to colposcopy follow-up among women with a positive primary human papillomavirus screening result at Kaiser Permanente Southern California

BACKGROUND

Timeliness of colposcopy follow-up after primary human papillomavirus screening has not been well examined.

OBJECTIVE

We evaluated time to colposcopy follow-up among women with an abnormal primary human papillomavirus screening result overall and by human papillomavirus genotype, triage cytology results, race/ethnicity, and neighborhood deprivation index.

STUDY DESIGN

Women aged 30 to 65 years who received primary human papillomavirus screening at Kaiser Permanente Southern California from July 15, 2020, to December 31, 2021 and had screening results that required colposcopy follow-up were identified. All data were collected from Kaiser Permanente Southern California's electronic medical records. Multivariable modified Poisson models were used to evaluate the associations between human papillomavirus type and triage cytology results, race/ethnicity, neighborhood deprivation index, and receiving a colposcopy within 3 months and 6 months of screening results.

RESULTS

A total of 5833 women were included. The mean age was 42.9 years; 11.4%, 9.8%, 48.7%, and 24.4% were of Asian/Pacific Islander, non-Hispanic Black, Hispanic, and non-Hispanic White race/ethnicity. Overall, 71% and 78% received colposcopy within 3 and 6 months of screening, respectively. Compared with women with non-16/18, other high-risk human papillomavirus types and low-grade cytology results, women with HPV 16/18 with normal low-grade or high-grade cytology results and women with other high-risk human papillomavirus and high-grade cytology results were more likely to have colposcopy within 3 months of screening results [risk ratio ranged from 1.21 (95% confidence interval, 1.16-1.25) to 1.34 (95% confidence interval, 1.25, 1.42)]. Non-Hispanic Black women (vs non-Hispanic White, risk ratio=0.93 [0.87, 1.00]) and women from the most deprived neighborhoods (vs least deprived, risk ratio=0.95 [0.90, 1.00]) had lower likelihoods of receiving colposcopy within 3 months of screening. Findings for 6 months of follow-up were similar to that of 3 months.

CONCLUSION

Our observations confirmed prioritization of diagnostic follow-up for women with human papillomavirus 16/18+ as well as high-grade cytology results. Barriers to incomplete colposcopy follow-up and disparity should be better understood and addressed.

Innovative smart biosensors for cancer theranostics: A new frontier in detection, diagnosis, and beyond

Cancer is still a major health concern worldwide, requiring ongoing improvements in methods of diagnosis and treatment. During the past decade, smart biosensors have become essential instruments in cancer theranostics, improving diagnosis accuracy, tracking treatment efficacy, and customizing patient care. This review thoroughly investigates how smart biosensors have revolutionized the field of cancer. The potential of major technical advancements, such as wearable technology, microfluidic platforms, and sensors based on nanomaterials to identify cancer biomarkers with high sensitivity and specificity is investigated. A detailed discussion is held regarding clinical applications that include early diagnosis, real-time monitoring of therapy responses, and support for personalized medicine techniques. Future directions targeted at optimizing the therapeutic utility of smart biosensors in oncology are also examined, along with issues pertaining to regulatory routes and clinical translation hurdles. This study highlights the potential of smart biosensors to transform cancer treatment, bringing in a new era of precision medicine and better patient outcomes by combining insights from multiple viewpoints.

Exploring cervical cancer screening awareness, beliefs, barriers, and practices among indonesian muslim women in Japan: a qualitative study

BACKGROUND

The population of migrant women in Japan is increasing, with a corresponding need for access to health services. Cervical cancer screening (CCS) coverage remains very low within this group. This is an increasingly difficult challenge for Muslim migrant women due to their religious values and beliefs. However, research addressing the awareness, beliefs, barriers, and practices of Muslim migrant women in Japan regarding CCS is lacking. This study aims to fill this gap by exploring CCS awareness, beliefs, barriers, and practices among Indonesian Muslim women in Japan.

METHODS

A qualitative study was conducted in Osaka, Japan, involving in-depth interviews with 12 Indonesian Muslim women. Data were collected between January and April 2023. All participants were between 20 and 50 years old, Muslim, married, had resided in Japan for a minimum of 3 years, and had no cervical cancer diagnosis.

RESULTS

The participants demonstrated awareness regarding cervical cancer and CCS. However, in actual practice, they encountered several obstacles that might have prevented them from undergoing CCS, including language barriers, lack of information, pain, and psychological factors. All participants preferred female doctors for CCS procedures.

