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Agaba CD, Namuli A, Ainomugisha B, Tibaijuka L, Ninsiima M, Ngonzi J, Akatukwasa C, Owaraganise A. Providers and women's perspectives on opportunities, challenges and recommendations to improve cervical cancer screening in women living with HIV at Mbarara Regional Referral Hospital: a qualitative study. BMC Womens Health 2024; 24:392. [PMID: 38978020 PMCID: PMC11229203 DOI: 10.1186/s12905-024-03239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 06/30/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Cervical cancer screening uptake remains low despite being a critical prevention method for adult women living with HIV(WLHIV). These women experience greater incidence and persistence of high-risk human papillomavirus (HPV) and severe outcomes, including cervical cancer comorbidity and death. OBJECTIVE We explored the opportunities, challenges, and recommendations of clinical care providers and WLHIV to improve cervical cancer screening uptake among WLHIV in Southwestern Uganda. METHODS In a cross-sectional qualitative study from January to June 2021 at Mbarara Regional Referral Hospital, we interviewed six key informant clinical care providers and held four focus group discussions with women living with HIV. Data was coded using Atlas ti software and analysed using thematic inductive analysis. RESULTS The participants identified several prevailing opportunities for cervical cancer screening, including skilled clinical care workers, public awareness for demand creation, optimized clinic flow, provider-led referrals, and peer-led information sharing that ease clinic navigation and shorten participant throughput. However, challenges occurred due to standalone services resulting in double queuing, longer clinic visit hours, missed chances for screening alongside unsupported lower health facilities leading to crowding at the referral hospital, and inadequate patient privacy measures leading to shame and stigma and the misconception that cervical cancer is incurable. Integrating HPV-DNA testing in HIV services was perceived with ambivalence; some participants worried about the quality of sample collection, while others valued the privacy it offered. Optimising self-collected DNA testing and sufficient counselling were recommended to improve cervical cancer screening uptake. CONCLUSION Opportunities for cervical cancer screening included trained clinical care professionals, increased public awareness, improved clinic flow, provider referrals, and peer education. Challenges, such as unsupported lower-level health facilities, misconceptions, inadequate patient privacy, and uncertainty about integrating HPV-DNA screening into HIV services, were cited. Adequate counselling and self-sample collection were recommended to foster screening. Our findings may guide healthcare programs integrating cervical cancer screening into HIV clinics to reach the 70% World Health Organisation targets by 2030.
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Affiliation(s)
- Collins David Agaba
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexcer Namuli
- Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Brenda Ainomugisha
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Leevan Tibaijuka
- Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Mackline Ninsiima
- Department of Epidemiology, School of Public Health, Makerere College of Health Sciences, Kampala, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Asiphas Owaraganise
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
- Infectious Diseases Research Collaboration, Kampala, Uganda.
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Klasnja P, Meza RD, Pullmann MD, Mettert KD, Hawkes R, Palazzo L, Weiner BJ, Lewis CC. Getting cozy with causality: Advances to the causal pathway diagramming method to enhance implementation precision. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895241248851. [PMID: 38694167 PMCID: PMC11062231 DOI: 10.1177/26334895241248851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Background Implementation strategies are theorized to work well when carefully matched to implementation determinants and when factors-preconditions, moderators, etc.-that influence strategy effectiveness are prospectively identified and addressed. Existing methods for strategy selection are either imprecise or require significant technical expertise and resources, undermining their utility. This article outlines refinements to causal pathway diagrams (CPDs), a method for articulating the causal process through which implementation strategies work and offers illustrations of their use. Method CPDs are a visualization tool to represent an implementation strategy, its mechanism(s) (i.e., the processes through which a strategy is thought to operate), determinants it is intended to address, factors that may impede or facilitate its effectiveness, and the series of outcomes that should be expected if the strategy is operating as intended. We offer principles for constructing CPDs and describe their key functions. Results Applications of the CPD method by study teams from two National Institute of Health-funded Implementation Science Centers and a research grant are presented. These include the use of CPDs to (a) match implementation strategies to determinants, (b) understand the conditions under which an implementation strategy works, and (c) develop causal theories of implementation strategies. Conclusions CPDs offer a novel method for implementers to select, understand, and improve the effectiveness of implementation strategies. They make explicit theoretical assumptions about strategy operation while supporting practical planning. Early applications have led to method refinements and guidance for the field.
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Affiliation(s)
- Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Rosemary D. Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Michael D. Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kayne D. Mettert
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Rene Hawkes
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Lorella Palazzo
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Bryan J. Weiner
- Hans Rosling Center Global Health, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle WA, USA
| | - Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Papastamelos C, Linder M. Human papillomavirus anogenital screening in solid organ transplant recipients: a narrative review. Arch Gynecol Obstet 2023; 307:1277-1283. [PMID: 35476141 DOI: 10.1007/s00404-022-06577-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/12/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To provide a narrative review of anogenital screening for human papillomavirus in solid organ transplant recipients. METHODS Keyword searches of PubMed and Ovid MEDLINE databases were performed. Keywords included human papillomavirus, malignancy, cervical cancer, Pap smear, solid organ transplant, and immunosuppression. Manual searches were also conducted of other relevant journals and reference lists of primary articles. RESULTS Forty-one studies, articles, or clinical practice guidelines across 25 years of literature were included. Eligible literature was written in English or offered an English translation. CONCLUSION Human papillomavirus-related anogenital malignancies disproportionately affect transplant recipients compared to the general population. Evidence-based guidelines for cervical cancer screening and prevention in transplant patients are lacking. Current practice guidelines generally agree on increased Pap screening for transplant recipients compared to the general population. However, recommended screening frequency differs between organizations and amongst medical specialties. Vaccination against HPV remains the most effective strategy to prevent HPV-driven pre-malignant and malignant lesions.