CONCLUSIONS

This research provides information regarding factors that influence Indonesian Muslim migrant women seeking CCS. The need for structured and organized efforts is critical to improve the healthcare system and increase Japan's readiness to accept not only Muslim patients but also migrant patients in general.

TRIAL REGISTRATION

Not applicable.

Sexually transmitted human papillomavirus and related sequelae

SUMMARYMore than 40 types of sexually transmitted human papillomavirus (HPV) infect the oropharyngeal and anogenital mucosa-high-risk types are associated with precancerous and cancerous lesions of the cervix, vagina, vulva, penis, anus, and oropharynx, and low-risk types cause non-malignant disease, such as anogenital warts. Though most HPV infections resolve spontaneously, immunodeficiencies may result in persistent infection and increased risk of HPV-related sequelae. The mechanism by which HPV results in malignant transformation is multifaceted, involving interactions with numerous cellular pathways, the host immune system, and potentially the host microbiome. Vaccination against HPV is highly efficacious in the prevention of infection and related sequelae, and there now exist several approved formulations that protect against both high- and low-risk types. Despite the advent of vaccination, early detection and treatment of cervical and anal precancerous lesions continues to be integral to secondary prevention-molecular HPV testing, cytology, and tissue biopsy allow for triaging of patients, after which appropriate treatment with close follow-up can avert cancer development.

Multi-center evaluation of the Alinity m HR HPV assay with liquid-based cytology cervical specimens in the United States

Incorporating molecular testing for human papillomavirus (HPV) into the screening of cervical specimens can improve risk stratification and, in turn, patient management. Infection with a high-risk (HR) HPV genotype is associated with greater risk for persistent infection, viral integration, and progression of cervical neoplasia. Current guidelines consider HPV 16 or HPV 18 clinically actionable with referral to colposcopy; however, 12 Other HR HPV genotypes have been associated with cervical cancer risk, suggesting a benefit of extended genotyping. In this multi-center study, we evaluated the performance of the Alinity m HR HPV assay, which reports HPV 16, 18, and 45 individually and aggregates of HPV 31/33/52/58 and HPV 35/39/51/56/59/66, compared with cobas HPV and Aptima HPV assays, across a variety of cytology result categories. A total of 746 de-identified residual cervical specimens, collected as part of routine cervical cancer screening programs, were tested using Alinity m HR HPV and at least one comparator assay. The overall percent agreement was ≥90.7% for results from the Alinity m HR HPV assay and cobas HPV assays and 90.5% for results from the Alinity m HR HPV and Aptima HPV assay. In patients with any abnormal cytology result, Alinity m identified 78 specimens with non-HPV 16/18 results, underscoring the benefit of detecting additional HR HPV genotypes to guide patient management more accurately. Among specimens with normal cytology, Alinity m detected 14 additional specimens with non-HPV 16/18 genotypes. Extended HR HPV testing can provide additional information to triage patients for appropriate testing and follow-up.IMPORTANCEExtended genotyping for high-risk human papillomavirus (HPV) types enhances diagnostic precision by identifying additional oncogenic HPV types beyond 16 and 18 therefore offering a more nuanced risk profile. This more comprehensive detection may aid in identifying persistent infections that are more likely to progress, thereby supporting future risk-based patient management strategies.

Estimated Cancer Risk in Females Who Meet the Criteria to Exit Cervical Cancer Screening

Importance

Cervical screening guidelines in the US recommend that most females can exit routine screening at age 65 years following 2 recent consecutive negative cotest results (concurrent human papillomavirus and cytology tests). However, empirical data on the subsequent risks of cancer and cancer death in this subgroup of females are limited.

Objective

To estimate the risks of cervical cancer and cervical cancer death among females who meet the cotesting criteria to exit screening.

Design, Setting, and Participants

In this decision analytical comparative modeling study, 4 decision analytical models from the Cancer Intervention and Surveillance Modeling Network-Cervical modeling consortium that fit common US epidemiological data targets were validated against published estimates of 3- and 5-year risks of cervical intraepithelial neoplasia grade 3 (CIN3) among females meeting exit criteria at Kaiser Permanente Northern California (KPNC).

Main Outcomes and Measures

Age-conditional and cumulative risks of cervical cancer and cervical cancer death at ages 65, 70, 75, 80, and 85 years were estimated by performing a comparative modeling analysis of the 4 models to estimate the risks of cervical cancer and cervical cancer death after exiting screening.

Results

All models estimated a 5-year risk of CIN3 that was within the range of empirical data from KPNC. Projections of the cumulative and age-conditional risks of cervical cancer and cervical cancer death increased with time since exiting screening. The cumulative risks of cervical cancer and cervical cancer death by age 70 years were estimated to range from 0.001% to 0.003% and from 0% to 0.001%, respectively. The cumulative risks of cervical cancer and cervical cancer death by age 85 years ranged from 0.026% to 0.081% and from 0.005% to 0.038%, respectively, across models. Results were sensitive to assumptions about screening test sensitivity and incidence of high-risk human papillomavirus.

Conclusions and Relevance

In this decision analytical comparative modeling study, a low risk of cervical cancer and cervical cancer death was estimated among females who fulfilled the US criteria to exit screening with cotesting; however, the risks increased with age and/or time since screening exit. The findings suggest that future guidelines should consider acceptable risk levels when defining screening modality and exit age requirements.

Comparative evaluations of different surgical and non-surgical treatment methods for early invasive and micro invasive squamous cell carcinoma in the oral and maxillofacial regions: A systematic review

OBJECTIVES

The pathogenesis and progressive behavior of head, neck, oral and maxillofacial (HNOMF) squamous cell carcinoma (SCC) has been suggested to be a multistep and multifactorial procedure that necessitates epithelial hyperplasia, epithelial dysplasia, micro invasive squamous cell carcinoma (MISCC) and early invasive squamous cell carcinoma (EISCC); EISCC and MISCC might have a completely different behavior and development process. There are only a limited number of reported HNOMF cases of EISCC or MISCC. There are still no guidelines for the treatment of EISCC and MISCC lesions in the HNOMF regions.

MATERIAL AND METHODS

This systematic review was conducted to gather all surgical and non-surgical treatments for EISCC and MISCC lesions in the HNOMF. The study question according to the PICO format was as followed: clinical and histopathological results (O) of all types of treatments (I) for patients with EISCC and MISCC lesions in HNOMF (P) compared to untreated lesions (C). Medline, Scopus, and Google Scholar were searched and the search was limited to English-language.

RESULTS

Eight clinical human studies were included. Photodynamic therapy (PDT) after topical application of methyl aminolevulinate (MAL-PDT) and topical Imiquimod 5 % cream both had remarkable outcomes.

CONCLUSIONS

However, due to the very limited number of studies conducted on the treatment methods of MISCC and EISCC in the HNOMF regions, further studies are necessary to provide reliability for non-surgical treatment methods.

Cervical cancer screening rates in females living with HIV at three healthcare settings in the United States, 2010-2019

PURPOSE

Females living with human immunodeficiency virus (FLWHIV) are at increased risk of cervical cancer and U.S. guidelines, first published in 2009 and updated since then, recommend more frequent screening in this population. We examined screening rates among FLWHIV in the U.S. during 2010-2019.

METHODS

This cohort study included 18-89-year-old FLWHIV during 2010-2019 at three U.S. healthcare settings. Sociodemographics, comorbidities, and cervical cancer screening tests were ascertained from administrative and clinical databases. We reported cervical cancer screening rates overall and by modality. Generalized estimating equations with Poisson distribution were used to estimate screening rate ratios (SRRs) and 95% confidence intervals (CIs) for the associations between screening rates and calendar year, age, race and ethnicity, and comorbidity.

RESULTS

Among 3,556 FLWHIV, a total of 7,704 cervical cancer screening tests were received over 18,605 person-years during 2010-2019 (screening rate = 41.4 per 100 person-years). Relatively lower screening rates were associated with later calendar years (SRR = 0.71 [95% CI 0.68-0.75] for 2017-2019 versus 2010-2013), older age (SRR = 0.82 [95% CI 0.74-0.89] for 50-65-year-olds versus 18-29-year-olds), non-Hispanic white race versus non-Hispanic Black race (SRR = 0.89 [95% CI 0.81-0.98]) and greater comorbidity burden (SRR = 0.89 [95% CI 0.82-0.98] for ≥ 9 versus 0-6 comorbidity score).