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Affiliation(s)
| | - Mitchell Linder
- University of Rochester Medical Center, Obstetrics and Gynecology, Rochester, NY, USA
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Schapira MM, Rendle KA. Rising to the De-escalation Challenge: Multilevel Change Needed to Align Clinical Practice with Cancer Screening Guidelines. Med Decis Making 2022; 42:1045-1047. [PMID: 36255190 PMCID: PMC10225245 DOI: 10.1177/0272989x221125168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marilyn M Schapira
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Katharine A Rendle
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Sefuthi T, Nkonki L. A systematic review of economic evaluations of cervical cancer screening methods. Syst Rev 2022; 11:162. [PMID: 35945642 PMCID: PMC9361672 DOI: 10.1186/s13643-022-02017-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aims of this systematic review were to (1) identify primary- and model-based economic evaluations of cervical cancer screening methods and to (2) provide a contextual summary of valuation outcomes associated with three types of cervical cancer screening tests: visual inspection with acetic acid, human papillomavirus deoxyribonucleic acid, and Papanicolaou smear. INTRODUCTION Cervical cancer screening is an important public health priority with the potential to improve the detection of precancerous lesions in high-risk females for early intervention and disease prevention. Test performance and cost-effectiveness differ based on the specific screening method used across different platforms. There is a need to appraise existing economic evaluations of cervical cancer screening methods. METHODS This review considered primary-based and model-based full economic evaluations of cervical cancer screening methods. The evaluation methods of interest included cost-effectiveness analysis, cost-utility analysis, cost-minimization analysis, cost-benefit analysis, and cost-consequence analysis. We searched Scopus, PubMed, National Health Economic Evaluation Database (NH EED), Cochrane, and the Health Economic Evaluation Database for full economic evaluations of cancer screening methods. No formal date restrictions were applied. Model-based and primary-based full economic evaluations were included. A critical appraisal of included studies was performed by the main investigator, while a second independent reviewer assessed critical appraisal findings for any inconsistencies. Data were extracted using a standardised data extraction tool for economic evaluations. The ultimate outcomes of costs, effectiveness, benefits, and utilities of cervical cancer screening modalities were extracted from included studies, analysed, and summarised. RESULTS From a total of 671 screened studies, 44 studies met the study inclusion criteria. Forty-three studies were cost-effectiveness analyses, one study reported both cost-utility and cost-effectiveness outcomes, and another study reported cost utilities of cervical cancer screening methods only. Human papillomavirus (HPV) DNA testing was reported as a dominant stand-alone screening test by 14 studies, while five studies reported visual inspection with acetic acid (VIA) as a dominant stand-alone screening test. Primary HPV screening strategies were dominant in 21 studies, while three studies reported cytology-based screening strategies as the dominant screening method. CONCLUSIONS Existing evidence indicates that HPV-based and VIA testing strategies are cost-effective, but this is dependent on setting. Our review suggests the limited cost-effectiveness of cytology-based testing, which may be due in part to the need for specific infrastructures and human resources. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020212454 .
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Affiliation(s)
- Thatohatsi Sefuthi
- Division of Health Systems and Public Health, Global Health Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - Lungiswa Nkonki
- Health Economics, Division of Health Systems and Public Health, Global Health Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Kim J, Dove MS, Dang JHT. Sociodemographic factors associated with HPV awareness/knowledge and cervical cancer screening behaviors among caregivers in the U.S. BMC Womens Health 2022; 22:335. [PMID: 35941594 PMCID: PMC9358833 DOI: 10.1186/s12905-022-01918-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 08/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Family caregivers may be at a higher risk for several chronic diseases, including cancer. Cervical cancer is one of the most common causes of cancer death among women. Despite family caregivers' vulnerability, the status of their HPV awareness, knowledge, and preventive health behaviors, including cervical cancer screening, has been understudied. Thus, this study aimed to examine the sociodemographic factors associated with HPV awareness and knowledge and adherence to the cervical cancer screening guidelines among caregivers in the U.S. METHODS Nationally representative cross-sectional survey data were obtained from the Health Information National Trends Survey (HINTS 5, 2017-2020). Female caregivers aged 21-65 were included (N = 1190). Weighted multivariable logistic regression was performed to identify factors associated with HPV awareness (heard of HPV), knowledge (HPV can cause cervical cancer), and adherence to the United States Preventive Service Task Force 2018 cervical cancer screening guidelines by sociodemographic factors (age, race/ethnicity, education, household income, marital status,) and the intensity of caregiving. RESULTS An estimated 79% of female caregivers were aware of HPV and 84% adhered to the cervical cancer screening guidelines. Caregivers who were older than 50 (OR = 3.62, 1.91-6.85, adherence of aged 21-50 vs. 51-65), Hispanics of race/ethnicity compared with Black/African Americans (OR = 3.14, 1.31-7.52, adherence of Black/African Americans vs. Hispanics), with a high school education or less (OR = 2.34, 1.14-4.82, adherence of Some college or more vs. High school education or less), and with intense caregiving duty (spending 35 h/week or more on caregiving) compared with light-duty (OR = 2.34, 1.10-5.00, adherence of 5-14 h vs. 35 h or more, weekly) had poor adherence to the cervical cancer screening guidelines. Caregivers who were older, racial minorities (Asian, Native Hawaiian/Pacific Islander, American Indian/Alaska Native, Multiple races), and less educated showed lower HPV awareness (Heard of HPV) than their counterparts. CONCLUSIONS There are caregiving populations whose HPV awareness and cervical cancer screening adherence are low. To improve their awareness and knowledge of HPV and support their cervical cancer screening behaviors, we need to consider interventions that target those specific populations.
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Affiliation(s)
- Jiyeong Kim
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, USA.
| | - Melanie S. Dove
- grid.27860.3b0000 0004 1936 9684Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, USA
| | - Julie H. T. Dang
- grid.27860.3b0000 0004 1936 9684Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, USA
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Garg A, Galvin AM, Matthes S, Maness SB, Thompson EL. The Connection Between Social Determinants of Health and Human Papillomavirus Testing Knowledge Among Women in the USA. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:148-154. [PMID: 32564250 DOI: 10.1007/s13187-020-01798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Human papillomavirus (HPV) causes 99% of cervical cancers. In the USA, HPV testing has recently been recommended as a stand-alone option for cervical cancer screening in women over 30 years of age. Yet, studies have shown low awareness of HPV testing. This study examines awareness and knowledge that US women possess regarding HPV testing using the social determinants of health (SDOH) framework. Women aged 30 to 65 years, without hysterectomy, completed an online survey (N = 812). The outcome variables included HPV testing awareness and HPV testing knowledge, a six-item validated scale. Predictor variables included three domains of the Healthy People 2020 SDOH framework: economic stability, education, and health and healthcare. Other important sociodemographic predictors were also included. Multiple logistic and linear regression identified variables associated with HPV testing awareness and knowledge, respectively. 62.4% of the women were aware of HPV testing, and the mean knowledge score was 2.8 (out of 6). Lower awareness and knowledge were observed in older women compared with younger women and among women who had either not received HPV vaccination or were unsure of their vaccination status. Higher education attainment was associated with greater awareness and knowledge. Also, women who had a well-woman visit in the last year had better knowledge. Findings from the study can be used to develop targeted prevention strategies and initiatives to improve HPV testing awareness and knowledge to help women make more informed health decisions and promote uptake of this screening tool.