CONCLUSION

The decrease in cervical cancer screening rates during 2010-2019 in this large cohort of FLWHIV may be explained at least partly by guideline changes during the study period recommending longer screening intervals. Our findings of relatively lower screening rates in FLWHIV who were non-Hispanic white, older, and with greater comorbidity burden should be confirmed in other U.S.

SETTINGS

The cross-sectional association between lifestyle behaviors and breast and cervical cancer screening among Hispanic women along the Texas-Mexico border

Objective

Lifestyle behaviors may influence timely cancer screening, but their relationship is unknown among Hispanic women who have low cancer screening rates.

Methods

We used Cameron County Hispanic Cohort data from 2014 to 2022 to evaluate the relationship between lifestyle and compliance with mammography and Papanicolaou (Pap) screening guidelines ("up-to-date") among Hispanic women along the Texas-Mexico border. The 2018 World Cancer Research Fund scoring system characterized cancer-preventive lifestyle adherence. Multivariable logistic regression assessed the association between lifestyle behaviors and mammography and, separately, Pap screening.

Results

Among 385 age-eligible women for mammography and 412 age-eligible women for Pap test screening, up-to-date mammography and Pap screening were seen in 66.7 % (95 % CI: 58.8-73.7 %) and 71.4 % (95 % CI: 63.6-78.0 %) of women, respectively. Compared to non-adherence, adherence to waist circumference (AOR adjusted odds ratio 9.1, 95 % CI: 1.1-77.9; P = 0.04) and alcohol guidelines (AOR 9.4, 95 % CI: 1.1-81.6; P = 0.04) were associated with up-to-date mammography. Consumption guideline adherence to fruit and vegetable (AOR 4.0, 95 % CI: 1.2-13.4; P = 0.03), ultra-processed foods (AOR 7.5, 95 % CI: 1.6-34.7; P = 0.01), red meat (AOR 6.8, 95 % CI: 1.3-34.8; P = 0.02), and sugary beverages (AOR 16.9, 95 % CI: 2.1-138.4; P = 0.01) were associated with up-to-date Pap screening.

Conclusions

Differential factors were associated with increased odds of being up-to-date with mammography versus Pap test screening. Lifestyle behavior promotion complements cancer prevention interventions. Contextual insight into the association between lifestyle and cancer screening provides a foundation for future endeavors to augment these two core components of cancer prevention to address Hispanic women's rising breast and cervical cancer risk.

Gynecologic Cancer Screening and Prevention: State of the Science and Practice

OPINION STATEMENT

Gynecological cancers, including cervical, endometrial, ovarian, and vulvovaginal cancer, have increasing incidence and mortality globally over the last three decades. In that time, there have been advances in medical therapies and paradigm shifts in surgical treatment which have resulted in a greater quality of life for patients. Clinicians have also refocused efforts to preventing gynecologic cancer. The state of screening and prevention is varied in each of the cancer types. The most comprehensive screening program and only preventable gynecological cancer is cervical cancer, which has been heavily studied since the 1900s. Cervical cytology, primary high-risk human papillomavirus (HPV) testing only, and co-testing are all effective in detecting cervical dysplasia and touted by the major medical. An additional arsenal is prevention through vaccination which has been shown to decrease cervical cancer. Unfortunately, the other gynecological cancers do not have effective screening strategies. The high rates of symptoms in endometrial cancer facilitate detection at an early stage but thus far, asymptomatic screening is only advocated in very high-risk population due to the invasive nature. Novel non-invasive mechanisms are currently under study though none have translated into clinical practice as of yet. Ovarian cancer remains the most innocuous with vague symptoms at onset resulting in late-stage diagnosis. Recommendations for prophylactic oophorectomy only apply to subsets of the population with predisposing genetic mutations. This has led to an ardent push for creative strategies such as opportunistic salpingectomy and a national genetic screening program. These efforts are in addition to the investigations underway researching radiologic, liquid biopsy, and genetic marker screening modalities for all gynecologic cancer. This review article discusses the state of screening, prevention, and recent advancements and pilot studies for each gynecological cancer.

Evidence-Based Periodic Health Examinations for Adults: A Practical Guide

Periodic health examinations, or annual clinical checkups, are a primary reason for seeking medical care. The objective is to identify hidden problems or diseases in their early stages and to promote behaviors that prevent or minimize the consequences of these conditions. However, the practice of conducting annual reviews with clinical, laboratory, and imaging examinations indiscriminately is not associated with outcomes that matter to the patient (such as reducing morbidity and mortality) and may result in harm, including overdiagnosis and overtreatment. The objective of the present work is to review and summarize the measures currently recommended and supported by scientific evidence from the main regulatory authorities of the United States (United States Preventive Services Task Force (USPSTF)) and Canada (Canadian Task Force on Preventive Health Care (CTFPHC)), in order to create a practical guide for evidence-based checkups.