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Affiliation(s)
- Ashvita Garg
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Annalynn M Galvin
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sarah Matthes
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sarah B Maness
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| | - Erika L Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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Suk R, Hong YR, Rajan SS, Xie Z, Zhu Y, Spencer JC. Assessment of US Preventive Services Task Force Guideline-Concordant Cervical Cancer Screening Rates and Reasons for Underscreening by Age, Race and Ethnicity, Sexual Orientation, Rurality, and Insurance, 2005 to 2019. JAMA Netw Open 2022; 5:e2143582. [PMID: 35040970 PMCID: PMC8767443 DOI: 10.1001/jamanetworkopen.2021.43582] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Cervical cancer screening rates are suboptimal in the US. Population-based assessment of reasons for not receiving screening is needed, particularly among women from historically underserved demographic groups. OBJECTIVE To estimate changes in US Preventive Service Task Force guideline-concordant cervical cancer screening over time and assess the reasons women do not receive up-to-date screening by sociodemographic factors. DESIGN, SETTING, AND PARTICIPANTS This pooled population-based cross-sectional study used data from the US National Health Interview Survey from 2005 and 2019. A total of 20 557 women (weighted, 113.1 million women) aged 21 to 65 years without previous hysterectomy were included. Analyses were conducted from March 30 to August 19, 2021. EXPOSURES Sociodemographic factors, including age, race and ethnicity, sexual orientation, rurality of residence, and health insurance type. MAIN OUTCOMES AND MEASURES Primary outcomes were US Preventive Services Task Force guideline-concordant cervical cancer screening rates and self-reported primary reasons for not receiving up-to-date screening. For 2005, up-to-date screening was defined as screening every 3 years for women aged 21 to 65 years. For 2019, up-to-date screening was defined as screening every 3 years with a Papanicolaou test alone for women aged 21 to 29 years and screening every 3 years with a Papanicolaou test alone or every 5 years with high-risk human papillomavirus testing or cotesting for women aged 30 to 65 years. Population estimation included sampling weights. RESULTS Among 20 557 women (weighted, 113.1 million women) included in the study, most were aged 30 to 65 years (16 219 women; weighted, 86.3 million women [76.3%]) and had private insurance (13 571 women; weighted, 75.8 million women [67.0%]). With regard to race and ethnicity, 997 women (weighted, 6.9 million women [6.1%]) were Asian, 3821 women (weighted, 19.5 million women [17.2%]) were Hispanic, 2862 women (weighted, 14.8 million women [13.1%]) were non-Hispanic Black, 12 423 women (weighted, 69.0 million women [61.0%]) were non-Hispanic White, and 453 women (weighted, 3.0 million women [2.7%]) were of other races and/or ethnicities (including Alaska Native and American Indian [weighted, 955 000 women (0.8%)] and other single and multiple races or ethnicities [weighted, 2.0 million women (1.8%)]). In 2019, women aged 21 to 29 years had a significantly higher rate of overdue screening (29.1%) vs women aged 30 to 65 years (21.1%; P < .001). In both age groups, the proportion of women without up-to-date screening increased significantly from 2005 to 2019 (from 14.4% to 23.0%; P < .001). Significantly higher rates of overdue screening were found among those of Asian vs non-Hispanic White race and ethnicity (31.4% vs 20.1%; P = .01), those identifying as LGBQ+ (gender identity was not assessed because of a small sample) vs heterosexual (32.0% vs 22.2%; P < .001), those living in rural vs urban areas (26.2% vs 22.6%; P = .04), and those without insurance vs those with private insurance (41.7% vs 18.1%; P < .001). The most common reason for not receiving timely screening across all groups was lack of knowledge, ranging from 47.2% of women identifying as LGBQ+ to 64.4% of women with Hispanic ethnicity. Previous receipt of a human papillomavirus vaccine was not a primary reason for not having up-to-date screening (<1% of responses). From 2005 to 2019, among women aged 30 to 65 years, lack of access decreased significantly as a primary reason for not receiving screening (from 21.8% to 9.7%), whereas lack of knowledge (from 45.2% to 54.8%) and not receiving recommendations from health care professionals (from 5.9% to 12.0%) increased significantly. CONCLUSIONS AND RELEVANCE This cross-sectional study found that cervical cancer screening that was concordant with US Preventive Services Task Force guidelines decreased in the US between 2005 and 2019, with lack of knowledge reported as the biggest barrier to receiving timely screening. Campaigns addressing patient knowledge and provider communication may help to improve screening rates, and cultural adaptation of interventions is needed to reduce existing disparities.
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Affiliation(s)
- Ryan Suk
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
- University of Florida Health Cancer Center, Gainesville
| | - Suja S. Rajan
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Zhigang Xie
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Yenan Zhu
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Jennifer C. Spencer
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin
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Tumors of the Female Reproductive Organs. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sonawane K, Suk R, Chiao EY, Schmeler KM, Montealegre J, Fernandez ME, Deshmukh AA. Evaluation of Cervical Cancer Screening Uptake and Adherence Among Women Without Human Papillomavirus Vaccination in the US. JAMA Netw Open 2021; 4:e2131129. [PMID: 34698852 PMCID: PMC8548945 DOI: 10.1001/jamanetworkopen.2021.31129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This cross-sectional study compares uptake rates of cervical cancer screening and adherence among US women who were vaccinated for human papillomavirus vs those who were not vaccinated.
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Affiliation(s)
- Kalyani Sonawane
- Center for Health Services Research, Department of Management, Policy & Community Health, UTHealth School of Public Health, Houston, Texas
- Center for Healthcare Data, Department of Management, Policy & Community Health, UTHealth School of Public Health, Houston, Texas
| | - Ryan Suk
- Center for Health Services Research, Department of Management, Policy & Community Health, UTHealth School of Public Health, Houston, Texas
| | - Elizabeth Y. Chiao
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, Texas
| | - Kathleen M. Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas
| | - Jane Montealegre
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, Texas
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy & Community Health, UTHealth School of Public Health, Houston, Texas
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Becker NV, Moniz MH, Tipirneni R, Dalton VK, Ayanian JZ. Utilization of Women’s Preventive Health Services During the COVID-19 Pandemic. JAMA HEALTH FORUM 2021; 2:e211408. [PMID: 35977205 PMCID: PMC8796922 DOI: 10.1001/jamahealthforum.2021.1408] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022] Open
Abstract
Question How has utilization of preventive health services among commercially insured women changed during the COVID-19 pandemic? Findings In this cross-sectional study of 685 373 women enrolled in a large commercial health maintenance organization plan in Michigan, rates of breast cancer screening, cervical cancer screening, sexually transmitted infection screening, and prescriptions and new insertions for contraceptives all significantly declined in 2020 compared with 2019. For some services, there were small declines in utilization among women residing in zip codes that are lower income with higher proportions of non-White and non–English-speaking residents. Meaning The pandemic has disrupted the utilization of women’s preventive health services and may be associated with increased disparities in access to these services. Importance The association of the COVID-19 pandemic with women’s preventive health care use is unknown. Objective To describe utilization of women’s preventive health services. Design, Setting, and Participants Cross-sectional study of women aged 18 to 74 years enrolled in a commercial health maintenance organization in Michigan. Exposures COVID-19 pandemic (2019-2020). Main Outcomes and Measures Adjusted odds ratios (AORs) of receiving breast cancer screening, cervical cancer screening, sexually transmitted infection (STI) screening, long-acting reversible contraception (LARC) insertions, and pharmacy-obtained contraception, adjusted for month, age, county, zip code characteristics (per-capita income, non-White percentage of population, non–English-proficient percentage of population), and plan designation (primary plan holder vs dependent). Results The study population included 685 373 women aged 18 to 74 years, enrolled for 13 000 715 person-months, of whom 10 061 275 person-months (77.4%) were among women aged 25 to 64 years and 8 020 215 (61.7%) were the primary plan holder, with mean zip code per capita income of $33 708, 20.2% mean zip code non-White population, and 3.4% mean zip code non–English-speaking population. For services requiring an in-person visit (breast cancer screening, cervical cancer screening, STI testing, and LARC insertions), utilization declined by 60% to 90% during the spring of 2020, with a nadir in April 2020, after which utilization for all services recovered to close to 2019 levels by July 2020. Claims for pharmacy-obtained hormonal contraceptives in 2020 were consistently 15% to 30% lower than 2019. The AORs of a woman receiving a given preventive service in 2020 compared with 2019 were significantly lower for breast cancer screening (AOR, 0.80; 95% CI, 0.79-0.80), cervical cancer screening (AOR, 0.80; 95% CI, 0.80-0.81), STI screening (AOR, 0.83; 95% CI, 0.82-0.84), LARC insertion (AOR, 0.87; 95% CI, 0.84-0.90), and pharmacy-obtained contraception (AOR, 0.73; 95% CI, 0.72-0.74) (all P < .001). Conclusions and Relevance In this cross-sectional study of women enrolled in a large US commercial health maintenance organization plan, the COVID-19 pandemic was associated with large but transient declines in rates of breast cancer screening, cervical cancer screening, STI screening, and LARC insertions, and moderate persistent declines in pharmacy-obtained hormonal contraceptives. The overall odds of a woman receiving a given preventive service in 2020 was 20% to 30% lower than 2019. Further research into disparities in access to care and the health outcomes of decreased use of these key health services is warranted.
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Affiliation(s)
- Nora V. Becker
- Division of General Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Program on Women’s Healthcare Effectiveness Research, University of Michigan Medical School, Ann Arbor
| | - Michelle H. Moniz
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Program on Women’s Healthcare Effectiveness Research, University of Michigan Medical School, Ann Arbor
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
| | - Renuka Tipirneni
- Division of General Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Vanessa K. Dalton
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Program on Women’s Healthcare Effectiveness Research, University of Michigan Medical School, Ann Arbor
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
| | - John Z. Ayanian
- Division of General Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Editor, JAMA Health Forum
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12
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Abstract
PURPOSE OF REVIEW The risks of developing cancer and dementia both increase with age, giving rise to the complex question of whether continued cancer screening for older dementia patients is appropriate. This paper offers a practice-based clinical approach to determine an answer to this challenging question. RECENT FINDINGS There is no consensus on the prevalence of cancer and dementia as co-diagnoses. Persons with dementia are screened less often compared to those without dementia. There is significant literature focusing on screening in the geriatric population, but there is little evidence to support decision-making for screening for older patients with dementia. Given this lack of evidence, individualized decisions should be made in collaboration with patients and family caregivers. Four considerations to help guide this process include prognosis, behavioral constraints, cognitive capacity, and goals for care. Future research will be challenging due to variability of factors that inform screening decisions and the vulnerable nature of this patient population.
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13
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Grimes DR, Corry EMA, Malagón T, O’Riain C, Franco EL, Brennan DJ. Modeling Cervical Cancer Screening Strategies With Varying Levels of Human Papillomavirus Vaccination. JAMA Netw Open 2021; 4:e2115321. [PMID: 34190993 PMCID: PMC8246311 DOI: 10.1001/jamanetworkopen.2021.15321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Cervical cancer screening is a lifesaving intervention, with an array of approaches, including liquid-based cytology (LBC), molecular testing for human papillomavirus (HPV) infection, and combinations via parallel cotesting or sequential triage. Maximizing screening efficacy while minimizing overtreatment is vital, especially when considering how the HPV vaccine will affect the interpretation of results. OBJECTIVES To estimate the likely outcomes of different screening modalities and to model how the increasing uptake of the HPV vaccine could affect the interpretation of screening results. DESIGN, SETTING, AND PARTICIPANTS This decision analytic model established a simple Markov model to compare the outcomes of different cervical cancer screening modalities on a simulated population of women (aged ≥25 years), considering different levels of HPV vaccination. MAIN OUTCOMES AND MEASURES The number of cases of cervical intraepithelial neoplasia (CIN) grade 2 and 3 detected and missed, the number of false positives, and the number of tests required to achieve a given level of accuracy. Positive and negative predictive values of different modalities were simulated under varying levels of HPV vaccination and therefore HPV prevalence. RESULTS In a simulated population of 1000 women aged 25 years and older with an HPV prevalence of 2%, HPV-based modalities outperformed LBC-based approaches, detecting 19% more true positives (HPV test sensitivity, 89.9% [95% CI, 88.6%-91.1%]; LBC test sensitivity, 75.5% [95% CI, 66.6%-82.7%]). While cotesting markedly reduced missed cases, detecting 29% more true positives than LBC alone (19.5 [95% CI, 19.3-19.7] per 1000 women screened vs 15.1 [95% CI, 13.3-16.5] per 1000 women screened), it unacceptably increased excess colposcopy referral by 94% (184.4 [95% CI, 181.8-188.0] false positives per 1000 women screened vs 95.1 [95% CI, 93.1-97.0] false positives per 1000 women screened). By contrast, triage testing with reflex screening substantially reduced false positives by a factor of approximately 10 (eg, HPV with LBC triage, 9.6 [95% CI, 9.3-10.0] per 1000 women screened). Over a lifetime of screening, reflex approaches with appropriate test intervals maximized therapeutic efficacy; as HPV vaccination rates increased, HPV-based screening approaches resulted in fewer unnecessary colposcopies than LBC approaches (HPV testing, 80% vaccine coverage: 44.1 [95% CI, 40-45.9] excess colposcopies; LBC testing, 80% vaccine coverage: 96.9 [95% CI, 96.8-97.0] excess colposcopies). CONCLUSIONS AND RELEVANCE In this decision analytic model, the effectiveness of cervical cancer screening was dependent on the prevalence of cervical dysplasia and/or HPV infection or vaccination in a population as well as the sensitivity and specificity of various modalities. Although screening is lifesaving, overtesting or modalities inappropriate to the target population may cause significant harm, including overtreatment.