Modeling HPV Self-Sampling Impact on Cervical Cancer in East African Immigrants

INTRODUCTION

Cervical cancer screening uptake among East African immigrants in the U.S. is low. Offering self-collected samples for human papillomavirus (HPV) testing increases screening coverage among underserved populations, but the potential impact on cervical cancer incidence and mortality is understudied.

METHODS

A Markov cohort state-transition model was used to predict the impact of primary HPV screening with self-sampling on cervical cancer incidence and mortality among East African immigrant women in Washington state. The model estimated cervical cancer cases and deaths for a hypothetical cohort from ages 25 to 80 years under alternative screening, diagnostic colposcopy and treatment scenarios. Base case scenarios compared primary HPV testing by clinician-sampling exclusively (standard of care) with self-sampling exclusively, assuming higher screening coverage (70% vs 63%) but lower colposcopy adherence with self-sampling (67% vs 83%) with equal treatment coverage of 85%, based on Washington state patient data. Sensitivity analyses with varied coverages, and also the combinations of the 2 strategies were evaluated. The model was developed and fitted between 2022 and 2024.

RESULTS

In the base case scenario, an exclusive self-sampling strategy results in 4% higher cervical cancer incidence and mortality compared to the standard of care. Self-sampling results in lower cancer incidence and mortality if colposcopy adherence is raised to the level of the standard of care and/or if coverage is increased beyond 90%. In scenarios combining clinician- with self-sampling, the benefits of reaching more women with self-sampling are attenuated if more than 34% of screening is done by self-sampling.

CONCLUSIONS

Self-sampling has the potential to improve cervical cancer prevention for underserved populations. The impact of the strategy can be enhanced with stronger linkage to follow-up care.

Benchmarking high-risk human papillomavirus testing against cytology and biopsy results in the detection of cervical dysplasia to inform clinical screening guidelines

INTRODUCTION

The United States Preventive Services Task Force (USPSTF) recommendation for cervical cancer screening includes the option to screen with high-risk human papilloma virus (hrHPV) alone, but some studies have reported that hrHPV testing alone missed precancerous and cancerous lesions. In this study, we evaluated the test performance characteristics of hrHPV in detecting cervical dysplasia with cervical cytology and biopsy as comparators.

MATERIALS AND METHODS

We conducted a retrospective analysis of Papanicolaou smears between January and December 2019 performed at our institution with concurrent hrHPV and cytology testing. Cases were identified in the laboratory information system and abstracted data included patient age, hrHPV result, concurrent cytology result, and follow-up cervical biopsy result where available.

RESULTS

A total of 3748 cases were identified with concurrent hrHPV and cytology testing and 79 cases with concurrent hrHPV and biopsy results. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) "hrHPV for detecting dysplasia on cytology was 70% (95% CI: 60.7%-77.8%), 98% (95% CI: 97.4%-98.4%), 53% (95% CI: 46.2%-58.8%), and 99% (95% 98.7%-99.2%), respectively (P value <0.00001). The sensitivity, specificity, PPV, and NPV of hrHPV for detecting dysplasia on biopsy was 76% (95% CI: 61.1%-86.7%), 30% (95% CI: 14.7%-49.4%), 64% (95% CI: 57.0%-70.5%), and 43% (95% CI: 46.6%-61.0%), respectively (P value <0.3).

CONCLUSIONS

hrHPV testing alone would have missed 30% of dysplastic samples identified by cytology and 24% of dysplastic samples confirmed by cervical biopsy. These findings support a comprehensive strategy of dual cervical cancer screening with cytology and hrHPV testing.

Optimizing Care for Women Through Gynecologic Organ Considerations During Cystectomy: A Pre-Operative Checklist of Important Considerations

Bladder cancer is a relatively rare malignancy; however, women are more likely to present with muscle invasive disease and require radical cystectomy. Radical cystectomy is a life-altering operation, requiring thoughtful consideration of both urologic and gynecologic organs. In order to improve the standard of care for women undergoing radical cystectomy, urologists should adopt a thorough, patient-centered approach to surgical planning. This narrative review provides a review of the extant literature pertaining to the management of gynecologic organs in women undergoing radical cystectomy, including the management of the cervix, uterus, and adnexa.