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Affiliation(s)
- David Robert Grimes
- School of Physical Sciences, Dublin City University, Glasnevin, Dublin, Ireland
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Edward M. A. Corry
- Department of Gynaecological Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | - Ciaran O’Riain
- Department of Histopathology, St James’s Hospital, Dublin, Ireland
| | - Eduardo L. Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | - Donal J. Brennan
- Department of Gynaecological Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
- Systems Biology Ireland, University College Dublin School of Medicine, Belfield, Dublin, Ireland
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14
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Affiliation(s)
- Elizabeth R. Wolf
- Virginia Commonwealth University, Department of Pediatrics, Richmond
| | - Alex H. Krist
- Virginia Commonwealth University, Department of Family Medicine and Population Health, Richmond
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15
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Miglioretti DL, Bissell MCS, Kerlikowske K, Buist DSM, Cummings SR, Henderson LM, Onega T, O’Meara ES, Rauscher GH, Sprague BL, Tosteson ANA, Wernli KJ, Lee JM, Lee CI. Assessment of a Risk-Based Approach for Triaging Mammography Examinations During Periods of Reduced Capacity. JAMA Netw Open 2021; 4:e211974. [PMID: 33764423 PMCID: PMC7994953 DOI: 10.1001/jamanetworkopen.2021.1974] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/26/2021] [Indexed: 12/19/2022] Open
Abstract
Importance Breast cancer screening, surveillance, and diagnostic imaging services were profoundly limited during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic. Objective To develop a risk-based strategy for triaging mammograms during periods of decreased capacity. Design, Setting, and Participants This population-based cohort study used data collected prospectively from mammography examinations performed in 2014 to 2019 at 92 radiology facilities in the Breast Cancer Surveillance Consortium. Participants included individuals undergoing mammography. Data were analyzed from August 10 to November 3, 2020. Exposures Clinical indication for screening, breast symptoms, personal history of breast cancer, age, time since last mammogram/screening interval, family history of breast cancer, breast density, and history of high-risk breast lesion. Main Outcomes and Measures Combinations of clinical indication, clinical history, and breast cancer risk factors that subdivided mammograms into risk groups according to their cancer detection rate were identified using classification and regression trees. Results The cohort included 898 415 individuals contributing 1 878 924 mammograms (mean [SD] age at mammogram, 58.6 [11.2] years) interpreted by 448 radiologists, with 1 722 820 mammograms in individuals without a personal history of breast cancer and 156 104 mammograms in individuals with a history of breast cancer. Most individuals were aged 50 to 69 years at imaging (1 113 174 mammograms [59.2%]), and 204 305 (11.2%) were Black, 206 087 (11.3%) were Asian or Pacific Islander, 126 677 (7.0%) were Hispanic or Latina, and 40 021 (2.2%) were another race/ethnicity or mixed race/ethnicity. Cancer detection rates varied widely based on clinical indication, breast symptoms, personal history of breast cancer, and age. The 12% of mammograms with very high (89.6 [95% CI, 82.3-97.5] to 122.3 [95% CI, 108.1-138.0] cancers detected per 1000 mammograms) or high (36.1 [95% CI, 33.1-39.3] to 47.5 [95% CI, 42.4-53.3] cancers detected per 1000 mammograms) cancer detection rates accounted for 55% of all detected cancers and included mammograms to evaluate an abnormal mammogram or breast lump in individuals of all ages regardless of breast cancer history, to evaluate breast symptoms other than lump in individuals with a breast cancer history or without a history but aged 60 years or older, and for short-interval follow-up in individuals aged 60 years or older without a breast cancer history. The 44.2% of mammograms with very low cancer detection rates accounted for 13.1% of detected cancers and included annual screening mammograms in individuals aged 50 to 69 years (3.8 [95% CI, 3.5-4.1] cancers detected per 1000 mammograms) and all screening mammograms in individuals younger than 50 years regardless of screening interval (2.8 [95% CI, 2.6-3.1] cancers detected per 1000 mammograms). Conclusions and Relevance In this population-based cohort study, clinical indication and individual risk factors were associated with cancer detection and may be useful for prioritizing mammography in times and settings of decreased capacity.
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Affiliation(s)
- Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Michael C. S. Bissell
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
| | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Steven R. Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco
| | | | - Tracy Onega
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Garth H. Rauscher
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago
| | - Brian L. Sprague
- Office of Health Promotion Research, University of Vermont Cancer Center, Department of Surgery, Larner College of Medicine at the University of Vermont, Burlington
| | - Anna N. A. Tosteson
- Norris Cotton Cancer Center, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Janie M. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
- Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
| | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
- Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
- Department of Health Services, University of Washington School of Public Health, Seattle
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16
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Gates A, Pillay J, Reynolds D, Stirling R, Traversy G, Korownyk C, Moore A, Thériault G, Thombs BD, Little J, Popadiuk C, van Niekerk D, Keto-Lambert D, Vandermeer B, Hartling L. Screening for the prevention and early detection of cervical cancer: protocol for systematic reviews to inform Canadian recommendations. Syst Rev 2021; 10:2. [PMID: 33388083 PMCID: PMC7777363 DOI: 10.1186/s13643-020-01538-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To inform recommendations by the Canadian Task Force on Preventive Health Care on screening in primary care for the prevention and early detection of cervical cancer by systematically reviewing evidence of (a) effectiveness; (b) test accuracy; (c) individuals' values and preferences; and (d) strategies aimed at improving screening rates. METHODS De novo reviews will be conducted to evaluate effectiveness and to assess values and preferences. For test accuracy and strategies to improve screening rates, we will integrate studies from existing systematic reviews with search updates to the present. Two Cochrane reviews will provide evidence of adverse pregnancy outcomes from the conservative management of cervical intraepithelial neoplasia. We will search Medline, Embase, and Cochrane Central (except for individuals' values and preferences, where Medline, Scopus, and EconLit will be searched) via peer-reviewed search strategies and the reference lists of included studies and reviews. We will search ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. Two reviewers will screen potentially eligible studies and agree on those to include. Data will be extracted by one reviewer with verification by another. Two reviewers will independently assess risk of bias and reach consensus. Where possible and suitable, we will pool studies via meta-analysis. We will compare accuracy data per outcome and per comparison using the Rutter and Gatsonis hierarchical summary receiver operating characteristic model and report relative sensitivities and specificities. Findings on values and preferences will be synthesized using a narrative synthesis approach and thematic analysis, depending on study designs. Two reviewers will appraise the certainty of evidence for all outcomes using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and come to consensus. DISCUSSION The publication of guidance on screening in primary care for the prevention and early detection of cervical cancer by the Task Force in 2013 focused on cytology. Since 2013, new studies using human papillomavirus tests for cervical screening have been published that will improve our understanding of screening in primary care settings. This review will inform updated recommendations based on currently available studies and address key evidence gaps noted in our previous review.