Self-Collection for Primary HPV Testing: Acceptability in a Large Urban Emergency Department

STUDY OBJECTIVE

Overdue cervical cancer screening increases the risk of invasive cervical cancer. It is important to identify settings where self-collection for primary human papillomavirus (HPV) testing can be implemented to have high effect on cervical cancer screening among hard-to-reach women with overdue screening. Herein, we examined the acceptability of HPV self-collection, including completion rates, attitudes, and experiences among women seeking noncritical care at a high-volume urban safety-net hospital emergency department (ED) in Houston, Texas, United States.

METHODS

In this single-arm intervention pilot study, we recruited women overdue for cervical cancer screening in the waiting areas of a safety-net hospital ED, seeking noncritical care from November 2023 to April 2024. Participants completed a preintervention survey and were offered an HPV self-collection kit. A postintervention survey followed immediately after HPV self-collection.

RESULTS

Nearly 30% (119 of 401) screened for eligibility were overdue for cervical cancer screening. Of these, 93% were enrolled and were predominantly Hispanic, non-US born, and uninsured, with a median age of 45 years (IQR: 37 to 53). HPV self-collection completion rate was 90% (95% CI 82.9% to 94.9%). More than a quarter (27%) of these women had never been screened, and 14% had a screening >10 years prior. Most women who completed the HPV self-collection had positive attitudes and experiences and reported that the kit was easy to use (97%) and would be very willing to use HPV self-collection for regular screening (88%).

CONCLUSION

HPV self-collection for primary cervical cancer screening during noncritical ED visits is possible and highly acceptable among women overdue for cervical cancer screening.

Risk of Cervical Carcinoma After Unfavorable Behavior and High Genetic Risk in the UK Biobank: A Prospective Nested Case-Control Study

Background: Previous studies have established a general understanding of the association between risky sexual behavior, genetic risk, and cervical carcinoma. However, these studies were conducted several years ago and lack systematic analysis using high-quality and population-based data. Methods: We conducted a prospective nested case-control study to identify risky behaviors and developed a behavior score. Combining the behavior score and genetic risk, we evaluated the effect of sexual and reproductive behavior and PRS on cervical carcinoma through the developed conditional logistic regression models. Results: We verified increased carcinoma risk in individuals with early sexual intercourse (OR: 1.41 [95% CI 1.09 to 1.83], p = 0.0083), non-monogamous sexual partners (OR: 3.13 [95% CI 2.15 to 4.57], p < 0.0001), three or more live births (OR: 1.44 [95% CI 1.12 to 1.84], p = 0.0040), and high PRS (polygenic risk score) (top 25% of PRS, OR: 1.58 [95% CI 1.15 to 2.16], p = 0.0044). The unfavorable sexual and reproductive behavior score we developed was linked to a 151% increased risk (OR: 2.51 [95% CI 1.79 to 3.52], p < 0.0001) after adjusting for PRS. Women with both unfavorable behavior and high genetic risk had a 5.5-fold increased cervical carcinoma risk (OR: 5.45 [95% CI 2.72 to 10.95], p < 0.0001) compared to individuals with favorable behavior and low genetic risk. Conclusions: Unfavorable sexual and reproductive behavior increases the risk of cervical carcinoma, especially in those with a high genetic risk. These findings encourage us to adhere to a healthy sexual and reproductive pattern.

Race/Ethnicity, Human Papillomavirus Vaccination Status, and Papanicolaou Test Uptake Among 27-45-Year-Old Women: A Cross-Sectional Analysis of 2019-2022 Behavioral Risk Factor Surveillance System Data

Purpose

The human papillomavirus (HPV) vaccine was recently approved for 27-45-year-olds. We examined the association between HPV vaccination status and having an up-to-date Papanicolaou (Pap) test for 27-45-year-old women across racial/ethnic groups.

Methods

We conducted a cross-sectional analysis using 2019-2022 Behavioral Risk Factor Surveillance System data. We performed weighted multivariable logistic regressions to examine the association between being unvaccinated, initiating, and completing the HPV vaccine series and Pap test uptake.

Results

Among 7,052 women, non-Hispanic White (NHW) women had the highest rate of HPV vaccine series completion (14.0%). Non-Hispanic Black (NHB) had the lowest rate of HPV vaccine series completion (9.2%) and the highest rate of up-to-date Pap tests (71.2%). Non-Hispanic Other (NHO) women had the lowest rate of up-to-date Pap tests (52.1%). Completing the HPV vaccine series was associated with increased odds of having an up-to-date Pap test (odds ratio [OR]: 1.66 95% confidence interval [CI]: 1.23-2.24). Among Hispanic and NHW women, HPV vaccine series completion was associated with increased odds of up-to-date Pap testing (Hispanic: OR: 2.16, 95% CI: 1.02-4.58; NHW: OR: 1.49, 95% CI: 1.01-2.21). HPV vaccine series initiation was associated with up-to-date Pap tests for NHB (OR: 2.75, 95% CI: 1.19-6.34) and NHO women (OR: 3.15, 95% CI: 1.56-6.37).

Conclusions

Unvaccinated women had decreased odds of up-to-date Pap testing. Shared clinical decision-making should be utilized to help 27-45-year-old women decide if they want to receive the HPV vaccine; culturally tailored efforts should be made to improve utilization of Pap testing across racial/ethnic groups.

Associations of social support, living arrangements, and residential stability with cancer screening in the United States

PURPOSE

Social support has been linked to increased use of preventive care services. Living arrangements and residential stability may be important structural sources of social support, but few studies have examined their impact on cancer screening.

METHODS

Data were from the 2021 National Health Interview Survey. Participants were classified as up-to-date or not with female breast cancer (BC), cervical cancer (CVC), and colorectal cancer (CRC) screening recommendations. Multivariable logistic regression was used to model associations between screening and residential stability (< 1 year, 1-3 years, 4-10 years, 11-20 years, or > 20 years), living arrangement (with spouse/partner only, children only, both, or neither), and perceived social support (rarely/never, sometimes, usually, or always available), overall and stratified by sex (CRC) and age group (CVC).

RESULTS

The adjusted odds of BC (odds ratio [OR]  0.61, 95% CI 0.45-0.81) and CVC (OR 0.76, 95% CI 0.60-0.96) screening were lowest for those who reported never/rarely vs. always having social support. The adjusted odds of BC (OR 1.44, 95% CI 1.22-1.70) and CRC (ORFEMALE = 1.42, 95% CI 1.20-1.68; ORMALE = 1.61, 95% CI 1.35-1.90) screening were higher for those living with a spouse/partner only vs. those living with neither spouse/partner nor children. Less residential stability was associated with increased CVC screening among females 21-34 years of age, but not BC or CRC screening.

CONCLUSIONS

Social support measures were associated with screening to varying degrees by site and age, but higher perceived social support and living with a spouse/partner only demonstrated a consistent positive association. Interventions that mobilize social support networks and address the unmet social needs of parents/caregivers may improve cancer control.

Acceptability of Home-Based Urine Self-Collection for Cervical Cancer Screening Among Women Receiving Care at the Arab Community Center for Economic and Social Services in Michigan

BACKGROUND

Michigan's Middle Eastern-North African (MENA) community is an essential and growing part of the state's population. However, MENA individuals are underrepresented in the research literature due to a lack of recognized demographic categorization. Prior work shows that MENA women face barriers to traditional clinician-directed cervical cancer screening. This study aims to capture the perspectives of MENA women about home-based urine cervical cancer screening using HPV kits and to assess whether such methods could positively impact future screening intent.

METHODS

Through collaboration with a community partner in southeast Michigan, we recruited MENA women ages 30-65, with 44 completing the study. Participants used urine HPV self-sampling kits at home and then shared their perspectives through a phone interview. We used an inductive, thematic approach to analyze the interviews, which captured experiences with home-based self-sampling, screening preferences, and impact on future screening intent.

RESULTS

Participants found that urine home-based self-sampling was acceptable as a convenient and comfortable way to screen for cervical cancer. Most (80%) preferred self-sampling over traditional clinician-directed screening and preferred collecting urine samples at home (73%) rather than in the clinic. Overall, 80% reported that access to urine self-sampling would positively impact their future screening intent.

CONCLUSIONS

MENA participants in this study positively received home-based cervical cancer screening using urine HPV self-sampling kits. These findings support the clinical implementation of self-sampling and home-based cervical cancer screening to increase participation, particularly among those in under-screened communities.