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Affiliation(s)
- Allison Gates
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Jennifer Pillay
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Donna Reynolds
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rob Stirling
- Centre for Chronic Disease Prevention and Health Equity, Public Health Agency of Canada, Ottawa, Canada
| | - Gregory Traversy
- Centre for Chronic Disease Prevention and Health Equity, Public Health Agency of Canada, Ottawa, Canada
| | | | - Ainsley Moore
- Family Medicine, McMaster University, Hamilton, Canada
| | | | - Brett D. Thombs
- Faculty of Medicine, McGill University and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Dirk van Niekerk
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada
| | - Diana Keto-Lambert
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
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17
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Montealegre JR, Anderson ML, Hilsenbeck SG, Chiao EY, Cantor SB, Parker SL, Daheri M, Bulsara S, Escobar B, Deshmukh AA, Jibaja-Weiss ML, Zare M, Scheurer ME. Mailed self-sample HPV testing kits to improve cervical cancer screening in a safety net health system: protocol for a hybrid effectiveness-implementation randomized controlled trial. Trials 2020; 21:872. [PMID: 33087164 PMCID: PMC7580009 DOI: 10.1186/s13063-020-04790-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Almost 20% of U.S. women remain at risk for cervical cancer due to their inability or unwillingness to participate in periodic clinic-based screening. Self-sampling has been shown to be an effective strategy for screening women for high-risk human papillomavirus (HR-HPV) infection in specific contexts. However, its effectiveness among medically underserved women in safety net health systems has not been evaluated. Furthermore, it is also unclear whether implementation strategies such as patient navigation can be used to improve the success of self-sample screening programs by addressing patient-level barriers to participation. METHODS/DESIGN The Prospective Evaluation of Self-Testing to Increase Screening (PRESTIS) trial is a hybrid type 2 effectiveness-implementation pragmatic randomized controlled trial of mailed self-sample HPV testing. The aim is to assess the effectiveness of mailed self-sample HPV testing kits to improve cervical cancer screening participation among patients in a safety net health system who are overdue for clinic-based screening, while simultaneously assessing patient navigation as an implementation strategy. Its setting is a large, urban safety net health system that serves a predominantly racial/ethnic minority patient population. The trial targets recruitment of 2268 participants randomized to telephone recall (enhanced usual care, n = 756), telephone recall with mailed self-sample HPV testing kit (intervention, n = 756), or telephone recall with mailed self-sample HPV testing kit and patient navigation (intervention + implementation strategy, n = 756). The primary effectiveness outcome is completion of primary screening, defined as completion and return of mailed self-sample kit or completion of a clinic-based Pap test. Secondary effectiveness outcomes are predictors of screening and attendance for clinical follow-up among women with a positive screening test. Implementation outcomes are reach, acceptability, fidelity, adaptations, and cost-effectiveness. DISCUSSION Hybrid designs are needed to evaluate the clinical effectiveness of self-sample HPV testing in specific populations and settings, while incorporating and evaluating methods to optimize its real-world implementation. The current manuscript describes the rationale and design of a hybrid type 2 trial of self-sample HPV testing in a safety net health system. Trial findings are expected to provide meaningful data to inform screening strategies to ultimately realize the global goal of eliminating cervical cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT03898167 . Registered on 01 April 2019. TRIAL STATUS Study start data: February 13, 2020. Recruitment status: Enrolling by invitation. Estimated primary completion date: February 15, 2023. Estimated study completion date: May 31, 2024. Protocol version 1.6 (February 25, 2020).
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Affiliation(s)
- Jane R Montealegre
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS: 305, Houston, TX, 77030, USA.
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.
| | - Matthew L Anderson
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Susan G Hilsenbeck
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Elizabeth Y Chiao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Harris Health System, Houston, TX, USA
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan L Parker
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Shaun Bulsara
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Betsy Escobar
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Ashish A Deshmukh
- Center for Health Services Research, Department of Management, Policy, and Community Health, The University of Texas School of Public Health, Houston, TX, USA
| | - Maria L Jibaja-Weiss
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- School of Health Professions, Baylor College of Medicine, Houston, TX, USA
| | - Mohammed Zare
- Harris Health System, Houston, TX, USA
- Department of Family and Community Medicine, The University of Texas McGovern School of Medicine, Houston, TX, USA
| | - Michael E Scheurer
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS: 305, Houston, TX, 77030, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
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18
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Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, Donahue K, Doubeni CA, Epling JW, Kubik M, Ogedegbe G, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: US Preventive Services Task Force Recommendation Statement. JAMA 2020; 324:674-681. [PMID: 32809008 DOI: 10.1001/jama.2020.13095] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Approximately 20 million new cases of bacterial or viral sexually transmitted infections (STIs) occur each year in the US, and about one-half of these cases occur in persons aged 15 to 24 years. Rates of chlamydial, gonococcal, and syphilis infection continue to increase in all regions. Sexually transmitted infections are frequently asymptomatic, which may delay diagnosis and treatment and lead persons to unknowingly transmit STIs to others. Serious consequences of STIs include pelvic inflammatory disease, infertility, cancer, and AIDS. OBJECTIVE To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of behavioral counseling interventions for preventing STI acquisition. POPULATION This recommendation statement applies to all sexually active adolescents and to adults at increased risk for STIs. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that behavioral counseling interventions reduce the likelihood of acquiring STIs in sexually active adolescents and in adults at increased risk, including for example, those who have a current STI, do not use condoms, or have multiple partners, resulting in a moderate net benefit. RECOMMENDATION The USPSTF recommends behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. (B recommendation).
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Affiliation(s)
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | | | | | | | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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19
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Cancer Screening Among Older Adults: a Geriatrician's Perspective on Breast, Cervical, Colon, Prostate, and Lung Cancer Screening. Curr Oncol Rep 2020; 22:108. [PMID: 32803486 DOI: 10.1007/s11912-020-00968-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We summarize the evidence of benefits, harms, and tools to assist in individualized decisions among older adults in screening for breast, prostate, colon, lung, and cervical cancer. RECENT FINDINGS The benefits of cancer screening in older adults remain unclear due to minimal inclusion of adults > 75 years old in most randomized controlled trials. Indirect evidence suggests that the benefits of screening seen in younger adults (< 70 years old) can be extrapolated to older adults when they have an estimated life expectancy of at least 10 years. However, older adults, especially those with limited life expectancy, may be at increased risk for experiencing harms of screening, including overdiagnosis of clinically unimportant diseases, complications from diagnostic procedures, and distress after false positive test results. We provide a framework to integrate key factors such as health status, risks and benefits of specific tests, and patient preferences to guide clinicians in cancer screening decisions in older adults.
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20
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Sun W, Qin X, Zhou J, Xu M, Lyu Z, Li X, Zhang K, Dai M, Li N, Hang D. Mitochondrial DNA copy number in cervical exfoliated cells and risk of cervical cancer among HPV-positive women. BMC WOMENS HEALTH 2020; 20:139. [PMID: 32615963 PMCID: PMC7331179 DOI: 10.1186/s12905-020-01001-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 06/25/2020] [Indexed: 01/05/2023]
Abstract
Background Although human papillomavirus (HPV) infection has been regarded as the cause of cervical cancer in over 99% of cases, only a small fraction of HPV-infected women develop this malignancy. Emerging evidence suggests that alterations of mitochondrial DNA copy number (mtCN) may contribute to carcinogenesis. However, the relationship between mtCN and cervical cancer remains undetermined. Methods The current study included 591 cervical cancer cases and 373 cancer-free controls, all of whom were infected with high-risk HPV. Relative mtCN in cervical cancer exfoliated cells was measured by qRT-PCR assays, and logistic regression analysis was performed to compute odds ratios (ORs) and 95% confidence intervals (CIs). Interaction between mtCN and HPV types was assessed by using the Wald test in logistic regression models. Results HPV16, 18, 52, and 58 were the most common types in both case and control groups. Median mtCN in cases was significantly higher than that in controls (1.63 vs. 1.23, P = 0.03). After adjustment for age and HPV types, the highest quartile of mtCN was associated with increased odds of having cervical cancer (OR = 1.77, 95% CI = 1.19, 2.62; P < 0.01), as compared to the lowest quartile. A dose-response effect of mtCN on cervical cancer was also observed (Ptrend < 0.001). The interaction between mtCN and HPV types was statistically nonsignificant. Conclusions In women who test HPV positive, the increase of mtCN in cervical exfoliated cells is associated with cervical cancer. This suggests a potential role of mtCN in cervical carcinogenesis.
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Affiliation(s)
- Wei Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, No. 101 Longmian Ave, Jiangning District, Nanjing, 211166, China.,Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210036, China
| | - Xueyun Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, No. 101 Longmian Ave, Jiangning District, Nanjing, 211166, China
| | - Jing Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, No. 101 Longmian Ave, Jiangning District, Nanjing, 211166, China
| | - Mingjing Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, No. 101 Longmian Ave, Jiangning District, Nanjing, 211166, China
| | - Zhangyan Lyu
- National Office for Cancer Prevention and Control, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - Xin Li
- National Office for Cancer Prevention and Control, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - Kai Zhang
- National Office for Cancer Prevention and Control, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, China.,Department of Cancer Prevention, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - Min Dai
- National Office for Cancer Prevention and Control, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - Ni Li
- National Office for Cancer Prevention and Control, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - Dong Hang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, No. 101 Longmian Ave, Jiangning District, Nanjing, 211166, China. .,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China.
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21
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Day AT, Fakhry C, Tiro JA, Dahlstrom KR, Sturgis EM. Considerations in Human Papillomavirus-Associated Oropharyngeal Cancer Screening: A Review. JAMA Otolaryngol Head Neck Surg 2020; 146:656-664. [PMID: 32379293 DOI: 10.1001/jamaoto.2019.4811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The incidence of human papillomavirus (HPV)-positive oropharyngeal cancer (OPC) is anticipated to rise over the next few decades until the effects of prophylactic vaccination are realized, which highlights the potential importance of secondary prevention. The objective of this review is to evaluate the evidence associated with screening for HPV-positive OPC. Observations Evaluation of a potential clinical preventive screening service requires characterization of the disease burden, the at-risk target screening population, screening tests, treatment, and screening benefits and harms. The lifetime risk of OPC is 0.7% for men and 0.2% for women and is expected to increase. The disease burden of HPV-positive OPC is substantial; most patients undergo morbid multimodality treatment and incur high costs in the process. Middle-aged and older adult men with elevated number of lifetime vaginal or oral sex partners are at highest risk. Patients may benefit from early detection of the disease-the 4-year overall survival of patients with stage I HPV-positive OPC is 87%, a considerable portion of whom are eligible for less morbid single-modality therapy. However, available screening tests are insufficiently sensitive and specific considering the current HPV-positive OPC incidence rates in the most at-risk patients. Further, the benefits and harms of screening for HPV-positive OPC are unknown. Conclusions and Relevance The current and projected future population-level burden of HPV-positive OPC supports further exploration of secondary preventive interventions. However, screening for HPV-positive OPC is not currently justified. Advances in biomarker discovery and improved characterization of (1) a highly at-risk, target screening population and (2) the benefits and harms of screening will be necessary. Large-scale clinical trials and rigorous evaluation of how to best implement this service into clinical practice will also be needed.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jasmin A Tiro
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
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Simon MA. Unnecessary Bimanual Pelvic Examinations and Papanicolaou Testing in Adolescents and Young Women-Learning How to Unlearn. JAMA Intern Med 2020; 180:281-282. [PMID: 31904844 DOI: 10.1001/jamainternmed.2019.6291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Melissa A Simon
- Department of Obstetrics and Gynecology and Center for Health Equity Transformation, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Tumors of the Female Reproductive Organs. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_112-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Winer RL, Lin J, Tiro JA, Miglioretti DL, Beatty T, Gao H, Kimbel K, Thayer C, Buist DSM. Effect of Mailed Human Papillomavirus Test Kits vs Usual Care Reminders on Cervical Cancer Screening Uptake, Precancer Detection, and Treatment: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1914729. [PMID: 31693128 PMCID: PMC6865279 DOI: 10.1001/jamanetworkopen.2019.14729] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE In the United States, more than 50% of cervical cancers are diagnosed in underscreened women. Cervical cancer screening guidelines now include primary human papillomavirus (HPV) testing as a recommended strategy. Home-based HPV self-sampling is a viable option for increasing screening compliance and effectiveness; however, US data are needed to inform health care system implementation. OBJECTIVE To evaluate effectiveness of mailed HPV self-sampling kits vs usual care reminders for in-clinic screening to increase detection and treatment of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and uptake of cervical cancer screening. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted in Kaiser Permanente Washington, a US integrated health care delivery system. Women aged 30 to 64 years with health plan enrollment for 3 years and 5 months or more, a primary care clinician, no Papanicolaou test within 3 years and 5 months, and no hysterectomy were identified through electronic medical records and enrolled from February 25, 2014, to August 29, 2016, with follow-up through February 26, 2018. INTERVENTIONS The control group received usual care (annual patient reminders and ad hoc outreach from primary care clinics). The intervention group received usual care plus a mailed HPV self-sampling kit. MAIN OUTCOMES AND MEASURES Two primary outcomes were (1) CIN2+ detection within 6 months of screening and (2) treatment within 6 months of CIN2+ detection. Screening uptake within 6 months of randomization was a secondary outcome. RESULTS A total of 19 851 women (mean [SD] age, 50.1 [9.5] years) were included, with 9960 randomized to the intervention group and 9891 randomized to the control group. All women randomized were included in analysis. In the intervention group, 12 participants with CIN2+ were detected compared with 8 in the control group (relative risk, 1.49; 95% CI, 0.61-3.64) and 12 cases were treated vs 7 in the control group (relative risk, 1.70; 95% CI, 0.67-4.32). Screening uptake was higher in the intervention group (2618 participants [26.3%] vs 1719 participants [17.4%]; relative risk, 1.51; 95% CI, 1.43-1.60). CONCLUSIONS AND RELEVANCE Mailing HPV kits to underscreened women increased screening uptake compared with usual care alone, with no significant differences in precancer detection or treatment. Results support the feasibility of mailing HPV kits to women who are overdue for screening as an outreach strategy to increase screening uptake in US health care systems. Efforts to increase kit uptake and follow-up of positive results are warranted to maximize detection and treatment of CIN2+. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02005510.
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Affiliation(s)
- Rachel L. Winer
- Department of Epidemiology, University of Washington, Seattle
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - John Lin
- Department of Epidemiology, University of Washington, Seattle
| | - Jasmin A. Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Kilian Kimbel
- Kaiser Permanente Washington Health Research Institute, Seattle
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Sawaya GF, Sanstead E, Alarid-Escudero F, Smith-McCune K, Gregorich SE, Silverberg MJ, Leyden W, Huchko MJ, Kuppermann M, Kulasingam S. Estimated Quality of Life and Economic Outcomes Associated With 12 Cervical Cancer Screening Strategies: A Cost-effectiveness Analysis. JAMA Intern Med 2019; 179:867-878. [PMID: 31081851 PMCID: PMC6515585 DOI: 10.1001/jamainternmed.2019.0299] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Many cervical cancer screening strategies are now recommended in the United States, but the benefits, harms, and costs of each option are unclear. OBJECTIVE To estimate the cost-effectiveness of 12 cervical cancer screening strategies. DESIGN, SETTING, AND PARTICIPANTS The cross-sectional portion of this study enrolled a convenience sample of 451 English-speaking or Spanish-speaking women aged 21 to 65 years from September 22, 2014, to June 16, 2016, identified at women's health clinics in San Francisco. In this group, utilities (preferences) were measured for 23 cervical cancer screening-associated health states and were applied to a decision model of type-specific high-risk human papillomavirus (hrHPV)-induced cervical carcinogenesis. Test accuracy estimates were abstracted from systematic reviews. The evaluated strategies were cytologic testing every 3 years for women aged 21 to 65 years with either repeat cytologic testing in 1 year or immediate hrHPV triage for atypical squamous cells of undetermined significance (ASC-US), cytologic testing every 3 years for women age 21 to 29 years followed by cytologic testing plus hrHPV testing (cotesting), or primary hrHPV testing alone for women aged 30 to 65 years. Screening frequency, abnormal test result management, and the age to switch from cytologic testing to hrHPV testing (25 or 30 years) were varied. Analyses were conducted from both the societal and health care sector perspectives. MAIN OUTCOMES AND MEASURES Utilities for 23 cervical cancer screening-associated health states (cross-sectional study) and quality-adjusted life-years (QALYs) and total costs for each strategy. RESULTS Utilities were measured in a sociodemographically diverse group of 451 women (mean [SD] age, 38.2 [10.7] years; 258 nonwhite [57.2%]). Cytologic testing every 3 years with repeat cytologic testing for ASC-US yielded the most lifetime QALYs and conferred more QALYs at higher costs ($2166 per QALY) than the lowest-cost strategy (cytologic testing every 3 years with hrHPV triage of ASC-US). All cytologic testing plus hrHPV testing (cotesting) and primary hrHPV testing strategies provided fewer QALYs at higher costs. Adding indirect costs did not change the conclusions. In sensitivity analyses, hrHPV testing every 5 years with genotyping triage beginning at age 30 years was the lowest-cost strategy when hrHPV test sensitivity was markedly higher than cytologic test sensitivity or when hrHPV test cost was equated to the lowest reported cytologic test cost ($14). CONCLUSIONS AND RELEVANCE Cytologic testing every 3 years for women aged 21 to 29 years with either continued cytologic testing every 3 years or switching to a low-cost hrHPV test every 5 years confers a reasonable balance of benefits, harms, and costs. Comparative modeling is needed to confirm the association of these novel utilities with cost-effectiveness.
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Affiliation(s)
- George F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco.,University of California, San Francisco Center for Healthcare Value, San Francisco
| | - Erinn Sanstead
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Fernando Alarid-Escudero
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis.,now at Drug Policy Program, Center for Research and Teaching in Economics, Aguascalientes, Aguascalientes, Mexico
| | - Karen Smith-McCune
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | | | | | - Wendy Leyden
- Division of Research, Kaiser Permanente, Oakland, California
| | - Megan J Huchko
- Department of Obstetrics and Gynecology, Global Health Institute, Duke University, Durham, North Carolina
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Shalini Kulasingam
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
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Affiliation(s)
- George F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
- UCSF Center for Healthcare Value, San Francisco, California
| | - Karen Smith-McCune
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
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Sanford NN, Sher DJ, Butler S, Xu X, Ahn C, D’Amico AV, Rebbeck T, Aizer AA, Mahal BA. Cancer Screening Patterns Among Current, Former, and Never Smokers in the United States, 2010-2015. JAMA Netw Open 2019; 2:e193759. [PMID: 31099863 PMCID: PMC6537823 DOI: 10.1001/jamanetworkopen.2019.3759] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE National guidelines recommend screening for several cancer types, yet screening rates remain below target. To date, cancer screening patterns by smoking status, a major cancer risk factor, are unknown. OBJECTIVE To assess cancer screening patterns among individuals who never smoked (never smokers), formerly smoked (former smokers), and currently smoke (current smokers) in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study assessed data from the National Health Interview Survey years 2010, 2013, and 2015. Adult participants (aged ≥18 years) who had never reported a cancer diagnosis were included in the analysis. Data were analyzed from August 1, 2018, through February 1, 2019. EXPOSURES Receipt of cancer screening, including colonoscopy, mammography, prostate-specific antigen testing, and Papanicolaou test per the US Preventive Services Task Force guidelines. MAIN OUTCOMES AND MEASURES Multivariable logistic regression defined adjusted odds ratios (AORs) and 95% CIs for undergoing cancer screening by smoking status. Among participants who received a specific screening test, AORs and 95% CIs of receiving the test within guideline-recommended intervals were also assessed. RESULTS Among 83 176 participants (45 851 [55.1%] women; mean [SD] age, 47 [18] years), 51 014 (61.3%) were never smokers; 17 235 (20.7%), former smokers; and 14 927 (17.9%), current smokers. Compared with never smokers, current smokers were less likely to ever have received a colonoscopy (43.8% vs 57.7%; AOR, 0.74; 95% CI, 0.68-0.82; P < .001), mammogram (88.8% vs 93.3%; AOR, 0.70; 95% CI, 0.57-0.87; P = .001), or prostate-specific antigen test (46.1% vs 60.8%; AOR, 0.76; 95% CI, 0.64-0.90; P = .001). Among those who had ever received a specific screening test, current smokers were less likely to have undergone colonoscopy (92.1% vs 95.1%; AOR, 0.75; 95% CI, 0.59-0.96; P = .02), mammography (62.4% vs 79.4%; AOR, 0.52; 95% CI, 0.45-0.60; P < .001), or Papanicolaou test (80.9% vs 90.8%; AOR, 0.61; 95% CI, 0.56-0.67; P < .001) within the recommended time frame compared with never smokers. Former smokers were more likely than never smokers to undergo any of the screening studies evaluated, with the exception of prostate-specific antigen screening (colonoscopy, 65.2% vs 57.7%; AOR, 1.20; 95% CI, 1.12-1.30; P < .001; mammography, 95.7% vs 93.3%; AOR, 1.35; 95% CI, 1.07-1.70; P = .01; Papanicolaou test, 97.6% vs 91.4%; AOR, 2.51; 95% CI, 1.93-3.26; P < .001). CONCLUSIONS AND RELEVANCE This study found that current smokers appeared to be less likely to receive guideline-concordant screening studies for breast, prostate, and colorectal cancer compared with never smokers. Further research is needed to identify barriers to screening among current smokers with the goal of increasing acceptance and uptake of cancer screening among this population at high risk of cancer.
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Affiliation(s)
- Nina N. Sanford
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - David J. Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Santino Butler
- Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xiaohan Xu
- Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
- Department of Statistical Science, Southern Methodist University, Dallas, Texas
| | - Chul Ahn
- Harold Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas
| | - Anthony V. D’Amico
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Timothy Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ayal A. Aizer
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Brandon A. Mahal
- McGraw/Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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Coronary Artery Calcium: Recommendations for Risk Assessment in Cardiovascular Prevention Guidelines. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:89. [DOI: 10.1007/s11936-018-0685-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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